To correct and stabilize spinal segments in scoliosis the external fixators are used at the Department of Neurosurgery, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics.

Surgery was performed at several stages. At the first stage a costal humpback was resected; at the second stage transpedicular insertion of half-pins above and below the apex of the curvature arch, the fixator assembling and deformity correction were performed. At the third stage the achieved correction was stabilized. Stabilization of countercurvature arch was carried out at stage IV. The fixator was removed when a bone or bone-fibrous block was formed.

Discotomy of one or two discs at the scoliotic arc apex was performed through posterior approach in 43 patients. Out of them in 17 patients autografts were inserted bilaterally into the disc space. Posterior spinal fusion with autoribs was performed in 9 patients; anterior fusion with autobone - in 6 patients, with homobone - in 11 and with porous nickeltitanium - in 53 patients. The mean period of treatment with the fixator was 6 months, including 2.5 months of prolonged deformity correction, and 3.5 months of fixation. To support the obtained correction after fixator removal the patients used a brace for 6-12 months.

Use of the external transpedicular fixator allows maximum possible correction of spine deformity, prevention of neurologic and vascular complications related to one-stage correction, and to create optimal conditions for spine reorganization maintaining its mobility after the deformity correction. For effective deformity correction without any neurologic consequences in case of III-IV degree scoliosis we consider expedient the formation of anterior "wedging" body fusion on the concave side of the curvature apex. The results obtained suggest that the use of the porous nickel-titanium implants for anterior spinal fusion has given the possibility to decrease the risk of postoperative deformity progression at the expense of the implant mechanical strength, and to reduce the period of treatment due to their high adaptive properties.

Study Design. A clinical retrospective study was conducted.

Objective. To evaluate the clinical and radiographic outcome of anterior and posterior instrumental correction for lumbar and thoracolumbar scoliosis.

Methods. Thirty-three patients who underwent anterior and/or posterior surgical reconstruction for thoracolumbar and lumbar scoliosis were included in this study. Out of them there were 14 adolescents (range, 14-16 years) and 19 - adults (range, 32-62 years). In 7 adolescents correction was performed with CDI, and in 7 - with anterior Hopf instrumentation. In adult patients only posterior instrumentation (CDI) was used. Seven patients underwent only correction and posterior spinal fusion. In 10 cases with clinical and radiological signs of spinal stenosis multilevel decompression and posterior instrumentation were performed and out of them 5 cases were followed by additional interbody fusion with Interfix cages.

Results. The correction of deformity in adolescents treated with anterior or posterior instrumentation ranged from 40 % to 90 %. In patients with anterior instrumentation correction of the total curve and central angles was insignificantly higher. In adult patients clinical improvement with pain relief was achieved in all cases. Radiographic investigations demonstrated improvement with partial correction of deformity and fusion.

Conclusions. Both anterior and posterior instrumentations are effective techniques for the management of lumbar and thoracolumbar scoliosis in adolescents. In adult patients with lumbar and thoracolumbar scoliosis the goal of surgical treatment is first of all clinical and neurological improvement, which can be achieved by spinal decompression followed by posterior instrumentation.

Comparative assessment of the surgery outcomes in patients with adolescent idiopathic scoliosis operated on with CDI and Harrington rods was carried out. The evaluation was performed using routine X-ray for Cobb angle estimation and original computer optical topography for quantitative analysis of patients' back surface. Seventy-six patients were examined before, immediately after the corrective surgery and 2 years later. Out of them 41 were operated on with CDI and 35 with the Harrington rods. Computer optical topography demonstrated marked changes in a back shape and position of patient's trunk in three-dimensional space. Dynamic follow-up also revealed the different 3-D changes in patients who have been operated on with CDI and Harrington rod.

Objective. To develop algorithm for planning of surgical intervention in patients with progressing congenital scoliosis.

Materials and methods. The results of surgical treatment of 35 patients with various modifications of Cotrel - Dubousset instrumentation (CDI) were studied. Out of them 29 patients were women and 6 - men. The age varied from 5 to 39 years (М = 15,4 years). All patients were divided in two groups. In the first group (n = 25) the algorithm of planning depending on apex localization of a blocking basic arch in the curve, and also on inclusion in the block of its mobile and rigid levels adjacent to basic arch was used. Five subgroups of deformity localization were differentiated: upper thoracic, thoracic, thoracolumbar, lumbar and lumbosacral, according to which 5 algorithmic block diagrams were offered. In the second group (n=10) the offered algorithm was not used. Follow-up terms were from half a year to three years.

Results. Use of the offered algorithm in the patients of the first group allowed achieving good results. The absence of algorithmic planning in the second group resulted in unsatisfactory results (deformity progression, trunk misbalance) in many patients.

Conclusions. Use of an offered method provides precise determination of the spinal fusion extent of the basic and compensating arches, permitting to reduce the number of cases of deformity postoperative progression and trunk decompensation development, and thus the necessity of reoperations.

A case of successful application of Cotrel - Dubousset instrumentation in a patient previously treated with Harrington distracter for progressing scoliosis is reported in the article. Surgery was performed in two stages and trunk balance was normalized.

Objective. The purpose of this study was to determine influence of various factors on an estimation of surgery outcomes with a Russian version of Scoliosis Research Society Outcomes Instrument-24 (SRS-24).

Materials and methods. Questionnaire SRS-24 has been developed for patient self-assessment of outcome after scoliosis surgical correction. It includes 24 questions in 7 domains. Each of 100 patients, which underwent surgery answered the questionnaires at controlled follow-up (232 questionnaires).

Results: Regarding pain and a level of professional activity, boys demonstrated the best parameters, and regarding function after operation, satisfaction by results and the consent to operation, the girls did. Patients with congenital deformations demonstrated the best parameters at an estimation of pain and a level of the general activity, and patients with idiopathic scoliosis - at an estimation of appearance and function after operation. CDI application provided the best parameters at an estimation of pain syndrome, function after operation, the general and professional activity, and Drummond technique - at an estimation of result satisfaction and the consent to operation.

Conclusion. Questionnaire SRS-24 is an attempt to estimate surgery outcomes in patients with scoliosis taking into account patient satisfaction. The questionnaire is simple in filling, does not demand additional financial expenses, and is convenient for interpretation.

To assess the quality of life, changes in self-estimation and satisfaction with surgery, 50 patients, who underwent dorsal correction and Cotrel - Dubousset instrumentation, completed standard Scoliosis Research Society questionnaires. It was revealed that alongside with some decrease in daily and sport activity after surgery there was reliable improvement of variables of all other criteria. As a whole all patients demonstrated high satisfaction with surgery outcomes, and abatement of sufferings related to scoliosis.

Cardiorespiratory system was examined in 47 patients with severe thoracic scoliosis: Grade III - 23 patients and Grade IV - 24 patients. Examination included evaluation of external respiration function, echocardiography (ECHOCG), and bicycle ergometer test (BEMT). It was shown that the function of external respiration was reliably lower in patients with Grade IV scoliosis than this in patients with Grade III. ECHOCG revealed reliable enlargement of the right ventricular and thickening of its wall as well as considerable increase in pulmonary hypertension. Tolerance to physical load at BEMT and working capacity were reliably lower and the term of restoration was longer in patients with Grade IV scoliosis. Progressive deterioration of cardiorespiratory functional parameters indicates that timely surgical correction of scoliosis is necessary.

The development of neurological impairments tragic for a patient is one of the most dangerous complications after surgical correction of severe spine scoliotic deformities. The main task of a surgeon and anesthesiologist during such operations is the earliest awakening of a patient and recovery of his muscle activity for timely postoperative estimation of neurological status. Some cases require an intraoperative monitoring of spinal cord function. Myorelaxant (Nimbex) was introduced in the anaesthesia program for surgical correction of Grade IV scoliosis in 58 patients. Study revealed that neuromuscular block is easily controlled and has a rather short period of spontaneous recovery regardless of surgery duration. This provides correct estimation of neurological status both at the stage of spine deformity correction and immediately after surgery. Intraoperative cardiovascular stability and absence of side effects prove the clinical safety of Nimbex use in children and adolescents with a high surgical risk.

Shape and frontal plane orientation of the spine were evaluated in 40 patients with congenital scoliosis by means of kinematics analysis. Six typical forms of the deformities related to a zone of anomaly localization have been differentiated, and their biomechanical characteristics are presented. The atypical forms of spine deformation arising in the presence of additional anomaly zone are revealed. Their comparative biomechanical characteristics are discussed.

Blood serum of children with idiopathic scoliosis injected into experimental rat’s spinal canal causes changes in motor reactions in the back extremity muscles. Mostly the side of these changes is similar to the curve pattern in children (in case of the right curve scoliosis the changes occur in the right side, and in the left curve scoliosis - in the left). The summery index of recipient’s motor disorders correlates with the severity degree of child’s disease. The model has been worked out which permits to reproduce motor disorders in children with idiopathic scoliosis.

Vertebral body growth plates of concave and convex sides of a curve in III-IV degree idiopathic scoliosis were studied by methods of morphology, biochemistry, and ultrastructural analysis. The concave side of vertebral body growth plates has shown zonality impairment, decrease in chondroblasts synthetic potentials, and alteration of cells ultrastructural organization. The synthesis conversion to keratansulphate is observed. The appearance of chondroblasts in cytoplasm and of keratansulphate-related fraction of proteoglycans in matrix combined with chondroitinsulphate number decrease is regarded as reflection of genetic disorders in homeostasis regulation in "cell-matrix" system. The growth asymmetry related to the expression of mutant gene, which regulates the morphogenesis of lateral zones of vertebral body growth plates is a pathogenetic mechanism of deformation development. The hypothesis of secondary compensatory growth zone is presented.

Computer optical topography study of posture and spine shape is carried out in 3963 children and adolescents of the north of Tyumen area. The examined persons are divided into three clinical groups depending on an ethnic belonging and environment conditions: children of north aborigines living in habitual environments and conditions of life; children of the urbanized aborigines; children of non-aboriginal new settled population. Control group included 2200 children from Novosibirsk. Distinctive features of posture and spine shape in these groups are revealed. The trunks of north aboriginal children have smaller longitudinal size and larger transverse one comparing with this in non-aboriginal children. Aborigines living in habitual environments have more harmonious and balanced posture comparing with this in other groups. Prevalence of scoliosis in children of no-aboriginal new settled population is much higher than in children of aboriginal population living under habitual natural conditions of countryside.

The article contains an original definition of preventive pediatric vertebrology as a scientific direction engaged in primary prophylaxis of spine diseases in children population. Methodological scheme of hygienic anthropologic pathology is presented and on its basis methodological scheme of preventive pediatric vertebrology is suggested. Intensive investigation of six main directions in preventive pediatric vertebrology permitted to solve theoretical and practical aspects of early diagnosis and treatment for spine diseases in children both at individual and population levels.

The nature of idiopathic scoliosis, the most frequent spinal deformity, remains unknown. The current theories of aetiology, pathogenesis and pathomechanism of this condition are presented.