Objective. To analyze clinical efficiency of some variants of staged surgical treatment of posttraumatic deformities in the thoracic and lumbar spine by transpedicular instrumentation osteosynthesis (ТО). Material and Methods. Presented information includes the experience of surgical treatment of 35 patients (19 male and 16 female patients at the age of 18 to 54 years) with posttraumatic deformities of the thoracic and lumbar spine who were operated on within 6 months to 7 years after trauma. Three variants of staged surgical technique were used. The first variant included TO with internal instrumentation, and anterior interbody fusion of injured vertebral motion segments (VMS). The second variant comprised of TO with external device for gradual restoration of anatomical relations in the injured spinal segments, TO with internal transpedicular system, and interbody fusion. The third variant included TO with external apparatus, anterior interbody fusion after reposition, and spine osteosynthesis with ventral spinal system. Results. Used tactics resulted in 77.1 % of good and 20.0 % of satisfactory treatment outcomes. One patient (2.8 %) presented an unsatisfactory result due to late suppuration and removal of hardware. Conclusion. An additional stage of transpedicular osteosynthesis with the device for external fixation enables favorable conditions for reposition. Spine osteosynthesis with ventral systems performed at the conditions of full-scale reposition and stabilization of the injured VMS has the tactical advantages and is to be preferred.

Clinical cases of surgical treatment of patients with thoracolumbar junction injuries are presented. Unstable injuries at this level are proposed to be treated with polysegmental vebtral systems.

Objectives. To analyze the causes of late inflammatory complications in patients operated on for spinal deformities. Material and Methods. A total of 205 patients of different ages with spine deformities were operated on. Deformity correction was performed through posterior approach with two-plate endocorrector «Medilar» (60 patients) and LSZ (145 patients). Patients were examined by clinical, radiological, histological, and microbiological methods. Results. In 8 patients (13.3 %) from the «Medilar» group late pyogenic complications developed in 3 to 10 months after operation; in the LSZ group similar complications were observed only in 3 patients (2.1 %). Conclusion. Application of LSZ endocorrector made of highly purified Titanium low profile alloy, avoiding soft tissues damage during instrumentation, operation time shortening, and blood loss reduction resulted in a decrease in late inflammatory complication rate from 13.3 % to 2.1 %.

Objective. Validation of the Mehta sign reliability on dynamic spine radiographs of patients with progressive idiopathic scoliosis. Material and Methods. Radiographs of 65 patients with progressive idiopathic right-side thoracic scoliosis examined in dynamics were analyzed. The rib-vertebra angle difference (RVAD) was assessed in accordance with Mehta techniques, and scoliosis evolution was followed up. Results. Initial RVAD in 35 patients was less than 20°. Deformity progressed with time in all patients, and in 71 % of them it evolved into a severe form. Almost half of these patients (43 %) have a curve of 30° to 63° even at initial examination. Equality of rib-vertebra angles (RVA-L and RVA-R) does not indicate the absence of scoliosis. Nine patients (26 %) with equal RVA had the Cobb angle of deformity of 6° to 28°. Conclusion. Our findings raise doubt on reliability of the Mehta sign. Further research is necessary including series of patients with non-progressive forms of idiopathic scoliosis.

Objective. To analyze the function of the trunk and lower limb muscles in grade II and III idiopathic scoliosis. Material and Мethods. Ten healthy volunteers and 50 patients with grade II–III idiopathic scoliosis with Cand S-shaped spinal curvatures were examined. Computer electromyographic testing allowed receiving EMG-pattern of muscles of the trunk and lower limbs and the quantitative indices of muscle work during walking. Results. The following changes in EMG parameters during walking were detected in idiopathic scoliosis patients: many muscles on the convex side of the trunk increase their electrical activity, while on the concave side – decrease. Electrical activity of lower limb muscles has an opposite character (muscle activity increases in the leg at the concave side, and decreases in the leg at the convex side). The quantitative disturbances in EMG-pattern of muscles were accompanied by qualitative ones: reduction of activity peaks in amplitude and their prolongation to adjacent phases of the locomotor cycle. Conclusion. The observed disturbances of the innervation structure of walking are sharply increased from grade II to grade III scoliosis and are more evident in C-shaped curvature of the spine. Most symptoms of muscle activity changes are related to a weakening of trunk muscles’ function with increasing of deformity degree and with compensatory body response to stability loss during walking.

A clinical case of surgical treatment of a girl with progressing juvenile scoliosis is presented. The surgical correction of a scoliotic deformation was performed in two stages. Primarily, under conditions of continuing growth of the patient, a ventral correction of a central angle of spine deformation was carried out, and a dorsal correction of the scoliotic deformation using the CDI was realized after completion of growth.

Objective. To analyze a prevalence of coronal static deformities of the spine, their structure and biomechanical origin. Material and Methods. The method of computer optical topography was used in examination of 1,000 children and adolescents to detect spine deformity and lower limbs length discrepancy. Results. Out of children with coronal deformity of the spine up to 10 degrees 86 % have small discrepancy between lower limbs with left limb shortening, and 10 % – with right limb shortening. The main causes of the lower limb shortening were determined. Cause-effect relation of knee recurvation with shortening of a relative length of the limb, pelvic tilt, and formation of a functional spinal curve. Conclusion. A small discrepancy is a consequence of lumboiliac muscle contracture, lower limb recurvation, and its idiopathic shortening. Shortening of one limb causes a lateral pelvic tilt, as the spine to maintan its vertical axis forms a compensatory curvature due to change of static and dynamic state of spinal-pelvic obliquity.

Objective. To assess the efficacy of percutaneous radiofrequency facet ablation in treatment of patients with postdiscectomy syndrome in the lumbar spine. Material and Мethods. Percutaneous radiofrequency facet denervation was performed in 26 patients with failed back surgery syndrome (postdiscectomy syndrome). Treatment results were assessed with a visual-analog scale, follow-up period was 36 months. Results. A satisfactory clinical effect was observed in 80 % of patients within 3 months after the procedure, and within 36 month follow-up this rate decreased up to 70 %. No treatment-related complications were recorded. Conclusion. Percutaneous radiofrequency facet ablation reliably enhances the quality of life of patients with postdiscectomy syndrome without reoperation for a sufficiently long-term period .

Objective. To analyze short-term results in patients with spine degenerative disease treated by intradiscal puncture thermoplasty with domestically-produced diode laser. Material and Мethods. A series of 155 patients with compression and irritative degeneration disease of the spine were treated using a puncture laser thermoplastic method. The procedure was performed under local anesthesia, with electron- optic transformer control using laser scalpel and 0.9 mm internal diameter needle. During the procedure saline solution was injected into the disc to cool the laser-influenced area, secure disc tissues, and form additional heat carrier. Results. No complications were observed during the procedure. In 120 patients (77.4 %) a regression of reflector, sensitive and motor disorders substantiated by electroneuromyography data and significant reduction of hernial protrusion were observed. In three months they returned to work unrelated to heavy physical activity. The recurrence of pain syndrome within 12 months was observed in 23 patients (14.8 %), out of them 12 patients were admitted to hospital where two patients underwent laser thermoplasty at the adjacent level. Conclusion. Application of low-power radiation (970 nm wave length) and saline solution as a heat carrier allows avoiding destructive damage to the intervertebral disc tissue without intervertebral space changes. Twelve months followup after minimally invasive procedure revealed sufficiently stable positive effect in 85 % of cases.

Objective. An estimation of cold plasma nucleoplasty efficiency in the treatment of intervertebral disc herniation. Material and Methods. Cold plasma nucleoplasty was performed in 33 patients at the age of 16 to 42 years with different localization of disc herniation. Coblation in the lumbar spine was made in 31 patients, in the cervical spine – in 2 patients. All patients before surgery received conservative treatment which did not give any effect. Preoperative examination included clinical, radiological, and CT studies. Procedure was performed under CT and image tube control. Results. MRI study was performed in 10 patients at 1 to 3 months after nucleoplasty. It revealed a reduction of herniation by 3–5 mm in 3 patients. Seven patients did not present herniation reduction but a change to drop-shaped form accounted for a decrease in intradisc pressure. In 2 patients the pain syndrome remained, and required the open surgery intervention for herniation removal. Conclusion. Nucleoplasty is an effective method for disc herniation treatment and has a number of advantages over other minimally invasive methods, but it requires a differentiated approach to procedure fulfillment and intraoperative visualization.

Objective. To assess the efficacy of preoperative procurement of autologous blood components and application of preoperative hemodilution in surgical treatment of scoliosis. Material and Methods. Ninety seven patients operated on for grade IV scoliosis underwent the blood loss replacement with predeposited blood components combined with preoperative hemodilution. Preoperative autologous blood donation was accompanied by the complex medicamental support. It provided intensive recovery of erythropoiesis and protein metabolism allowing to procure the required volume of blood components in a short time. Results. Hemodilution regimen with Ht level of 28,1 ± 1,3 l/l and Hb level of 87,7 ± 3,1 g/l was maintained during surgery. Hemodilution degree with Ht level <26 % and Hb level <80 g/l is not feasible in scoliosis patients with limited pulmonary and cardiovascular functions. In all cases operative period exhibited stable hemodynamic parameters and respiratory function, diuresis was 2.29 ± 1.4 ml per hour. There were no transfusion reactions in patients who received only autologous blood components. Conclusion. The developed method of intraoperative blood loss replacement permitted to avoid the use of donated blood components and to improve the quality of intraoperative and postoperative course in 76.2 % of patients.

Objective. To study a possibility of cultured chondroblast transplantation into nucleus pulposus of the intact intervertebral disc for correction of structural-functional disorders at early stages of degeneration. Material and Methods. Chondroblasts isolated from the spine of newborn wild-type puppies were cultured in appropriate media. Second passage chondroblasts were transplanted into intervertebral disc of wild-type mature dogs. Specimens were extracted at 14 days, 1, 3, and 6 months and studied using biochemical, in-depth morphohistochemical, and ultrastructural analyses. Aggrecan gene expression in a transplant was analyzed by a polymeraze chain reaction. Results. Second-passage chondroblasts transplanted into intervertebral disc realize their genetic program in several steps. During first two weeks an adaptation of chondroblasts to metabolic conditions in vivo is observed. The process of cell functioning consists in auto- and paracrine regulation, and cells are under steady-state condition. The second stage includes activation of synthetic and mitotic processes, formation of extracellular matrix, and amplification of the ultrastructural organization of chondroblasts. At the third stage isogene groups, columnar structures, and chondronic organization are registered. This testifies to multilevel organization of cell functioning providing a formation of organospecific hyaline cartilage. Conclusion. Chondroblasts transplanted into appropriate metabolic medium are subjected to multilevel evolutionary fixed regulation resulting in formation of specific hyaline cartilage which can facilitate structural-functional integrity of the intervertebral disc.

Objective. To analyze the quality of medical aid to patients with combined spinal column and spinal cord injury in St. Petersburg. Material and Methods. Organization and evaluation of the quality of medical aid to 741 patients with combined spinal column and spinal cord injury were analyzed. A method of integrated quality evaluation adapted to the given problem was used with a highest index being 1.0. Results. The majority of patients with combined injury (74.8 %) were primarily cured by specialized and maneuver teams of emergency medical service. The integrated index in special medical aid teams was 0.76 for diagnosis quality, and 0.87 for treatment quality. Integrated indices for both diagnosis and treatment quality in maneuver teams were 0.75. Conclusion. Quality indices of medical aid to patients with combined spinal column and spinal cord injury in St. Petersburg at pre-admission and admission stages are low. The study showed that there is a possibility to enhance medical aid quality by the way of staff development and management quality improvement.

Objective. To reveal the spine pathology and phenotypic markers of nondifferentiated connective tissue dysplasia (DCT) syndrome, and to determine their severity level in patients with a primary juvenile glaucoma and myopia. Material and Мethods. A total of 50 patients at the age of 12 to 32 years (23 male, 27 female) with a primary juvenile glaucoma in 43 cases associated with different grades of myopia were examined. Examination in all cases included ophthalmologic and clinical study with a complex assessment of outer phenotypic markers. Spine pathology was revealed by the method of computer optical topography. Results. Phenotipic signs of connective tissue dysplasia were detected in patients with a primary juvenile glaucoma and myopia. These signs included such spinal pathologies, as flat back, scoliosis, functional instability of the cervical spine, as well as platypodia and skin changes. Grade I of connective tissue dysplasia was observed in 16 % of cases, grade II – in 80 %, and grade III – in 4 %. Conclusion. The presence of connective tissue dysplasia results in the development of myopia and primary juvenile glaucoma, and determines the progression of disease.

The glossary presents terms that are currently or have been recently used in the literature on orthopaedics, neuropathology, arthrology, and roentgen diagnostics. The treatment of some terms suggested in the glossary differs from conventional one what stems from natural progress of medical technologies, accumulation of new knowledge, and critical assessment of currently available one.