Objective. To assess the dynamics of neurological disorders after surgical treatment in pediatric patients with complicated fractures of the thoracic and lumbar spine using ASIA scale.

Material and Methods. Outcomes of surgical treatment in 32 children aged from 3 to 17 years with isolated injuries of the thoracic and lumbar spine accompanied by neurological disorders were analyzed. Type A3 fractures occurred in 50.0 %, type B in 6.3 %, and type C in 43.7 % of cases. Patients were divided into 2 groups: Group I included 12 patients with complete spinal cord injury, and Group II - 20 patients with incomplete injury.

Results. In all patients, a vertebral-medullary conflict was eliminated and a rigid fixation of the damaged spinal motion segments was achieved. Voluntary movements in lower limbs of patients from Group I did not recover. Patients from Group II had significant decrease in paresis degree and sensitivity recovery in lower limbs: the ability of independent walking without aids and assistance was completely restored in 37.5 %, the ability to walk with one/two-sided assistive devices was achieved in 18.8 %, and significant improvement in lower limb support ability - in 6.3 % of cases.

Conclusion. Surgical treatment of children with complicated spinal injury should include the elimination of vertebral-medullary conflict, complete reduction, and rigid stabilization with reconstruction of physiological profiles of injured spinal motion segments.

Dynamic cervical plates, due to their constructive features, provide more proportional load sharing on interbody support that optimizes interbody healing after anterior cervical interbody fusion in the surgical treatment of injuries and diseases of the cervical spine. However, complication rate after their application remains sufficiently high. Analysis of complications of anterior interbody fusion with dynamic cervical plates was performed with respect to their constructive features and the option of interbody support restoration. Complications specific to each type of dynamic cervical plate were determined.

Objective. To investigate the comparability of the topographic angle of lateral asymmetry and radiographic Cobb angle at early stages of idiopathic scoliosis.

Material and Methods. The study included 50 children and adolescents aged 6 to 18 years (mean age 12.98 ± 3.51; 26 boys, 24 girls) with suspected scoliosis. The average Cobb angle of the primary curve was 9.90 ± 5.74° (range: 2.47° to 32.32°). Thirty two patients had grade I deformity, 17 - grade II, and 1 - grade III (according to V.D. Chaklin’s classification).

Results. The mean value of the difference between the angle of lateral asymmetry and Cobb angle was -0.092°, i.e. topographic angle provides an unbiased estimate of the scoliosis. The standard deviation of the difference between the angle of lateral asymmetry and Cobb angle was 1.013°, i.e. topographical angle gives the exact magnitude of scoliosis. The maximum difference between the angle of lateral asymmetry and Cobb angle ranged from -2.45° to +2.19°. Pearson’s correlation between the angle of lateral asymmetry and Cobb angle was 0.985.

Conclusion. Six-year experience in the operation of the TODP system in children’s polyclinic No. 110 in Moscow showed that the method of computer optical topography provides high accuracy in diagnosing early stages of scoliosis and can significantly reduce the need for X-ray examination of patients for primary diagnosis defining and dynamic observations. 

The review of literature presents the results of studies on methods for predicting the course of congenital spinal deformities in children.

Objective: To study the range of motion of segments proximal to the fused area and its relationship with some parameters of vertical posture in patients with lumbar degenerative disc disease and degenerative lumbar spondylolisthesis at stages of the surgical treatment.

Material and Methods. Protocols of clinical and radiological examination of 52 male patients with instability of the low lumbar segments combined with spondyloarthrosis and/or spinal stenosis, and/or herniated lumbar intervertebral discs were analyzed.

Results. Preoperative examination detected a flattening of the lumbar lordosis and verticalization of the sacrum combined with a significant decrease in excursions of the lumbar spine. Improvement in the sagittal contour of the spine achieved after surgery did not improved significantly the lumbar segments kinematics.

Conclusion. The altered lumbar segmental mobility may be caused by incorrect movement patterns due to unrepaired myotonic reactions and inadequate spinal motion strategies. 

To assess the efficacy of using intraoperative cone-beam O-arm computed tomography and navigation system in surgical treatment of the spine and spinal cord disorders. A total of 106 patients with degenerative spine diseases and spine and spinal cord tumors underwent surgery with O-arm iCT and navigation system from August 2013 to March 2014. The iCT system was used for tumors localized in anatomically hard-to-reach areas to control radicality of removal of bone tumors and those of the spinal cord with ossification, and for needle guidance in vertebroplasty. During stabilization stage the O-arm iCT and navigation system were used to control the accuracy of implant placement and to monitor decompression zones. The O-arm iCT with navigation system is particularly useful when surgery is performed in difficult anatomical conditions, and the use of two-dimensional images does not provide visualization of the surgical zone. Duration of the first surgeries using iCT and navigation system was longer, but within the first month there was a trend towards its shortening. Conclusions. Application of the O-arm iCT with navigation system in surgical treatment of spinal disorders provides high quality treatment, is safe for a patient, and allows for surgical intervention in difficult anatomical conditions.

A case of complication after percutaneous vertebroplasty for unverified tuberculous spondylitis is discussed. The patient underwent staged surgical treatment aimed at eliminating the source of inflammation, decompression of the spinal сord by means of cement removal, and stabilization of the spine. To reduce negative effects of myelopathic syndrome, epidural electrodes were implanted at the T₁₂-L₁₃ spinal segments. The patient further underwent 1 month neurorehabilitation therapy, which reduced the pain severity and spastic manifestations. Neurological disorders changed from Type A (ASIA/ISIOP) to Type B.

Objective. To analyze clinical results of surgical treatment of patients with craniocervical junction tumors.

Material and Methods. A total of 47 patients with tumors of the craniocervical junction were operated on. There were 8 (17,0 %) intramedullar and 39 (83,0 %) extramedullar tumors, including 5 dumbbell tumors. Tumors were located anteriorly in 6 (12,7 %), anterolaterally in 10 (21,3 %), laterally in 14 (29,8 %), posterolaterally in 7 (14,9 %) and posteriorly in 10 (21,3 %) patients. Meningiomas were diagnosed in 25 (53,2 %), neurinomas in 10 (21,3 %), astrocytomas in 4 (8,5 %), ependymomas - in 3 (6,4 %), hordomas in 4 (8,5 %), and hemangioblastomas in 1 (2,1 %) patient. Removal of 4 (8,5 %) tumors located at the clivus level was performed via anterior transoral approach. The remaining patients were operated on using posterior and posterolateral approaches in 36 (51,1 %) and far-lateral approach in 7 (14,9 %) cases.

Results. Total removal of the tumor was achieved in 86,0 % of cases. Tumors in 7 (14,0 %) patients were removed subtotally due to their hard-to-reach location and large size.

Conclusion. Total removal of craniocervical junction tumors through posterolateral (far-lateral) approach is possible not only in cases of their posterolateral or lateral location, but also of anterior one. The method of choice for removal of clivus tumors is transoral approach.

Objective. To analyze morphological features of tissue structures (bone and muscle tissue) and their correlation with osteodensitometry data for predicting the volume of intraoperative blood loss in surgery for idiopathic scoliosis.

Material and Methods. Articular processes of vertebrae and fragments of muscle tissue obtained from 50 patients undergoing surgery for idiopathic scoliosis were investigated. All patients underwent osteodensitometry before surgery. Data on the volume of intraoperative blood loss were analyzed.

Results. Morphologic study of specimens (n = 21) revealed significant features: atrophy of bone trabeculae with irregular arrangement of osteocytes, widening of intertrabecular spaces, large number of hemosiderophages in the bone marrow, absence of the process of osteogenesis, atrophy of muscle fibers, and enlarged thin-walled vessels. Intraoperative blood loss in patients with these observations - from 30 to 50 % of total blood volume, and osteodensitometry revealed osteoporosis. The study found a weak correlation between indicators of bone density and volume of intraoperative blood loss.

Conclusion. Morphological changes in bone and muscle tissue in patients with idiopathic scoliosis are risk factors for massive blood loss in surgery for scoliosis. Findings of preoperative osteodensitometry may be an indirect predictor of the volume of intraoperative blood loss.

Objective. To present experimental prototypes of tissue-engineered bone equivalent (TEBE) based on nanostructured bioresorbable synthetic polymer cellular matrices (BSPCMs) and osteogenic differentiated cells created to repair bone defects.

Material and Methods. Nanostructured BSPCMs were developed and produced, which further served as the basis for creating TEBE. Cultured cells were transferred on the surface of nanostructured matrix, where patterns of their growth, expansion, and behavior were studied. Topography and surface properties of TEBE prototypes were investigated using methods of light-optical, scanning electron, and atomic force microscopy.

Results. A possibility of creating experimental TEBE prototype based on BSPCM, which copies to the maximum extent the bone structure at the micro- and nanoscales is shown. Surface of the BSPCM was additionally nanostructured by formation of longitudinally oriented nano-trenches, to increase adhesion and osteoconductive properties.

Conclusion. A strategy for creating nanostructured BSPCM and TEBE was developed, and experimental prototypes suitable for further investigations to form biodegradable implants for needs of traumatology, orthopaedics, and spine medicine were produced. 

Objective. To analyze the efficacy of the restoration of shape and strength of fractured vertebral bodies of the thoracolumbar junction by bone defect substitution with alumina bioceramic granules.

Material and Methods. The study was conducted on 19 vertebrae obtained from thoracolumbar spines of four individuals died from extra-vertebral pathology. All specimens were subjected to axial compression resulting in vertebral body deformation. Thereafter, reconstruction of the vertebrae was performed with alumina granules and deproteinized bone granules inserted under pressure into their bodies.

Results. Vertebral reconstruction resulted in increase in the height of anterior, middle and posterior portions of the vertebral bodies. Mean vertebral body strength was 3.223 MPa in specimens with bioceramic granules and 3.018 MPa in specimens with deproteinized bone granules. The compressive strength of the vertebrae after reconstruction with alumina bioceramic granules exceeded the original value by 8.00 %, while that after insertion of deproteinized bone granules decreased by 23.01 %.

Conclusion. Reconstruction of compressed vertebral bodies with alumina bioceramic granules allows to restore both the shape and compressive strength of the vertebral body in experiment. 

Objective. To study the most important medical and social parameters of spinal injuries, to substantiate the importance of factors influencing the efficiency of management decisions in organization of appropriate preventive, treatment and rehabilitation measures.

Material and Methods. The study included 271 patients treated for traumatic spinal injuries during 2009-2010 in Saratov NIITO.

Results. Key problems and factors related to traumatic spinal injuries were formulated, and the importance of their comprehensive analysis for effective evaluation of medical and social consequences of considered pathological conditions was shown. The study outlined directions of improving organization of specialized medical care to patients with spinal cord injury, including updating of formalized algorithms of care.

Conclusion. The crucial task of organization of specialized medical care for traumatic injuries of the spine is an integrated approach that consists, on the one hand, in using reasonable methods of prevention, and on the other, in developing evidence-based organizational algorithms of care.