Objectives. To study some peculiarities of psychophysiology of children and adolescents with scoliosis and to assess its dynamics after surgical treatment.

Material and Methods. Total of 58 patients with scoliosis of grade III–IV at the age of 10 to16 years were examined, out of them 17 were operated on by Cotrel – Dubousset technique. Control group consisted of 18 practically healthy individuals of similar age. Clinical, rontgenologic and psychophysiologic methods of analysis were used. Psychoemotional state was assessed by depression level, indexes of personal and reactive anxiety, and by patients’ attitude to their disease and vital functions. Psychovegetative reactivity was evaluated by oculocardiac, cardiac-sinus and celiac-plexus reflexes. The patients were examined three times: before operation, in six and twelve months after operation.

Results. Psychophysiologic status of children and adolescents with scoliosis essentially differs from that of normal ones. Psychoemotional disorders are characterized by a high level of depression, situational and personal anxiety, and by violation of social adaptation, and psychovegetative disorders – by increase in lability and reduction of reactivity of the vegetative nervous system.

Conclusion. It was revealed that the psychophysiologic status of children and adolescents with scoliosis has essential peculiarities. In the nearest postoperative period the positive dynamics is mainly seen in psychoemotional status, but psychovegetative state remain without any essential dynamics.

Objectives. To analyze the results of correction and stabilization of the spine with new generation implants for congenital malformation of the vertebrae in children of 1 to 5 years old.

Material and Methods. A metal construction for surgical treatment of congenital anomalies of the spine in children of 1 to 5 years old was developed, consisting of transpedicular and laminar support elements. This construction was used in 38 patients with congenital thoracic and lumbar spine deformities associated with malformations of the vertebral bodies. Six patients had an isolated lateral or posterior-lateral hemivertebra in the thoracic spine and 11 – in the thoracolumbar junction, 3 patients had wedge-shaped vertebra in the thoracolumbar spine, and 18 – multiple or combined developmental anomalies of the spine. Initial angulation of scoliotic deformity was 24° to 50° and kyphotic deformity – 20° to 46°. Surgical treatment consisted of one-moment three-staged operation according to developed technique.

Results. Correction of deformity within 92–100 % was achieved in patients with isolated hemivertebra in the thoracic and lumbar spine, and posterior wedge-shaped vertebrae in the thoracolumbar junction. In patients with multiple and combined developmental anomalies of the spine the correction of scoliotic deformity was 52–76 % and of kyphotic one – 58–80 %.

Conclusion. The suggested metal construction provides the possibility to perform surgery at early stages even for developmental anomalies of the spine posterior support column in patients of 1 to 5 years old with congenital spine deformities.

Objectives. To study a role of the central nervous system (CNS) in development of idiopathic scoliosis (IS) and to reveal potential neurophysiologic mechanisms participating in this process.

Material and Methods. Electroencephalography (EEG) has been applied to examine patients with IS. For the first time the received data were processed by a mathematical method which allowed to establish the temporal organization of basic brain rhythm formation (α, β, θ).

Results. Variants of deviations in functioning of basal structures of the brain and its trunk distinctive for sluggish and rapid progressing forms of IS are revealed. Theoretical description of pathogenetic links of idiopathic three-plane spine deformity formation is suggested. It is proved that a basic condition for its development is a disturbance in longitudinal growth conjugation of the spine bone structures and the spinal cord, which demands certain compensating reactions.

Conclusion. Long-term uncontrolled asymmetric change in paravertebral muscle tone is a key link in a clinical formation of IS.

Objective. To study microcirculation in spinal membranes, and its correlation with the magnitude of spinal deformity and the outcomes of surgical treatment in patients with grade III–IV idiopathic scoliosis.

Material and Methods. Intraoperative laser Doppler flowmetry was performed to measure microcirculation in spinal membranes at the deformity apex and adjacent segments during surgical correction of scoliosis in 10 patients at the age of 14 to 17 years.

Results. It was revealed that the volumetric capillary blood flow in spinal membranes at the deformity apex was decreased by 27–57 % as compared to sufficient level. Decompensation of microcirculation in membranes was more expressed in Sshaped deformity. Blood flow reduction is in direct relation to the angle of spine deformity. Spine deformity correction with intraoperative distraction measuring from 5 to 20 mm could cause neurologic complications if blood flow in spinal membranes at the apex of deformity is less than 20ml/min per 100 g and cranial blood flow ranges from 18 to 40 ml/min per 100 g. These patients should be treated with a more sparing intraoperative distraction of the spine (≤5 mm) followed by conservative enhancement of spinal cord microcirculation.

Conclusion. Parameters of volumetric capillary blood flow in spinal membranes at the deformity apex and adjacent segments could be used for prediction of neurological complications in surgical correction of idiopathic scoliosis.

Objective – to determine parameters concerning the technical principles of brace design and methodical principles of brace treatment. A model of spine deformity correction is represented as a pattern of three-point bending of a beam. With regard to the trunk in a brace, this model presents the relationship between the active force and responces depending on active force location within the span between beam bearings. The influence of correcting forces locality factor on an issue of approach to deformity apex in different types of scoliosis is considered. Potential effect of different brace types is assessed. The problem questions of development of correction brace effective design are stated and variants of their solution are suggested. The force patterns of correction are discussed for some types of spine deformity.

Objective.To analyse results of surgical teratment of lower thoracic and lumbar spine injuries with transpedicular fixation alone and in combination with other types of stabilization.

Material and Methods. A total of 90 patients with fractures of the spine were operated on with the help of transpedicular fixation (TPF). Out of them 35 % had stable injury, 65 % – unstable; fracture was complicated in 59 cases, uncomplicated in 31 cases. The surgical approach depended on injury type, complication absence or presence, and kyphotic deformity magnitude. Complete and incomplete comminuted uncomplicated fractures were treated with transpedicular fixation alone or in combination with posterior fusion or tunnel corporoplasty with porous NiTi granules. Complicated comminuted fractures with adjacent disc injury were treated in two stages: first stage – extended laminectomy, spinal cord anterior decompression, and transpedicular fixation, and second stage – anterior fusion simulteneously or after patient stabilization.

Results. Long-term outcomes of transpedicular fixation were analysed in 50 patients in follow-up period of 1 to 5 years. The smallest loss of obtained deformity correction was observed in cases of incomplete stable comminuted fractures (4.5° ± 0.9°), the largest – in those of complete and incomplete unstable fractures (9.9° ± 0.2°), and intermediate loss – in cases of complete stable fractures (7.9° ± 1.1°). The treatment result was good in 40 patients, satisfactory in 7, and unsatisfactory – in 3.

Conclusion. Primary and permanent stabilization of injured spinal motion segments in unstable complicated and uncomplicated comminuted fractures in lower thoracic and lumbar spine should be performed by means of anterio-posterior fusion.

Objectives. To determine the efficacy of various procedures of precise differentiated surgical decompression for elimination of prevailing clinical manifestations of degenerative stenosis depending on a character and localization of morphological changes (degenerative or posttraumatic) in the cervical spine, the expediency and necessity of application of various fixation and stabilization techniques.

Material and Methods. Eighteen patients included in the study were examined for degenerative stenosis in the cervical spine. All of them underwent decompressive surgery. International representative scales were used to estimate results depending on basic clinical syndrome.

Results. The increase in latency and central sensory conduction time (according to somatosensory evoked potentials data) indicates that ischemic compression lesion is mainly caused by dorsal compression. In this case a laminectomy according to Hirabayashi was performed. The increase in central motor latency time (according to central transcranial magnetic stimulation) greater by 30 % than a norm indicates that ischemic lesion is caused by anterior vertebral artery compression. In this case a corporectomy was performed.

Conclusion. Compression lesions in cervical spine stenosis have local ischemic character and correspond to blood supply basin of compromised spinal or segmental artery. There is a correlation of ischemic compression focus localization with a character of electrophysiological conduction and responses. Differential character of surgical decompression provides observation of minimal invasive principles and better neurological restoration of patients.

Objectives. To analyze the efficacy of contemporary decompressive-and-stabilizing techniques, including percutaneous vertebroplasty, in patients with a spine and spinal cord myelomatosis (SSCM).

Material and Methods. Seventy-two patients with SSCM were evaluated with respect to the results of treatment. Sixty-two patients underwent surgical interventions followed by radiotherapy and chemotherapy: open interventions were performed in 53 (85.5 %) patients and percutaneous vertebroplasty (PVP) – in 9 (14.5 %). Ten patients underwent only a specific therapy for SSCM. Pain regression, neurologic state and quality of life were evaluated after surgery.

Results. Radiotherapy and chemotherapy are the methods of choice for SSCM. However in some cases with increasing neurologic deficit, intractable pains and instability of an involved spine segment a surgical intervention is necessary and capable to prevent catastrophic complications. Best results, regarding neurologic impairments and quality of life, were achieved in a group of patients in whom decompressiveand- stabilizing procedures were performed.

Conclusion. PVP is a minimally invasive procedure ensuring quick regression of a pain syndrome and prevention of pathologic fractures in patients with myelomatosis of the spine.

Objective. To study parameters of sagittal spinopelvic balance in patients with chronic low back pain and sciatica, and mechanism of vertical posture formation in a sagittal plane.

Material and Methods. Total of 100 patients (32 female and 68 male, mean age 38.7 years) with chronic low back pain and sciatica underwent clinical and radiological examinations. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and global lumbar lordosis (GLL) were measured on lateral standing radiograms. Statistical analysis of the obtained data was performed.

Results. The mean value of PI (50.7°) in patients with back pain and sciatica and in healthy volunteers was almost equal, while SS and GLL were significantly lower in patients, and PT – higher, than those in volunteers. Number of patients with PI ≤ 35 was significantly higher than that of volunteers. Pearson’s correlation coefficient between GLL and PI was 0.916, between GLL and SS – 0.902, and between GLL and PT – 0.326. Vertical posture in patients with chronic low back pain and lumbar sciatica is characterised by backward pelvic rotation relative to hip and by hypolordotic shape of the lumbar spine.

Conclusion. Vertical posture in patients with low back pain and sciatica is determined by a backward rotation of the pelvis, therefore SS and GLL decrease, and PT increases. A prevalence of extremely low values of PI (≤35°) may be considered as a risk factor for lumbar spine degenerative diease. Alteration of vertical posture is a kind of protective mechanism.

Objective. To analyze the efficacy of dispensary system for children with spine deformities in remote regions of Western Siberia.

Material and Methods. Total of 4400 children at the age of 6 to 16 years were screened being divided into three groups: 1 – children of aborigines residing in habitual country-side; 2 – children of aborigines residing in towns; 3 – children of migrants. Control group included 2200 schoolchildren from Novosibirsk City. A posture and a spine shape were evaluated by Computer Optical Topograph (COMOT). Screening and monitoring of children living in remote villages was performed in expeditions with mobile version of COMOT.

Results. Children of Group 1 have the smallest degree of spine deformity. This group presented the lowest incidence of scoliosis, absence of severe forms, and the largest number of healthy children (18.8 %). There were the smallest figures (3.63°) of spine curvature and the lowest index (0.62) of arch lateral tilt among overall sample in this group. The spine curvature in this group is the smallest (3.63°) from that of the whole sample, as well as the lowest index of lateral arch deviation (0.62). In accordance with standard topographic criteria for assessing posture disorder and spine deformity in three planes only 4.7 % of all examined children and adolescents were healthy and had a balanced posture. Children of aborigines have the most balanced posture and the smallest degree of spine deformity.

Conclusion. Revealing of risk territories and factors, and possible zoning of spine pathology distribution are the priorities of preventive spine medicine. Account must be taken of territorial risk factors and peculiarities of aborigine constitution when specialized medical care is organized in remote regions.

Total Quality Management (TQM) is a new approach to administration of an institution aimed to achieve long-lasting success due to maximum efficiency of its activity with minimal production costs and steady quality of output products. Practically it took 80 years to realize the necessity to combine two systems of management: of activity and of quality, to meet customers’ requirements. Today quality of medical help is identified as a main goal of state policy in the field of health care. Health institutions need a system of quality management, providing conditions when the quality demanded by a customer is ensured at each step of medical care delivering. Novosibirsk Research Institute of Traumatology and Orthopaedics is among narrow minority of medical institutions which have a quality management system of medical care certified according to International Standard ISO 9001:2000. Implementation of this system based on TQM requirements permitted the administration and the staff of the Institute to proceed from direct control and maintenance of quality of medical care to assured permanent improving of quality thereby promoting a competitiveness of the institution.

Objective. To study etiologic factors and pathogenetic mechanisms of scoliosis development.

Material and Methods. We investigated vertebral body growth plates (GP) from convex and concave sides of the curve, intervertebral discs (IVD), and vertebral bone tissue – surgical material obtained from 100 patients at the age from 10 to 14 years with III–IV grade idiopathic scoliosis (IS). Structural components of the spine of 12–14 years old children obtained from the forensic medicine department were used as controls. The methods of morphohistochemistry, biochemistry, and ultrastructural analysis were used to study glycosaminoglycans (GAGs), oxidation-reduction enzymes, alkali and acid phosphatases, RNA, DNA, qualitative and quantitative composition of GAGs. The expression of proteoglycan genes of cartilage tissue and their protein products was investigated with molecular genetic assays.

Results. Pathogenetic mechanism of spine deformity formation in idiopathic scoliosis was formulated. It was shown that idiopathic scoliosis development is predetermined by a disorder in regulation and synthesis of proteoglycans in vertebral GP. The decrease of chondroitin sulphate and increase of keratan sulphate components in proteoglycans indicate the change of proteoglycan spectrum in IS. The revealed keratan sulphate fraction is a result of increased expression of lumikan gene in condition of sharp decrease of aggrecan gene expression and its protein product quantity in chondroblasts of patients with III–IV grade IS.

Conclusion. Alteration in aggrecan gene expression at the level of transcription and translation testifies for its involvement in scoliosis development.