Objective. To analyze the results of surgery for cervicothoracic deformity fractures in patients with ankylosing spondylitis.

Material and Methods. Retrospective review of treatment for fractures of cervicothoracic deformity in 6 patients with ankylosing spondylitis was performed. All patients had transdiscal fractures caused by low-energy trauma, most frequently at C5–C6 and C6–C7 levels. Each patient had at least one comorbidity. The spinal cord was injured in 100 % of cases.

Results. Postoperative complications were registered in all patients. Analysis of postoperative x-rays showed that spinal deformity was corrected in most cases, and the stable fixation was achieved at the operated level of the spine. Three patients who had underwent anterior fixation showed the regression of neurological symptoms. Patients classified as Frankel A died of cardiopulmonary insufficiency at 2–7 days after surgery without any signs of neurological symptom regression. Autopsy revealed severe spinal cord injury. Mortality rate was 50 %.

Conclusion. Surgical treatment of cervical spine fractures providing a stable fixation reduces the risk of complications and allows for early activation of patients with ankylosing spondylitis.

Objectives. To perform assessment of vertebral body mechanical properties after stentoplasty with bioresorbable bone cement in comparison with isolated use of polymethylmethacrylate (PPMA) and bioresorbable cement for vertebroplasty in experimental human cadaveric vertebral body.

Material and Methods. Twelve intact osteoporotic vertebrae from the cadaveric thoracolumbar spine (Th12, L1) were tested. They were subjected to X-ray investigation to exclude injury. Densitometry results confirmed the decreased mineral density of selected vertebrae. The mechanical compression of specimens was performed to simulate a wedge compression fracture of vertebral body.

Results. The mean compression strength of intact vertebrae was 3.2 MPa, that of vertebrae after vertebroplasty with PMMA – 8.8 MPa, after vertebroplasty with osteoconductive cement – 3.0 MPa, and after stentoplasty with osteoconductive cement – 3.6 MPa.

Conclusion. Vertebral body stenting with bioresorbable osteoconductive cement improved mechanical properties of fractured vertebrae as compared with intact vertebrae and those augmented only with bioresorbable cement. The obtained data on mechanical properties of vertebral specimens do not preclude a possible clinical application of stentoplasty with bioresorbable cement for vertebral body fractures.

Objective. To describe an optimal sequence of actions for the execution of the VCR method and to analyze results in a small group of patients.

Material and Methods. Ten patients with severe rigid spinal deformities were operated on. Correction was performed using advanced stabilization systems. Posterior approach in a single stage was performed in 7 patients, and in two stages with 7–10 day interval – in 3 patients.

Results. The average Cobb angle of the spinal deformity before surgery was 92°. The average angle of deformity correction was 61°. All patients demonstrated good sagittal and frontal alignment in the postoperative period.

Conclusions. The VCR technique enables surgeons to treat severe rigid spinal deformities. It should be accompanied by mandatory spinal cord monitoring and performed by experienced personnel in a specialized hospital.

Objective. To analyze specific features of thoracoscopic discectomy and results of its application in children with thoracic idiopathic scoliosis.

Material and Methods. A total of 42 patients (33 females and 9 males) aged 13 to 18 years who had right-sided thoracic idiopathic scoliosis were operated on. All patients underwent one stage endoscopic discectomy with corporodesis through anterolateral approach, and posterior correction of the deformity with multiple-anchor instrumentation accompanied by intraoperative halo-tibial traction and followed by posterior local fusion. The follow-up period ranged from 6 months to 3 years.

Results. Postoperative Cobb angle of residual scoliotic deformity was 10–20° as reported by X-ray study. Deformity correction was 79.9 ± 6.5 %. Patients were verticalized on the 3–6th days and discharged on the 8–10th days after surgery to outpatient treatment. The improvement or complete restoration of the trunk balance was achieved. The pain syndrome intensity was 6–7 scores.

Conclusion. Indications for thoracoscopic discectomy are rigid curves less than 90 degrees and unfinished growth in a child. Application of endoscopic discectomy at the anterior stage of surgical intervention in patients with idiopathic scoliosis provided insignificant blood loss during discectomy, decreased intensity of postoperative pain syndrome, and improved cosmetic outcome after the surgery.

Objective. To assess a reliability of topographic evaluation of patients with severe Scheuermann’s kyphosis vs X-ray study, to study topographic parameters of posture in the sagittal plane before and after surgery, and to develop 5-point scale for evaluating surgical kyphosis correction using X-ray and topography findings.

Material and Methods. The study included 32 patients with Scheuermann’s disease operated on in the Clinic of Child and Adolescent Vertebrology at the Novosibirsk RITO. Patients were distributed into two groups: those with normal and cranial location of the kyphotic apex (Group 1), and those with caudal location (Group 2). Group 1 included 22 patients (16 males, 6 females, mean age 18.6 ± 3.5 years), and Group 2 – 10 patients (7 males, 3 females, mean age 20.2 ± 4.6 years).

Results. Integral normalized height of kyphosis (HIK) is better consistent with a Cobb angle than any of the primary topographic parameters for kyphosis when severe kyphosis associated with Scheuermann’s disease is estimated. Surgical correction of kyphosis results in statistically significant changes in most of topographic parameters of posture in the sagittal plane. To assess surgery results the 5-point scale was suggested considering the value of kyphosis correction and its postoperative deviation from the norm, which is suitable for both topographic and X-ray findings.

Conclusion. Topographic data may be a supplement to common X-ray data in evaluation of surgical treatment results for Scheuermann’s kyphosis. The suggested complex assessment is close to a patient-reported one, agrees well with a clinical assessment, and can be recommended for use in spine surgeon practice.

Objective. To assess a spectrum of X-ray biomechanical parameters of the spine kinematic chain and to determine their influence on the outcome of surgical treatment for lumbar intervertebral disc hernia.

Material and Methods. A retrospective analysis of data on 332 patients operated on for intervertebral disc hernias at the L4–L5 and L5–S1 levels was performed. Patients were distributed into two groups: I – patients with hernia recurrence, and II – without recurrence. Preoperative X-ray parameters were compared.

Results. Hernia recurrence was observed within 10.40 ± 1.18 months after primary surgery. Intervertebral disc height index was 0.35±0.06 mm in Group I and 0.26 ± 0.03 mm in Group II. This determined a significant difference between groups (P = 0.001) and meaningful correlation ( = 0.44). Sagittal range of motion was 10.20° ± 1.84° in Group I and 7.60° ± 1.74° in Group II (P = 0.001,  = 0.35); central lordosis angle was 32.80° ± 5.73° in Group I and 47.10° ± 8.15° in Group II (P = 0.001,  = -0.46). Recurrence correlated with Pfirrmann grade III degeneration ( = 0.42) and articular cartilage degeneration grade according to Grogan ( = 0.32). The slope of a chord, Modic changes, hernia types, subchondral sclerosis according to Grogan classification, lumbalization, and retrolisthesis did not correlate with recurrence, though significantly differed in the studied groups.

Conclusion. Analysis of data on radiological parameters can help to optimize the surgical approach and improve the outcome of treatment for lumbar intervertebral disc hernias.

Objective. To perform retrospective review of diagnostic studies and treatment results in patients previously operated on for intervertebral disc herniations and to explore the possibilities for modified laminectomy to eliminate compression of nerves and vascular structures.

Material and Methods. Results of comprehensive diagnosis and surgical treatment in 88 patients who underwent 1 to 5 re-operations for lumbar degenerative diseases were analyzed. Examination included MRI in all patients and MR myelography in 84 (95.5%) patients. Re-operations were performed in a period of 1 to 3 years after initial surgical intervention. Modified laminectomy was the main surgical procedure. The course of pain syndrome was studied using the VAS at immediate and long-term follow-ups.

Results. The pain score decreased from 7.2–7.6 before surgery to 1.4–1.7 after surgery; the mean pain score at long-term follow-up (in 6–12 months after surgery) was 2.1–2.7. Repeated surgical interventions proved to be effective in 73 % of cases, when it was possible to improve significantly the quality of patients’ life.

Conclusion. The modified laminectomy is a pathogenetically-based and technically appropriate intervention to treat the patients with failed back surgery syndrome in cases of recurrent or progressive degenerative-dystrophic process.

Objective. To analyze the restoration of structure-metabolism relationships within the spinal segment in experimental model using tissue engineering method.

Material and Methods. Correction of early stages of osteochondrosis induced in the experimental model was performed using 3D tissue-engineered chondral graft. The studies were conducted on eight adult mongrel dogs. The chondral graft was inserted into the bed of the removed nucleus pulposus of the L4–L5 intervertebral disc. The mechanism of correction involves restoration of the disc height, microcirculation and lymph drainage, and prevention of formation and development of herniations and neuro-vertebral conflict.

Results. The intervertebral disc with a height equal to that of a healthy one was distinctly contoured on the X-ray in 1 month after transplantation of the 3D chondral graft. After 3 and 6 months the X-ray pattern did not change. Osteophytes developed at the edges. Histological assay showed that in 3 months the cartilage tissue was formed and it filled the bed of nucleus pulposus, being restricted by annulus fibrosus. Bone tissue did not differ from healthy specimens in structure. In 6 months the mature hyaline cartilage was formed in the region of nucleoplasty. Type II collagen and proteoglycans were observed in the matrix. The degree of regenerate differentiation is evidenced by the organized chondron-like structure of the cartilage.

Conclusion. 3D chondral graft possesses high regenerative potencies realized by proliferative and synthetic activity inherent to embryonic cartilage. Nucleoplasty with chondral graft with its subsegment transformation into a definitive cartilage tissue improves structure-metabolism relationships and prevents neuro-vertebral conflict and intervertebral disc herniations.