Objective. To analyze results of compensating spine fusion in children aged 1 to 3 years with vertebral segmentation disorders of the thoracic spine.

Materials and Methods. Forty children with asymmetric (lateral) segmentation disorder in the thoracic spine underwent anterior-lateral fusion on the side opposite to a vertebral block. In 3 children the fusion was supplemented with rib synostosis on the side opposite to vertebral block. Dynamics of the primary curve, thoracic spine sagittal alignment, deformity progression rate before and after surgery, and changes in left and right hemithorax volumes, SAL index and thorax asymmetry index were followed up.

Results. Mean rates of deformity progression correlate with the extension of congenital block and the amount of segments included in compensating spine fusion. Progression rate decreased by more than 50 % in 10 children having the number of surgically fused segments exceeding the number of congenitally unsegmented vertebrae. In 8 children with equal number of congenitally and artificially blocked segments the rate of deformity progression decreased by 44 %. Compensating spondylosyndesis did not influence the thorax deformity.

Conclusion. The rate of spinal deformity progression after compensating spine fusion depends on the length of unsegmented rod and the number of artificially blocked segments on the opposite side.

Objective. To access the efficacy of surgical treatment of scoliosis using anterior approach.

Material and Methods. Twenty four patients aged 9–18 years (22 females, 2 males) were operated on. Twelve patients had thoracic deformity, and 12 – thoracolumbar and lumbar. Correction was performed through anterior approach using thoracotomy and thoracophrenolumbotomy with single and double rod instrumentation.

Results. Mean correction of thoracic deformity was 84 %, mean number of fixed vertebrae was 7. Mean correction of lumbar and thoracolumbar deformity was 74 %, mean number of fixed vertebrae – 6. In all cases a good sagittal alignment of the spine was achieved.

Conclusion. Anterior correction is indicated for Lenke type I and V scoliotic deformity. Anterior instrumentation is feasible for thoracic deformity below 75°, and for thoracolumbar and lumbar – below 85°.

Objective. Basing on authors’ experience and literature review to analyze the concepts of surgical treatment of scoliotic deformities depending on their type, severity, and localization.

Material and Methods. Three hundred and sixty six patients with scoliosis were operated on for deformity correction with dorsal CDI and anterior Hopf and Antares instrumentations. Surgical technique was chosen depending on scoliosis type, deformity severity, patient’s age, and other parameters, and with the account for continuous analysis of immediate and long-term results. Thoracic scoliosis in 299 patients was treated by oneor two-stage surgery, halo-pelvic traction, and anterior release. Sixty seven patients with lumbar and thoracolumbar scoliosis underwent anterior and posterior correction with CD instrumentation.

Results. Surgical treatment of severe scoliosis by single-step multilevel discectomy and posterior correction provided a mean correction of the total angle of 40-50°. Anterior release of the spine added 40% to the achieved correction. Deformity correction in patients with lumbar and thoracolumbar scoliosis was 40 % to 90 %. Somewhat better correction of total and central angles was observed after application of anterior instrumentation.

Conclusion. Differentiated approach to surgical treatment of scoliosis depending on deformity type, mobility, and severity, as well as application of anterior release, halo-pelvic traction, and modern instrumentation allows achievement of optimal correction of deformity with good radiological and clinical outcome.

Objective. To assess a subjective component of the quality of life in adolescents with severe spinal deformities of different genesis for improving the efficacy of rehabilitation processes.

Material and Methods. Eighty adolescents aged 12 to 17 years with safe opportunities for intellectual development were examined. Thirty patients had idiopathic, and 20 – dysplastic scoliosis. The control group included 30 healthy adolescents. The intellectual level was determined in scoliotic patients with Slosson’s test. A standard interview and SF-36 questionnaire were used.

Results. Health status and pain syndrome significantly decrease physical activity of patients with severe deformities, reduce their vital activity, thus forming negative notions of perspective of treatment and future recovery. Patient’s satisfaction with their health status and physical activity, dominant emotional status which precludes solution of everyday problems, all these render a decisive influence on patient satisfaction with different aspects of their vital activity, and determine the quality of life as a whole.

Conclusion. Adolescents with severe spinal deformities have lower level of life quality when compared with healthy age-matched children. Efficacy of medical rehabilitation of orthopedic patients could significantly influence both physical and psychological health components, and determine objective and subjective aspects of life quality of scoliotic adolescents.

Objective. To assess surgical treatment of children with congenital lumbar spine deformities associated with congenital developmental disorders of vertebrae and to select optimal approach to the treatment of such patients.

Material and Methods. We have operated 16 patients aged from one year and 11 months to six years and three months with congenital scoliosis and kyphoscoliosis associated with developmental disorders of the lumbar vertebrae. Orthopedic status and the state of deformed spine before and after surgical intervention were evaluated based on data of clinical, neurological, and radiological examinations. Degree of immediate postoperative correction of congenital deformity and long-term outcomes after metal device removal were assessed.

Results. Surgical treatment of patients younger than 3 years of age with isolated hemivertebra in the lumbar spine resulted in up to 86.0 % correction of scoliotic deformity and up to 77.5 % that of kyphotic deformity. The further child’s growth is associated with a tendency toward spontaneous correction of residual deformity. In children of four to seven years old the mean correction of scoliosis reached 80.0 %, and that of kyphosis – 87.5 %. The loss of correction was not observed during a short-time follow-up period.

Conclusion. The optimal age for surgical treatment of congenital deformity in developmental vertebral disorders is the age below 3 years. Deformity correction at this age can provide a maximum approach of frontal and sagittal contours to their physiological norms.

Objective. To study the laws of hemodynamic changes in patients undergoing staged surgical correction of severe scoliosis ander with different variants of anesthetic protection.

Material and Methods. Non-invasive monitoring of basic parameters of central and peripheral hemodynamics by impedance cardiography was performed in 59 patients with severe scoliosis undergoing surgery under anesthetic protection with different hypnotic components of general anesthesia.

Results. It was defined that main factors determining the patient’s hemodynamic status during surgical scoliosis correction were the following: intraoperative position, duration of exposure, and intensity of cardiodepressive and vasodilative effects of drugs used for anesthetic protection. The study has shown that inhalation anesthesia with sevoran in comparison with total intravenous anesthesia with propofol is associated with more adverse hydration status of the lungs, which increases the risk of respiratory and pulmonary-cardiac insufficiency.

Conclusion. Non-invasive impedance cardiography for the real time assessing the hemodynamic state of patients may appear to be crucial in selection of anesthesia components.