Objective. To develop an optimal algorithm of diagnostics and treatment of patients with consequences of primarily uncomplicated trauma of the cervical spine.

Material and Methods. Ninety seven patients with clinical symptoms of radiculopathy associated with posttraumatic changes in the spine were examined. To clear pathogenetic diagnosis the plain, functional, and 3/4 radiographs were taken added by positive myelograms, CT, MRI, and electroneuromyographic studies. Cervical positive myelography was performed in 61 patients, CT of the cervical spinal cord – in 74. Additional MRI study of the cervical spinal cord was performed in 85 patients.

Results. Grade I deformation of the spinal column was detected in 42 patients, grade II and III – in 55 patients. Comparison of clinical and radiological findings showed that of patients with uncorrected grade II and III deformity of the spinal canal 35 patients (63.6 %) had marked signs of myelopathy, and 20 (36.4 %) had pain and radicular syndromes. At the same time among 42 patients with grade I deformity the signs of myelopathy and the pain and radicular syndromes were observed in 19.2 % and 80.8 % of cases, respectively. Comparison of clinical signs and instrumental examination findings allowed to develop an algorithm of diagnostic and treatment of patients with consequences of primarily nuncomplicated trauma of the cervical spine. The degree of angular deformity of the spinal canal was one of the key factors which form the basis of the suggested diagnostic scheme.

Conclusion. The developed procedure for diagnosis of reflectory and compression syndromes of cervical myelopathy allows to select the proper treatment of patients with consequences of primarily nuncomplicated spinal trauma.

Objectives. To analyze the outcomes of anterior stabilization for lower cervical spine injuries.

Material and Methods. Total of 235 patients was operated on for lower cervical spine injuries. Long-term results (6 months to 3 years) were assessed in 68 patients. All of them underwent plan and functional radiography of the cervical spine. MSCT and MRI were performed to the patients with pain syndrome and residual neurologic symptomatology.

Results. Control radiograms demonstrated interbody fusion in all patients. There was a loss of correction on 3° ± 2° in 9 % of cases caused by subsidence of a crown fixator in a cancellous part of the vertebral body after anterior mono-segmental spinal fusion with resection of a damaged part of the vertebral body. In a group of patients with a plate fixator the achieved perioperative correction of a segment kyphosis was preserved including the cases after anterior mono-segmental spinal fusion with resection of a damaged part of the vetebral body.

Conclusion. Anterior spinal fusion with a bone autograft and plate fixation is a method of choice for unstable lower cervical spine injuries. Complete correction of all types of deformations at a damaged spine segment, safe stabilization of achieved correction, and efficient rehabilitation permit to achieve favorable outcomes after surgery.

Objective. To summarize own experience and to assess early results of surgical treatment of the lumbar spine degenerative disease using COFLEX and DIAM dynamic implants.

Material and Methods. Dynamic interspinous fixation was performed in 96 patients at the age of 23 to 72 years. Pathologic substrate of clinical syndromes was intervertebral disc herniation and protrusion, osteophyte, degenerative spinal stenosis, and spinal segmental instability. In 88 cases interspinous fixation was combined with spinal root decompression, in other 8 cases the adjacent segment fixation was performed in the course of spinal fusion. Clinical and radiological results of the treatment were observed during 6 months after surgery.

Results. Mean values of the Oswestry Disability Index in patients examined at 3 and 6 months postoperatively decreased till the level of minimal lesions. Interspinous fixation resulted in the intervertebral disc height increase in its posterior and, to a lesser degree, middle parts. Despite some decrease in segmental angle, there were no cases of kyphotic deformity. Flexion/extension mobility of the operated segment in a sagittal plane almost halved. The achieved correction of intersegment relations remained unchanged in 6 months after surgery. There were no complications associated with implant insertion. Radiological signs of bone tissue resorption in bone-implant interface were not observed. Reliable differences of the treatment results depending on the type of interspinous implant (COFLEX or DIAM) were not revealed.

Conclusion. The studied technique is feasible, does not assume a distruction of any anatomical spine structures, and can be widely used not only for repair, but also for prevention of segmental instability.

Objective. To compare the efficiency of thoracoscopic and conventional posterolateral approaches with costotransversectomy for thoracic discs herniations, and to assess the applicability of thoracoscopic surgery for various pathologies of the thoracic spine.

Material and Methods. Thoracoscopic techniques were applied in 19 patients admitted to the clinic with thoracic disc herniations, thoracic trauma without neurological signs, metastases and primary tumors of thoracic vertebrae, and sympatic ganglia. Control group included patients after costotransversectomy.

Results. The assessment of outcomes after thoracoscopy for thoracic disc herniations using Frankel score revealed almost double improvement of neurological status without negative postoperative dynamics.

Conclusion. Thoracoscopic approach is a method of choice for treatment of thoracic intervertebral disc herniations due to high rate of neurological restoration.

Objective. Electromyographic assessment of neurological deficiency in lower limbs of patients with dysplastic scoliosis before the treatment and at different stages of surgical correction of the spine.

Material and Methods. A total of 107 patients at the age of 11 to 27 years with dysplastic C- and S-shaped scoliosis of grades III and IV was examined. The methods of general and stimulation electromyography were applied before surgery, intraoperatively, and after surgery.

Results. Preoperative neurological status of patients with grade III–IV scoliosis could be defined more exactly using the suggested version of complex neurophysiological testing of sensorimotor apparatus of the lower limbs. Data of postoperative electroneuromyographic analysis of conduction integrative functions of the spinal cord evidence that spine deformity correction in patients with grade III–IV scoliosis by applying an external transpedicular fixation is less invasive but this does not exclude the need for intra- and postoperational neurophysiological monitoring.

Conclusion. Surgical intervention and prolonged correction of the spine axis result in development and subsequent involution of subclinical forms of sensory and motor deficiency in the lower limbs which are more intense in grade IV scoliosis patients.

Objective. To study correlation between spinopelvic balance parameters and degenerative changes in the low lumbar spinal segments.

Material and Methods. Clinical and radiological findings in 100 patients (32 women, 68 man; mean age 38.7 ± 9.7 years) with chronic lumbodynia and lumbar ischialgia were analysed. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT) and global lumbar lordosis (GLL) were measured from lateral radiographs. The severity of degenerative changes in three lower lumbar segments: disk, facet, anterior and posterior supportive columns was assessed using a specially developed scale. The obtained data were statistically processed.

Results. It was revealed that disk and anterior supportive column degenerations correlate negatively with parameters of PI, SS and GLL, whereas facet and posterior supportive column degenerations demonstrate positive correlation with the same parameters. Age does not effect disk and anterior supportive column degenerations, but degenerations of facet and posterior supportive column increase severely with age (r = 0.564 and r = 0.467, respectively).

Conclusion. Degenerative disc changes predominate in patients with low values of PI, SS, and GLL. Degeneration of facet joints and summaraized severity of posterior supportive column degeneration predominate in patients with high values of PI, SS, and GLL.

Objective. To assess surgical treatment techniques for treatment of patients with nonspecific vertebral osteomyelitis and their long-term results.

Materials and Methods. A total of 125 patients with vertebral osteomyelitis were treated, out of them 49 (39.2 %) patients underwent major reconstructive surgery. Operative contraindications were multiple comorbidity, septic course of disease, or elderly age. All patient were treated with rational parenteral antibioticotherapy, detoxication therapy, extracorporal detoxication and immunomodulatory therapy according to the developed algorithm.

Results. Long-term results were followed-up for 1 to 10 years after surgery. It was noted that in 1 year the graft remodeling mainly completed, in 2-3 years vertebral body sclerosis had a tendency to decrease, and trabecular bone structure became similar to that of the adjacent vertebrae. Restoration of supportive function of the spine (formation of a bone block at the level of surgery) was achieved in all patients.

Conclusion. Timely minimally invasive surgery allows arresting inflammatory process, regression of neurologic symptoms, and restoration of supportive function of the spine in a majority of patients.

The clinical case of total tumor removal with shortening vertebrotomy and instrumented fixation in 9 years old child with giant cell tumor of L4 vertebra is presented. The longterm outcome was followed up during one year after surgery.

Objective. To study clinical presentations of spine disorders in pregnant women previously operated on for vertebral pathology.

Material and Methods. A total of 27 pregnant women opreated on for vertebral body fracture (12 patients), degenerative disease (6 patients), scoliosis (6 patients), and spondilolisthesis (3 patients) before pregnancy were examined. Diagnostic procedure included anamnesis, complains evaluation, and spine examination.

Results. Pain syndrome, vertebral deformities, and palpatory tenderness of the spine were diagnosed in 100.0 % of the examined patients. Spine function disorder was revealed in 92.6 % of cases, muscle strain – in 81.5 % of cases. Pathology of sacroiliac joint was diagnosed in 66.7 % of cases, of pubic articulation – in 18.5 %, and of sacrococcygeal one – in 7.4 %.

Conclusion. The problem of specific course of dysplastic and degenerative dystrophic spine disorders in pregnanat women is at the interface of two major medical professions – orthopaedics and obstetrics. Our experience shows the need for obstetricians, orthopaedists-traumatologists, and neurologists to be trained the foundations of perinatal spine problems.

Objective. To substantiation an appropriate concentration of dimephosphon for evaluation of its effect on function of the injured spinal cord.

Material and Methods. The experiment was carried out in 40 mongrel dogs divided in three groups. Spinal pathway conductivity was studied by transcranial magnetic stimulation of the brain motor cortex, and a state of the lumbosacral motoneurons – by stimulation electromyography before and after spinal cord injury. Injured spinal cord specimens were histologically examined. In the third group of animals dimephosphon in a doze of 18.75 mg/kg was injected intravenously during 10 days after spinal cord injury.

Results. In 90 % of animals of the third group transcranial stimulation produced motor responses in the anterior tibial muscles in one day after injury. Latent periods of motor responses did not definetely change, which evidenced for preservation of the spinal cord conduction. Dimephosphon reduced the quantity of reflectory reacting motorneurones in acute period of trauma, which is also confirmed by lesser potentiation of reflectory reaction value at high-frequency tetanization.

Conclusion. Dimephosphon promotes the reparation and restoration of function of the injured spinal cord segments effecting the bloodstream and neuronal activity of the spinal cord.

Objective. To develop an experimental model of transpedicular fixation and to study the effect of such fixation on a growing spinal motional segment.

Material and Methods. Age-related anatomic and histological peculiarities of the lumbar vertebrae were studied in ten 3-month-old puppies. Another 20 puppies were divided into four groups and underwent transpedicular fixation at L3-L4.

Results. It was revealed that a histological structure of the vertebral body and pedicle in puppies is identical to that in younger children. X-ray examinations revealed stability of screws and constructions in four groups during the observation period. There were no torsion deformations of the vertebral bodies, canal stenosis and deformation of adjacent segments.

Conclusion. Basing on the created experimental model it was revealed that transpedicular fixation did not exert negative effect on a growth and development of a fixed spinal motional segment in experimental animals.

The effective quality management demands clear-cut documented requirements both for the qualities of medical services and for the processes of production. Working out of the documentation is one of the most complicated and labourintensive stages of quality management system (QMS) introduction. The organization should determine a volume and structure of QMS documentation, establish common requirements, norms and rules of formation, execution and use of the documents. The article presents main types of QMS documents, worked out at Novosibirsk NIITO, which regulate the requirements for medical care and ensure a competitiveness of medical institution in conditions of market economy.