During recent decades the spine specialists’ views on mechanism and nature of various injuries of the subaxial cervical spine have changed and become fuller. This predetermined the choice of pathogenetical therapy for each type of injury. In this respect the concept of treatment regimen for cervical spine injuries is presented from long-term experience of Trauma Clinics of Novosibirsk RITO and newer literature data. The problems of clinical semeiology, radiodiagnosis, lower cervical spine injury classifications are discussed. Issues of conservative and surgical treatment choice, medical rehabilitation of all types of subaxial cervical spine injuries in accordance with modern classification are considered in detail.

Objectives. To estimate macroscopically the strength, rigidity and limit of elasticity in the “spinal segments – transpedicular fixator” system. versus similar characteristics of the intact spine under dislocating rotational loads.

Material and Methods. Еxperiments with anatomic specimens of Th12–L2 segments were performed. Unstable damages of L1 and transpedicular fixation with 4 screw transpedicular spinal system were imitated. All specimens were exposed to the testing rotational load in universal test machine Zwick 1464.

Results. It is established that under rotational load general strength of the injured Th12–L1–L2 spinal segments fused with transpedicular fixator is 20 % lower than that in a corresponding intact spine segment. Rigidity parameters of fused segments are 17.5 % lower than those of intact segments. Destabilization of «spinal segments – transpedicular fixator» system under rotational loads is caused by the compression of a bone substance in Th12 and L2 bodies with screws and a turn of screws around longitudinal rods due to a rod slip in anchoring elements.

Conclusion. The performed study may serve a basis for following data analysis from a viewpoint of metal resistance and for development of optimal rehabilitation loads to the injured spine during postoperative period.

Objectives. To analyze the outcomes of halo-traction for treatment of the upper cervical spine injuries.

Materials and Methods. The outcomes of treatment of 354 patients with the trauma of the cervical spine were analyzed. Out of them 150 patients had injuries of С1–С2 (42,4 %). Bipolar halo-traction was used for treatment of fresh, old and neglected injuries with fragment dislocations in the upper cervical spine. Clinical, radiological and CT examinations of the cervical spine were performed.

Results. Bipolar halo-traction was performed in 31 out of 59 patients with transdental dislocations, in 14 out of 26 patients with traumatic spondylolisthesis, and in 9 out of 13 patients with multifocal disorders. Monopolar halo-traction was used in 3 out of 7 patients with С1 Jefferson fractures. Satisfactory results were achieved in 47 out of 48 patients treated by halo-traction. The treatment has failed in one patient with a false joint of the dens and atlanto-axial instability.

Conclusions. Bipolar halo-traction is effective for acute monofocal or multifocal injuries of the cervical spine, and for pathological course of bone regeneration after fractures of the upper cervical vertebrae.

Objectives. To analyze the degenerative process in the lumbar spine in patients with and without scoliosis, in order to determine potential risk factors, which may be related to the development of de novo scoliosis.

Material and Methods. In 121 adults (≥50 years), analyzed radiological parameters included: listhesis, wedging, and height of each lumbar vertebra, wedging and height of each disc, length of vertebral spurs, lumbar lordosis, lumbosacral, lumbo (L5) horizontal and sacro-horizontal angles, pelvic tilt on A-P X-ray, depth of L5 from the intercrest line, also – if present – pattern of curve, and level prsenting with the most obvious degenerative changes (MODC). Uni- and multi-variate statistical tests were used for analysis.

Results. Degenerative changes were most obvious in the middle lumbar region. MODC at the L2 vertebra/L2–L3 disc and L4 vertebra/L4–L5 disc levels were more frequent in cases with scoliosis (p = 0.013; p = 0.022, respectively). Upon multivariate analysis the presence of scoliosis was closely related to the presence of lateral listhesis of L3, wedging of L3–L4disc, or pelvic tilt (p = 0.000; p = 0.000; p = 0.001, respectively). Cases with MODC at the L3–L4 disc level, or a more cranial apex of curve had a higher degree of scoliosis (p = 0.009; p = 0.017, respectively). Whereas, MODC at the L5–S1 level coexist with a low degree or no scoliosis (p = 0.009). Degenerative changes in the middle lumbar region, and pathologic conditions in the hip or lower extremities resulting in pelvic tilt, are frequent findings in cases with de novo scoliosis. Likewise, asymmetric degenerative changes at the L3–L4 disc level, and a more cranial apex of curve, were associated with an increased scoliotic curve. However, degenerative changes at the L5 vertebra/L5–S1 disc level carries lower risk in producing scoliosis.

Conclusion. Degenerative changes in the lumbar spine are more intensive in its upper and middle parts, particularly at the level of L3 vertebral body and L3–L4 disc.

Recent literature review includes general statements on the origin, prevalence and conventional criteria for neurofibromatosis diagnosis. Peculiarities of spine, single vertebra, and rib deformities developing in neurofibromatosis are described in detail. Special attention is given to such complications of pathological process as vertebra dislocations and neurological disorders. Pathological changes in the cervical spine often associated with neurofibromatosis are described in detail. The review presents a large body of literature data on conservative and surgical treatment techniques of scoliosis and kyphoscoliosis, and on their efficacy.

Objectives. To assess the possibility of application of transpedicular fixation for congenital spine deformities in patients early than 5 years old.

Materials and Methods. Eleven patients aged from 1.5 to 5 years with congenital vertebral scoliosis and kyphoscoliosis caused by abnormalities in formation of thoracolumbar and lumbar vertebrae were operated on using spinal instrumentation with transpedicular support elements. Four patients had single vertebra malformation, and seven patients – multiple ones.

Results. Surgically achieved correction of the deformity was 92–100 % for a single hemivertebra and 50–70 % for multiple abnormalities. Stable fixation was achieved in all cases. The use of transpedicular supporting elements in infants with congenital scoliosis resulted from vertebral formation failure in thoracolumbar and lumbar spine is a method of choice in cases with severe deformity and underdevelopment or absence of posterior vertebral elements.

Conclusion. Installation of transpedicular screws in infant’s lumbar vertebral bodies is a realizable procedure, which has some advantages as compared with traditional hook supports.

Objective. On the basis of clinical and anatomico-functional results of surgical treatment of patients with degenerativedystrophic disease of the lumbosacral spine to develop and introduce into clinical practice orthopaedic surgical approaches aimed mainly to the correction and stabilization of the spine.

Materials and Methods. The results of surgical treatment of 340 patients operated on for degeneconventionally and by the technique proposed by authors with the account for orthopaedic factors rative-dystrophic disease of the lumbosacral spine were analyzed.

Results. The treatment outcome was mainly influenced by the following factors: spinal stenosis, instability and lumbosacral shape (balance) disturbance. The pattern of preopreative planning was developed on the basis of the introduced comprehensive methods of diagnosis. The suggested approach to surgical treatment has gone through clinical approbation resulted in recommendations for its application in practice. The paper presents the advantages of use of modern neuroorthopaedic technologies for various forms of spinal stenosis, and orthopaedic correction techniques in patients with discogenic radiculopathy associated with instability and deformity of the lumbosacral spine.

Conclusion. The modern level of neuroorthopaedic care suggests new approaches to diagnosis and surgical management of patients with degenerative-dystrophic disease of the lumbosacral spine.

Objectives. To develop algorithms of deferential choice of microsurgical approach and application of endoscopic video monitoring related to phases of disease clinical course and data of radiologic examination.

Materials and Methods. The study was based on the analysis of 542 cases with primary (489 patients; 90.2 %) and relapsing (53 patients; 9.8 %) lumbar-sacral disc herniations, which caused chronic discogenic pain syndromes.

Results. Phases of a clinical course were determined depending on a clinical picture of discogenic compression. Comparative analysis of results of preoperative radiographic diagnosis and intraoperative verification of a level, localization and causes of neurovascular compression in the lumbar spine were carried out. The informative diagnostic value of contemporary radiological techniques was estimated. The most frequent causes of postoperative recurrences of pain syndromes were revealed. Advantages of endoscopic video monitoring, used at the most important intraoperative stages both in primary and repeated operations, were substantiated.

Conclusion. The choice of approach depends on a phase of a clinical course of discogenic compression, on a nature of herniation, as well as on anatomico-topographical relations of disc herniation with nerve root, dural sac, and spinal canal structures.

The paper presents an analytical literature review on pain relief by denervation of spinal facet joints for spondiloarthrosis. Abstracts from Medline Database and papers from Journal of Bone and Joint Surgery, Spine, European Spine Journal, and other relevant medical journals for last 10–15 years were used in preparing the review.

Objective. To define optimal pathogenetic surgical techniques for pain syndrome recurrence after lumbar discectomy.

Materials and Methods. The study included 176 patients operated on for pain syndrome recurrence. Decompressive and decompressive-stabilizing (posterior or anterior interbody fusion, dynamic fixation with DYNESYS instrumentation) reoperations were performed. The results were followed for 3 to 24 months. The dynamics of neurologic status and pain syndrome intensity were assessed with visual-analog scale and Osvesty index.

Results. The main causes of pain syndrome recurrence were a herniation of the operated disc (52.8 %) and its combination with degenerative stenosis (9.7 %). Degenerative stenosis alone was a cause of pain recurrence in 21.6 % of cases. Hernia recurrence of the operated disc caused a pain syndrome more frequently within 2 years after surgery. Degenerative stenosis both alone and in combination with operated disc hernia occurred more often in a later follow-up period. Hypertrophic articular processes and vertebral arches, osteophytes, thickened yellow ligament and peridural fibrosis were the pathomorphologic substrate of stenosis. Fibrous changes were revealed intraoperatively in all cases. Peridural fibrosis never was a single cause of neurovascular compression but always was combined with other stenosing factors. Treatment results were better in patients who underwent decompressive-stabilizing surgery. Repeated recurrences of pain syndrome occurred in 9.8 % of cases after surgical decompression and in 1.4 % after decompressivestabilizing surgery.

Conclusion. Decompressive-stabilizing surgery with posterior interbody fusion is a pathogenetical and technically adequate surgical treatment of pain syndrome recurrence after lumbar disc hernia removal.

The paper reports a rare case of dysplastic multilevel spondylolisthesis of lumbar vertebrae in the girl of 15 years old followed up during 7 years. The deformation pattern and its progression have lead to a necessity of palliative surgical procedure of dorsal spondylodesis with autografts from the wing of iliac crest.

Objectives. To analyze issues of surgical treatment of complicated spondylolisthesis in the lumbar spine.

Materials and Methods. Forty-five patients at the age of 14 to 62 years were operated on with a device for external transpedicular fixation. All patients underwent clinical, radiological and physiologic examinations. To characterize the degree of spondylolisthesis the Meyerding classification was used. Grade I and II dislocations were treated by laminectomy of a displaced vertebra, excision of scars and mobilization of a dural sack, discectomy at a pathologic level involving both end plates of the adjacent vertebral bodies, impacting of 2 autografts (of the bone excised during laminectomy) into a disc space, and placement of a device for external transpedicular fixation. For Grade III and IV the second stage was performed after instrumentation and maximum possible reduction of dislocation. The procedure included anterior fusion of displaced and adjacent vertebrae in the achieved position either with autografts of the illiac crest or with porous nickel titanium implants through trans- or extraperitoneal approach.

Results. Achieved results of application of the device for external transpedicular fixation in patients with spondylolisthesis enable to consider clinically justified a partial or total reduction of a displaced vertebra followed by neurologic status monitoring and radiological control during the post-operative period. Use of porous nickel titanium implant accelerates the formation of a bony block and decreases the time of surgery, as there is no need for autograft preparation.

Objective. To analyze the efficacy of dynamic neurophysiologic monitoring for diagnosis and treatment of patients with spine diseases and injuries during decompression and decompression/stabilization surgery of the spine.

Materials and Methods. Somatosensory evoked potentials (SSEP) were recorded in 297 patients with the spine diseases and injuries. Besides, 118 patients underwent intraoperative monitoring of SSEP and neural evoked potentials. Patients with abdomen dysfunction were examined by cystometry, profilometry, and urofluometry.

Results. Neurophysiological examinations for spine injuries allow to verify the level of spinal cord conductor injury and to assess the degree of functional disorders in spinal cord structures. In degenerative spine the changes in SSEP parameters occur only in disturbed spinal arteriovenous and venous circulation accompanied by expressed motor and sensitive conduction disorders. The SSEP study is most informative when inflammatory process is localized in the cervical or thoracic spine. In different forms of dysraphic status (diastematomyelia, syringomyelia, Chiari malformation) the SSEP study can not be a determinative diagnosis method.

Conclusion. Considering the relative simplicity of SSEP study and its value for dynamic examination of spinal cord conductors, it can be recommended as an obligatory test to assess indications for spine surgery for vascular disorders associated with degenerative-dystrophic diseases of the spine.