Objective. To analyze the outcomes of sacroplasty in patients with low-energy sacral fractures.

Matherial and Methods. Sacroplasty was performed in 20 patients for persistent pain caused by low-energy sacral insufficiency fracture. The procedure involved bone cement injection under the guidance of CT fluoroscopy. The pain intensity was assessed with the Visual Analog Scale (VAS) preoperatively, one day, one month and three months after surgery.

Results. In each case a needle was inserted precisely into the site of fracture. Pain intensity in the sacral region at the next day after sacroplasty was 5.7 scores on the VAS. Sixteen patients underwent follow-up examination in a month. The average VAS score was 4.1. In three months 12 patients were examined. They assessed their pain perception as 2.3 score. All examined patients were able to walk independently without pain.

Conclusion. Sacroplasty provides long-term pain relief and improves quality of life in patients with low-energy sactral insufficiency fractures. The sacroplasty advantages are minimal intraoperative tissue trauma, low risk of intra- and postoperative complications, and relatively low cost of treatment.

The paper presents a case of surgical treatment of unstable three-column ligamentous injury of the thoracic spine (type В 3.2) in a patient with ankylosing spondylitis. Despite relatively favorable X-ray findings and clinical features, the injury required surgical treatment including monosegmental transpedicular spinal instrumentation.

The paper presents a new version of fixing implant used in spinal deformity surgery. Universal Clamp includes a polyesther (Dacron) band that is passed under the lamina at the selected level, and then is connected to a rod and tighten by a titanium clamp. The implant contributes to additional correction in three dimensions and provides additional points of fixation. The authors submit four clinical observations supporting efficacy of Universal Clamp.

Objective. Investigation of psycho-emotional conditions in patients with scoliosis.

Material and Methods. A total of 275 individuals with an average age of 30 years were enrolled in the study. The study group included 233 patients with scoliosis, and the control group – 42 adolescents aged 15–16 years who had no clinical manifestations of scoliosis and never sought medical attention for complaints of the back pain. Examinees were offered to estimate their current state on a five-point scale. Patient-reported scores were transferred to the corresponding diagnostic factors, which were summarized within scales, and a patient-specific diagram of test results was built.

Results. Neurotic conditions were noted in 16 % of patients with scoliosis. Among them obsessive-phobic disorders and neurotic depression prevailed. Neurotic depression is more than three-fold frequent in patients with scoliosis than in conditionally healthy subjects. Neurotic depression is registered even in patients with grade I and II scoliosis. The incidence of psycho-emotional disorders is higher in children than in adults and in women than in men.

Conclusion. Data obtained from testing will help in development and implementation of patient-specific program to render psychological aid at different stages of treatment. It will allow to shorten restorative postoperative period, to decrease the occurrence and severity of depressive conditions and the risk of somatic complications, to increase the satisfaction with care, and thus to improve the patient’s quality of life.

Objective. To analyze results of surgical correction of spinal deformity using transpedicular instrumentation in children with idiopathic scoliosis.

Material and Methods. A total of 106 patients aged 13 to 18 years with Cobb angle of 40? to 136? were operated on. Out of them 56 (52.8%) patients had Lenke I deformity, 23 (21.7%) – Lenke III, 15 (14.2%) – Lenke V, and 12 (11.3%) – Lenke VI scoliosis.

Results. The deformity correction achieved after surgery was 48 % to 100 % in patients with Lenke I, 72 % to 100 % – with Lenke III, 81 % to 100 % – with Lenke V, and 75 % to 100 % – in patients with Lenke VI scoliosis. Derotation of the apical vertebra varied between 0 % and 77 % in Lenke I scoliosis, between 10 % and 79 % in Lenke III, between 9 % and 57 % in Lenke V scoliosis. In patients with Lenke VI idiopathic scoliosis the apical vertebra derotation was 10 % to 58 % in the thoracic spine and 7 % to 50 % in the lumbar spine. Extension of the fixation region ranged from 10 to 14 vertebrae in Lenke I idiopathic scoliosis, from 7 to 12 – in Lenke III, from 5 to 9 – in Lenke V, and from 11 to 14 vertebrae – in Lenke VI idiopathic scoliosis.

Conclusion. The total transpedicular fixation along the curvature length allows performing effective correction, true derotation of apical vertebral bodies, and stable preservation of the achieved results postoperatively.

The paper presents a review of scientific literature on the problem of neurological complications in scoliosis surgery over the last 35 years. The incidence of neurological complications in different time periods is analyzed. Main types of neurological complications and risk factors are described, and key issues in this medical specialty are emphasized.

Objective. To analyze the causes of interspinous dynamic stabilization failures in patients with lumbar spine degenerative disorders.

Material and Methods. Retrospective analysis of 155 cases of interspinous dynamic stabilization using DIAM device was performed. Twenty three cases with poor results were selected for detailed analysis.

Results. It was revealed that reoperation rate for this method was 15 %, but only 8 % of failures were related to the technology itself. Main complications associated with interspinous stabilization devices included fracture and erosion of the spinous processes, destruction and migration of implants, and infection. In nine cases poor results were associated with surgeon’s mistake in planning or performing of the procedure.

Conclusion. Decision making for performing interspinous stabilization should be based on evaluation of indications and factors, which adversely affect its prognosis. These factors include elderly age of a patient, decreased bone quality, narrow and short interspinous gap, significant deformation and hypertrophy of the articular processes, significant slope of the spinous process, and essential amount of the planned bone decompression.

The paper presents a review of the literature on the surgical treatment of degenerative diseases of the lumbar spine in patients with overweight and obesity. The results of surgical treatment for lumbar disc hernias, and current problems related to surgical intervention and postoperative management of patients with this disorder are reviewed. Etiology and pathogenesis of the lumbar spine degenerative diseases in overweight and obese patients are discussed.

Objective. To analyze the efficacy of surgical treatment for spinal tuberculosis using titanium mesh.

Material and Methods. A total of 70 patients with generalized tuberculous spondylitis were operated on using anterior interbody fusion with bone autograft or titanium mesh, with or without posterior instrumentation. Dynamics of the fusion area linear characteristics was investigated.

Results. The use of biologically inert titanium mesh filled with bone tissue provides stability and supportability of the spine, is not accompanied by graft resorption, does not prevent formation of a solid bone block, and does not provoke the infection aggravation. Posterior instrumented fixation ensures the deformity correction and its stable preservation in long-term follow-up period.

Objective. To perform comparative analysis of the laws of formation and genetic regulation of chondrogenesis in healthy vertebral growth plates and iliac bone growth plates.

Material and Methods. Growth plates of vertebral bodies and iliac articular cartilage obtained from 10 mini-pigs in the period of intensive growth were investigated. The following studies were performed: morphohistochemistry, electron microscopy, immunohisochemistry, gene expression study, biochemical study of proteoglycans and GAGs, and morphometric analysis.

Results. Structural and functional organization of cells and matrix, and periodization of the processes of proliferation, differentiation, and genetic regulation (expression of aggrecan, lumican, Pax1, Sox9, HAPLN1, etc.) were similar in the examined growth plate specimens.

Conclusion. The processes of genetic regulation of chondrogenic differentiation of chondroblasts in the growth plates of vertebral bodies and the iliac bone crest are synchronous.

Cervical spine surgery in children is uncommon and performed in a few specialized centers of our country. Nevertheless, physicians of different specialties regularly face cervical spine pathology which can lead to death or severe disability of patients. The paper presents an experience of five healthcare providers in diagnosis and surgical treatment of the cervical spine pathology in children. All patients were divided into five groups: trauma, manifestation of congenital malformation, lesion associated with genetic and/or systemic disease, tumor or infectious destruction, and syndrome of acute torticollis and atlantoaxial blocking. Patients from all groups required surgical, often urgent interventions. Treatment success in these groups of patients depends mainly on overcoming the educational and organizational problems. Diagnosis and treatment are based on common principles and approaches. Ideology assumes the establishment of professional, age and technological continuity.