Objective. To analyze results of minimally invasive surgery for lower thoracic and lumbar spine fractures.

Material and Methods. The method of minimally invasive anterior fusion and percutaneous pedicle screw fixation for treatment of non-complicated fractures of the lower thoracic and lumbar vertebrae was developed and successfully used in 56 cases. In 19 patients with type BI (n = 11) and BII (n = 8) fractures according to AO/ASIF classification the anterior stabilization of the spine was performed in combination with minimally invasive transpedicular fixation. Type AII and AIII fractures were treated by anterior fusion with porous NiTi implant combined with internal fixation (n = 11). A comparative analysis of suggested minimally invasive and conventional methods of anterior fusion and transpedicular fixation was performed.

Results. The long-term outcomes of minimally invasive treatment were followed in 31 patients. Good results were achieved in 93.5 % of cases (n = 29), satisfactory — in 6.5 % (n = 2), unsatisfactory results were not registered.

Conclusion. Minimally invasive anterior fusion and percutaneous internal transpedicular fixation as compared with conventional methods provided adequate stabilization of fractured spinal motor segment, decrease in surgery invasiveness, and elimination of cosmetic defect.

Objective. To perform comparative analysis of reducing and stabilizing properties of external and internal transpedicular systems in patients with posttraumatic deformities of the lower thoracic and lumbar spine.

Material and Methods. One hundred patients of active age with comminuted penetrating fractures of lower thoracic and lumbar vertebrae were operated on. Out of them 20 patients underwent two-stage surgical treatment (external transpedicular spondylosynthesis with postoperative dynamical correction of the deformity and autograft fusion); 80 – internal transpedicular spondylosynthesis by single-step correction of posttraumatic deformity with innovative reposition device (interbody fusion was performed in 22 cases with persistent vertebrodural conflict, and in 8 cases with posttraumatic vertebral defect).

Results. The use of innovative reposition device for transpedicular spondylosynthesis provides complete graduated correction of posttraumatic multiplane spinal deformities regardless of the injury age. The long-term treatment outcomes directly reflex the applied spondylosynthesis technique. Removal of external fixation apparatus results in a loss of the obtained correction, while internal transpedicular constructions provide a stable immobilization of the injured spine.

Conclusion. To achieve long-term effective fixation of injured spinal motor segment a stable internal transpedicular spondylosynthesis is preferable.

This conceptual paper formulates basic postulates for various types of kyphotic and kyphoscoliotic deformities of the spine, their definitions, biomechanical features, and classification. Various anterior surgical interventions, including spinal cord decompression, with or without posterior instrumentation, are substantiated from a three-dimensional point of view. Specific aspects of preoperative examination and postoperative management of these patients are described.

Objective. To perform 3D biomechanical analysis of spine deformity and relevant anatomical structures in children.

Material and Methods. A total of 37,000 children and adolescents aged from 7 to 17 years were screened for multiplane spinal deformity. Screening was performed using computer optic topography. Deformity was assessed with topographical criterion.

Results. The coronal plane deformity was detected in 4,230 (11.4 %), sagittal — in 2,048 (5.5 %), and horizontal — in 1,072 (2.9 %) patients. Out of all children with detected pathology, 68.1 % had single plane deformity, 26.6 % — two-plane, and 5.3 % — three-plane deformity. Pathogenesis of multiplane deformities was considered. Seven variants of spinal deformity were identified.

Conclusion. In children, as a rule, the deformity under 10° has a single-plane character and more than 10° degree — a multiplane one. Multiplane deformities cause changes in topography of all anatomical structures, which ultimately results in deformity of locomotor system as a whole.

Objective. To study peculiarities of the functional state of neuromuscular system in children with grade I–II scoliosis depending on plasticity of neurodynamic processes in the central nervous system (CNS).

Material and Methods. Patients with right-sided lumbar grade I-II scoliosis aged from 15 to 18 years were examined. Functional state of cerebral cortex was evaluated by EEG of fronto- occipital lead, and that of the lumbar spine muscles — by EMG of m. erectum spinae. The effort, morphofunctional reorganization of motor units, differential diagnosis of primary muscular diseases, and dysfunction of motoneurons or their axons were determined.

Results. Groups of patients with low, moderate, and high plasticity of central mechanisms of self-regulation of functions were isolated. Findings of EMG study showed that maximum muscular effort is reached in patients with high plasticity of neurodynamic processes. The frequency of the examined muscle response varies within a small range, irrespective of the CNS plasticity.

Conclusion. High plasticity of neurodynamic processes is associated with greater number of motor units involved into motor activity, higher density of muscle fibers, greater number of phasic motor units, and lesser number of motoneurons and greater number of muscle fibers within each motor unit.

The paper presents a review of literature on the problem of epidural fibrosis occurring after lumbar discectomy in terms of its clinical significance. Causes and development mechanisms of epidural adhesive process are analyzed, and features of its clinical manifestation are described. Possibilities of modern methods for diagnosis of postoperative epidural fibrosis are discussed. The necessity of further investigation into the problem of prevention and preoperational prognosis of compression epidural fibrosis appearance are shown.

Objective. To analyze outcomes of spinal osteochondrosis treatment using puncture methods.

Material and Methods. Treatment of 752 patients with compression and reflectory forms of spinal osteochondrosis was performed. Puncture methods including mechanical fenestration (n = 302), chemical dereception (n = 265), and laser nucleoplasty (n = 185) were used. Procedures were performed under local anesthesia.

Results. Three-year follow-up after minimally invasive manipulations revealed stable positive effect in 71.9 % of fenestration cases, 64.1 % of dereception cases, and 78.5 % of nucleoplasty cases.

Conclusion. Puncture methods for treatment of degenerative spinal diseases including mechanical fenestration, chemical dereception, and laser nucleoplasty of intervertebral disc are less invasive and effective procedures without complications.

Objective. To study the effect of spinopelvic balance parameters and degeneration of spinal segments on the development of degenerative lumbar spinal stenosis.

Material and Methods. Spinopelvic balance parameters, severity of degeneration of anterior and posterior column, severity of zygapophyseal, interspinous, and apicoarcual arthroses, degree of central, lateral, and foraminal spinal canal stenosis, and cumulative severity of spinal canal narrowing were measured on radiographs, CT and MRI scans of 100 patients with chronic lumbalgia. Descriptive statistics, correlation and regression analyses were used.

Results. Degenerative narrowing of spinal canal positively correlates with age, pelvic incidence, and lumbar lordosis, with zygapophyseal, interspinous, and apicoarcual arthroses, as well as with posterior spinal column degeneration. In addition, the correlation was revealed between narrowing severity in different spinal canal regions and spinopelvic balance, zygapophyseal, interspinous and apicoarcual arthroses, posterior spinal column degeneration and age.

Conclusion. Probability of occurrence and severity of degenerative narrowing of central, lateral, and foraminal regions of the spinal canal, and cumulative severity of degenerative spinal stenosis positively correlates with spinopelvic balance parameters and with severity of posterior spinal column degeneration.

Objective. To analyze results of preclinical tests and clinical application of new carbon implants for fusion in patients with spinal tuberculosis and osteomyelitis.

Material and Methods. Experimental and clinical study was performed to assess the opportunity of application of new carbon implants produced by nanomolecular synthesis for anterior fusion in inflammatory spinal diseases.

Results. The implants have high strength, maintain the achieved kyphosis correction, prevent postoperative deformity increase, promote union of bone grafts and preclude their resorption and fracture. Application of the implant as a drug delivery depot provides the maintenance of therapeutic antibiotic concentration directly in the fusion zone without adverse effects during four weeks.

Conclusion. The performed study is the first stage of investigation into the properties of carbon nanomaterials used in spine surgery. Manufacturing of such implants with not only predetermined shape and porosity but also with controlled drug adsorption and desorption is rather promising.

Objective. To assess the efficacy of multimodal approach to perioperative management of scoliosis surgical correction using blood salvage techniques and continuous epidural analgesia.

Material and Methods. The study included 85 patients aged from 12 to 23 years. Patients from Group I (n = 26) and Group II (n = 35) received hypotensive epidural anesthesia with 0.75% ropivacaine and general anesthesia with propofol (Group I) or sevoflurane (Group II) before anterior and posterior spinal fusion. Patients from control group (n = 24) received total intravenous anesthesia with propofol, fentanyl, and clonidin.

Results. The best effect was observed in groups with epidural analgesia. Intraoperative blood loss decreased by 50 % in both groups.

Conclusion. The developed method of multimodal perioperative management of scoliosis surgical correction provides effective and safe intra- and postoperative analgesia, early extubation and mobilization of patients, and opportunity to avoid using donated blood components.

Objective. To analyze results of anesthesiological protection and correction of intestinal insufficiency during high-risk orthopaedic surgeres.

Material and Methods. The study included 972 patients who underwent surgery for traumatic injury, thoracolumbar spine degenerative disease and stage II–III hip arthrosis. Complex clinical laboratory, morphological, and microbiological studies, clinical analysis of gastrointestinal function, gastrofibroscopy, intestinal fibroscopy, phonoentherography, and chronography were performed.

Results. The study confirmed that acute intestinal insufficiency occurs in patients with thoracolumbar injuries. It was revealed that a symptom complex of gastrointestinal disorders is naturally developing at degenerative diseases of the spine and hip. The worked out complex measures for prevention and reduction of acute intestinal insufficiency in thoracolumbar fractures permits to shorten a hospital stay by 5.0 ± 0.9 bed days, to eliminate an incidence of acute intestinal insufficiency by 47 %, and to reduce its intensity. The system of measures for prevention and reduction of chronic intestinal insufficiency in patients with degenerative spine and hip diseases allows reducing the probability of acute intestinal insufficiency onset by 10–12 %, which helps to decrease the incidence of early postoperative complications by 23–26 %.

Conclusion. Anesthesiologic protection TIVA+ALV+EA and CSEA and CEA combined with early enteral nutrition has an important clinical significance in correction of gastrointestinal dysfunction in perioperative period.

Objective. To analyze correlation between clinical signs of gastrointestinal disorder and endoscopic and morphological findings in patients with spine and hip degenerative disease. Material and Methods. The study included data on 648 patients with spine and hip degenerative diseases. Clinical analysis of gastrointestinal function, gastrofibroscopy, intestinal fibroscopy, chronographic study, and morphological examination of small-intestinal mucosal biopsy specimens were performed in all examined patients. Results. The obtained data demonstrate sufficiently close correlation between clinical signs of gastrointestinal disorder and changes in mucosal endoscopic pattern and histological structures. Conclusion. Patients with degenerative spine and hip diseases have a comorbid condition presented by clinically significant complex of gastrointestinal disorders correlated with endoscopic and morphological changes in the intestinal wall.

Objective. To perform comparative study of composition and strength properties of osteoplastic biomaterials subjected to technological processing.

Material and Methods. Specimens of native (initial) and deproteinized bone tissue were analyzed. Strength properties of specimens were studied by single-axis static extension with automatic recording of load curves. Load-extension curves were used to calculate mechanical parameters: proportionality limit, strength limit, relative deformation before destruction, and the Young’s module. Dependence between a processing type and changes in the surface morphology, element composition, overall dimensions, and dry weight of specimens was identified.

Results. All bone tissue specimens had small amount of deformation typical for fragile materials – 1 %. Proportionality limit for native bone tissue was 27 MPa, and that for deproteinized tissue –29 MPa. Strength limit did bone on the type of chemical processing of tissue and had the value of 80–90 MPa. Collagen presence influenced the Young’s module which was 110 MPa in deproteinized bone tissue, two-fold decreased from that in initial bone tissue (230 MPa). Topography of specimens and fracture surfaces were more pronounced after deproteinization.

Conclusion. The study of physical and mechanical properties and composition of compact bone specimens gives an understanding of processing type influence on bone tissue structure and properties.

Objective. To define the rate of bone tissue integration with porous implant and quantity of calcium and phosphorus in implants extracted in 4.5 months and 1.5 years after insertion.

Material and Methods. Microstructure of specimens of porous titanium nickelide was examined by phase contrast. Chemical composition of specimens was determined by micro X-ray spectral analysis.

Results. In 1.5 years after implantation the organic tissues of various morphology, density and thickness occupied 100 % of analyzed area, and in 4.5 months 60 % of pores were filled with tissue. Calcium and phosphorus contents in surface pores were close to their natural concentrations in human bone in 1.5 years.

Conclusion. Bone – porous implant integration meets the tasks of porous device for bone defect replacement and spinal fusion. It is impossible to separate the implant from bone in 4.5 months after implantation. This demands strict adherence to surgical technique involving the use of porous implants.