Objective. To estimate the efficacy of decompressive and decompressive-stabilizing operations for spine and spinal cord injury and degenerative dystrophic spine disease performed using rigid instrumented fixation or dynamic NiTi fixators.

Material and Methods. Decompressive and decompressive-stabilizing operations were performed in 212 patients with spinal injury and 256 patients with disc degeneration complicated by spinal cord and root compression. Spine stabilization with transpedicular systems was performed in 98 cases, and with dynamic fixators of NiTi with effects of memory, hyperelasticity, and self-regulated compression – in 89 cases.

Results. Instability of transpedicular fixation was observed in 6 (5.9 %) cases. The fracture of dynamic fixator in transition area between horizontal and loop parts occurred in 2 (2.4 %) patients in 7 years after surgery due to high physical load. The study of long-term results of dynamical fixator application for spine degeneration has not revealed radiological signs of overload and degeneration progression in the adjacent segments.

Conclusion. Results of operations performed with different fixation devices are comparable. Dynamical spinal fixation has certain advantages of lessening the intervention duration and decreasing in incidence of long-term complications.

Objective. To analyze diagnosis and treatment results of 38 patients with concomitant injuries to the spine and hindfoot.

Material and Methods. Thirty eight patients with concomitant injury to the spine and hindfoot were treated. One group of patients received surgical treatment of injured segments, and another was treated conservatively. All patients have undergone X-ray examination of the injured foot in two planes, estimation of calcaneostragaloid angle and Boehler angle. The spine was studied for the presence of muscle strain and kyphosis. Spondylography in two planes was performed for the assessment of kyphotic deformity, compression degree, and fracture stability.

Results. Complete correction of kyphosis was achieved in 86.0% of the second group patients; and in 80.0 % of the first group patients. The mean value of Boehler angle was 21° ± 3° in surgery group and 4° ± 6° in conservative group. In the group of patients with conservatively treated calcaneus fractures the events of posttraumatic arthritis were detected in 9 (64.2%) cases, in the group of operated patients they were detected in 2 (67.0%) cases.

Conclusion. Concomitant spine and hindfoot injuries are in most cases the result of catatrauma. The most efficient and reasonable technique of hindfoot fracture treatment is open reduction and fusion with plate and screw instrumentation with utmost accurate reconstruction of joint surfaces.

Objective. To assess the efficacy of surgical treatment of kyphosis of various etiology, and to develop a differential etiology-based approach to the choice of surgical correction technique.

Material and Methods. Seventy four patients with extended kyphotic deformities were operated on, including 13 patients with posttraumatic kyphosis; 13 – with congenital kyphosis and kyphoscoliosis with a prevalence of kyphotic component; 7 – with Scheuermann’s kyphosis; 12 – with dysplastic kyphoscoliosis; 11 – with neurogenic kyphosis and kyphoscoliosis; and 18 – with iatrogenic kyphotic deformities. Various types of corrective vertebrectomy were performed in 68 patients.

Results. Average Cobb angle in patients with extended kyphosis decreased from 65.78° ± 30.70° to 40.00° ± 19.93°. The application of corrective vertebrectomy in 61 patients allowed for rise in efficacy of intraoperative deformity correction by 32.0 ± 13.5 %. Differential approach to the choice of treatment technique resulted in good outcome in 66 patients (83.8 %), and in satisfactory - in 10 patients (13.5 %).

Conclusion. Differential approach to surgical treatment of extended kyphotic deformities in thoracic and lumbar spine increases the efficacy of surgical correction, decreases the risk of neurologic disorder development and progression, and restores the spine support function.

Objective. To summarize the experience of surgical treatment of patients with secondary spinal deformities.

Materials and Methods. Forty one patients with kyphoscoliotic postlamynectomy and iatrogenic III–IV grade spinal deformities were treated. Secondary deformities developed after spinal cord tumor removal in 28 patients, and after surgical intervention for spinal injuries and tumors – in other patients. After the estimation of deformity mobility and all examinations the surgery planning was performed including selection of surgical approach and definition of correction level.

Results. Average magnitude of scoliotic deformity at admission was 103 degrees, that of kyphotic deformity – 87 degrees. Correction after surgical treatment was 46 % for scoliotic deformity, and 67 % – for kyphotic one.

Conclusion. The use of combined approaches and modern instrumentation in conjunction with comprehensive examination of patient and thorough preoperative planning allows to recieve good treatment results.

Objective. The choice of optimal surgical approach to congenital spinal deformities involving abnormally developed vertebrae outside the apical region.

Material and Methods. Twelve patients with progressive scoliotic deformities and neutral abnormalities located at the least two segments cranial or caudal to the apical vertebra or intervertebral disc. The mean follow-up period was 2.1 years.

Results. In the first group (n = 7) of patients with inclusion of all abnormal vertebrae in the fusion area the mean major curve decreased from 73.8° to 17.6° immediately after surgery. In 2 years this magnitude increased by 2.5° and achieved 20.1°. A mean magnitude of a secondary curve decreased from 44.2° to 22.6° immediately after surgery, and in 2 years remains practically unchanged – 21.8°. In the second group (n = 5) of patients the abnormal vertebrae were left beyond the fusion area. Immediately after surgery a primary curve decreased from 76.2° to 23.4° and in 2 years increased only by 1.2°. Different dynamics was observed in the secondary curve: initial correction from 45.2° to 26.2°, and significant augmentation of deformity during postoperative period up to 36.2°.

Conclusion. Congenital vertebra abnormalities located outside the apical area of progressive scoliotic deformities should not be considered as neutral, since not being included in the fusion they cause severe progression of the secondary curve, i.e. they are active. Scoliotic deformities, similar in appearance to idiopathic ones but including abnormal vertebrae outside the apical region should be considered as congenital.

Objective. To summarize our own experience in the treatment of degenerative spondylolisthesis and to explain the choice of surgical approach depending on vertebral body displacement and clinical neurological presentation.

Material and Methods. Results of surgical treatment in 42 patients operated on for grade I–II degenerative lumbar spondylolisthesis were analyzed. Discectomy, reduction of the displaced vertebra, and intercorporal fusion with titanium cages with bone autograft were performed through anterior extraperitoneal approach. Treatment results were assessed during the follow-up period of 1–3 years based on clinical and radiological data.

Results. Thirty six (86 %) patients with grade I-II degenerative spondylolisthesis had good, and six (14 %) patients – satisfactory clinical results of treatment. Interbody fusion was formed in all patients without any loss of the achieved segmental correction.

Conclusion. Anterior intercorporal fixation with titanium cage is a pathogenetically substantiated and effective in the treatment of grade I–II degenerative lumbar spondylolisthesis.

Objective. To analyze present-day variants of surgical treatment of L5 spondylolisthesis in children.

Material and Methods. The outcome analysis of surgery for L5 spondylolisthesis in 26 patients aged 10 to 17 years was performed. Two patients had Grade I spondylolisthesis, 7 patients – Grade II, 6 – Grade III, 7 – Grade IV, and 4 patients had spondyloptosis. The paper presents variants of surgical treatment for spondylolisthesis in children depending on a degree of L5 displacement, clinical manifestation of disease, and neurological disorders. The posterior approach was used in all patients. The surgery restored spinal canal anatomy, physiological relations within impaired segment, and trunk balance, reducted clinical manifestations, and eliminated neurological disorders.

Results. Complete reduction of L5 vertebra was achieved in patients with Grade I–III spondylolisthesis, reduction to Grade II–III - in patients with Grade IV and spondyloptosis. Pain and radicular syndromes regressed in 2–3 days and 2–3 weeks after surgery, respectively. Patients with lower limb monoparesis and contractures showed a regression of neurological deficit and restoration of phisiological range of motions within 1–1.5 months after surgery.

Conclusion. The choice of treatment technique for L5 spondylolisthesis depends on vertebra displacement degree, occurrence of segmental instability, intensity of clinical manifestations and neurological symptoms.

Objective. To study the chronic intestinal insufficiency in patients with degenerative spine and large joint diseases as a possible independent risk factor in a perioperative period.

Material and Methods. The study included 200 case histories selected by double-blind sampling out of 823 histories of patients with degenerative diseases of the spine and hip who received non-steroid anti-inflammatory drugs. All patients underwent highly traumatic surgical procedures, and clinical analysis of gastrointestinal tract, fiberoptic gastroduodenoscopy, fibercolonoscopy, phonoenterography, chronography, and dysbiosis test were performed to all of them.

Results. The developed scale of chronic intestinal insufficiency signs represents a significant prognostic criterion for treatment selection in patients with degenerative spine and large joint diseases. It suggests that 74 % of patients have chronic intestinal insufficiency as a baseline clinically significant pathological condition.

Conclusion. Chronic intestinal insufficiency is an essential risk factor in patients with degenerative diseases of the spine and large joints in perioperative period.

Objective. To study the patterns of clinical manifestations of bronchopulmonary complications in acute and early periods of the spine and spinal cord injury.

Material and Methods. Treatment results of 30 patients with closed complicated spine and spinal cord injuries in acute and early period were analyzed. Clinical manifestations of bronchopulmonary complications were investigated. The study included clinical, neurologic, radiological, electrophysiological, endoscopic, and bacteriological methods.

Results. Bronchopulmonary complications developed in 24 (80%) patients. The evident signs of respiratory insufficiency in patients typically occur at third day irrespective of wether they underwent surgical intervention or not. Respiratory insufficiency is caused by high grade neurological deficit. The treatment of patients with bronchopulmonary complications developed in early period of cervical spine and spinal cord injury in nearly 2/3 of cases is associated with a change of microflora what requires a timely correction of antibacterial therapy.

Conclusion. The timely sanitation bronchoscopy permits clinically significant reducing of indications for tracheotomy and artificial pulmonary ventilation.

Objective. To analyze the roll-out of regional specialty care system for children with orthopaedic pathology and quality management system suitable for screening and diagnostic programs.

Material and Methods. Diagnostic audit of the implementation of screening and diagnostic programs and medical care using procedures prescribed by ISO 9001 requirements was performed in Pediatric Orthopaedic Centre (POC).

Results. The adoption of quality management system into the practice of regional Pediatric Orthopaedic Centre (POC) allowed to optimize screening programs and stages of medical care delivering and make them valid and structured.

Conclusion. The extension of quality management system principles on the direct care process enables the obtaining of effective results of specialty medical care and warranting the quality of medical care delivered to customers.

Objective. Translation and cross-cultural adaptation of the Russian Oswestry Disability Index (ODI) version 2.1a.

Material and Methods. To validate the translation of the original version of the ODI, the following process was performed: forward and backward translations, expert committee review of the text, creation of a preliminary version, pre-test of the preliminary version, formation of a final version, study of reliability and validity, and submission of the final version and study results to the author.

Results. Adapted Russian version of the ODI is valid. It is recommended to be used in clinical practice and research to measure the level of disability in patients with low back pain.

Conclusion. ODI is one of two commonly used instruments recommended by international scientific community for measurement of disability in patients with low back pain. The study was approved by Prof. J. Fairbank, the author of the ODI.