The diagnosis, classification, and choice of optimal treatment for craniospinal injuries are discussed. Special attention is paid to craniocervical trauma: a fracture of the occipital condyle, various types of atlas fractures, atlas-axial instability, associated atlas fractures, C1-C2 subluxation and dislocation, and to complications caused by such injuries.

The treatment techniques of unstable C2 vertebra arch fracture are controversial. Some authors prefer conservative methods, other - posterior stabilization. In our practice we use a stabilization of ventral column by internal fixator, what allows to correct a deformation and to provide a solid fusion at C2-C3 levels. Out from 49 patients with axis arch fracture, in 25 patients the injury was unstable. To stabilize In 10 patients the spine was stabilized by ventral interbody arthrodesis with internal fixator and autograft. Postoperative halo-fixation was required in 4 of these patients. In 9 patient halo-apparatus was used as a monotherapy. Six patients with essential contraindication to surgical intervention were treated conservatively. Three patients with type III injury - C2 arch fracture-dislocation - underwent a closed reduction (by Richet - Hueter technique) followed by interbody arthrodesis with internal fixator and autograft. In one patient the closed reduction of C2-C3 joint dislocation has failed. She underwent a twostage surgical procedure. It was noted that surgical treatment provides better outcome as compared with conservative one.

To our knowledge, atlantoaxial fractures account for 10-12 % of cervical spine lesions and for 1-2 % of total amount of spinal fractures in adults. Atlantoaxial injuries entail some difficulties in diagnosis. In most cases atlantoaxial lesions are detected in some months or years after trauma when patients appeal to specialized traumatologic or neurosurgical departments for examinations due to their increased neurological deficit. Surgical policy in 218 patients with C1 neglected and complicated traumatic dislocation is presented. The necessity of spinal decompression and reliable stabilization of the operated segments is validated. Stabilization was achieved with application of original fixative devices of shape memory alloys.

The treatment outcomes of 97 patients with thoracic and lumbar spine fractures are presented. The injuries were uncomplicated in 55 cases, while 42 fractures had neurological complications. Stabilization of the spine was achieved with transpedicular fixators (Steffee, CD, Tenor, TSRH) in 86 cases, with Z-plates in seven cases, and with Luque rods - in four cases. In case of acute uncomplicated fracture the spinal canal indirect decompression was fulfilled by means of ligamentotaxis. The instrumented fixation was complemented by a posterior-lateral fusion. Uncomplicated compression fractures of thoracic spine with a spinal canal stenosis were treated by anterior decompression and spine fixation by a wire mesh filled with autograft, and by Z-plates. The gross neurological symptoms required spinal canal decompression by an extensive laminectomy and Urban wedge resection. The displacement of vertebrae was reduced and spinal canal stenosis was totally eliminated in all cases of fracture-dislocation. A chronic posttraumatic and post-laminectomy kyphosis was corrected and fixed with the CDI system through a posterior approach. A differential choice of spine injury treatment resulted in good results in 61 % of patients, satisfactory in 32%, and unsatisfactory - in 7 %.

The authors report the analysis of large clinical data (476 patients). Basing on its results practical recommendations to optimize surgical management of patients with acute thoracic and lumbar injuries are suggested. Decompressionstabilization surgery for spine-spinal cord injury is expedient during the first hours of admittance to the specialized department but only after bringing a patient out of shock to the condition of moderate severity and after salvage operation. First three days after trauma are the optimal terms for stabilizing surgery in patients with uncomplicated spine injuries. For severe multiple and concomitant injuries the surgeries only through lateral or posterior-lateral approaches are permissible, any broadening of surgical intervention caused increase in mortality. Choice of correction and stabilization technique should be based on the character of spine fracture, surgeon's skill and equipment facilities of a hospital. If surgeon's skill is high and modern sets of instruments and implants for spine stabilization are available, it is more preferable to use transpedicular or multihooked systems and anterior spinal instrumentation. Authors have not revealed reliable differences in application of bone autografts and majority of contemporary implants for reconstruction of vertebral bodies. However, it is the authors' opinion that implants of porous material and of hollow design combined with bone autoplasty are preferable for anterior spinal fusion. The outcomes of surgical treatment were followed for 1 to 10 years.

Spinal injury, as presented in the literature, accounts for 1,5-4 % of total incidence of traumatic cases. Spinal canal deformation with spinal cord compression and the impairment of the supporting function of the injured spinal segment were considered the indication for the surgical treatment in our patients. Results indicate beneficial effects of both spinal cord decompression and reliable stabilization of the operated segments. Surgical management with NiTi porous implants as supporting and stabilizing components was performed in 288 patients with cervical and thoracolumbar spinal cord trauma. Besides in 44 patients the spinal fusion of the injured spinal column was performed with reinforced NiTi porous implants.

Posterior instrumentation of the lumbosacral spine with application of rigid fixation devices with hook supporting elements was performed in 8 patients. Out of them 3 patients had an active tuberculous spondylitis, 3 - hematogenous osteomyelitis of vertebral bodies, 1 -apathetic spine tuberculosis and 1 suffered from its consequences. From 2 to 12 vertebrae were involved. The diagnosis was confirmed histologically in all cases. Stabilization of the affected spine levels was achieved in all patients. This provided favorable conditions for graft adaptation in the zone of anterior reconstruction, permitted to eliminate pain syndrome and to activate patients significantly earlier.

Objective - to investigate spectral characteristics of laserinduced fluorescence (LIF) of bone substances, and to develop a new technique of osteoporosis diagnosis. Sixty-nine patients surgically treated for thoracic and lumbar spine fractures were examined. Clinical examinations, plain radiography in two projections, CT and MRI were used for spine fracture diagnosis. Saville index was a criterion for osteopenia. Bone mineral density was assessed by dual-energy X-ray densitometry. Histological and histomorphometric analyses were applied to 46 fragments of vertebral bodies and spinous processes taken intraoperatively, and 96 autopsy fragments of vertebral bone, spinous processes, iliac crest, and the ninth rib taken from patients died of trauma who had no metabolic bone diseases in their previous history. Fluorescence spectra were analyzed with multichannel system of spectrum registration. Gas-discharge KrF excimer laser with a wave length of λ = 28 nm and impulse energy of 5-10 mJ was used as a source of radiation. Spectral characteristics of fluorescence intensity of biological substances forming a bone tissue have shown that the most expressed fluorescence of hydroxyapatite is observed in the band of 380-450 nm. The LIF technique permits not only to differentiate the structural-functional layers of bone, but also to determine a bone tissue mineralization degree. The possibility to perform express diagnosis is one of the advantages of the technique. It is especially topical for traumatology.

Study objective. To increase the efficiency of anesthetic protection by combined use of general and epidural anaesthesia (EА) and prolonged epidural analgesia (PEA).

Material and methods. The combined general anesthesia (EA with naropin, sedation with propofol, and myoplegia with trakrium) followed by PEA with 0,2% naropin has been applied in 45 patients (Group I) out of total 104 patients. An anesthetic aid to another 59 patient (Group II) included standard multicomponent total intravenous anesthesia with calypsol, fentanil, relanium as a base, and myoplegia with arduan, in combination with artificial lung ventilation.

Results. The combined general anesthesia provided stability of hemodynamic parameters with authentic decrease in initial values of systolic, diastolic, and mean blood pressure levels at all stages of surgery. Cortizol concentration in patients of Group I was relatively stable at all surgery stages. The postoperative period was characterized by fast awakening, absence of pain syndrome and adequate pain relief by PEA with 0,2 % naropin. In Group I an average pain severity score was 2,4 ± 0,3 as compared with 5,4 ± 0,14 in Group II.

Conclusions. The suggested variant of anesthetic management provides the high level of neurovegetative protection and endocrine-metabolic stability with significant decrease in pharmacological load on a patient. The prolonged epidural analgesia is the optimum anesthetic technique, which essentially decreases the effect of a surgical stress and excludes a necessity for narcotic analgesics.

To develop a new technique of quantitative assessment of cervical spine deformation in a sagittal plane and, on its basis, a computer method of C2-C7 injury diagnosis, as well as a technique of preoperative calculation of an implant size for total correction of deformation.

Spine kinematic analysis, developed by authors, was used for unbiased characterization of the cervical spine shape and orientation in a sagittal plane. To create a normative database 40 individuals (age range 20-22 years) without any spine pathology were examined. After statistical data processing the formalized characteristics of the normal spine shape and orientation in a sagittal plane and confidence interval limits were obtained. Kinematic analysis of the injured cervical spine in a sagittal plane was the basis for the development of formalised criteria to assess various cervical spine pathologies with biomechanical parameters. Obtained data were used to develop diagnosis codes and computer diagnostic program of «lockand- key» type. Diagnosis code is formed automatically during computer processing of parameters of the spine shape and orientation in a sagittal plane. The method of preoperative calculation of transplant (implant) length is presented which allows achieving a planned kyphosis correction in the cervical spine. The transplant (implant) length is calculated by assessment of positional relationship of the lower end plate of the superior vertebra and of the upper end plate of the inferior vertebra. The application of techniques in 158 patients treated for various uncomplicated cervical spine injuries produced good results.

Objective. To define the range of body axis deviations outside of which a postural imbalance is determined.

Materials and methods. Static constituents in 25 individuals without spine pathology and pain syndrome in the previous history were studied according to data of computer optical topography and electromyography. Artificial disturbing factor in the form of the oblique pelvis was created at the expense of gradual extremity lengthening. For this purpose discrete supports with a step of 1 cm were placed in turn under each leg.

Results. Body axis oscillations with supports of 1 cm and 2 cm did not differ reliably from those without support, oscillations of interferential curve amplitude preserved their sinusoidal character with period enlargement, in other words this disturbing factor was compensated by the adaptive abilities of the organism. Body axis oscillations with a support of 3 cm reliably differed from those without support: in frontal and horizontal planes when body weight transferred to both legs and in sagittal plane when body weight transferred to the right leg.

Conclusion. Support of 2 cm is a maximum allowable disturbing factor, which organism can eliminate independently. This functional load can help to reveal in due time a latent deficiency of compensating mechanism and to organise correct treatment-and-preventive measures.

Treatment of patients with severe concomitant injuries is a hard and complicated problem due to the insufficient development of strategy and tactics of surgical aspects, which results in prolonged care terms and high mortality and disablement rates. A case of successful staged surgical treatment of a patient with severe concomitant catatrauma to the head, chest, spine, pelvis and extremities is reported.

Ankylosed spine fracture associated with Bekhterev's disease is a severe injury of the musculoskeletal system. Complex clinical and instrumental examination methods allow detecting such injuries to provide necessary treatment. Otherwise, the fracture nonunion and spine pseudoarthrosis may develop despite the increased osteogenous properties of bone tissue at Bekhterev's disease. This entails a deformation aggravation and a persistent pain syndrome, which, as a rule, is mistaken for basic process worsening. Successful treatment of spine pseudoarthrosis is possible only with a firm fixation of pathologically mobile level and a fusion with a bone graft. The most effective fixation technique in patients with ankylosed spine is a transpedicular fixation, which not only provides a level immobility, but in case of need corrects or normalizes axial deformations of the spine. Even in stable condition the fusion is necessary and preferable in ventral spine, to provide a reliable formation of bone tissue which will close a pseudoarthrosis. Due to the ankylosis of costovertebral junction a thoracotomy is a difficult surgical procedure. Ventral fusion can be performed endoscopically, which provides surgical aggression reduction and better conditions for postoperative rehabilitation of patients with this severe pathology.

The issues of quality management of specialized medical care to patients with spine trauma are discussed. The quality management system (QMS), which meets the requirements of international standard ISO 9001: 2000 has been developed, introduced, and certified ensuring high-quality medical service to a consumer. The key and auxiliary processes of medical service life cycle, their sequence and interaction are defined and described in detail. The complex standard Organization of Treatment and Diagnosis Process of Medical Care Rendering in Clinics of Novosibirsk RITO has been introduced in clinical departments providing a highly specialized help for spine traumas of various genesis. For standardization of the volume of medical services in RITO the programs of examination and treatment has been developed and introduced. They consist of uniform standards of diagnostic, therapeutic and preventive procedures, terms of hospital stay and requirements to treatment results. Introduction of QMS permits to raise significantly functioning potency and effectiveness of specialized medical institution in the field of spine surgery, quality of services rendering to patients with spine trauma, and satisfaction of consumers and other interesting parties.

The article is a review of current concepts on etiology and pathogenesis of dysplastic spondylolisthesis. Key role in the genesis of dysplastic spondylolisthesis belongs to sagittal spine-pelvis imbalance and lumbosacral dysplasia. Researches in these directions are considered the most promising and important not only for prognosis of development and clinical course of dysplastic spondylolisthesis, but also for optimization of treatment programs.

The review summarizes Russian and foreign literature on a demineralized bone graft as a stimulator of osteogenesis. Osteostimulative factors and mechanisms of their action are discussed. Advantages of demineralized bone matrix are considered in comparison with ceramic and polymer materials. Reparative regeneration mechanisms are analyzed in detail.