Objective. To study efficiency of primary stable metal constructions and halo-vest for lower cervical spine injuries.

Material and Methods. Experience in surgical treatment of 62 patients with various injuries of lower cervical spine has been analyzed and summarized. The patients were grouped according to two main factors causing the injured spine dysfunction: dislocation damages (dislocations, fracture-dislocations), in which compression of neurovascular structures and disturbance of spine support ability are caused by vertebra dislocation; and vertebral body fractures (compression, compression-splintered) in which the compression and disturbance are arising from vertebral body destruction. In the first case a reduction of dislocated vertebra by various methods depending on the duration and rigidity of the injury was performed. In the second case a destroyed vertebral body was resected with subsequent stabilization.

Results. The choice of surgical tactics with use of modern metal fixation devices was substantiated for treatment of lower cervical spine injuries. Indications for the application of anterior and posterior stabilizing constructions were determined considering a compression direction of neurovascular structures and a degree of destruction of the spine support columns. An algorithm of surgical treatment was suggested basing on a principle of damage reposition irrespective of injury duration. High efficiency of Halo-traction for treatment of lower cervical spine injuries was proved and its most effective application (combination with various methods of internal fixation) was determined.

Conclusion. The application of primary stable metal devices in combination with halo fixation is a method of choice for treatment of lower cervical spine injuries.

Objective. To reveal anatomic peculiarities of the posterior spine support structures and basic landmarks suitable for transpedicular fixation in children of 1.5–5 years old.

Material and Methods. Anatomic and anthropometric studies of 18 cadaveric lumbar spines harvested from objects whose death was not related to spine pathology were carried out. Three age groups were singled out (of 1.5–2.5; 2.5–3.5 and 3.5–5 years old). The anatomic peculiarities of posterior support elements, spatial location of the processes and base of the neural arch were examined and a zone for transpedicular screws insertion was determined.

Results. It was revealed that a structure of the posterior support column in children of 1.5–5 years old differs from that in adolescents and adults. Arch articulations are formed by cartilaginous articular processes. There are no bony transverse processes in 2–3-years-old children. 50 % of 4–5-years old children have cartilaginous transverse processes which are not sharply defined during skeletonization. A zone of transpedicular screw insertion is 2–3 mm medial of the middle distance between upper and lower processes of the vertebra. Pedicle angle of inclination of a base of the neural arch to sagittal axis in a horizontal plane varies from 5° at L1 to 20° at L5.

Conclusion. Anthropometric measurements serve as basis for development of metal constructions for correction and fixation of the lumbar spine with transpedicular support elments in children of 1.5–5 years old.

Objective. Substantiation of combined fixation utilizing anterior cervical plates and porous implants for unstable cervical spine injury.

Material and Methods. Sixty-five patients (mean age of 31.3 years) were operated on for complicated and noncomplicated cervical spine injuries. Out of them there were 53 (81.5 %) men and 12 (18.5 %) women. Patients were grouped according to mechanisms of injury and terms of admission to the hospital. Isolated interbody fusion or combined fusion with anterior plate was performed depending on the degree of instability. Outcome assessment included a dynamics of neurologic regression, reconstruction of a spine axis (according to X-ray and CT data), and in some cases the spinal cord was assessed with CT and MRI.

Results. Complete spinal cord injury resulted in death of 5 patients despite complete decompression and rigid fixation of the injured segment, at discharge 14 patients had neurologic status of type A (ASIA scale), and 4 patients moved to type B. Patients with incomplete spinal cord injury demonstrated the following outcomes: in group of patients with type B neurologic deterioration 4 patients improved to type C and 2 – to type D; in type C group 5 patients improved to type D and 5 – to type E; in type D group 5 patients improved to type E.

Conclusion. Combination of interbody fusion with anterior plate fixation significantly augments the reliability of fixation, permitting to avoid external immobilization and to activate patients earlier, which finally improves neurologic prognosis and provides favorable conditions for bone-metal block formation.

Objective. To analyse the outcomes of surgery for severe idiopathic scoliosis.

Material and Methods. Seventy nine patients at the age of 12 to 20 years (male and female ratio is 8:71) with spine deformity more than 90° operated on with CDI with ventral fusion (72 patients) and without it (7 patients) were examined. Average follow-up is 1.3 years. Data of X-ray, COMOT examination, intervertebral disk morphological study and Russian version of SRS-4 questionnairy were analyzed.

Results. Average correction was 55.0°. Postoperative progression was 3.4°. CDI correction with previous intervertebral disk excision at the apex of scoliotic arch added 26.5° to preoperative correction in lateral bending, and in combination with skeletal traction – 40.6°. Counter-curvature initially averaged 69.7°, correction was 36.5°, and postoperative progression – 4.0°. Preoperative thoracic kyphosis was 59.6°, postoperative – 33.8°, lumbar lordosis was decreased from 68.1° to 48.7°. Patient’s satisfaction was 100.0 % and did not decline in time. Positive dynamics was noted in all parameters of dorsal trunk shape.

Conclusion. Contemporary segmental instrumentation for treatment of severe idiopathic scoliosis allows achieving and reliably retaining substantial correction of deformity. Various types of preoperative traction can be replaced by intraoperative release of the deformed spine including discectomy.

Objective. To study aorta topography, spinal cord blood circulation, and spinal arachnoid microcirculation, as well as to evaluate thermographically microcirculation in soft tissues of the back and peculiarities of its neurovegetative regulation in scoliotic spine deformity.

Material and Methods. Seventy four angiographies have been performed in 69 patients with scoliosis. In 21 patients laser doppler flowmetry was used intraoperatively to study spinal arachnoid microcirculation in red and infrared spectra before and after deformity correction. In 26 patients microcirculation and trophism of soft tissues of the back was studied in pre- and postoperative period.

Results. Angiographic data show that in severe and extremely severe scoliosis the shape of aorta, but not its diameter, is changed. Examination of patients with secondary kyphoscoliosis showed a system of posterior arteries that was not visualized in patients with dysplastic scoliosis. Study of microcirculation in spinal arachnoid revealed that correction of relatively light scoliosis with CDI system improved the indices of microcirculation. In extremely severe scoliosis there is a tendency towards blood circulation disturbance in deeper layers of the arachnoid. Normalization of vegetative segmental regulation takes place in 2/3 of patients within a postoperative period.

Conclusion. Spinal blood supply system in patients with scoliosis is a self-regulating mechanism of hemodynamic interactions, the compensation degree of which depends on localization of afferent spinal arteries, deformation of vertebral canal and permeability of anterior spinal artery system.

The aim of this prospective radiological analysis is to determine the normal values of the kyphosis of the upper and lower thoracic segments, and to analyze their variation with age and sex, as well as to investigate if there is any interaction between them. The study includes 157 healthy individuals without any complaints related to their spine, and a thoracic kyphosis of not more than 50 degrees. Subjects were evaluated by medical history, physical examination, and standing spinal roentgenograms. Age and sex of the patient, together with the degree of upper (T2–T6), lower (T6–T12) and the total (T2–T12) thoracic kyphosis – measured by the Cobb method – were the parameters used for statistical analysis. There were 49 males and 108 females with the mean age of 42 ± 16 years (range, 11–76). Mean values of the upper, lower, and total thoracic kyphosis were found to be 13° ± 6° (range, 2–30°), 21° ± 8° (range, 4–43°), and 34° ± 9° (range, 11–50°), respectively. An older age correlated to a higher degree of kyphosis in the lower thoracic segment (p = 0.007), without an increase in the upper thoracic kyphosis. There was also a negative correlation between the degree of the upper and lower thoracic kyphosis (p = 0.015).

Objective. Comparative assessment of decompression and decompression-stabilization techniques for degenerative diseases of the lumbar spine in elderly and senile patients.

Material and Methods. A total of 106 patients at the age of 60 to 83 years (mean age 65.7 years) operated on for degenerative disease of the lumbar spine were included in the prospective study. The outcomes were evaluated in 3–4 and 12–24 months. A dynamics of neurologic state, intensity of pain according to VAS, and functional activity according to Oswestry scores were evaluated.

Results. Good results were achieved in 70 % of cases after decompression – stabilization surgery, as compared to 46 % after decompression only. There were 26 % of unsatisfactory results of treatment after decompression, and 5 % – after decompression and stabilization. Surgical complications were typical for these kinds of surgical interventions. There were no infectious and systemic complications as well as metal implant induced complications such as its destruction, migration or subsidence, and bone resorption around implant.

Conclusion. Decompression and stabilization surgery is the most reasonable and effective technique for treatment of lumbar degenerative diseases in elderly and senile patients. Preference should be given to posterior approach surgery concluded by stabilization of operated vertebral segments.

Objective. To compare the effectiveness of laser discectomy and radio-frequency nucleoplasty in patients with nonsequestrated disc herniations accompanied with lumbar osteochondrosis.

Material and Methods. Radio-frequency nucleoplasty and laser discectomy were performed in patients from 24 to 57 years old with nonsequestrated disc herniations. Thirty patients who underwent radio-frequency nucleoplasty (main group) and 30 patients after vaporization (control group) were included in the study. Groups were similar in age, gender, concomitant diseases, hernia localization and duration of illness. Pre- and postoperative examination consisted of clinical, radiological, CT and MRI data. The outcomes were assessed in two-three days, one month and 6 months after operation.

Results. In two-three days all patients of both groups reported absence of pain or its significant reduction in the lumbar spine or lower extremities. In 6 months 5 patients of a control group suffered of lumbar spine and lower extremities pain, which restricted their labor ability and demanded inpatient treatment. In a main group only 2 patients demanded inpatient care for the reasons given above.

Conclusion. The assessment of two technologies suggests that radio-frequency nucleoplasty is a safety technique for treatment of patients with disc herniation accompanied with osteochondrosis. It has obvious advantages over laser intervention.

Objective. To analyze the results of microdiscectomy with preservation of the ligamentum flavum.

Material and Methods. One hundred and fifty two patients underwent microdiscectomy with preservation of the ligamentum flavum. The ligamentum flavum was exposed and cut in an apron-like shape, after disk hernia total removal an «apron» of the ligamentum flavum was placed in the interarticular space.

Results. Radicular pain syndrome was completely arrested in 73.7 % of patients, significant decrease in radicular pain was observed in 22.4 %, and 3.9 % of patients had no any dynamics of radicular pain syndrome. A complete regression of motor and sensitive disturbances was observed in 31.6 % of patients, incomplete recovery – in 53.3 %, and absence of any neurological dynamics – in 15.1 %. Most of patients (76.1 %) returned to their work in 3 months.

Conclusion. Microdiscectomy with preservation of the ligamentum flavum is a new perspective method, which helps to minimize a surgical trauma and to improve outcomes in patients with hernia of a lumbar intervertebral disc. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, is important for preventing epidural fibrosis that may cause a failed back surgery syndrome.

Objective. To study peculiarities of vertebral and cerebral hemodynamic disorders in adolescents with cervical spine osteochondrosis.

Material and Methods. The examination of 220 adolescents at the age of 14 to 18 years was conducted, which included clinical, radiographic, neuropsychologic, ultrasonic and neurophysiologic techniques.

Results. Asymmetry of linear blood velocity in vertebral artery (VA) was observed in 95.0 % of cases with compression irritative type of vertebrogenic VA syndrome and in 77.2 % – with reflex angiospastic type. Bilateral reduction of linear blood velocity in VA was revealed in 5.0% of cases with compression irritative type and in 22.8 % – with reflex angiospastic type of VA syndrome.

Conclusion. Hemodynamic changes in VA in adolescents with cervical osteochondrosis manifest themselves through asymmetry and bilateral reduction of linear blood velocity in VA.

Objective. To substantiate the efficacy of scoliotic deformity diagnosis by quantitative parameters.

Methods. The examination is performed with spine scanner. The spine is assessed separately in each plane: frontal, sagittal and horizontal. Each parameter is evaluated in automatic mode with developed program and a code is assigned to it depending on its magnitude.

Results. Basing on data received by spine scanning the criteria for estimation of various pathologic conditions in spine scoliosis using biomechanical parameters were developed. Formalized signs of scoliotic deformities in three planes are defined with corresponding diagnostic codes necessary for detection of scoliotic deformity type. Both an existing scheme of orthopaedic examination and parameters received at scanning of scoliotic spine are reported.

Conclusion. The advantage of spine scanning over clinical and radiological techniques consists in assessment of a shape and a spatial orientation of the spine by several quantitative parameters without radiography, and in ability to formulate diagnosis within several minutes.

Objective. The impartial instrument assessment of a nature and degree of cephalic and cervical spinal cord functional abnormalities and dynamics of their changes in patients with Chiari malformation before and after surgery.

Material and Methods. Visual evoked potentials (VEP), somatosensory (SSEP) and brainstem auditory evoked potentials (BAEP), and motor responses to the transcranial magnetic stimulation (TMS) were registered in 28 patients preoperatively and in 12–30 days postoperatively.

Results. Initial VEP and SSEP showed deviations from normal values caused by hydrocephalus and increased intracranial pressure. In majority of patients a latent time of VEP P100 was abnormally short. Lateral asymmetries of P100 delay and amplitude, and VEP shape changes were also observed. P100 delays increase and VEP asymmetry were observed when foci of vascular dysmetabolic genesis and dystrophic changes were present. SSEP had changes in N30 cortical components. Initial N20 components were radically changed only in patients with cervical syringomyelia. The same patients had the worst M-responses to the TMS. BAEP were registered with decreased V component and increased interpeak IV–V interval.

Conclusion. Arnold – Chiari syndrome is reflected in various deviations of electrophysiological parameters characterizing a functional condition of the central nervous system. Postoperative dynamics showed prevalence of positive shifts and normalization of electrophisiological parameters

Objective. To analyze quantitative and qualitative composition of glycosaminoglycans in intervertebral disc tissues in patients with idiopathic scoliosis.

Material and Methods. Intervertebral discs and growth plates were obtained from 50 patients at the age of 12 to 14 years undergoing surgical correction for idiopathic scoliosis of Grade III–IV with apex in the thoracic spine. Autopsy material (20 samples) from forensic medical examination was used as a norm. Nucleus pulposus, annulus fibrosus and growth plate were anatomically separated from tissues.

Results. It was established that qualitative composition of glycosaminoglycans is changed both in all parts of the intervertebral discs and in growth plate. Abundance of keratan sulfate increased and of chondroitin sulfate decreased. A great deal of nonacetylated hexosamines appeared and abundance of sulfate groups reduced.

Conclusion. Revealed changes are related to the disorders in synthesis and processes of chain modification in glycosaminoglycans.