Historical aspects of development of techniques for treatment of pathological states of the vertebral column since antiquity till nowadays are presented in the article. Special attention is paid to surgical techniques for treatment of injuries, deformities and degenerative disorders of the spine.

The article presents literature data on social consequences of spinal diseases and injuries. Concepts of vertebrology, spine and spine-induced pathology are defined. New approach to vertebrology problem research is suggested which consists in integration of social, organizational and clinical aspects. Classifiers of spine pathologies were elaborated. The sociologic data on 24 705 patients with spine pathology who have appealed to medical institutions, 1194 persons with temporary disability and 1033 disabled persons because of spine disease and injuries, 5224 in-patients and 505 out-patients treated for diseases and injuries of the spine were studied in 8 administrative territories of Russia. Moreover 5571 patients underwent screening for spine pathology. Data on incidence, appealability, true morbidity, invalidity and temporary disability were received. Current state and future trends of development of specialized spine services are discussed.

Achievements in spine surgery in Byelorussia during last two decades are discussed. The Republican Research-and- Practical Center performs all modern surgical interventions for injuries, tumors, scoliosis, osteochondrosis and other spine disorders. New implants, fixators, correction devices of titanium and instruments for their installation are created in cooperation with MEDBIOTECH company. Innovations are widely introduced into practice.

Study Design. A clinical retrospective study was conducted.

Objective. To evaluate the clinical and radiographic outcomes of reduction followed by pedicle screw fixation and L5-S1 interbody fusion for L5 isthmic spondylolisthesis.

Methods. 30 patients underwent treatment for L5 isthmic spondylolisthesis with reduction followed by pedicle screw fixation. Interbody fusion at L5-S1 level was performed in 28 cases: in 22 cases - anterior interbody fusion by Burns method through retroperitoneal approach, in 4 cases - posterior transsacral interbody fusion with cortical allograft and in 2 cases - PLIF with Interfix cages. The average follow-up period was 29 months (range, 9-72 months). According to Meyerding grading scale there were 10 cases with Grade I-II, 17 - with Grade III-IV and 3 - with spondyloptosis.

Results. Good clinical results with complete pain relief were achieved in 93,3 % of cases, satisfactory - in 6,7 %. There were 2 cases of postoperative neurological complications. Implant breakage occurred in 7 cases without initial interbody fusion. Radiographic indexes demonstrated improvement with partial reduction and fusion.

Conclusions. Pedicle screw instrumentation followed by interbody fusion is an effective technique for L5 isthmic spondylolisthesis, as assessed by radiographic and clinical criteria. Pedicle screw instrumentation for high-grade spondylolisthesis requires interbody fusion with cortical allograft.

Authors suggest a new tactics of surgical treatment of spondylolisthesis, which is based on rich clinical experience (64 patients). The new technologies of preoperative planning and individual plates for spine stabilization make possible to perform operations through mini-invasive retroperitoneal anterior approach. Such operations are also effective in complex cases of FBSS. The observing during 6 months to 5 years has displayed good results in 95,3 % cases. An analysis of complications and methods of their elimination was conducted.

Controversial data concerning specific syndromes of articulationes zygapophysealis (ZA) arthrosis and clinical value of this disease are still reported by many authors. Spondyloarthrosis, which is known as «facet syndrome» in foreign literature, is associated with spinal osteochondrosis, therefore, its reflex syndromes are often considered by doctors as osteochondrosis symptoms. Compression syndromes of spondyloarthrosis are still not well studied even by specialists in vertebrology because they are not common.

Paracentetic chemical stimulation was performed in the area of clinically urgent ZA in 100 studied patients in order to induce noncompression (reflex) syndromes. Analysis of localization and the character of induced pain reflex syndromes made it possible to rate these syndromes according to classification scheme. Chemical denervation of ZA removed pain reflex syndromes, depending on the pathologic impulse generated from ZA, and validated the results of these treatmentand- diagnostic blockades. In 89% of our patients with reflex syndromes of spondyloarthrosis the results were rated as excellent or very good.

Surgical management of spinal artery compression caused by marginal osteochondrous vegetation of articular processes was found to be effective in 16 patients. Excellent and very good results were found in 8 out of 11 patients following root decompression on cervical level; in 2 patients operated on thoracic level; and in 80 out of 98 patients operated on lumbar level.

When compression syndromes are combined with reflex syndromes of spondyloarthrosis («spondyloarthrosis focus»), then therapeutic measures, besides decompression, stabilization and decompression-stabilization surgical procedures, should involve conservative treatment utilizing paracentetic denervation of articulationes zygapophysealis.

The experience in treatment of degenerative lumbar spine by the dynamic fixation with DYNESYS instrumentation (Sulzer Medica, Switzerland) was analyzed. From 2000 to 2003 the dynamic fixation was performed in 49 patients. Stabilization was combined with decompression in 44 patients, and pure stabilization was performed in 5 cases. The postoperative period was characterized by fast regression of pain syndrome, which was determined by segmental instability as well. Long-term results were followed up to 34 months. Pain and neurologic syndrome recurrences were not registered. Dynamic fixation, which preserved mobility in operated segments, created optimal functional conditions for patients' postoperative adaptation to regularity of living. Radiological examination did not reveal pedicle screw fracture or migration. Reduction of bone tissue density around screws in one case was asymptomatic. Cinematic analysis of the spine radiograms confirmed the maintenance of mobility in operated spinal segments but with less range of motion than before operation. Correction of the spine shape and orientation was not observed.

The purpose of the study was to justify the use and evaluate the effectiveness of Nd-YAG laser in surgery for extramedullar tumors (EMT). Analysis of clinical-neurologic, MRI and radiological data revealed the benefits of Nd-YAG laser for microsurgical resection of EMT. Safe and effective power of Nd-YAG laser functioning is 30-35 Vt. Its use provides less traction and thus less traumatic lesion to the spinal cord and its roots, less intensity of focal symptomatology and higher quality of patient's life in postoperative period than the traditional surgery. High coagulation ability of Nd-YAG laser enables to reduce blood loss almost in 2 times and increase the degree of efficacy of EMT removal by 7.1 % as compared with traditional methods. The developed original techniques of laser surgery allow to diminish traumatic lesion caused by surgical approach and to resect EMT only through hemi- and interlaminar approaches.

The peculiarities of congenital kyphosis were studied in 98 patients. The modification of congenital kyphosis classification is based on the differences of the anatomic-radiological form of abnormalities. Few subtypes of congenital kyphosis were indicated. The subtypes of congenital kyphosis vary in the clinical appearance, degree of spinal stenosis, the age of the pain syndrome onset and frequency of neurological deficit.

Long-term experience in purposeful experimental and clinical investigations of spine surgery problems accumulated in Russian Center for Spine Pathology at the Research Institute of Traumatology and Orthopaedics (Novosibirsk) and results of author's personal 44-year experience are the basis for analytic coverage of evolution stages of surgical methods that are quickly advancing and are more often used in the system of a restorative treatment of severe spine injuries during a last decade. Evolution of surgery for thoracic and lumbar spine injuries during last four decades is presented. Special attention is paid to contemporary surgical methods, which came to take place of the conservative treatment for certain clinical forms of spine injuries. Their pathogenetic validity, which determines considerable improvement of treatment results, is underlined. Contemporary surgical techniques for various upper and lower cervical spine lesions, which demand urgent diagnosis and varied treatment tactics and methods, are discussed in details. The importance of timely choice of a grounded surgical technique is shown for each clinical form of injuries in the craniocervical area and lower cervical spine. Future of spinal surgery is quite obviously related to further development of less invasive endoscopic interventions and functional stabilization of the injured interbody zone of a vertebral segment, in particular by intervertebral disc arthroplasty, when it is indicated.

The paper under report describes total disc replacement at the lumbar level through minimal invasive anterior retroperitoneal approach. The authors present a comparative analysis of this method with PLIF combined with transpedicular screws. Description of disc prosthesis is given. The authors report 2 clinical cases of total disc replacement.

Fracture of C2 dens in a close to vertical plane is rare because of peculiar mechanisms causing such injury. Its diagnosis demands clinical, plain radiographic and CT examinations. Frontal and sagittal instability in the atlantoaxial junction is caused by dislocation of dens fragment. Fixation and moderate traction along a spine long axis with a halo-apparatus provide an effective treatment of such fracture.

Authors analyzed the results of two-staged scoliosis surgery in 105 patients aged 4 to 18 years. Anterior and posterior spine surgical interventions were subsequently performed in a single day under three various types of anesthesia management. Hemodynamic characteristics and levels of blood cortisol, lactate and glucose were studied. It was established that application of anesthesia variants with clofelin stress-protector permitted to reduce considerably the manifestation of operation stress, to reduce fentanyl dose up to 50%, to shorten the period of postoperative APV, terms of conscience restoration, cough reflex and extubation with preservation of effective analgesia. Use of dormicum permits to achieve quick awakening of a patient in post-anesthesia period without adverse side effects. Intraoperation spinal cord monitoring in 8 patients is presented. A variant of anesthetic management based on propofol and nimbex is a method of choice in situations when planned waking up of a patient is necessary during the stage of spine correction.

Authors' developments and analytical review of modern approaches to studying the motor functions of the spine are presented in the article. Critical evaluation of advantages and shortcomings of each method and prospects of their use in the clinical practice are discussed. Authors suggest classification of existing methods for study of spine motor function. Ways of further improvement and development of methods for spine biomechanics study applicable in the clinical practice are outlined.

The article discusses problems related to back pain. Up to date a description of this pathology is a subject of much controversy, there is no common view on a cause of the pain syndrome onset and localization of pathomorphologic substratum. Solution of these problems will allow to arrive at an understanding among specialists engaged in this problem.

It is genetically determined asymmetrical growth distortion, that appears pathogenetic mechanism of spine deformation. Our report is devoted to the investigation of regularities in chondroblast differentiation and proliferation during the intensive growth period. Methods of profound morphology and biochemistry were used to study main structural cell components and matrix in critical periods of ontogenesis. It was found that correlation and location of separate zones, quantitative and qualitative cell distribution along with the synthesis intensity depend on growth intensity, according to which proliferation and differentiation indexes of chondroblasts change. Regulation growth mechanisms in norm are considered. Possible versions of distortion in growth processes under pathology conditions are discussed.

An implant for intervertebral fusion made of porous nickeltitanium (PNT) was evaluated in the ewe. Sixteen ewes received each one two implants: the system «Bagby and Kuslich» (BAK) being used as control and the PNT. The objective was to evaluate the osteointegration, osteoconduction and bone growth in the presence of these two cages subjected to the same mechanical loads. After implantation, the sheeps were sacrificed by group to three different periods: three, six and twelve months, and the spines carrying the implant were taken. The qualitative (microscopic and visual observation) and quantitative (histomorphometry) histological analyses were carried out on histological slices of cages and adjacent tissues. The results indicated that the PNT, had performed better than the BAK. A rigorous statistical analysis of these results made it possible to confirm this observation. The performance of two implants seemed to be influenced by the biofonctionnality which is related to the structure and the shape of the implant. The biocompatibility of two implants seemed however comparable.