The review presents data on proximal junctional kyphosis developing in patients with spinal deformities of different origin after surgical correction. Risk factors for this complication are discussed separately for children and adolescents, adults, and patients with juvenile kyphosis. The incidence, classification, and modern methods of prevention and treatment of proximal junctional kyphosis are presented. Hir. Pozvonoc. 2014;(1):11-23.

The paper presents a clinical case of spinal deformity associated with neurofibromatosis type 1 complicated by a dislocation at the cervicothoracic junction in a 12-year-old child. Clinical and radiological data, surgery, postoperative complications and their treatment are described. Hir. Pozvonoc. 2014; (1):24-28.

The paper presents three clinical cases of a rare congenital abnormality of the cervicothoracic spine observed in patients aged 1 year 5 months to 8 years. Data on complex clinical and radiological (X-ray, CT, MRI) examinations are presented, and principles of surgical techniques and postoperative treatment features and complications are described. Hir. Pozvonoc. 2014;(1):29-34.

Objective. To perform a comparative analysis of the results of anterior versus posterior spinal fusion in patients with idiopathic scoliosis. Material and Methods. A total of 30 patients with idiopathic scoliosis were operated on. Group I included patients who underwent anterior spinal fusion, and Group II - those who underwent posterior spinal fusion. Cobb angles of the primary curve and countercurve, thoracic kyphosis and lumbar lordosis before surgery and 2 years after treatment, average number of fixed vertebrae, intraoperative blood loss, surgery duration, and duration of hospital stay were assessed. Results. The study revealed no statistically significant differences between groups in the pre- and postoperative Cobb angle values in both the frontal and sagittal planes. Both methods equally allowed to carry out the correction of all components of scoliotic curvature. Statistically significant difference in thoracic kyphosis and lumbar lordosis angles is caused by anatomic features of sagittal contour in two groups of patients. At the same time a normal sagittal contour of the spine was disturbed neither by anterior no by posterior fusion, and postoperative parameters were within permissible limits. Conclusion. Application of anterior corrective spinal fusion methods reduces intraoperative blood loss, length of spine fixation, and duration of hospital stay, and improves the patient’s quality of life. Hir. Pozvonoc. 2014; (1): 36-41.

Objective: To analyze results of surgical treatment of patients with congenital kyphosis in the thoracolumbar spine.

Material and Methods. A total of 24 patients aged 3 to 57 years with congenital kyphosis were operated on. Vertebral malformation was detected in 13 patients, malsegmentation - in 4, mixed abnormality - in 1, unclassifiable abnormality - in 3, and congenital vertebral displacement - in 3. Congenital kyphotic deformities were treated using five surgical techniques. Neurological complications were observed in one patient. Results. The average postoperative kyphosis angle was 42° (range: 7° to 68°). The average rate of correction was 34 % (range: 6 to 84 %).

Conclusion. Differential use of surgical techniques allows achieving good outcomes of treatment, restoring coronal and sagittal balance, and creating conditions for the proper development of the spine. Hir. Pozvonoc. 2014;(1):42-54.

Objective. To analyze results of surgical treatment of children with congenital deformity of the thoracolumbar junction of the spine caused by isolated vertebral malformations.

Material and Methods. Surgical treatment results in 37 patients aged 10 months to 12 years with congenital scoliosis caused by isolated lateral and posterolateral hemivertebrae in the thoracolumbar junction were analyzed. Magnitude of scoliosis before surgery was 18 to 52°, and that of kyphosis - 4 to 49°. Extirpation of the abnormal hemivertebra was performed in 33 (89.2 %) patients, and limited resection - in 4 (10.8 %).

Results. Correction of scoliotic deformity after surgical treatment was 85.0% (0-26°), and correction of kyphotic component - 78.6 % (15-23°). Compensatory cranial and caudal counter curves leveled out at the background of the primary curve correction in all patients. Destabilization of instrumentation requiring repeat surgery was observed in two children. The findings showed the efficacy of the surgical treatment by main objective measures in 81.0 % of patients.

Conclusion. Progression of congenital spinal deformity with lateral and posterolateral hemivertebrae in the thoracolumbar junction requires an early radical surgical correction with restoration of the spinal canal anatomy and physiological curves of the spine at the level of deformity. Hir. Pozvonoc. 2014; (1): 55-64.

Objective. To analyze the outcomes of surgical treatment of severe combined kyphosis secondary to myelocele.

Material and Methods. Retrospective analysis of outcomes in six patients operated on for severe combined kyphosis secondary to myelocele was performed. Correction and posterior instrumented bicortical fixation (PIBF) with expandable systems (VEPTR, TSRH) by type of dynamic bracing were used in patients with mobile kyphosis less than 30°. Correcting vertebrotomy at the curve apex with PIBF was performed for rigid kyphosis greater than 30°. Patients with severe kyphosis and bed sores in the area of the curve apex underwent halo-pelvic external fixation for extrafocal deformity correction, stabilization and creating conditions for soft tissue healing before corrective vertebrotomy at the apex of kyphosis and PIBF.

Results. The average correction was 71 %. In all children support function of the spine was restored, and functional class and physical status improved.

Conclusion. The choice of technique in patients with spinal hernia sequelae and progressive kyphosis should be differentiated depending on the size and rigidity of kyphosis and trophic complications. Degree of correction should be sufficient to consider deformity as compensated one. This assumes corrected contour of the spine, restored its support ability, increased volume of the deformed thorax, and improved respiratory function. Hir. Pozvonoc. 2014; (1):65-70.

Objective. To analyze the content and results of specialized medical care delivered to patients with adverse consequences of spine and spinal cord injury.

Material and Methods. The retrospective analysis included 307 patients treated for adverse consequences of the spine and spinal cord injury. Main reasons for low quality of life of patients and basic pathological conditions causing poor anatomical and functional results in them were studied.

Results. Rational volume of surgery based on the clinical and X-ray data included decompression of the spinal cord and its roots, the spine release, correction of post-traumatic spinal deformities, anterior column reconstruction, and spinal fusion. Out of 257 patients with neurological disorders the regression was achieved in 156 (60.6 %) cases. Correction of posttraumatic deformity was 28.2° in the thoracic, 17.7° in the cervical, and 23.4° in the lumbar spine.

Conclusion. Surgical treatment of the spine and spinal cord injury, even in its late period, is very effective and allows achieving partial or complete regression of neurological deficit and pain, permanent stabilization of the spine, correction of posttraumatic deformity, and significant improve in the function and quality of life of patients. Hir. Pozvonoc. 2014;(1):71-77.

Objective. To study pathogenic mechanisms of formation of a vertebral artery reflex angiospastic syndrome caused by a combination of cervical degenerative disc disease and spondyloarthrosis, by comparing the efficacy of puncture methods for their treatment.

Material and Methods. A prospective randomized controlled study of pathogenesis of vertebrogenic reflex syndrome of the vertebral arteries included 250 patients.

Results. The most objective evidence of correlation between vertebral artery reflex syndrome and pathological impulses from the affected intervertebral disc (in degenerative disease) or joint (in spondyloarthrosis) is provided by a puncture diagnostic and treatment manipulation. Pain symptom which is familiar to a patient can be accurately reproduced by a solution injection into the disc or to the joint and instantly eliminated by means of alcohol-novocaine denervation. When clinical and radiographic signs of combination of cervical degenerative disc disease and spondyloarthrosis were identified the puncture diagnostic and treatment manipulations confirmed the dependence of the vertebral artery reflex syndrome mainly on degenerative disc disease in 32.4 % of cases, on spondyloarthrosis - in 6.4 % of cases, and equally on degenerative disc disease and spondyloarthrosis - in 59.6 % of cases.

Conclusion. Vertebral artery vertebrogenic reflex syndrome more often depends on a combination of pathological impulses from the intervertebral disc and from the facet joint, so insufficient therapeutic effect of either disc or joint denervation should prompt their combined consecutive application. Hir. Pozvonoc. 2014; (1):78-85.

Objective. To analyze the reasons for revision surgery after decompression and stabilization in patients with degenerative lumbar spinal stenosis.

Material and Methods. A total of 308 patients with degenerative lumbar spinal stenosis were operated on. They underwent decompression and stabilization surgery using transpedicular fixation involving from 1 to 8 spinal motion segments.

Results. Clinical manifestations of radiculopathy and back pain were completely eliminated in 166 (53.9 %) patients. Another 86 (27.9 %) patients reported the absence of radicular pain syndrome with sustained mild low back pain during physical exertion. Significant reduction in radicular and low back pain was achieved in 49 (15.9 %) patients. Poor long-term results of surgical treatment requiring revision surgery in the long-term period were detected in 30 (16.1 %) patients.

Conclusion. Multi-level surgery for lumbar spinal stenosis increases the risk and probability of indications for revision in the long-term period. When performing extended decompression and stabilization procedure at four or more spinal motion segments including the L5-S1segment stabilization, it is advisable to insert caudal pedicle screws into posterior portions of the os illium instead of the S1 vertebral body. Hir. Pozvonoc. 2014;(1):86-93.

Objective. Quantitative estimation of intraoperative blood loss volume in surgical correction of idiopathic scoliosis with patient’s positioning ensuring complete decompression of the anterior abdominal wall.

Material and Methods. Results of surgical correction of idiopathic scoliosis in 122 patients who underwent surgery involving skeletal traction and posterior correction with hybrid instrumentation in the prone position were analyzed. Posterior correction in 60 patients from Group I was performed on a standard orthopedic table, and in 62 patients from Group II - on a modular operating table for spinal surgery providing complete decompression of the anterior abdominal wall.

Results. The studied parameters in groups were as follows: deformity magnitude - 54.7° ± 16,3° in Group I vs 61.5° ± 19.4° in Group II, the length of the posterior spinal fusion - 12.5 ± 1.1 vs 12.8 ± 0.9 segments, the number of levels in transpedicular fixation - 4.1 ± 1.1 vs 4.2 ± 1.8, and surgery duration - 169.4 ± 30.3 min vs 159.0 ± 31.6 min, respectively. The volume of intraoperative blood loss showed significant difference between groups: 1024.9 ± 409.2 ml (28.6 ± 12.3 % of circulating blood) in Group I, and 595.2 ± 208.6 ml (16.7 ± 6.2 % of circulating blood) in Group II.

Conclusion. Complete decompression of the anterior abdominal wall during surgical correction of idiopathic scoliosis allowed reducing intraoperative blood loss by 41.6 % and ensuring the absence of indications for blood transfusion in 48.4 % of operated patients. Hir. Pozvonoc. 2014; (1): 94-99.

The paper presents results of in vitro and in vivo tests of bone-ceramic composite implants and methods for their surface modification for the purpose of osteogenesis enhancement. Hir. Pozvonoc. 2014;(1):100-110.