A posterior occipitocervical fusion with a novel fixation device developed at Sytenko Institute for Spine and Joints Pathology and a technology of its application have been biomechanically substantiated. The analysis of surgeries in 6 patients with upper cervical spine injuries and disorders was performed. The results were assessed as excellent in 3 patients and good in 3 ones. Some criteria for comprehensive estimation of clinical effectiveness of surgeries performed were proposed.

The experience of diagnostics and treatment of 82 patients with various injuries of the upper cervical spine was analyzed. The most frequent injuries were fractures of C2 odontoid process and arch. The treatment included a wide application of halo apparatus, and, when indicated, a surgical instrumention stabilization of the upper cervical spine.

Common clinical electromyography was performed to perfect treatment technique with biological feedback (BF) and to determine the mechanism of its action. Sixty eight patients at the age of 18 to 39 years with lower thoracic and lumbar spine and spinal cord injuries were examined at a period of a fullscale picture of spinal cord disease and a period of rehabilitation. The application of BF provided the average 60.2 % growth of muscular activity amplitude due to increase in total excitability of spinal alpha-motoneurons (10 %) (of mainly small (64.8 %) and reduction of excitability of big ones) and braking influence of the central nervous system (112.5 %).

Comprehensive diagnostics, accepted classifications, and selection of pathogenetic methods of treatment (including surgery) for axis injuries, odontoid process fractures, axis traumatic spondylolisthesis and hangman’s fractures are discussed in the paper. The presented data prove the necessity and possibility of early exhaustive diagnosing to differentiate the type of a craniocervical disorder and to provide a timely choice of pathogenetic treatment technique, especially of a surgical one.

Till now the etiology and pathogenesis of idiopathic scoliosis remain a subject of brisk discussion. In the submitted review of Russian and foreign literature this problem is discussed from the sides of modern neurology and neurophysiology. The cited data allow considering idiopathic scoliosis from a non-traditional point of view.

A comprehensive surgery of idiopathic scoliosis should be based on the following principles: application of third generation segmental instrumentation, obligatory preoperative planning, and multilevel outcome estimation. Segmental instrumentation has proven its numerous advantages. Preoperative planning reduces unavoidable though unwanted sequelae of the spine locking. Differentiated technique suggests four main variances: for juvenile scoliosis, for scoliosis in patients of 11–13 years old; for adolescent scoliosis, and for extremely severe advanced cases. Multilevel outcome estimation requires the use of patient questionnaires and computer optical method.

Objectives. To estimate efficiency, safety and traumatizing impact of endoscopic discectomy in comparison with traditional microsurgical discectomy.

Material and methods. A total of 330 patients underwent Destandau endoscopic discectomy and 964 – open microsurgical discectomy. The operative times, terms of patient postoperative bed and hospital stays, postoperative dynamics of neurologic deficiency, surgical complications and frequency of herniation recurrences were estimated in both groups. Pain intensity was assessed with the 10-score Visual Analog Scale (VAS), and functional activity – with the Oswestry Disability Index (ODI).Results of surgical treatment were estimated in 8–10 days, 6 and 12 months after operation.

Results. VAS and ODI data have not revealed essential distinctions in pain regression dynamics after endoscopic and open surgeries. Surgical complications after endoscopic intervention were not more often, than after microsurgical discectomy. Damage of dura mater occurred in 2.4 % of cases, and increase in neurologic deficiency (hypoesthesia) – in 0.6 %. Herniation recurrences have evolved in 3.0 % of cases after endoscopic discectomy and in 4.7 % – after open microsurgical one.

Conclusion. Destandau endoscopic surgery is a low invasive method of effective treatment for lumbar disc herniations, which by its technical opportunities and results is competitive with classical open microsurgical discectomy.

Patients with vertebrobasilar insufficiency, which are frequent in neurological and neurosurgical practice, require a complex examination to reveal its ethiology and to perform a differential diagnostics. The study objective was to develop a diagnostic algorithm for detection of clinically significant forms of Kimmerle anomaly, and to introduce a new technique for surgical treatment under intraoperative monitoring of the vertebral artery decompression. When a patient with the Kimmerle anomaly shows a vertebrobasilar insufficiency, a comprehensive surgical policy includes a complex clinicalphysiological assessment of the vertebrobasilar basin (from vertebral arteries entrances up to the basilar artery and its branches). If any other pathology is excluded, the Kimmerle rings (foramen arcuale) are removed and hemodynamics in the vertebrobasilar basin is estimated by clinical and graphical Doppler methods.

Literature review is dedicated to an important problem – treatment of neurological manifestation of vertebral osteochondrosis by minimal invasive method, i.e. endoscopic nucleotomy. Consistent stages of method transformation from intervertebral disc puncture to complete decompression under endoscopic control have been followed. Indications and contra-indications, complications and results of treatment are analyzed in detail. Potentialities inherent in various techniques of visual intraoperation control (CT, MRI, fluoroscopy) are discussed. The reported information convincingly proves great potential of endoscopic nucleotomy.

The purpose of the study is the development and improvement of methods for radical surgical ablation of primary and metastatic tumors in the spine. Radical surgeries of spine tumors were performed in 16 patients. Moderate rate of local relapses (2 patients) suggests the possibility of radical ablation of the isolated tumor of the vertebra using offered methods of blood loss reduction and of ablastic safety increase. The preliminary results testify that it is necessary to improve methods of block resections of vertebra to increase oncological radicalism.

The analysis of literature data on blood saving in pediatric spinal surgery is presented in the review. The advantages and shortcomings of each method are critically evaluated. It is marked that the highest efficiency is achieved by combination of several methods in one patient. Special attention is paid to the risk of reducing spinal cord blood supply and necessity of thorough monitoring of systemic hemodynamics and oxygen transport.

The results of application of new blood-saving techniques in surgeries for scoliosis were compared in 289 patients aged from 9 months to 17 years, and the analysis of their efficiency was performed. The authors have estimated volume and velocity of blood loss, and changes in hemoglobin rate under balanced anesthesia with spinal blockade, clonidine hypotensive anesthesia and acute preoperative isovolemic hemodilution with autoplasma. The highest efficiency of spinal blockade in lumbar surgery is marked. Hemodilution was found more effective in comparison with hypotensive anesthesia in the patients with CDI correction of scoliosis. Clonidine hypotensive anesthesia (the only variant of blood-saving anesthesia used for hemivertebrae extirpation in our study) has appeared inefficient.

The paper presents a mathematical model with graphic visualization, which describes spine geometric parameters and conditions of their changes in time and space. Reduction of data file size necessary for reproduction of vertebra shape and storage of this structure in a computer with the least losses is achieved with algorithm of geometrical interpolation and vertebral body shape reconstruction – with trigonometric interpolation sums (TIS). The developed spine model is based on three concepts. A spline interpolation is used for reproduction of the whole spine. The spline polynomial is built on data received by calculation of transition matrices. This requires the parameters of not each point, but only of three key ones (in the basic spine levels). Application of spline interpolation considerably reduces time expenses for transition matrices calculation. The developed model takes into account the geometrical features of human vertebra, and changes of its kinematic characteristics in space and time. The model will allow observation of deformation of the whole spine caused by change of one or several randomly chosen parameters. Thus the geometrical characteristics necessary to calculate matrix chain of the second model are the results of the first model calculations. Having a set of the statistical data, the given model can be used for observation of spine response to various disturbing factors. After assigning initial spine parameters a graphic interpretation of the model will enable to receive a three-dimensional spine image, to shift and rotate it, to assign a direction of load application, to trace the changes in the spine shape during physiological movements and walking.

Objectives. To determine the biological response of growing spine to rigid segmental fixation. Summary of background data. Pedicle screw is gaining popularity in pediatric deformities. Yet, biological response of actively growing spine to rigid pedicle screw fixation remains unclear.

Methods. Twelve mini pigs in actively growing period were subjected to posterior segmental screw-rod instrumentation spanning 9 levels and creation of experimental scoliosis. There was no attempt of posterior arthrodesis. The pigs were subjected to periodic radiological examinations and were euthanized at 18 months for analysis.

Results. There was no significant fixation failure despite conspicuous growth of the animals. Initial scoliosis of 31 ± 5° was reduced to 27 ± 8° at 18months, but there was no statistical significance (p=0.37). Though there was no change in length of the implant construct, the vertebrae within the instrumented section showed mean longitudinal growth of 6 ± 3 mm (p = 0.000). The growth occurred at expense of the disc spaces that progressively narrowed with time. On necropsy, the instrumented region was completely fused posteriorly with crossing of the osseous traberculae across the former facet joints. Intervertebral discs were severely atrophic in all the discs with occasional spontaneous fusion.

Conclusions. Even in the actively growing spine, the force of growth does not overcome the fixation offered by segmental pedicle screws. Longitudinal growth occurs at the expense of the joint spaces and leads to spontaneous intervertebral fusion. Our results may explain the favorable outcomes in pedicle fixations in pediatric population, showing little implant failure or nonunion.

The etiologic factor of idiopathic scoliosis (IS) is a subject of discussions for scientists of different disciplines. The great number of theories testifies to an absence of a uniform sight on etiology and pathogenesis of this pathology. Objectives: to investigate the mechanism of genetic determination of IS.

Materials and methods: 101 probands with II–IV grade IS and 703 family members of I–III degree of relationship were examined by clinical-genetic, radiological and optical-topographical methods. The pedigrees were processed by a method of segregation analysis. G3 exon of agrecan gene was studied from isolated family DNA by method of PCR reaction.

Results: Segregation analysis of pedigrees, in which proband had II–IV grade IS has shown, that IS is inherited according to autosomal-dominant type with incomplete genotype penetrance depending on sex and age. It is revealed that idiopathic scoliosis is controlled by a major gene. Study of connection of agrecan gene to determination of IS development on a small sample of pedigrees has not revealed a reliable association of IC with polymorphism of G3 exon. Investigation of another exons of agrecan gene on expanded pedigrees is continued.

Surgical treatment of Pott’s disease is a difficult problem. Techniques of radically corrective surgery with rib autograft developed for this pathology are not always radical enough, while the bone grafting has a number of blind sides. The paper presents a clinical case of combined fusion with shape memory clamps and anterior support porous NiTi implant after a failed fusion with rib autograft for Pott’s disease.

Clinical, intraoperative and paraclinical description of a case of successful surgery for severe open penetrating spinal cord trauma in the upper cervical spine is reported.

Objective. Provide guidance to investigators and authors regarding appropriate conduct and reporting of case-series studies. Summary of Background Data. Evidence-based practice has provided a substantial contribution to advancing clinical science. Many study designs have been critically examined, and the quality of the research literature has improved. A common study design in musculoskeletal medicine is the case series: a description of the course of patients over time. Case series can provide valuable information as to: case definition, trend analyses regarding outcomes, and clues as to causation. Case series cannot be used to draw inferences regarding treatment effect.

Methods. Examination of previous work on identification of characteristics of high quality study designs such as cohort studies; extending this work to case series.

Results. We identified draft characteristics that good case series studies should address: clearly defined study question; well-described study population; well-described intervention; use of validated outcome measures; appropriate statistical analyses; well-described results; discussion/conclusions supported by the data presented; funding sources acknowledged.

Conclusions. We propose these measures to authors and journal editors as one mechanism to improve the quality of the case series study.