Objective. To appreciate peculiarities and efficacy of surgical treatment of children with multiple unstable uncomplicated fractures of thoracic and lumbar vertebrae.

Material and Methods. Thirty-nine patients aged of 10 to 17 years with unstable uncomplicated spinal injuries were operated on, including 12 patients with fractures in thoracic spine, and 27 — in lumbar. Two fractured vertebrae were adjacent in 31 cases, and in 8 cases, one or more motion segments divided them. Twenty-two patients were admitted to the hospital in the nearest hours or days after the trauma, 6 — in 1—1.5 months, and 11 patients — after partial or complete course of conservative treatment during 2—24 months.

Results. Long-term follow-up period varied from 9 months to 9 years. Vertebral body height restoration, fracture consolidation, and posterior fusion formation in patients operated on immediately or within first months after trauma were achieved in 1—1.5 years. Patients with late surgery presented anterior and posterior fusion in 1.5—2 years after surgery.

Conclusion. The choice of treatment for multiple and multilevel vertebral fractures in children should be determined by the nature and term after the injury onset considering the number of injured vertebrae, their localization, and injury severity.

Objective. To develop a surgical scheme for management of children with cervical spine abnormalities.

Material and Methods. Case histories of 62 children with cervical abnormalities were analyzed. Out of them 20 patients (2 to 16 years old) underwent various techniques of surgical treatment: halo traction, anterior and posterior instrumentation and fusion, decompression of the brain, spinal cord and cervical arteries, revision of the spinal canal, neurolysis, and meningolysis.

Results. According to the basic syndrome all cervical abnormalities in children were divided into four groups, which included neutral, unstable, compressive, and ischemic abnormalities, and their combinations. Appropriate scheme of surgical treatment was developed basing on this division.

Conclusion. The formation of groups in accordance with a basic syndrome makes it possible to work out an individual algorithm of examination and treatment thus preventing development of neurological complications.

Review of modern literature on the problem of thoracic insufficiency syndrome in small children with severe congenital scoliosis associated with abnormal development of vertebrae and ribs is presented. Pathogenesis and clinical picture of this condition are described, and examination methods allowing to objectify thorax and spine status in a child in the process of natural development of pathology and its treatment are considered.

Objective. To analyze results of new method of treatment for progressive infantile and juvenile scoliosis of different etiology using VEPTR instrumentation. Material and Methods. Twenty two patients at the age of 1.5 to 8.7 years were operated on, most of them for idiopathic and congenital scoliosis. Mean value of primary scoliotic curve was 66.3°. Besides routine investigations all patients underwent MRI and MSCT of the spine, and detailed examination by neurologist, pediatrician, and specialized doctors. Arrangement of endocorrector depended on etiology and nature of the spine deformity. Results. The first operation resulted in reduction of a primary scoliotic curve angle to 47.9°. Correction was 18.4° (27.8 %). Before the first expansion in 12 patients a mean deformity angle was 65.5°, and after expansion — 54.0°. Only two patients underwent more than two expansions. Complications were noted in two cases. Despite a large quantity of co-morbidities, all patients showed tolerance to performed intervention. Conclusion. Principal novelty of the method of treatment for progressive infantile and juvenile scoliosis stipulates accumulation of experience and revelation of advantages and drawbacks of the VEPTR instrumentation.

Objective. To study topographical features of the trunk posture and spinal deformities in patients with unilateral shortening of the lower limb.

Material and Methods. Seventy-eight patients at the age of 5 to 22 years with unilateral shortening of the lower limb were examined: Group 1 included 59 patients with anatomical shortening of the lower limb of 2.0 to 17.0 cm; Group 2 included 19 patients with functional shortening of the lower limb of 1.0 to 1.5 cm. Efficacy of the spinal correction was assessed by computer optical topography.

Results. Posture disorders and spine deformities observed in lower limb length discrepancy are mainly the manifestations of the locomotor system adaptation to biomechanically off-normal conditions for function. Adaptive responses of the locomotor system such as posture disorders, postural asymmetries, and spine deformities were preserved in 39 % of cases. Depending on the side of shortening and the amount of limb length discrepancy the spinal adaptive deformities have different rates of resistance to the performed corrective manipulations: conservative therapy for deformity, surgical elimination of lower limb length discrepancy, and compensation for a short limb with supports.

Conclusion. Adaptive deformities of the spine in patients with small discrepancy between the length of lower limbs turned out to be more resistant to correction, than those in patients with large anatomical shortening of the lower limb.

Objective. To study immediate results of the treatment of discogenic reflex and compression pain syndromes from an angle of differential application of minimally invasive technologies.

Material and Methods. Complex examination of 160 patients with degenerative disease of the lumbar spine and pain syndromes was performed. Examination included plain and functional spondylography, positive myelography, CT, and MRI. Eighty-three patients underwent minimally invasive interventions: disc puncture (by radiofrequency, laser, and cold plasma techniques) was applied in 52 patients, and open endoscopic excision of disc hernia — in 31.

Results. Favorable outcomes after puncture treatment were achieved in 42 (80.8 %) patients. Disc puncture application resulted in 10‑fold reduction of hospital stay. Out of 31 patients who underwent Destandau discectomy 29 (93.6 %) patients had favorable results. Standard conservative treatment was effective only in 32 (68.0 %) patients from the control group.

Conclusion. Differentiated use of minimally invasive techniques and careful selection of patients for these operations allowed achieving favorable results in most patients.

Objective. To compare efficacy of coblation and chemical disc denervation in the treatment of patients with pain syndromes of spine degeneration.

Material and Methods. Randomized prospective study was performed to compare treatment results in 58 patients with reflex pain syndromes in the lumbar spine. The study group included 36 patients with reflex pain syndromes of the lumbar spine degenerative disease treated by coblation technique. The control group included 22 patients with similar manifestations of the lumbar degeneration treated by denervation of intervertebral disc with alcohol-novocaine solution. Patients underwent clinical neurological examination, MRI study, and X-ray of the lumbar spine. Pain syndrome was assessed using visual analogue scale. Indication for puncture treatment was a persistent pain syndrome unresponsive to multimodal conservative treatment for 1.5—2 months.

Results. Fifty six patients were discharged the day after surgery. Out of them 37 patients had excellent results, 15 — significant improvement, and 4 — satisfactory results.

Conclusion. Coblation and chemical disc denervation are effective and safe techniques to treat patients with pain syndromes of spinal degenerative disease which allow achievement of clinical results with minimal traumatizing of surrounding tissues.

Results of surgical treatment of three patients with multilevel infectious defects of the spine including those caused by previously performed laminectomy. The study showed that significant in extent defects of the anterior and posterior spinal columns can be replaced by non-biological materials, which provide both restoration of supporting and stabilizing functions, deformity correction, and immediate spine stabilization even in cases when local infectious process cannot be radically eliminated due to its expanse or specificity.

Objective. To investigate anatomical anthropometric parameters of the spine valid for transpedicular fixation (TPF) in patients with active tuberculous spondylitis and its late sequelae.

Material and Methods. The vertebral parameters from T1 to S1 important for TPF (screw paths length, pedicle widths and lengths, and pedicle angle) were determined using computer tomography in 18 patients from the control group, 18 patients with active tuberculous spondylitis, and 15 patients with post-tuberculous kyphosis resulted from the active process during the childhood.

Results. In patients with spondylitis consequences, the screw path length and the pedicle lengths decreased, and the pedicle widths and the pedicle angle increased at the apex of kyphosis. Opposite changes were observed in the areas adjacent to gibbus. No significant differences in the studied parameters were found in patients with active tuberculous spondylitis as compared to the norm.

Conclusion. In adult patients with sequelae of early age tuberculous spondylitis complicated by kyphotic deformity, screw sizes and their insertion angles should be chosen with consideration for changes in anatomical parameters of the vertebrae. Transpedicular fixation in thoracic and lumbar spine of patients with active spinal tuberculosis can be performed using standard instrumentation.

Objective. To analyze outcomes in patients with bronchopulmonary complications in acute and early periods of the spine and spinal cord injury whose treatment was based on optimal approach to antibacterial therapy.

Material and Methods. Sixty patients (54 males and 6 females) with sequelae of complicated cervical spine and spinal cord injury were examined. Mean age of patients was 24.0 ± 7.5 years. Bronchopulmonary complications occurred in 48 (80.0 %) patients. Endobronchitis was complicated by pneumonia in 34 (70.1 %) cases. Examination included clinical and neurological, radiological, endoscopic, bacteriological and cytological methods.

Results. Radiological and endoscopic examination detected diffuse bilateral grade I—III endobronchitis in 18 patients from groups I and II. Bronchopulmonary complications in patients from the group III included tracheitis (4 cases) and grade III endobronchitis (20 cases). Patients from group IV had aspiration pneumonia. Variants of antibacterial therapy of infectious complications were offered accounting for causative agents, severity grade, and specifics of the injury.

Conclusion. The application of early and rational antibacterial therapy of bronchopulmonary complications allows pathological process being stopped at the level of multiple organ dysfunction, to prevent multiple organ failure, and to reduce the intensive care unit length of stay.