Objective. To analyze outcomes of posterior cervical fusion of different length and localization using fixing rod constructions for surgical treatment of patients with cervical spine injuries and diseases.

Material and Methods. The study included 15 patients at the age of 12 to 68 years. Cervical spine injuries were diagnosed in 66.66 %, degenerative diseases — in 20.00 %, tumors — in 6.67 %, and congenital deformities of the cervical spine — in 6.67% of patients. All patients underwent posterior cervical fusion of different length.

Results. Outcomes of surgical treatment were followed up during 35 months after surgery. Excellent (93.3 %) and good (6.7 %) results were achieved. There were no intraoperative or postoperative complications related to screw insertion technique or fixing construction itself.

Conclusion. Analysis of treatment outcomes shows the efficacy and safety of posterior cervical fusion technique and fixing rod constructions for posterior fusion of different length and localization. This approach also can be used in the presence of bone defects in posterior supporting complex of spinal motor segments.

Objective. To analyze clinical efficiency of transpedicular single-segment osteosynthesis for treatment of thoracic and lumbar spine injuries.

Material and Methods. Surgical treatment of 46 patients with thoracic or lumbar spine injuries was performed. Patients were operated on within 2 days to 7.5 months after trauma. Twostage surgical treatment was applied. The first stage included transpedicular osteosynthesis at one level with internal spinal fixation system. The second stage included anterior fusion of the injured motion segments of the spine. Cases of delayed seeking for medical assistance required application of original authors’ technique of intraoperative spine reposition or preliminary reposition with external transpedicular fixation device.

Results. The applied treatment approach allowed achieving good (82.6 %) and satisfactory (15.2 %) Unsatisfactory result in one patient (2.2 %) was caused by osteosynthesis destabilization due to osteoporosis, and required reosteosynthesis.

Conclusion. Transpedicular single-segment osteosynthesis has a high clinical efficiency and may be applied for the treatment of spinal injury with one destabilized motion segment, when preserved vertebral bone mass is sufficient for proper screw insertion.

A clinical case of single-step posterior-only approach in surgical treatment of a patient with severe kyphotic deformity.Surgery resulted in reduction of neurological deficit and pain, and restoration of proper trunk balance.

Objective. To study the efficiency and effectiveness of brace treatment in children and adolescents with scoliotic grade IV spinal deformities.

Material and Methods. The study included 417 patients at the age of 5 to 17 years having idiopathic scoliosis with primary curvature magnitude from 41° to 160°. Clinicoradiologic study with assessment of the curvature magnitude by Cobb method, of vertebral rotation — by Raimondi method, and of bone growth potential — by Risser and Sadofieva methods was performed. The Chêneau brace was used for treatment.

Results. Immediate results of corrective treatment were followed up in 161 patients. The maintenance of the achieved correction effect was noted in two patients; decrease in correction within the interval of the achieved grade, which was less than initial — in 62; and regression of the achieved correction up to initial deformity parameters or to their increase — in 84 patients.

Conclusion. Brace treatment is an effective mean of the spine correction and stabilization in grade IV idiopathic scoliosis. It allows decreasing or stabilizing the severity of orthopedic pathology in the process of patient’s physiological development, and conservative suppressing of the deformity progression up to the spine growth completion in cases of aggressive scoliosis.

Objective. The comparative analysis of surgical treatment results for progressive idiopathic scoliosis in children.

Material and Methods. The study included 138 patients operated on using Rodnyansky and Harrington methods in different modifications and 52 patients — using two-plate endocorrector for multilevel fixation. Clinical, radiological, and mathematical methods of investigation were used.

Results. The best correction of the spine was achieved in patients operated on using two-plate endocorrector for multilevel fixation. Among them patients of 11–13 years of age had better mean index of intraoperative correction of the spine, than patients of 14–17 years of age. Satisfactory indices of intraoperative correction in patients operated using Rodnyansky and Harrington methods in different modifications significantly reduced and minimum residual correction was preserved.

Conclusion. Application of multilevel two-plate endocorrector significantly decreases spinal deformity in three planes, arrests its further progressing, reduces duration of hospital stay, saves patients from a prolonged bed rest, external immobilization, and additional surgical interventions.

Objective. To analyze the effectiveness of complex remedial measures including biological feedback to pelvic girdle and spinal muscles in treatment of scoliosis in children with dysontogenetic- dystrophic syndrome.

Material and Methods. The study included 49 patients aged 6 to 16 years with combined deformities of the pelvis and the spine (grade I and II measured by Cobb method). All examined patients had S-shaped scoliosis and pelvic asymmetry. The treatment included application of biological feedback after EMG training of patients.

Results. The study showed that one of the basic requirements for successful EMG biofeedback application is a functional biocontrol. Patients are trained to control the activity of muscles and muscle groups, which are under disturbed or lost voluntary control. Functional biocontrol assumes using activity of the disturbed motor system itself. Biofeedback looping provides learning and fixation of motor patterns and a new behavior strategy allowing for voluntary correction of the disturbed motor functions.

Conclusion. The application of EMG biofeedback to pelvic girdle muscles resulted in reduction or reversal of scoliotic deformity in the thoracic and lumbar spine. Formation of new statodynamic system decreased trunk and spinal muscle imbalance, and changed the direction of spinal curves.

Objective. To analyze prevalence, characteristics, and peculiarities of trunk status changing in horizontal plane in patients with spinal deformities.

Material and Methods. Examination of 18,500 children and adolescents for trunk deformities in the horizontal plane was performed using computer optical topography.

Results. Spinal deformities were revealed in 536 (2.9 %) patients. Out of them 152 (28.4 %) patients had rotation of the shoulder girdle, 124 (23.1 %) — rotation of the pelvic girdle, and 260 (48.5 %) — torsion of the trunk. It was found that formation of the trunk rotation in the horizontal plane is caused by scoliosis in 93.3 % of cases, by kyphosis — in 5.8 %, and by congenital spinal abnormalities — in 0.8 %.

Conclusion. Rotational trunk deformity is essentially influenced by the level of the curvature localization.

The paper presents literature review on a rare congenital malformation of the spine and spinal cord. Key issues of etiology, classification, clinical presentation of caudal regression syndrome, and variants of conservative and surgical treatment are discussed.

Objective. To analyze clinical efficacy of spinal anesthesia in surgery for discogenic lumbosacral radiculitis.

Material and Methods. Spinal anesthesia was applied in surgical treatment of 220 patients with discogenic lumbosacral radiculitis. The first group included patients in whom individual features of vegetative regulation were not considered, while patients from the second group were examined for initial preoperative vegetative tonus. Concentration of anesthetics (lidocaine and marcaine) in cerebrospinal fluid during spinal anesthesia was measured at 2 and 8 minutes after anesthesia induction.

Results. The rate of decrease of anesthetic concentration in cerebrospinal fluid is directly proportional to the onset time of sensory and motor blocks. Herniated disc compression on the dural sac disturbs liquor circulation and affects distribution of local anesthetics in cerebrospinal fluid. Authors suggest an algorithm of cerebrospinal anesthesia involving intermittent administration of minimum local anesthetic doses with assessment of sensory block level after 8 minutes, preoperative examination of vegetative tonus, and appropriate medication administration.

Conclusion. Suggested method allows for efficient and safe performing of surgical intervention.

Objective. To assess the efficacy of extended interpleural block in the early postoperative period in children operated for idiopathic scoliosis using thoracic approach.

Material and Methods. Forty two patients of 14 to 18 years of age operated on for idiopathic scoliosis through thoracic approach were examined. Postoperative anesthetization was performed by interpleural analgesia in patients from the study group (n = 23), and by administration of narcotic analgesics and NSAIDs in patients from the control group (n = 19). Visual analog scale (VAS) was used to appreciate the adequacy of anesthesia. Respiratory function was examined using spirometry.

Results. In the control group, postoperative anesthetization was required earlier than in the study group, recovery agitation symptoms were observed in two cases, and four children (21 %) had vomiting and nausea. In the study group, reduction in analgesic daily intake was noted, with more effective adequacy of anesthetization in terms of VAS scores as compared to the control group. Spirometry findings showed that interpleural analgesia exerted a positive effect on respiratory function in patients from the study group.

Conclusion. Interpleural analgesia used during surgical correction of scoliotic deformity through thoracic approach provides effective postoperative anesthetization.

The study objective was to determine the efficacy of out-patient specialized medical care delivery within the clinic for spine pathology. Organizational principles of the day hospital activity were developed on the basis of Novosibirsk Research Institute of Traumatology and Orthopaedics which delivers specialized and high-tech medical care for spine pathologies. Performance indicators of the day hospital activity for the period of 2000–2008 were analyzed. Expert feasibility study of day hospital development and the analysis of patient satisfaction with specialized out-patient medical care based on questionnaire data were performed. Principal directions of further development of day hospital within the clinic for spine pathology were formulated.

The paper presents the analysis of process management system for preanalytical stage of laboratory service in a medical research institution. Systematic analysis of data obtained in the process of detection and registration of non-conformances with informational system and results of internal audit of all departments concerned with laboratory service provides the basis for management decision making and introduction of the complex of corrective and preventive actions with a subsequent mandatory estimation of their performance. The introduction of process management system allows for continuous improvement of the process of laboratory service and quality of laboratory investigations.