Objective. To assess the efficacy of endoscopic surgery for treatment of thoracolumbar spine fractures.

Material and Methods. Retrospective case history review of 88 patients operated on for acute unstable fractures of thoracic and lumbar vertebrae was performed. Radiological dynamics of kyphosis, operation time, intraoperation blood loss, and pain syndrome severity were assessed in the early postoperative period using visual analogue scale.

Results. The best results in combined interventions were achieved using anterior spinal fusion with implant insertion. The average operation time for thoracoscopic fusion exceeded that for thoracotomic approach. The blood loss was less than during open surgery. The pain syndrome intensity was less in patients who underwent thoracoscopic fusion.

Conclusion. A two-stage combined intervention provides a reliable short-segment stabilization at the injured level with minimal loss of correction due to a circumferential fixation. Endoscopic fusion ensures formation of a solid bone block by less invasive surgery. The smallest loss of correction is observed when anterior implants are used.

Objective. To analyze treatment results of patients with acute spinal injury in thoracic and lumbar spine and to determine the causes of low quality of life and disability.

Material and Methods. Results of surgical treatment of 76 patients who underwent revision surgery for sequelae and complications after spinal trauma of thoracic and lumbar localization were analyzed.

Results. The causes of insufficient results after primary surgeries in patients with acute spinal trauma were determined. Pathological conditions responsible for low quality of life in patients after spinal trauma were identified as posttraumatic myelo-, caudo-, and radiculopathy, severe spinal deformity, chronic spinal instability, pseudoarthrosis of injured vertebral bodies, posttraumatic degenerative changes in injured and adjacent vertebral segments, and posttraumatic (postoperative) osteomyelitis.

Conclusion. The pathologic condition development was caused not only and not so much by the trauma severity, as by insufficient implementation of urgent surgical interventions including spinal cord and nerve root decompression, posttraumatic deformity correction, and stabilization of the spine.

Objective. To assess the efficacy of short-segment transpedicular fixation and grafting with deproteinized bone material for injury of thoracic and lumbar vertebrae.

Material and Methods. The study included 101 patients aged 37 to 65 years with uncomplicated osteoporotic fractures of thoracic and lumbar vertebrae. Split fractures (type A2) were identified in 42.6 % of patients, burst fractures (type A3) – in 57.4 %. All patients were treated by short-segment transpedicular fixation and transpedicular osteoplasty with deproteinized bone graft (n = 82) or autograft (n = 19).

Results. Results of surgical treatment were evaluated at 6 to 40 months after operation. Good results were achieved in 79.8 % of cases, satisfactory results – in 20.2 %. The better long-term outcomes of deformity component correction at the injured spinal segment was observed in patients with deproteinized bone grafts.

Conclusion. The use of short-segment transpedicular fixation for acute osteoporotic fracture of the thoracic and lumbar vertebrae provides correction of deformity components at the injured spinal segment, and when combined with deproteinized bone grafting – maintenance of this correction and improvement of long-term results.

Objective. To assess possibilities of surgical treatment of patients with super severe (Cobb angle of 120 degrees and more) idiopathic scoliosis.

Material and Methods. Surgical treatment was performed in 15 patients (14 females, 1 male) with idiopathic scoliosis with Cobb angle exceeding 120 degrees. Patients were followed up during 2 years and more. The mean age of patients was 16.1 years. Preoperative examination included plain and functional radiography of the spine, and traction radiography. All patients before and after operation were examined with computer optical topography and answered the SRS questionnaire. A primary method of treatment included correction of spinal deformity with segmental Cotrel-Dubousset instrumentation and posterior fusion with local bone autograft.

Results. The primary curve was reduced from 129.9° to 72.5°(44.2 %). Postoperative progression was 5.9° (10.2 % of the achieved correction). Trunk imbalance was 31.2 mm before surgery, 23.2 mm just after surgery, and 15.5 mm at last follow-up. The tilt of the lowest instrumented vertebra was 26.0° before surgery, 10.7° at two weeks, and 16.7° at long-term follow-up. Thoracic kyphosis was 88.5° at initial examination, 48.1° after surgery, and 59.3° at last follow-up. The mean body height increased by 11 cm. Spirometry test showed mean respiratory volume 1357.1 ml before surgery, and 1690.0 ml at last follow-up.

Conclusion. Surgical treatment of patients with super severe idiopathic scoliosis using modern instrumentation is not only possible but also necessary since it allows for radical changing in shape of the spine and the trunk, normalization of position and functions of interior organs, and improvement of patient’s quality of life.

Objective. To study anatomical and morphometric parameters of individual vertebrae and of the spine as a whole in scoliosis and to specify their role in preoperative planning.

Material and Methods. Thirty six patients aged 8 to 16 years with grade III-IV scoliosis (in accordance with V.D. Chaklin’s classification) were operated on using posterior or anterior instrumentation. Clinical and radiological examination techniques were used. Morphometric study was performed on anatomical specimens of vertebral bodies from 12 scoliotic spines and from 5 spines without any visible pathology (control group).

Results. Comparative analysis of morphometric and radiological findings proved the efficiency of preoperative calculation of morphometric parameters using radiographs taken from patients with scoliosis. CT is the most informative study for this pathology defining more exactly the nature of changes. The choice of optimal surgical treatment depends on completeness of objective information obtained at preoperative examination.

Conclusion. Changes in morphometric parameters of vertebrae involved in the scoliotic curve are an integral part of scoliosis development process. Revealed disorders are interrelated with scoliosis grade and localization, therefore its surgical correction requires considering of all available morphometric parameters.

Objective. To perform preliminary analysis of epidemiology of congenital spine deformities in children and to determine approaches to their prognosis, diagnostics and management.

Material and Methods. Official statistics and literature data were analyzed, as well as authors’ experience in examination and treatment of more than 2,000 children aged 0 to 16 years having different congenital spinal abnormalities, out of which 40 % were operated on.

Results. The approach to treatment of children with congenital spinal abnormalities was substantiated basing on radiological signs predicting deformity development during growth. Preventative surgical intervention in young children (1 to 5 years of age) is recommended. The recommendations are suggested on establishment of spine centers for treatment of children with spinal abnormalities in Russia.

Objective. To assess the informative value of transcutaneous needle trepanobiopsy in children for diagnostics of destructive vertebral lesions restricted to a single spinal motion segment.

Material and Methods. Fifty children with destructive vertebral lesions were examined. Standard radiologic (X-ray, CT, MRI, and radioisotope scanning) and laboratory (bone marrow puncture) tests were supplemented by radiologically controlled transcutaneous trepanobiopsy with a consequent cytological analysis of aspirated material. Procedure was performed in 26 children aged 5 to 16 years.

Results. Cytological conclusions based on transcutaneous biopsy findings were obtained for 23 impression smears, while 3 smears were not informative for analysis. Comparison of cytological and histologic findings revealed their agreement in 19 out of 26 patients (73.0 %), and after exclusion of non-informative impression smears – in 19 out of 23 patients (82.6 %).

Conclusion. Transcutaneous needle trepanobiopsy of vertebral bodies is a less invasive and highly informative technique increasing the possibility of preoperative diagnostics of circumscribed destructive vertebral lesions in children up to the level close to 80.0 %.

Objective. To assess the efficacy of regional lymphotropic antibacterial therapy and anterior stabilization of the involved segment in the treatment of patients with spinal osteomyelitis.

Material and Methods. Regional lymphotropic therapy and surgical intervention including resection of the osteomyelitis locus, replacement of the cavity with autograft, and anterior stabilization of the spine were performed in 12 patients. Dynamics of the process was controlled radiographically.

Results. Regional lymphotropic antibacterial therapy proved to facilitate decrease in erythrocyte sedimentation rate, leucocytosis, and pain syndrome. Spinal fixation provided conditions for the graft implantation, and allowed early loading. Inflammatory process was arrested and spinal fusion was achieved in all patients.

Conclusion. Suggested multimodal treatment of patients with hematogenous osteomyelitis provides orthopaedic correction of kyphotic deformity if present, and rigid fixation of the operated segment, creates favorable conditions for fusion and remodeling of autografts without resorption, and prevents possible inflammatory complications in postoperative period.

Objective. To analyze disorders in spinal cord function in patients with intramedullary tumors (IMT) and to ascertain informative value of intraoperative monitoring of somatosensory evoked potentials (SSEPs) for prevention of neurological complications during tumor removal using infrared laser irradiation.

Material and Methods. SSEPs were recorded from upper and/or lower extremity nerve stimulation in 38 patients with IMT of different localization before surgery, during operation, at 14 to 28 days after surgery, and at long-term follow-up period. The nature and the rate of spinal cord conduction abnormality depending on the tumor localization and volume were analyzed.

Results. Postoperative examination showed a positive dynamics of SSEP parameters in 14.0 % of patients, and the absence of significant changes – in 65.6 %. It was found that SSEP responses can reflect short-term effects of surgical manipulations before a direct tumor removal, and of arterial pressure. Long-lasting anesthesia progressively increases SSEP delay time. These factors are taken into account in determining a threshold for functional permissibility of intervention at the stage of tumor removal and at the final stage when laser radiation is applied. Changes were assessed by comparison with parameters obtained just before a given stage.

Conclusion. Monitoring of SSEPs at main stages of surgery allowed avoiding additional traumatization of the spinal cord, performing total removal of the tumor, preventing its continuous growth, and achieving of good long-term clinical results of the treatment.

Objective. To study a clinical symptom complex as a risk factor associated with injuries at T12-L5 levels due to the trauma or vertebral surgery and determined as a syndrome of intestinal insufficiency.

Material and Methods. The clinical study included 462 patients in whom reduction of the syndrome of intestinal insufficiency was performed in accordance with suggested protocol (study group) and 462 patients who received standard treatment (control group). Anesthetic management (n = 844) included standard multicomponent total intravenous anesthesia and artificial lung ventilation based on propofol or midozalam, fentanil and myoplegia with atracurium. Combined general anesthesia followed by continued epidural analgesia was used in 80 patients. Patients of both groups underwent phonoenterographic, chronographic, clinical biochemical, and bacteriological studies in the perioperative period.

Results. Syndrome of intestinal insufficiency is a natural manifestation and is registered in 88.4 % patients after trauma. Suggested protocol for its prevention permits to reduce preoperative bed-days by 5.0 ± 0.9 days and to decrease the frequency of grade III intestinal insufficiency syndrome by 2.6 % and of grade II – by 12.4 %.

Conclusion. The suggested treatment algorithm makes it possible to prevent and decrease the rate and length of intestinal insufficiency syndrome. Developed device (phonoenterograph) and a proposed criterion for quantitative and qualitative evaluation of the syndrome intensity allow to assess the efficacy of treatment and preventive program.