Objective. To study clinical effectiveness of various technical options for dural sac decompression applied with transpedicular fixation (TPF) for treatment of injuries in the thoracic and lumbar spine accompanied with post-traumatic spinal stenosis.

Material and Methods. A total of 170 adult patients with injuries in the thoracic and lumbar spine, and post-traumatic stenosis of the spinal canal with narrowing from 25 to 100 % of its sagittal dimension were operated on. Out of them 116 (68.2 %) patients had a spinal cord injury with neurological deficit. TPF of the injured vertebral motion segments was used in all patients.

Results. Differential approach to the choice of variants of dural sac decompression in combination with TPF for treatment of patients with spinal cord injuries, accompanied with traumatic spinal stenosis yielded good results of treatment in 134 (78.8 %) patients, satisfactory - in 33 (19.4 %), unsatisfactory - in 3 (1.8 %). Unsatisfactory results were associated with destabilization of the metal construction and with the worsening of neurological deficit after surgery.

Conclusion. The choice of dural sac decompression method for traumatic spinal canal stenosis in the thoracic and lumbar spine should be designed individually for each patient taking into account the spondylometric features of lesions in spinal motion segments, time since injury, severity and dynamics of neurological disorders, localization of damage to the spine (above or below the medullary cone).

Objective. Representation of the algorithm for diagnosis and choice of treatment approach in patients with damage to the spine and spinal cord in concomitant injury.

Material and Methods. Data of complex examination and surgical treatment of 514 patients with concomitant spine and spinal cord injury treated at the NV Sklifosovsky Research Institute of Emergency Care in 2000-2010 were analyzed. The control group included 373 patients with isolated spinal cord injury.

Results. Based on the analysis of clinical data achieved in 2000-2003 the algorithms were developed and introduced to diagnose and treat patients with concomitant spine and spinal cord injury, which allowed reducing the number of complications by 2.5 times and deaths by 2.9 times. Risk factors in the acute period and during the operation were identified.

Conclusion. Compliance with the algorithms of diagnosis and treatment of patients with concomitant spine and spinal cord injury has reduced the number of complications and deaths.

Objective. To analyze results of surgical treatment of Scheuermann’s kyphosis using segmental instrumentation.

Material and Methods. Sixty eight operated patients were divided into two groups. Patients from Group 1 underwent only posterior procedure in skeletal traction, and patients from Group 2 - anterior and posterior procedures. In 18 (26.4 %) cases, patients were treated using segmental vertebrotomy and formation of compression anchor at the apex of deformity. The caudal anchor of instrumentation using transpedicular screws was formed in 10 (14.7 %) patients.

Results. Kyphosis decreased from 76.2° ± 11.3° to 42.4° ± 10.4° in Group 1, and from 80.1° ± 11.5° to 39.5° ± 12.2° in Group 2; the loss of correction at 1 year after surgery was 7.9° ± 4.4° in Group 1, and 2.9° ± 5.8° in Group 2. The use of transpedicular fixation reduces the length of instrumentation by one segment.

Conclusion. Two-stage surgical treatment including skeletal traction from calvarial bones to supramalleolar area, discectomy and interbody fusion with bone autograft at the apex, and correction of spinal deformity with segmental instrumentation, is the most effective treatment technique for severe progressive kyphosis in Scheuermann’s disease.

Objective. To analyze the exacted classification of horizontal plane postural disorders, accounting for different variants of disorders, and to study the structure of rotational postural disorders using this classification.

Material and Methods. Results of the computer optical topography (COMOT) screening of children and adolescents in six cities formed a clinical database including information from more than 33,000 patients approximately evenly distributed through ages from 4.5 to 17.5 years (mean age 11.17 ± 3.3 years).

Results. A new classification of horizontal plane postural disorders was elaborated based on the COMOT method findings using quantitative topographic criteria. This classification differentiates rotational postural disorders depending on their severity into mild, moderate and marked deviations, and divides moderate and marked deviations into three variants of rotational disorders according to the ratio of rotation of the shoulder girdle and pelvis.

Conclusion. The study performed using the proposed classification showed a significantly weaker gender difference in the structure of rotational postural disorders in children and adolescents compared with disorders in the sagittal plane.

Objective. To measure the volumes of health and degenerated intervertebral foramina and to analyze correlation between the obtained data and clinical presentation of disease.

Material and Methods. Intervertebral foramen volume was measured in 227 patients with bilateral degenerative disease in the cervical (89), thoracic (28), and lumbar (110) spine, using spiral computed tomography. Bone and soft tissue components of the foramen determined the volume loss in comparison with the opposite side. The loss was considered moderate if the volume decreased by 15–30 % as evidenced by at least one component, marked – by 31–60 % and significant – by more than 60 %.

Results. The volume of intervertebral foramina at all spinal levels in men exceeded that in women. Essential and statistically reliable differences between indicators at both sides were revealed neither in men, nor in women. Correlation between a foramen volume and a patient’s height was revealed: height increase was associated with volume accrual. Direct correlation between indices of intervertebral foramen volume, pain syndrome intensity, and radiculopathy severity was observed.

Conclusions. CT-assisted measurement of intervertebral foramen volume enables determining the rate of its loss from both bone and soft-tissue components. As well as any other results of additional investigation, digital parameters should be estimated in a complex, taking into account clinical presentation of disease.

Objective. To compare histological changes after coblation and denervation of intervertebral disc in a model of degenerative-dystrophic lesion of the spine.

Material and Methods. The experiment included 15 mongrel dogs, in which degenerative changes of the lumbar disc were initiated. Discs were affected by cold plasma and chemical denervation. Animals were sacrificed at 1, 3, and 6 months. Specimens were subjected to histological examination.

Results. In the early period after the alcohol injection a marked cell proliferative response over the entire disc was observed. Coblation caused a similar cell proliferation only in the area of electrode contact, while changes in surrounding tissues were not observed. There were no reliable histological differences between treatment groups in the late period. Coblation causes a destruction of the disc tissue in the area of impact without changes in the long-term period.

Conclusion. Injection of an alcohol solution results in micro-focal diffuse destruction of the disc tissue causing disc fibrosis in the long-term period. The obtained morphological data confirm the mechanism of effective use of alcohol denervation and cold plasma nucleoplasty in the treatment of discogenic pain syndromes caused by the disc protrusion.

Objective. To compare the results of interbody fusion and arthroplasty in patients with cervical spine degenerative disease.

Material and Methods. Thirty-seven Bryan cervical discs prosthesis were implanted in 31 patients after discectomy (Group 1). Interbody fusion was performed in 47 patients (Group 2). Comprehensive survey of all patients was performed preoperatively, immediately postoperatively, at 3, 6, 9, 12, and 24 months after surgery. A visual analogue scale (VAS), the scale of disability assessment, radiography, MSCT, and MRI were used.

Results. VAS assessment showed that in patients from Group 1 the pain relieved in the arm by 62.37 %, in the neck – by 38.75 %, and in Group 2 in the arm – by 38.75 % and in the neck – by 35.59 %. Quality of life improved by 53.18 % in Group 1 and by 30.34 % in Group 2. Adjacent segment degeneration within 24 months after surgery was observed in 5.30 % of patients from Group 1 and in 55.00 % of patients from Group 2. There were no subsidence and displacement of prostheses in the Bryan Group. In the Group of interbody fusion 35.00 % of patients showed subsidence and nonunion between implants and vertebrae of the operated segment.

Conclusion. Arthroplasty provided better clinical and radiographic results in early and long-term postoperative periods.

Objective. To study results of surgical treatment for spinal canal stenosis in patients with degenerative-dystrophic diseases of the cervical and lumbar spine.

Material and Methods. Complex pre- and postoperative examination of 56 patients with congenital and/or acquired spinal canal narrowing was performed. Clinical diagnosis was based on findings of neurological and orthopedic examination, X-ray investigation, spiral CT, MRI, Doppler sonography, and electroneuromyography. Treatment results were assessed at discharge and at 6 months after surgery. Immediate and longterm indices of pain syndrome intensity, vertebroneurological semiology, and scores of Oswestry Low Back Pain Disability Questionnaire and of Neck Disability Index were compared.

Results. We succeeded in significant decrease in pain intensity in most patients; the score of pain sense at discharge was 1 to 3. At follow-up after 6 months 30 patients had no radicular pain, 26 – had unpleasant pain senses, though transient, with intensity score of 3 to 4.

Conclusion. The choice of access, volume and nature of surgical exposure should be planned based on consideration of all factors promoting development of myeloradiculopathy. The cervical spine is operated using predominantly anterior decompression and stabilizing procedures, the lumbar spine – using posterior procedures. The choice of spine stabilization method depends on instability causes, degree of displacement and mobility of vertebrae.

Objective. Scientific rationale for innovative approaches to management of organizational development of medical institution using integrated tools.

Material and Methods. The study is based on results of the analysis of foreign and domestic literature, statistical data, methods of organizational modeling, experience in managing organizational development of the Novosibirsk Research Institute of Traumatology and Orthopaedics, the largest institution providing specialized and high-tech medical care in the field of spine and joint surgery and neurosurgery.

Results. New management concept was developed including radical revising the conventional framework of organizational structure of an institution and radical reengineering of business processes aimed to meet patient needs. Scientifically founded innovative approaches to manage organizational development of medical institution using integrated tools are presented.

Conclusion. Implementing innovative approaches gives a systemic nature to management as a process, results in optimization of organization and of medical care delivery, and efficient operation of medical institution.