Objective. To determine treatment tactics for spine and spinal cord injuries in multitrauma patients.

Material and Methods. 184 patients with spine and spinal cord injuries combined with multiple traumas were treated at Sklifosovsky Clinical and Research Institute for Emergency Medicine in 2000–2003, out of them 141 patients underwent surgical treatment. Diagnostic algorithm included general and neurologic examinations, ultrasound studies of the abdominal and pleural cavities, radiography of the skull, pelvic, ribs, injured extremities and all spine levels, and spine myelography and CT. Patients were examined by resuscitator, neurosurgeon, traumatologist and surgeon. Hemodynamic and arterial blood characteristics were monitored in critically ill patients. To assess the severity of multiple trauma the ISS scoring system was used.

Results. Single-stage operation in the spine and bones of the skeleton was performed in 13 patients, first-stage spine surgery (preceding another intervention) – in 39 patients, second-stage spine surgery – in 24 patients, and 65 patients underwent a spine surgery alone. Neurologic status improved in 60 patients. Total lethality was 22 % and postoperative one – 14 %.

Conclusion. Direct relation between surgery outcome and severity of multiple trauma was reveled. Application of upto- date transpedicular and laminar fixation techniques, and halo-apparatus provides the possibility to perform twostage surgery for complicated unstable vertebral fractures in patients with severe trauma.

Objective. To analyse the possibility of diagnostics improvement in children with spinal cord injuries.

Material and Methods. The observations of 147 cases of various spinal cord injuries in children at the age of 11 months to 15 years have been analyzed. Causes of trauma, age peculiarities of spinal injury manifestations, and difficulties of clinical and radiological diagnostics are discussed.

Results. Most cases of spinal cord injury in children could be revealed and adequately managed at a prehospital stage. It should be noted that the spine lesion and MRI changes do not always accompany spinal cord injury in children. This observation must be taken into account while making diagnosis.

Conclusion. Electromyography is an important examination confirming spinal cord injury without radiographic abnormalities (SCIWORA syndrome) in children.

Objective. To define the most effective assemblies of external transpedicular fixator for correction of kyphotic and scoliotic deformities of the spine.

Material and Methods. Treatment results in 108 adolescents with different kinds of III–IV degree scoliosis and kyphosis were studied. The spine deformation degree was assessed in accordance with V.D. Chaklin’ classification. Neurological examination have shown the absence of major neurological disorders. Deformation correction was performed with device consisting of transpedicularrods which were fixed to anchorage plates and coupled into support bases.

Results. The application of the fixator with additional lateral traction is optimal to correct C-shaped scoliosis and the frame with damping device allows correcting the curvatures of S-shaped deformities within a short time, in some cases even hypercorrection can be achieved. The application of additional fixing rod is fruitful in kyphosis correction.

Conclusion. The application of the external transpedicular fixator under radiological and clinical control allows the correction of various spine deformities without neurological deficit with the account of spine biomechanics.

The literature review is devoted to the important problem – orthotics in children and adolescents with idiopathic scoliosis (AIS). The main types of braces used in complex treatment of these patients are described. The indications for orthotic treatment and its results were analyzed. The orthotics potentialities in conservative correction of spinal deformities were shown.

Objective. To estimate results of surgical treatment of mobile forms of high-grade scoliosis by CDI with preliminary halo-pelvic-traction and without it.

Material and Methods. The outcomes of surgery for III–IV Grade scoliosis in 70 patients were analyzed. One stage dorsal deformity correction with CDI combined with posterior spinal fusion was performed in 38 patients. In 32 patients the instrumented correction was preceded by halo-pelvic-traction without anterior release. Mobility of the spine was estimated with Kazmin’s stability index, mobility index, correction at traction, and index of postoperative correction.

Results. In Group 1 the Kazmin’s index of stability was 0.82, and in Group 2 – 0.85. The mobility index was 55.96 in Group 1, and 62.90 in Group 2. Correction at traction was 44.04 in Group 1, and 37.10 % in Group 2. In Group 1 the achieved correction was 56.4 % and in Group 2 – 55.4 %. In Group 1 a deformity correction with CDI exceeded initial spine mobility by 20 % and in Group 2 – by 40 %. In both groups a disc height increased by 40 % on a concave side and decreased by 20 % on a convex side. Lordoscoliosis predominated in both groups (17 patients in Group 1, 15 – in Group 2). Kyphoscoliosis was in 9 patients in Group 1, and in 8 – in Group 2. Postoperative sagittal profile became normal in a majority of patients in both groups. There was no considerable derotation in patients of Group 1. In Group 2 a rotation of the whole spine in one direction was recorded after halo-pelvic-traction.

Conclusion. The CDI allows achieving significant curve correction in patients with mobile forms of scoliosis (more than 50 %). Preliminary halo-pelvic-traction without anterior release could be effective in patients with severe and rather mobile forms of scoliosis.

Objective. To analyze the dependence of the spine shape and orientation in a sagittal plane on localization of a flexion deformity associated with Bekhterev’s disease, and the outcomes of surgical deformity correction.

Material and Methods. The kinematic analysis of sagittal plane spondylograms of 44 patients (43 men and 1 woman, aged 21 to 49 years) with Bekhterev’s disease before and after surgery was performed basing on author’s classification of kyphotic deformities. Illness duration was 7 to 22 years.

Results. One-level correction vertebrectomy caused the increase of lordosis at two or three levels in 50 % of cases. Correction vertebrectomy for flat lumbar kyphosis resulted in normalization of all biomechanical spine parameters characterizing its shape and sagittal orientation in 100 % of cases. Lumbar vertebrectomy for flexion deformity in the thoracic spine normalized sagittal position of vertebrae only in isolated segments. Cosmetic hyperkyphosis remained, though the trunk orthostatic position had been restored. Similar results were recorded in the group with multilevel deformities. Lost of correction at vertebrectomy level and progression of flexible deformity above vertebrectomy were not revealed. Kyphotic deformity formation (ranged 16.0° to 32.0°) at the segments caudal to vertebrectomy was observed in 10 % of cases.

Conclusion. Flexion deformity localization in the spine determines the condition of its further progression in many respects. Correction lumbar vertebrectomy while reconstructing orthostatic trunk position does not always result in complete normalization of vertebra sagittal position in anchylosis spine.

Objective. Using high informative studies to analyze osteointegration processes in the presence of titanium implants and postoperative changes in the spinal canal after its decompression.

Material and Methods. A total of 362 patients (221 female and 141 male at the age of 11 to 78 years)were operated on through extraperitoneal mini-approach to anterior spine at L2–S1 level. Postoperatively all patients underwent standard radiography. High informative diagnosis methods (CT, MRI, spiral CT) were applied to 38 patients. In 38 patients data of high informative diagnostic methods were compared with radiographic findings and clinical manifestations.

Results. Complete disappearance of the pain syndrome within one year after surgery was observed in 24 patients. The pain has remitted in 14 patients. Three patients with osteoporosis had a delayed bone fusion formation. They still had a pain more than one year after surgery.

Conclusion. Radiodiagnostics after the ALIF surgery is performed to evaluate bone fusion, decompression completeness, and implant position. CT and spiral CT are more useful for the evaluation of interbody fusion, while MRI – for the qualitative evaluation of the spinal canal reconstruction.

The article is the current concept review on the problem of discogenic pain relieve by intradiscal procedures. The data for study included abstracts from the MEDLINE database over the last 10–15 years, articles published in Russian and Ukrainian periodicals, as well as in «Spine», «European Spine Journal» and other medical referral sources.

Objective. To validate the approach to treatment of patients with primary tumors of the spine.

Material and Methods. The experience of surgical treatment of 47 patients with benign tumors of the spine was analyzed. The treatment approach was defined with the account of tumor type and localization, and of patient’s somatic status. The diseased area was examined with the help of X-ray, CT scanning, and MRI, and a punch biopsy in some patients.

Results. The tumor recurrence was registered in 6 (14.6 %) patients. This shows that in some cases the exact margins of the tumor were not defined despite the comprehensive diagnostic possibilities. Functional results of the treatment implied the restoration of the spine support ability and the pain regress in all observations. Bone plasty was the method of choice for interbody defect replacement.

Conclusion. The radical surgery (corpectomy and spondylectomy) considerably reduces the risk of tumor recurrence. Lumbosacral location of the tumor with paravertebral extension presents serious technical problems in its total removal. Autogenic cortical cancellous bone proved to be a good plastic material for defect replacement after vertebra resection and fusion.

Objective. To study the reliability of musculoskeletal system (MSS) parameters obtained with the help of computer optical photometry.

Material and Methods. The study included 36 children distributed into clinical and age groups. The following parameters were used for MSS assessment in children: 1 – angle of shoulder girdle inclination; 2 – angle of pelvic girdle inclination; 3 – upper area index; 4 – lower area index; 5 – combined deviation of shoulder and pelvic girdles; and 6 – angle of body axis deviation from the plumbline.

Results. The study has shown a reliable parameter spread (p < 0,05) in younger children with low-grade spine deviations in contrast with that in elder children with significant spine deviations in a frontal plane. Authors offer to assess not the angular parameters themselves, but a ratio of their derivatives. As the derivative of the absolute magnitude (angle) the area of triangle made by this angle is used. Such parameters are the area indices of shoulder and pelvic girdles. The absolute magnitude derivatives appears to be the reliable parameters for all age and clinical groups (p < 0,05).

Conclusion. It is reasonable to use the ratio of derivatives of angular parameters of spine deviation in a frontal plane for the assesment of MSS in children during screening examination. Absolute angular parameters in identification of lowgrade deviations in a frontal plane, especially in younger children, show a significant mean deviation which raise a doubt about their reliability.

The aim of this study was to examine the effect of the presence of two types of metallic intervertebral lumbar fusion implants (a porous nitinol and a hollow titanium cylindrical implants) in the implant peripheral tissue after 3, 6 and 12 months post-implantation in a lumbar sheep model in order to evaluate and compare the biofunctionality and biocompatibility of both implants. 19 sheep were used to evaluate this bone density variation using computer tomography (CT). 16 of them received both implants at either level L2–L3 or L4–L5 and 3 other non-treated animals were used as controls. Results indicated that PNT obtained a superior biofunctionality that the conventional titanium implant. However, the biocompatibility of porous nitinol seemed comparable to that of titanium – a well-known long-term implant material.

Objective. To analyse the mechanism of Sheuermann’s disease genetic determination in a representative samples of pedigrees and to identify its hereditary phenotypic signs.

Material and Methods. Patients with Scheuermann’s disease (90 probands and 385 relatives of 1st–3rd relation degree) were examined using clinical-genetical, optical topographical, and radiological methods.

Results. Scheuermann’s disease incidence among closest relatives of the probands was 0.143 in sisters (n = 21), 0.476 in brothers (n = 21), 0.250 in mothers (n = 84), and 0.743 in fathers (n = 35). These values significantly exceed the incidence in general population, what confirms a familial aggregation of Scheuermann’s disease. The incidence was higher in brothers and fathers of the probands than in their sisters and mothers, respectively. Both parents have been examined in 32 probands. Out of these families 5 had both parents unaffected, 22 families had affected fathers, 4 families had affected mothers, and 1 family had both parents affected. This also indicates that men are more predisposed to Scheuermann’s disease than women.

Conclusion. Segregation analysis has shown that Scheuermann’s disease is a genetically dependent pathology inherited by autosomal dominant type and controlled by major gene with full pentrance in boys and 50 % penetrance in girls.