The paper is a review of adolescent idiopathic scoliosis (AIS) research carried out by a team of orthopedic spine specialists in the last 40 years. Based on the world literature data on this spinal disorder, as well as on own new findings, the authors validate the theoretical model of the AIS pathogenesis explaining its primary phenomenon - monoformity of three-axial deformity along with its polyetiologic nature. The first practical result of this model became the sequence of clinical symptom progression reflecting a transition of healthy spinal column into scoliotic one, which, in turn, defined criteria of risk for AIS development. Authors’ conclusions about the natural laws of the whole period of AIS development suggested reasons for some phenomena observed after its surgical correction. Based on these conclusions, authors discuss conceptual directions in prevention, conservative and surgical treatment of the most common spinal disorder.

Objective. To perform retrospective review of the natural history of spinal deformities caused by multiple vertebral malformations and to develop an algorithm for surgical correction with regard to a leading malformation.

Material and Methods. Treatment results in 94 patients aged 5 months to 33 years with congenital spinal deformities and multiple vertebral malformations were reviewed. Surgery was performed in 81 patients who were followed-up for 6 months to 5 years. Vertebral and thoracic syndromes, neurological dynamics, and functional disorders were evaluated. An algorithm for detection of the leading malformation was applied to predict a natural course of spinal deformity associated with multiple malformations and to choose a surgical approach.

Results. Patients were divided into four groups depending on the type of multiple vertebral anomalies: monosegmental (isolated), polysegmental, outspread multiple, and complicated. The approach to choosing of surgical tactics was offered.

Conclusion. Indications for surgical treatment of spinal deformities caused by multiple vertebral malformations appear to be life-saving. Surgical treatment for this cohort of patients may be performed only after comprehensive examination. The identification of leading malformation is necessary to determine the volume of surgical intervention.

Objective. To analyze emotional features and attitude of parents having children with idiopathic scoliosis towards the child’s illness, and to determine the relationship between the parent’s attitude towards the child’s illness and children’s attitude towards their own disease.

Material and Methods. The study involved 30 mothers of children with Grade III-IV scoliosis, 28 mothers of children with Grade I-II scoliosis, and their children aged 11-17. The control group included 30 mothers with relatively healthy children aged 11-17.

Results. Mothers raising teenagers with severe spinal deformity have higher rates of reactive and personal anxiety. Emotional and behavioral reactions of anxiety, concern, and nervousness in different situations are typical for mothers of children suffering from idiopathic scoliosis and requiring complex surgical treatment. There was positive dependence between such parameters of parental attitude towards the child’s illness, as “control activity“, “nosognosia”, “anxiety”, “overall tension”, and parameters of children’s attitude towards their own illness, care and hospital stay as a whole in the group of mothers of children with severe scoliosis.

Conclusion. There is a need for measures aimed at improving the interaction of the medical staff with patients’ parents, which may increase the level of awareness among parents on various aspects of the care process, and remove excessive emotional tension caused by the illness and by a view of complex treatment for a child. 

Objective. To analyze spinal mobility after anterior and posterior instrumented fusion in patients with idiopathic scoliosis, and to compare the obtained data with those in healthy subjects.

Material and Methods. The study included 45 individuals divided into three groups of 15 subjects in each. Group I consisted of patients after anterior spinal fusion, Group II - after posterior spinal fusion, and Group III included healthy individuals. Spinal mobility was assessed using Spinal Mouse device. The obtained data were processed by pairwise comparisons using t-tests.

Results. Results of t-statistic calculation in Groups I and II, compared with those in group of healthy individuals showed that index t is less for 19 out of 32 investigated parameters in the group of the anterior spinal fusion. Comparison of t-statistics of Group I and Group II revealed spine greater mobility in Group I.

Conclusion. Both the anterior and posterior techniques of corrective instrumented fusion result in restrictions of spine mobility. Anterior spinal fusion for scoliosis is preferable from the viewpoint of spine mobility preservation.

Objective. To analyze feasibility of posterior instrumented fixation of the craniocervical spine, and to describe technical aspects of screw insertion and instrumentation configuration depending on individual anatomical features and clinical settings.

Material and Methods. The paper presents the experience of surgical treatment of 29 patients who underwent different types of posterior screw fixation in the craniocervical spine from the occipital bone to the C2 vertebra. Technical aspects of screw insertion at different levels, possible complications and ways of their elimination and prevention were described.

Results. The follow-up period of patients varied from 6 months to 3 years. Good functional outcome was observed in all cases. There were no episodes of instability. The expected clinical picture included limited range of rotational motion, which became possible for the account of not fixed segments.

Conclusion. Posterior instrumented fixation using polyaxial screws and rods is a reliable stabilization method for various disorders of the occipitoatlantoaxial junction. Its use requires careful preoperative planning and knowledge of all technical aspects of screw insertion and possible complications. 

Objective. To analyze adverse outcomes of surgical treatment of radicular compression syndrome and to present an algorithm for diagnosis and differential treatment of radicular and pseudoraducular brachialgias.

Material and Methods. The catamneses of 60 patients hospitalized for adverse outcome of previous surgery for cervical radicular compression syndrome were studied. Analysis of errors and developed algorithm for diagnosis and differential treatment of upper limb pain syndromes facilitated the prospective study of 350 patients with pseudoradicular brachialgia caused by pathological impulses from the affected intervertebral discs and facet joints.

Results. Stable regression of pseudoradicular arm pain was achieved in 94 % of patients. Disc puncture reproduction of patient’s specific arm pain and its elimination by means of chemical denervation confirmed the dependence of this pain mainly on degenerative disc disease in 33.8 % of cases, on spondylarthrosis in 6.7 %, and equally on degenerative disc disease and spondylarthrosis in 59.5 %.

Conclusion. The developed algorithm for diagnosis and differentiated treatment of upper limb pain syndromes depending on the combination of different pathomorphological substrates and syndromes can improve the results of treatment in patients with brachialgia and achieve stable regression of pseudoradicular pain.

Objective. To compare open and minimally invasive decompression and stabilization for recurrent pain in the lumbar spine.

Material and Methods. The study included 138 patients who underwent reoperation on the lumbar spine. They were divided into two groups: Group I (minimally invasive surgery, n = 67) and Group II (open surgery, n = 71).

Results. Results were evaluated up to 3 months after surgery. The average blood loss was 332.8 ml in Group I, and 702.8 ml - in Group II, the average size of the surgical wound was 38 ± 12 and 472 ± 56 cm², respectively. Good result was achieved in 28.9 % of cases in Group I, and in 19.5 % in Group II; unsatisfactory result was observed in 15.8 % and in 24.4 %, respectively.

Conclusion. Results of minimally invasive decompression and stabilization for recurrent pain are comparable with those of open procedures, but are achieved in a less traumatic way. 

Objective. Assessment of method for preventing scar adhesions after lumbar microdiscectomy using biodegradable membrane.

Material and Methods. Results of surgical microdiscectomy in 90 patients aged 23 to 60 years with lumbar disc herniation were analyzed. Group I included 30 patients who underwent standard microdiscectomy with biodegradable material, Group II - 30 patients with adipose tissue autograft placed after microdiscectomy, and Group III (control) - 30 patients without any adhesion prevention. Preoperative, immediate postoperative and long-term results were evaluated based on clinical status and MRI, VAS, and Oswestry questionnaire data.

Results. Average VAS score for radicular pain syndrome in the leg decreased from 7.07 ± 1.62 to 1.53 ± 0.68 at discharge, to 1.40 ± 0.50 in 6 months, and to 1.30 ± 0.50 in 1 year after surgery. Average Oswestry index was 55.80 ± 19.90 before surgery and 15.80 ± 6.40 in 6 months after surgery. Dynamics of the VAS scores demonstrates the grater reduction of pain syndrome in Group I (1.23-0.90-0.80) as compared with those in Group II and in the control group (1.23-1.20-1.10 and 1.53-1.40-1.30, respectively).

Conclusion. Data of clinical status, MRI, VAS, and repeated surgical interventions allow to make assumption about safety and probable efficacy of biodegradable material in the prevention of periradicular fibrosis.

Objective. To assess the efficacy of postoperative continuous intralesional analgesia in patients with tuberculous spondylitis.

Material and Methods. Patients (n = 56) with tuberculous spondylitis undergoing radical reconstructive spinal surgery were randomized into two groups depending on the type of post-operative analgesia: standard parenteral analgesia in Group I, and continuous intralesional infusion with local anesthetic in Group II. The amount of administered narcotic and non-narcotic analgesics was evaluated with formalized Analgesic Assessment Scale, postoperative activity - with the Patient Activity Scale, and pain intensity - with the VAS. Side effects of analgesic therapy were registered.

Results. Statistical analysis revealed reliable differences in terms of the assessed analgesic amounts, VAS indexes and frequency of side effects between groups. Results in Group I were reliably higher than in Group II.

Conclusion. The study showed efficacy and safety of continuous wound analgesia with infusion of ropivacaine 0.2 % through a special catheter in the early postoperative period. 

The review considers the properties of tissue engineered scaffolds required for osteogenic differentiation, cell-cell signaling interactions, and scaffold vascularization, which are largely provided by the scaffold architecture: its porosity and pore sizes, the presence of pore-channel interconnectivity inside the scaffold and its influence on cell-cell interactions. The review shows, based on the literature data, that the geometry of surface, and sizes of pores and canaliculi providing internal communication between the pores in the matrix, and the matrix microarchitecture itself considered even without the influence of growth factors and materials of which the matrices are made can affect the cell proliferation, osteogenic induction, and osteoconductive abilities, which are realized via intercellular communications.

Objective. To perform comparative analysis of osseointegration of bioceramic alumina-based granules, hydroxyapatite-based granules, and granules of deproteinized bone tissue.

Material and Methods. The experiment was conducted on 52 adult male Kyoto-Wistar laboratory rats weighing 350 to 520 g. Animals were divided into five matched groups, which differed only in the type of implanted material. Granules were implanted in lumbar vertebral bodies and in distal right femur of each laboratory animal. Two months after surgery animals were euthanized with subsequent tissue sampling for morphological studies.

Results. Examination of specimens from groups with implantation of alumina granules revealed the formed trabecular bone with evidence for remodeling. Bone tissue filled the space between granules fitting closely to their surfaces. There was no connective tissue capsule on the border between the bone tissue and alumina granules.

Conclusion. Bioceramic alumina-based granules in the form of cylinders with a through inner channel have high strength surpassing that of analogs and ability for osseointegration close to that of hydroxyapatite and deproteinized bone granules.