Objective. To analyze mistakes in diagnosis and tactics of surgical treatment of children with the spine and spinal cord injuries.

Material and Methods. A retrospective analysis of treatment outcomes in 237 children aged 3 to 17 years with the spine and spinal cord injuries was carried out. Out of them 54 patients (23.0 %) had vertebral fractures complicated by neurological disorders, 183 (77.0 %) had unstable injuries. Mistakes made on stages of diagnosis and surgical treatment were evaluated.

Results. It was found that children with unstable spinal injuries misdiagnosed as compression vertebral fractures were treated conservatively in 26 cases (11.0 %). Laminectomy without instrumented stabilization, which resulted in the progression of posttraumatic kyphosis was performed in 9 cases (3.8 %). Incorrect placement of pedicle screws, which required reoperation, was detected in 6 patients (2.5 %). Application of anterior instrumentation caused development and progression of spinal kyphosis in 3 cases (1.3 %). Posterior reduction and instrumented stabilization without timely reconstruction of the anterior and middle columns of the fractured vertebral bodies in the growing spine were revealed in 3 children (1.3 %).

Conclusion. Mistakes in diagnosis and surgical treatment of children with the spine and spinal cord injuries resulted in repeated surgeries and sometimes in irreversible consequences. 

Objective. To analyze opportunities of short segmental fixation of C2-C3 (C4) vertebrae with direct repositioning of bone fragments using polyaxial screws for traumatic C2 spondylolisthesis.

Material and Methods. Short mono- or bisegmental posterior fixation of C2-C3 (C4) vertebrae was performed in 7 patients with hangman’s fracture.

Results. Clinical examination in 6 and 12 months after surgery revealed persisting pain in the cervical spine and limitation of rotational motion to the left up to 20° in one patient. Other patients had the same range of rotational motion as before surgery. All patients were able to return to their previous work, including that related with heavy manual labor.

Conclusion. Posterior instrumental fixation of C2 transpedicularly and of C3 (C4) into the lateral masses is an effective and reliable reposition-fixation option of hangman’s fracture stabilization.

Objective. To analyze results of atypical segmental corrective vertebrectomy in patients with painful thoracic kyphosis treated in the late period of spinal cord injury.

Material and Methods. Eight patients with painful kyphotic and shear deformities were operated on during 2012. The method of atypical segmental corrective vertebrectomy was used. Average kyphotic deformity was 43.1° ± 15.0°, the rate of anterior shear displacement varied from 25 to 48 %.

Results. The average kyphosis correction was 9.1° ± 5.8° with complete correction of shear deformity. Questionnaire data showed the decrease in pain score from 4.4 ± 1.8 to 2.6 ± 1.6 on VAS, and improvement in functional capacity from 74.4 ± 12.0 to 83.5 ± 9.0 on FIM (Functional Independence Measure) in the follow-up period.

Conclusion. Atypical corrective segmental vertebrectomy performed in the late period of spinal cord injury effectively eliminates post-traumatic deformity, and improves functional capacity of patients with complete neurological deficit. 

Objective. To estimate degenerative changes at adjacent spinal segments after surgical treatment of unstable uncomplicated injury of subaxial cervical spine in remote period.

Material and Methods. Data from patients operated on for uncomplicated unstable injury of subaxial cervical spine were analyzed. Functional activity of the patients was assessed on the Neck Disability Index, and radiologic degeneration - on Hilibrand and Parks scales.

Results. Fusion of the spinal motion segment of the subaxial cervical spine leads to aggravation of initial degenerative changes at one of adjacent levels in some patients.

Conclusion. Issues of the etiology of the adjacent segment disease are debatable and need further study. 

Objective. To analyze surgical treatment results in patients with severe progressive spinal deformities owing to Ehlers-Danlos syndrome.

Material and Methods. A total of nine patients with spinal deformities owing to Ehlers-Danlos syndrome were operated on during the period of 2003-2013. Mean age of patients was 12.5 years. One patient undergoes multistage treatment with VEPTR instrumentation, and eight patients underwent corrective posterior surgery using third-generation segmental instrumentation. Posterior correction was preceded by anterior stage including discectomy and interbody fusion with bone autograft in six cases.

Results. The mean primary curve was 95.2° before surgery, 50.9° immediately after surgery, and 59.1° at final follow-up. The kyphotic component was 93.7°, 53.9°, and 59.6°, respectively. The coronal trunk imbalance was 28.3 mm before surgery, 39.4 mm immediately after surgery, and 22.0 mm at final follow-up. Complications were observed in three patients: right-sided pneumothorax in one case, and instability of the cranial anchor of instrumentation system, which required reoperation in two cases. There were neither pyogenic or neurologic complications, nor massive bleeding.

Conclusion. Spinal deformities caused by Ehlers-Danlos syndrome are rare, though rapidly progressive disorders, which attain significant magnitude. Timely surgical treatment allows achieving satisfactory correction of both scoliosis and kyphosis, though can cause vascular and neuriological complications, especially with the anterior approach. 

Objective. To analyze the course of anxiety and resistance to stress in preoperative patients.

Material and Methods. The study included 72 patients (58 girls and 14 boys) with scoliosis of different etiology who had similar psychological status at the stage of preoperative examination. The study group included 34 patients, the control one - 38. Psychological status was evaluated with a set of psychodiagnostic instruments. Patients from the study group underwent biofeedback computer game-based training. Condition of patients in the immediate postoperative period was analyzed by their subjective evaluation on a pain scale. They also completed the treatment satisfaction questionnaire before discharge from the hospital.

Results. The severity of anxio-depressive experience was successfully reduced in patients from the study group (p = 0.01). The high correlation between the positive experience index and subjective comfort index (0.85) was observed. Inverse correlation existed between the pain score and the positive experience index (-0.69). Analysis of questionnaires showed significantly higher average satisfaction with all treatment parameters in the study group than in the control one (p = 0.00).

Conclusions. The presented set of psychodiagnostic instruments in conjunction with the technology of biofeedback computer game-based training can be used for diagnosis and correction of emotional stress in patients preparing for surgery, and for prediction of their condition in the immediate postoperative period, with a view to timely psychoprophylaxis. 

The paper presents a literature review on failed back surgery syndrome (FBSS). According to statistics, the proportion of cases of back pain recurrence after lumbar spine surgery ranges from 15 to 50 %. There are many causes of the FBSS development, the most common of these are misdiagnosis and incorrect selection of candidates for surgery. In accordance with international clinical protocols, FBSS is an indication for chronic epidural spinal cord stimulation (SCS) in case of conservative treatment failure, absence of direct unconditioned indications for reoperation, and neurogenic pain. High efficiency and economic feasibility of the given method is proved in multiple studies including in well-organized evidence-based researches. The wide international experience allows making assertions about long-term and stable analgesic effect of chronic electric stimulation of the spinal cord. It must be remembered that delaying a decision on application of the SCS method leads to poor results in catamnesis. In advanced cases, a care to such patients becomes simply impossible due to the centralization of pain syndromes.

Objective. To assess the efficacy of decompression, correction, and stabilization of the lumbar spine deformity using minimally invasive techniques in patients with degenerative lumbar scoliosis.

Material and Methods. A retrospective controlled two-center study included 62 patients who underwent surgery for clinical manifestations of degenerative scoliosis of the lumbar spinal canal.

Results. Average Oswestry index before surgery was 69.69 %, after surgery it decreased to 33.00 % and ranged between 14 and 50 %. Average magnitude of the lumbar lordosis after surgery was 39.2°; average rate of deformity correction - 56.53 %; average magnitude of deformity reduced to 13.46° ± 6.08°. Two-fold reduction of the apical vertebra rotation was observed.

Conclusion. The use of the principles of minimally invasive surgery allows to expand the indications for surgical treatment of degenerative spinal deformities and the scope of intervention, and to reduce intraoperative blood loss. 

Objective. To analyze the method for assessing a degree of spinal canal narrowing based on anatomical aspects of lumbar spinal stenosis.

Material and Methods. Twenty two patients with 41 stenotic segments were involved in the study. Mean age of patients was 51.8 years. Mean number of stenotic segments in one patient was 2.1. Eight radiological criteria were measured in all patients. Measurements were carried out at the level of the middle of intervertebral disc and facet joints. The linear pair correlation was calculated for all criteria. The regression equations were composed based on correlation coefficients.

Results. Strong linear correlation between the linear and area variables was found. The analysis of regression equations showed the adequacy of mathematical models and high value of the multiple correlation coefficient. To describe a degree of spinal canal narrowing the authors suggested using a stenosis coefficient as the ratio of the sum of lateral canal areas to the dural sac cross-sectional area. Comparison between average values of this coefficient in the study and the control groups showed statistically significant differences.

Conclusion. The new approach to searching for an optimal radiological criteria of spinal canal narrowing is used. Based on the obtained data, the parameter “stenosis coefficient” is introduced, which has high correlation with the numerical grading scales. Results obtained in the small sample are encouraging.

Objective. To analyze long-term clinical results of using neodymium laser for surgical treatment of patients with spinal dumbbell-shaped tumors.

Materials and Methods. Clinical material is based on results of surgical treatment in 83 patients (49 females and 34 males) with dumbbell-shaped tumors. The patients were divided into two groups depending on the tumor resection technology: 57 patients (control group) were operated on using conventional neurosurgical technique, and 26 (study group) - using laser radiation with a wavelength of 1.064 mkm.

Results. In the study group good long-term results were achieved in 10 patients (38.5 %), satisfactory - in 12 (46.1 %), and poor - in 4 (15.4 %). In the group of conventional technology of the tumor removal, good results were achieved in 10 patients (17.5%), satisfactory - in 27 (47.4 %) and poor - in 20 (35.1 %).

Conclusion: The use of a neodymium laser for removal of dumbbell-shaped tumors allows achieving higher levels of radical resection with a possibility of one-stage removal of intracanal and paravertebral fragments of the tumor with minimally injurious exposure of the spinal cord and its roots. Hir. Pozvonoc. 2014; (3):65-71.

Objective. To assess the efficacy of intensive therapy for complicated injury to the cervical spine and to define prognostic criteria for the disease course.

Material and Methods. The results of intensive therapy in 60 patients with complicated trauma to the cervical spine at the C3-T1 level were analyzed. Patients were divided into three groups depending on severity of the initial neurological deficit: Group A - complete spinal cord injury (n = 35), Group B - incomplete injury (n = 16), and Group C - incomplete injury (n = 9). Objectification of the severity of patient’s condition was performed over time using the SOFA and APACHE II scales.

Results. Patients from Group A developed multiple organ failure, pneumonia, and sepsis more frequent in comparison with patients from Group B and Group C, due to their more severe condition. This determined the length of their stay both in ICU and in hospital, and the rate of in-hospital mortality.

Conclusion. Retrospective analysis of outcomes in patients with the spine and spinal cord injuries showed the efficacy of the complex of intensive therapy methods, as confirmed by the absence of adverse outcomes in 2013. 

Objective. To analyze osteoconductive activity of a new composite bone-ceramic material.

Material and Methods. The experiment was conducted on male Wistar rats (5-6 months old, body weight ranged 260-320 g). Cylindrical ceramic alumina-zirconia or composite bone-ceramic implants were introduced into perforatied defects of the compact bone. Osseointegration of experimental specimens was studied on the 15th and 30th days after implantation using light, electron, and fluorescence microscopy.

Results. Simultaneous processes of bone resorption and osteogenesis were observed at all time periods after implantation of ceramic alumina-zirconia specimens in the bone bed. The resorption zone around the implant reached 200-250 microns in width and 400-450 microns in length, and marginal regeneration zone - 100-200 microns and 350-400 microns, respectively. Bone-ceramic composite implantation was characterized by the domination of osteogenesis. A large amount of newly formed bone tissue rich in blood vessels and cellular elements was observed along the whole periphery of the bone-ceramic implant already on the 15th day when it reached 50 to 150 microns in width, and on the 30th day it was 150 to 350 microns.

Conclusion. Implantation of the bone-ceramic composite material in the bone bed leads to the formation of bone tissue at the bone-implant interface in the form of bone bridges having a tendency to immuring the implant in the newly formed bone tissue. This suggests the superior osteoconductive properties of this material. 

Objective. To analyze the expression of candidate genes presumably responsible for the development of idiopathic scoliosis.

Material and Methods. The study subjects were vertebral body growth plates of children aged 11-15 years suffering from Grade III-IV idiopathic scoliosis. Real-Time SYBR Green PCR assay was used to investigate the expression of genes responsible for growth regulation, chondrogenic differentiation, matrix formation and synthesis, and sulfation and transmembrane transport of sulfates.

Results. Comparative analysis of gene expression did not give a clear answer. On the background of representative morphological and biochemical data including violation of the structural organization of cells and matrix on the concave side of deformity, presence of poorly differentiated chondroblasts, and lack of differentiation in columnar and hypertrophic structures, a sharp decline in synthetic potency of cells contradicted the data on high expression of IHH, TGFBR1, and EGFR genes, matrix proteoglycans genes ACAN, LUM, and VCAN, collagen types I and II, and of sulfation and sulfate transmembrane transport genes DTDST, CHST1, and CHST3. Expression of growth hormone receptor gene, differentiation genes SOX9 and PAX9, and link protein gene was reduced. Factor analysis of the studied genes has shown significant difference between gene expression in chondroblasts of patients with idiopathic scoliosis and that in controls.

Conclusion. Complex interaction of genes under the control of the central regulatory mechanisms coordinates the periodization of gene turning on, thereby integrating the process of the spine growth. Violation of any of the factors in the complex system of morphogenesis regulation causes asymmetric growth resulting in scoliosis development.

Presented clinical observation concerns the clinical picture, diagnosis, and treatment of angiogenic vertebral body destruction in a 14-year-old child with hemangioma having atypical clinical presentation and X-ray image. The literature on Gorham’s syndrome is analyzed. Type of publication: clinical case and literature review. Level of evidence - IV.

The paper presents the completed case of comprehensive staged surgical treatment of a patient with caudal regression syndrome combined with multiple malformations performed in Novosibirsk RITO in 2010-2012. Evaluation of the child’s condition was performed using clinical and radiological methods. Results of the treatment for rare severe malformation of the spine combined with multiple developmental musculoskeletal defects are demonstrated, and the opportunities of reconstructive surgery in the treatment of multiple defects of musculoskeletal system are presented.

The paper presents results of staged surgical treatment of patients with concomitant degenerative-dystrophic diseases of the hip and spine. The analysis of clinical observation suggests the possibility of decompensation of degenerative-dystrophic disease of the lumbosacral spine accompanied by spinal canal stenosis and instability of spinal motion segments after total hip arthroplasty. Decompression surgery eliminating spinal canal stenosis allows to restore lumbar lordosis and manage the pain syndrome. Surgical decompression combined with correction and fixation of the lower lumbar motion segments allows to normalize sagittal spinal-pelvic relationship by restoring both lumbar lordosis and anatomic pelvic anteversion.

The paper presents a clinical case of the annulus fibrosus plasty with Barricaid implant after removal of the herniated L5-S1 disc. The follow-up period was 6 months. The treatment had excellent clinical result including the absence of low back and leg pain, as well of continued degeneration of the intervertebral disc and the facet joints.

Two cases of safe and effective surgical treatment for high-grade rigid dysplastic spondylolisthesis manifesting by severe pain syndrome and neurological deficit are described. Surgical treatment relieved patients’ pain and eliminated neurological deficit.

A case of surgery for cervical myelopathy in a patient with extended spinal canal stenosis is presented. Two-stage surgical treatment included spinal cord decompression and screw-based and intervertebral stabilization. Surgery resulted in eliminated compression of the spinal canal neurovascular structures, stable fixation, and improved neurological status.

A case of minimally invasive surgical treatment of a patient with degenerative lumbar scoliosis is presented. Percutaneous multilevel transpedicular fixation with the deformity correction, decompression of spinal canal structures, and transforaminal interbody fusion at clinically relevant spinal levels were performed. Surgery provided restoration of sagittal balance, stable fixation, and steady regression of pain existed prior to surgery.

The paper describes long-term results of surgical treatment of a female patient with intramedullary ependymoma at the cervical level. Long relapse-free period was reported after the radical removal of intramedullary ependymoma. A complication developed after multilevel laminectomy required anterior fusion. Analysis of patient’s neurological symptoms and level of long-term social adaptation showed her full independence and preservation of working capacity.

The paper describes clinical features, diagnosis and treatment of spinal cord tumor localized in the anterior portion of the craniovertebral junction in a 43-years-old patient after a course of stereotactic radiotherapy with the CyberKnife linear accelerator. The surgical treatment included microsurgical total removal of intradural extramedullary tumor at the level of the craniovertebral junction through far lateral approach with neurophysiologic monitoring. Good clinical results achieved in the early postoperative period were presented by restoration of muscle force in the limbs (regression of tetraparesis) and headache relief.

The paper presents a case of surgical removal of dumbbell-shaped spinal root neurinoma with the neodymium laser. This surgical technique allows the one-step resection of large extravertebral component. Technical features of this method are laser ablation, subcapsular decompression of extracanal component, and its removal through an expanded foramen.

The Centre for emergency assistance to children with injuries to the spine and spinal cord was established on the premises of the spine pathology and neurosurgery department of the Turner Research Institute for Children’s Orthopedics which provides specialized and high-tech care to children with disorders of the spinal column and cord. Organizational and methodological activity of the Centre, and the algorithm for providing advisory and surgical assistance by the Centre’s specialists in the city of St. Petersburg are presented.

The paper presents a scientometric analysis of Russian public organizations conducting research in traumatology, orthopaedics, and spine medicine. A bibliometric analysis of a number of specialized scientific publications is also submitted. The measures aimed at optimization of research activity in traumatology, orthopaedics, and spine medicine are proposed based on provisions of the State Program of the Russian Federation on Development of Science and Technologies for 2013-2020, the State Program on Development of Healthcare in the Russian Federation, and the Strategy of the Development of Medical Science for the period up to 2025.