Thirty-four patients aged from 3 to 17 years were operated on for noncomplicated unstable injuries of the spine. The operation was performed within the next few hours or days after trauma in 15 cases and significantly later (in 2 to 6 months) in 19 cases. In the first group the surgery included indirect posterior instrumental reduction and stabilization of the spine. In the second group a two-stage surgery was performed simultaneously. The first stage included anterior decompression and stabilization, and the second – posterior instrumentation. In both groups the posterior fusion with bone autograft was done. The post-op follow-up was 5 years. The correction of deformity, spinal stabilization and pain arrest were achieved in all cases. The surgical treatment of unstable noncomplicated spinal injuries in children must be conducted by emergency indications within the first hours and days after trauma.

Objective. The authors analyze the causes of destabilization of transpedicular spinal instrumentation and prove the measures of its prevention basing on biomechanical modeling results and clinical data.

Material and Methods. Experimental study included three series of 10 tests and one series of 12 tests with human spine cadaver specimens. The stability of injured spinal segments after transpedicular instrumentation was studied under mechanical load similar to that experienced by the human spine. Clinical study included the outcome analysis of transpedicular instrumentation in 107 patients with unstable thoracic and lumbar spine injuries.

Results. The bone tissue mass around screws inserted in a cranial vertebra for two-segment spinal fusion proved to be the weakest place in a system consisting of a fourscrew transpedicular metal construction and spinal segments. The static mechanical strength of the injured vertebral motion segment stabilized with transpedicular device turned to be lower by 8–42 % (depending on loading conditions) than that of a corresponding intact vertebral motion segment. The identified factors negatively affecting the mechanical stability of transpedicular fixation were the following: osteoporosis, incomplete correction of deformity, motion coordination disorder due to neurological deficit, excessive weight, and postoperative regimen breach. A differentiated approach to reposition and transpedicular instrumentation for significant spinal deformities was offered allowing the restoration of anatomical interrelations and stable fixation in the spine regardless of the time of trauma.

Objective. To define the effective surgical management of posttraumatic kyphotic deformities in the thoracic spine basing on experimental biomechanical and clinical studies

Material and Methods. Experimental biomechanical study was performed in 30 spine specimens. Anterior wedge osteotomy and fixation of a specimen in a kyphotic position modeled kyphotic deformity. Deformity correction with various instrumentation systems was firstly performed by maximal extension of segments adjacent to kyphosis-producing block, and carried on after crossing of intervertebral anatomical structures. Clinical study consisted in X-ray and instrumental examinations of 80 patients operated on for thoracic spine trauma. The magnitude of true posttraumatic deformity was defined as a difference between measured Cobb angle and mean physiological kyphosis value in the studied spine level.

Results. Deformity rigidity, character of spine mobilization at the level of correction and size of posttraumatic deformity are the most significant factors determining the efficacy of thoracic posttraumatic kyphosis correction. The study resulted in defining rational approach to surgical correction of posttraumatic deformities in the thoracic spine.

Conclusion. Minor kyphotic deformities in the thoracic spine are effectively corrected by instrumentation without mobilization of the spine. Large unfixed kyphosis sometimes requires anterior mobilization. Cases with rigid posttraumatic kyphotic deformity should be operated on with combined mobilization of the spine.

The problem of surgical treatment of the cervical spine fracture- dislocation is discussed. Twenty-three patients with this pathology at the age of 15 to 55 years were surgically treated. Patients underwent clinical, neurological, radiological, and physiological examinations. The abnormality degree of spinal cord conduction was assessed with the American Spinal Injury Association (ASIA) Impairment Scale. Cervical spine surgical intervention technique consisted in decompressing and stabilizing procedures with autografts from a wing of the ilium, or with porous NiTi implants. The study resulted in conclusion that in case of acute fracturedislocation the anatomical integrity of the spine can be restored, vertebra-medullar conflict – eliminated, and the injured segment – reliably stabilized. In case of neglected fracture-dislocation the reduction of displaced vertebra is impossible. Spinal cord function recovery requires a removal of the compressing substrate and a stabilization of the spine. The fusion with porous NiTi implants allows to prevent the secondary displacement of vertebrae relatively each other due to autograft lysis and to reduce the operation time. The use of autograft is preferable in young patients and patients with individual metal intolerance.

Objective. The efficacy of low intensive laser irradiation in the treatment of decubitus and slowly granulating wounds is studied in comparison with conventional methods.

Materials and Methods. Eighty two patients with trophic ulcers after spinal cord injury were conservatively treated by routine methods (35 patients) and by local laser irradiation (47 patients). The efficacy of local laser therapy was assessed basing on clinical course of healing of decubitus and slowly granulating wound, and daily epithelization rate and percentage in experimental and control groups.

Results. The ulcer epithelization rate in all patients who underwent a local laser irradiation was reliably higher than in control patients. This study underlied the development of effective technique for decubitus sanation providing the increase in epithelization rate and improvement of ulcer healing.

Objectives. This study is aimed at assessing the real efficiency of surgery for IS on a long-term basis using three different techniques. A series of 311 patients with IS was operated on (1987–2003) using the instrumentations of Tanchev – Stefanov (TSI) in 286 cases and Cotrel – Dubousset (CDI) in 25 cases. A control group of 50 patients treated with Harrington rods (HI) before 1987 was included for comparative purpose, making a total of 361. To ensure long-term follow-up validity, only the patients operated on till December 31, 1998 (n = 265) were evaluated retrospectively in this study. The implant systems used included HI (n = 50), TSI (n = 190) and CDI (n = 25). Average preoperative coronal angles were 72°, 67° and 79°, respectively. Average follow-up time was 180, 70 and 67 months, respectively. Final clinical and radiological outcomes, bony fusion rate, complication rate, subjective patient appraisal, characteristics of implants applied, effect of thoracoplasty and cost-effectiveness of treatment were assessed.

Results. Final frontal correction obtained was 24.5 % for HI, being significantly lower (p < 0.05) than that in the TSI-group (43 %) and CDI-group (45 %).TSI and CDI revealed statistically equal results (p > 0.05). Sagittal correction was also comparable – 36 % and 34 %, respectively (p > 0.05). Minor derotative effect (4.5°) was found for both instrumenations. Primary bony fusion was achieved in 82 % of HI-group, in 95 % of TSI-group, and in 92 % of CDI-group. Complications were more frequent when using HI (30 %), while the complication rates were lower in TSI-patients (14 %) and CDI (12 %). The subjective patient appraisal of treatment outcome was positive – 82 % for HI, 91 % for TSI, and 92 % for CDI.

Conclusions. TSI and CDI provide equally favourable late results at a lower complication rate as compared to those obtained by using HI.

Objective. The objective of the study was the development of optimal, i.e simple, safe, and effective instrumentation for treatment of adolescent and adult scoliotic deformities.

Material and Methods. The paper presents the results of surgical treatment in 23 patients with thoracic and thoracolumbar scoliosis with application of novel dorsal instrumentation developed at the Chair of Traumatology and Orthopaedics of the Russian University of Peoples’ Friendship. Twenty three patients at the mean age of 15.6 years (range, 11–44 years) with Grade IV thoracic and thoracolumbar scoliosis were operated on. The smallest Cobb angle of deformation was 61°, the largest – 96°. Surgical correction of scoliosis was performed with application of universal dorsal instrumentation. The follow-up period was 1 year.

Results. The correction of Grade IV deformation with Cobb angle from 61 to 70° was 85.2–91.8 %; with Cobb angle from 71 to 80° was 83.8–90.5 %. The curvature from 81 to 96° was corrected by 65.6–73 % by single-stage operation.

Conclusion. The suggested universal instrumentation for spine scoliosis correction is a hi-tech technique. Its advantages are the simple and safe application, good correction in three planes of deformation, the possibility of use both in children and in adults, and the absence of spine growth restriction in children.

Objective. To analyze the results of two-stage surgical treatment of progressive kyphosis associated with Scheuermann’s disease performed in the Spine Surgery Department for Children and Adolescents from 1996 till 2004.

Material and Methods. Fourteen patients were surgically treated. Surgical intervention included segmental vertebrectomy, interbody fusion, and kyphosis correction with Cotrel – Dubousset Instrumentation (CDI).

Results. Kyphosis was reduced from 78.1° to 43.4°; the loss of correction during the follow-up period (minimum 2 years) was 4.4°. Sagittal contour of the lower thoracic and lumbar spine was also normalized.

Conclusion. Two-stage surgical intervention permits to achieve significant cosmetic and pain-reducing effect in patients with major kyphosis associated with Scheuermann’s disease.

Development history and construction features of the first Russian functional lumbar disc endoprosthesis, its application technique, as well as indications and contraindications for surgical disc replacement are presented. The early and long-term results of Russian devices application are compared with those of foreign analogs. The result evaluation was performed by objective methods of study: clinical biomechanics, neurophysiology, and functional spine radiology. The follow-up period ranged from 1 to 10 years.

The paper presents a descriptive kinematic radiographic study of changes in a shape, orientation and function of the lumbar spine in the sagittal plane due to various surgical interventions for lumbar degenerative disease. Literature analysis evidences for only few studies of spine shape and static interrelations in a spinal motion segment after surgical treatment. Any complex assessments of changes in a spine shape in the sagittal plane, its spatial orientation and function after surgical intervention has not been performed. The study includes a comparative kinematic computer analysis of pre- and postoperative radiographs of the lumber spine of 157 patients, including 62 patients after decompression, 50 after posterior interbody fusion, and 45 after dynamic transpedicular fixation. It was found that the overall range of motion has reduced during three years after any kind of surgical intervention; that surgery at the L5–S1 level takes the most significant biomechanical effect; and that decompressing and stabilizing procedures at the L5–S1 level facilitate a lumbar lordosis restoration. The L5–S1 interbody fusion results in interbody space increase and segmental angle decrease at the surgery level. The L4–L5 interbody fusion increases the range of motion in a subjacent motion segment; dynamic transpedicular fixation takes a minimal effect on a lumbar spine shape and vertebral interrelations and allows preserving the physiological mobility of all motion segments.

Pyogenic nonspecific spine disease is of special interest to neurosurgeons because it often results in acute neurological deteriorations and requires a combination of adequate surgical and conservative treatment. A group of 81 patients with the clinical and radiological sings of pyogenic nonspecific spine infections was prospectively followed from 1999 to 2004. Time to diagnosis was less than 2 months in 62,96 % of patients. Patients without neurological deficit (n = 8; 9.88 %) were conservatively treated with immobilization and intravenous antibiotic drugs. Patients with complete or rapidly progressing neurological deficit, septicemia (n = 73; 90.12 %) underwent surgery. Good results were achieved in 42 (57,55 %) patients, satisfactory – in 16 (21,91 %) with minor neurologic deficit, unsatisfactory – in 14 (19,17 %) with severe neurological deficit. Severe septicemia and multiorgan failure developed in one patient who died of this disease. Conclusions: еarly diagnosis and surgical treatment is a technique of choice for treatment of patients with pyogenic nonspecific spine diseases.

Objective. To specify a morphogenetic pathogenesis of the Scheuermann’s disease.

Material and Methods. Growth plates, intervertebral discs, vertebral body tissue (surgical material) from 25 patients of 12–14 years old with Scheuermann’s disease of Grade II–III were examined. In-depth morphohystochemical, biochemical, and ultrastructural analyses were used to study glycosaminoglycans, oxidation-reduction enzymes, alkaline and acid phosphatase, RNA, DNA, and qualitative and quantitative composition of glycosaminoglycans.

Results. Pathogenetic mechanisms of Scheuermann’s disease development are presented basing of previously obtained data on genetic dependence of this pathology. The starter of the spine kyphotic deformity is a disturbance of proteoglycan molecule synthesis and conformation in ventral growth plates of vertebral bodies. The structural change in proteoglycans, which perform barrier-trophic, informational, and antiinvasive functions results in a decreased mitotic and proliferative activity of chondroblasts. The spine kyphotic deformity develops in association with an active osteogenesis.

The paper presents the experience in development and introduction of the Quality Management System (QMS) which meets the requirements of international standard ISO 9001:2000. The arrangement of quality management is a task, which integrates general management of the institution on the basis of quality ideology as a highest strategic aim. The application of international standards ISO 9000 facilitates the wide dissemination of new principles of management directed to a customer and quality of servicing, which were not peculiar to the Soviet Public Health. The QMS introduction is a scaled and complex process for any organization involving the whole its staff – from the head to the attending personnel. It must be performed stageby- stage with application of process approach technique. The result of QMS model development in Novosibirsk RITO is a transition from «as it is» condition to «as it should be» condition to eliminate revealed inadequacies. The used criteria and methods of monitoring and analysis permit to estimate the effectiveness and level of key processes of medical care and to schedule their improvement. A voluntary certification of conformance to the international standard ISO 9001:2000 is the first system task in the field of comprehensive management in Novosibirsk RITO. The standard conformance means that the achieved management level meets a minimal set of standardized requirements which reflect internationally recognized means of management for the production of medical services of guaranteed quality.