Objective. To develop an algorithm of treatment of concomitant spine and spinal cord injury.

Material and Methods. The treatment outcomes in 57 injured persons with concomitant spine and spinal cord injury were analyzed. Patients were distributed into 2 groups according to the injury severity. The assessment of treatment results was based on the rate of mortality and the degree of neurological deficit regression.

Results. Algorithms for medical care to patients with light concomitant spine and spinal cord injury (R-AIS/NISS score ≤≤15) and to patients with polytrauma and spine and spinal cord injury (R-AIS/NISS score ≥16 points) were developed. The system of care should include a dynamic control of injuries.

Conclusion. The realization of developed algorithms provides a decrease in mortality rate and improvement in neurological outcomes of treatment.

Objective. The analysis of main clinical and statistical characteristics of spine and spinal cord injury and of organizational system of casualty medical care.

Material and Methods. Cohort retrospective studies of archive data of medical and prophylactic institutions were performed in Arkhangelsk city and its region. Medical histories, calling book of territorial centre for emergency medicine, forensic medical examination protocols were analyzed. One hundred and twenty cases of spine and spinal cord injury were assessed.

Results. Incidence rate of spine and spinal cord injury amounts 0.48 cases per 10 000 people with the majority being in men, and in the age group of 20 to 39 years. Complete spinal cord injury occurred in 40.2 % of cases and incomplete – in 59.8 %, according to the ASIA/IMSOP scale. Mortality caused by spine and spinal cord injury was 0.07 and 0.09 cases per 10 000 people in 2007 and 2008 respectively.

Conclusion. The study revealed detailed clinical and statistical characteristics of spine and spinal cord injury in the region, exposed gaps in medical care organization and allowed accounting of bed quantity required to manage injured persons.

Objective. The analysis of structure and frequency of unsatisfactory outcomes occurring after transpedicular spinal fusion.

Material and Methods. The results of spinal fusion with internal transpedicular constructions in 96 patients with uncomplicated fractures in the lower thoracic and lumbar spine were assessed.

Results. The following unsatisfactory outcomes were revealed within 1 to 5 years after surgery: breakage of rods – 9 cases, surface soft tissue inflammation – 3, screw misplacement outside anatomical landmarks – 2, kyphotic deformity, changing spinal axis in sagittal plane – 2, preservation of preoperative vertebral wedging after removal of the construction – 7 cases.

Сonclusion. Complex systemic prevention of unsatisfactory outcomes and optimization of preoperative stage allow improving treatment results in patients with uncomplicated fractures of lower thoracic and lumbar vertebra.

Objective. To assess surgical treatment results in children with thoracic idiopathic scoliosis.

Material and Methods. Surgical treatment was performed in 263 patients aged from 13 to 18 years and having spinal deformity of 50 to 152° Cobb angle. Three tactical options using dorsal Cotrel – Dubousset instrumentation were applied in surgical correction.

Results. The achieved surgical correction of idiopathic thoracic scoliosis varied from 46.2 to 95,0 %. Lost of correction within a follow-up period of 6-month to 10-year was 5.1 to 10.2 %.

Conclusion. Surgical approach to the treatment of idiopathic thoracic scoliosis should be individual and depend on patient’s age, growth potential, deformity severity, and curve mobility.

Objective. To analyze neurological status of patients, radiological presentation of disease, and an incidence rate of diasematomyelia’s association with skin and musculoskeletal disorders.

Material and Methods. The study included 20 patients with diastematomyelia aged from 1 to 18 years. Diagnosis was based on a case history, clinical examinations, spine radiography in coronal and sagittal planes, CT (20 cases), CT myelography (1 case), MRI (20 cases), and neurophysiological study (electroneuromyography of lower extremities). Septum resection was indicated in 17 children.

Results. All patients had cutaneous changes along the midline of the back such as hypertrichosis, hemangiomas, and dermal sinuses. Neurological symptoms were noted in 17 patients: lower paraparesis in 11, urinary incontinence in 2, monoparesis in 4, and pyramidal insufficiency in 2 patients. Three patients did not show any neurological deficit. Orthopedic examination revealed spinal deformities of various degrees of severity.

Conclusion. Resection of the septum in patients with diastematomyelia should be the first stage of surgical scoliosis correction and precede orthopedic correction of low extremity deformity. Patients having neither neurological deficit no orthopedic deterioration should be followed up, and in case of pathological symptoms augmenting or elecroneuromiography changing a question of surgical treatment should be regarded.

Objective. To analyze clinical variants of lumbar spondylolisthesis and differentiated choice of anterior stabilization and decompression-stabilization surgeries.

Material and Methods. Anterior stabilization and decompression- stabilization surgeries were performed in 142 patients with lumbar spondylolisthesis. In 44 patients the clinical neurological and instrumental examinations were supplemented by preoperative diagnostic puncture to reproduce reflex pain syndromes and their elimination.

Results. Clinical presentation of lumbar spondylolisthesis includes not only segmentary instability, but also reflex pain and/or compression syndromes. The method of anterior decompression of spinal nerve roots compressed by concomitant disc hernias or by posterior-upper edge of subjacent vertebral body was developed and successfully used.

Conclusion. Anterolateral retroperitoneal approach provides optimum conditions not only for vertebra reposition and solid interbody fusion with porous TiNi implant, but also for decompression of a compressed nerve root. The choice of surgical approach should depend on clinical variant of the disease.

Objective. To develop the programs of autologous blood deposition to compensate blood loss in surgical correction of spinal deformity.

Material and Methods. The study included 145 patients with spinal deformities who underwent one- and two-stage selective surgical interventions. In the study group (n = 100) autologous blood components were preoperatively deposited for intra- and postoperative blood loss compensation; in the control group (n = 45) prior deposition was not performed.

Results. It was found that, taking into account the terms of autologous blood shelf life and efficacy, a prior deposition of 20 % of total blood volume (TBV) providing compensation of blood loss up to 40–45 % of TBV is optimal for one-stage surgical intervention, and deposition of 30 % of TBV allowing loss compensation of 50–55 % of TBV is enough for twostage surgery.

Conclusion. Autologous blood deposition is an effective method for blood loss compensation. Blood deposition volume and techniques are determined by an expected blood loss associated with specific surgical intervention.

Objective. To study the influence which postural sway of a scoliosis patient holding natural pose without fixation exerts on the accuracy of lateral asymmetry angle estimation and other topographic parameters.

Material and Methods. The study included six patients with x-ray confirmed grade I–III structural scoliosis. Patients were examined in a natural pose with labeling using TODP system (Optical Topograph for Spinal Deformities) by means of tenshot series with 2 sec interval.

Results. Mean values and standard deviations of main topographic parameters were calculated for each patient. It was found that trunk movements have a random and aperiodic nature and are individual for each patient. Dispersion of basic topographic parameters in patients was greater than the instrumental error of TODP system and absolutely depended on stability of patient’s pose. However, even for patients with unstable pose, maximal standard deviation of lateral asymmetry angle for main scoliotic curve was 1.8°, which is quite acceptable for clinic practice.

Conclusion. Computer optical topography provides an acceptable accuracy of lateral asymmetry angle estimation in patients with structural scoliosis examined in a natural pose without fixation in case of correct labeling of the anatomical landmarks performed.

Objective. To analyze the most significant criteria for early detection of radiculopathy in patients with inflammatory diseases of the spine basing on the analysis of F-wave parameters obtained by stimulation electroneuromyography of lower extremities.

Material and Methods. Primary F-wave parameters were studied in two groups of patients with inflammatory diseases of the spine: with diagnosed radiculopathy (n = 12), and without radiculopathy (n = 14).

Results. The most diagnostically significant parameters of electroneuromyography were F-wave amplitude, minimal velocity, and tacheodispersion. They allow for detection of neurological pathology at early stages of its development when marked clinical symptoms of radiculopathy are not manifested.

Conclusion. Diagnostically significant parameters of the wave may be used in preclinical diagnosis of radiculopathy in patients with inflammatory diseases of the spine both for the assessment of initial neurological status and indications for surgical treatment, and for estimation of postoperative dynamics.