Objective. To study clinical and morphological features of degenerative lumbar spine disease in elderly and senile patients for substantiation of optimal surgical treatment.

Material and Methods. Prospective study included 128 consecutive patients operated for lumbar spine degeneration during 2003–2005. Patients were divided into two age groups: 88 patients of 60–83 years of age (mean 65.7 years) and 40 patients of 19–40 years of age (mean 31.8 years). Complex diagnosis consisted of anamnestic, general clinical, neurological, X-ray, MRI, and CT examinations.

Results. Patients with clinical manifestations of segmental instability and neurogenic intermittent claudication syndrome prevailed in the older group. Clinical symptoms in elderly patients were associated primarily with degenerative stenosis of the spinal canal. Radiological and CT signs of segmental instability (or hypermobility) were more frequent in older age group than in young patients. Degenerative spondylolisthesis and degenerative scoliosis of the lumbar spine were found only in elderly patients (20.4 % and 21.5 % of cases, respectively). Segmental hypermobility in elderly patients was presented predominantly as a linear translation of vertebrae. Sagittal translation of vertebrae over 3 mm was registered in 54.5 % of older age group patients and only in 22.5 % of young ones (р < 0,01). Flexion-extension hyperangulation of damaged spine segments was found in 61.3 % of older patients and in 65.0 % of young ones.

Conclusion. It may be assumed that surgical treatment of degenerative lumbar spine disease in elderly and senile patients should involve not only extensive decompression of neurovascular formations but also stabilization of damaged spine segments despite a higher risk and implementation difficulties of the surgery.

Objective. To assess the acupuncture efficiency for conservative treatment and postoperative rehabilitation of patients with spondylolisthesis.

Material and Methods. The study group included 42 patients with spondylolisthesis complicated by root syndrome. After surgical intervention the patients underwent treatment consisting of corporal acupuncture and drug therapy (NSAID, diuretics, vitamins, muscle relaxants). The McGill Pain Questionnaire (MPQ), visual analog scale (VAS) and EMG-examinations were used for pain assessment.

Results. Drug therapy contributed to pain decreasing in 10 % of patients on the first day of treatment and in 35 % – on the third. Complete relief of pain syndrome occurred in 55 % of patients on the fifth day. The combination of drug therapy and acupuncture provided complete reduction of pain syndrome in 95.4 % of cases during 5 days.

Conclusion. It is advisable to apply corporal acupuncture to complex postoperative rehabilitation of patients with spondylolisthesis complicated by root syndrome.

Objective. To determine a rational surgical strategy and approach to the treatment of patients with degenerativedystrophic disorders of the lumbar spine by percutaneous endoscopic discectomy.

Material and Methods. Percutaneous endoscopic nucleotomy was applied in surgical treatment of 60 patients. Out of them 46 patients had L4–L5 intervertebral disc herniation, 7 patients had L3–L4 intervertebral disc herniation, 2 patients – L4–L5 hernia relapse after microdiscectomy, 1 patient – ossificated foraminal hernia at L3–L4, 3 patients – unstable degenerative spondylolisthesis at L4 level, and 1 – the same at L3. Complex examination of patients included acquisition of complaints and anamnestic data, general clinical, neurological, laboratory, and radiologic evaluation. All patients had CT images, in 10 cases they were added by MRI, and in 16 cases – by CT myelography. Pain syndrome intensity was assessed by digital rating and visual-analogue scales allowing the analysis of pain at rest, in motion, and at night.

Results. Pain syndrome was arrested in 51 patients. Two patients showed residual radicular syndrome in the early postoperative period, and seven patients – residual reflex pain syndrome. Three months after the operation moderate reflex pain syndrome was observed in 6 cases, radicular syndrome in no one case. No aggravation of neurological deficit occured at the later follow-up period.

Conclusion. Percutaneous endoscopic nucleotomy is a minimal invasive technique for lumbar disc hernia removal which reduces hospitalisation terms and risk of postoperative complications.

Objective. To analyse results of multistage surgical treatment of idiopathic scoliosis including costal humpback resection.

Material and Methods. From 1996 to 2005 twenty girls with idiopathic scoliosis underwent spine deformity correction with Harrington distraction rod with Drummond interspinous wires (Group I) or with Cotrel – Dubousset Horizon Instrumentation (Group II). The final long-dated stage after correction of deformity included the costal humpback resection at the convex side only. Radiologic and topographic examinations were performed, and lung vital capacity parameter was used for lung function assessment. Patients answered the Russian version of SRS-24 questionnaire after correction and at each follow-up examination.

Results. In Group I the mean curvature was 81.7° ± 26.7° (range, 55–107°) before correction and 34.5° ± 13.1° after correction (primary curve correction 57.8 ± 14.1 %). Mean correction loss in dynamics before resection was 8°, after resection 4.3°. In Group II the primary curve magnitude before correction was 87.4° ± 27.1° (range, 48–126°), after correction 42.7° ± 16.9° (primary curve correction 51.9 ± 9.6 %). Average correction loss in dynamics before resection was 3.5°, after resection 2.4°. Spirometric findings presented the following dynamics: lung vital capacity before resection was 1980 ml with mean early postoperative decrease by 16.8 % and subsequent reversion to the preoperative level or increase to 2010 ml. According to the questionnaire survey 100 patients gave the consent for surgery.

Conclusion. Costal humpback resection as a cosmetic intervention improves the patient’s assessment of spine deformity surgical correction result.

Objective. To analyze the results of idiopathic scoliosis correction with instrumentation developed by the authors in patients previously operated by the Harrington method.

Material and Methods. Ten patients of 14–31 years of age with grade III–IV scoliotic deformity previously operated by the Harrington method were reoperated with universal endocorrector. The reasons for repeat surgery included a fracture of Harrington rod, insufficient correction of scoliotic deformity, perforation of the vertebral arch by distractor hook, and the trunk imbalance. All patients underwent simultaneous two-stage surgery involving distractor removal and scoliosis correction with universal endocorrector. The follow-up period was 6–24 months.

Results. Mean correction in rod fracture group was 61.08 % without complications, in undercorrection group (mean correction 27.24 %) it achieved 63.39 %. In the group of patients with vertebra arch penetration and pain syndrome the mean correction by universal endocorrector was 34.29 % with 100 % reduction of pain. During the 6–24 months follow- up there were no correction loss or neurologic and septic complications in operated patients.

Conclusions. The new instrumentation provides greater correction (1.8 times) of scoliotic deformity than Harrington rod instrumentation. It is successfully used in repeat surgery and equally effective both in adolescent and in adult scoliosis.

Objective. To compare the intensity of pain-relieving effect of percutaneous vertebroplasty (PV) in patients with gemangiomas, osteoporotic vertebral fractures, and malignant metastases.

Matherial and Methods. 210 percutaneous vertebroplasties (VP) were performed in 121 patients at the age of 18 to 87 years. Out of them 22 patients had metastases into vertebral body/bodies, 72 patients – osteoporotic fractures, and 27 patients – vertebral haemangiomas with high-grade pain syndrome. The levels of vertebroplasty were between T3 and S1, predominantly (178 cases) from T9 to L4 levels. Significant anatomic abnormalities in seven cases required CT-guidance of the percutaneous vertebroplasty. Pain syndrome intensity before and after PV was assessed by visualanalogue scale.

Results. Percutaneous vertebroplasty resulted in significant pain relief in all patients. One hundred-and-one patients reported full satisfaction with treatment, 17 patients – partial satisfaction, and 3 patients were not satisfied. Vertebroplasty complicated by cement leakage into the spinal canal in two patients with multiple myeloma. One patient with osteoporotic fractures has developed L5 radiculopathy after four-level PV, which was eliminated in 5 days. Three patients had transient complications.

Conclusion. The achieved results confirm a high painrelieving efficacy of percutaneous vertebroplasty. A choice of vertebroplasy technique depends on a nature of pathology and peculiarities of vertebral anatomy. Application of cement based on calcium phosphate, bioceramic and bone morphogenetic proteins improves the long-term outcomes of percutaneous vertebroplasty.

Objective. To analyze treatment results in patients with osteoporitic fractures of the thoracic and lumbar vertebral bodies.

Material and Methods. The study was performed in 301 patients (aged 20 to 81 years) with noncomplicated fractures of thoracic and lumbar vertebral bodies associated with osteoporosis. Compression fractures were diagnosed in 42.5 % of patients, splintered – in 21.3 %, and burst – in 36.2 %. Grade I osteoporosis was observed in 12.6 %, Grade II – in 52.5 %, Grade III – in 27.5 %, and Grade IV – in 7.4 % of patients. Conservative treatment was performed in 188 patients. After pain syndrome relief and fixation with removable spinal brace the patients were discharged for follow-up care. Another 113 patients underwent surgical treatment: transpedicular fixation was done in 15.0 % of cases, transpedicular fixation with osteoplasty – in 50.4 %, two-stage surgical procedure – in 24.7 %, and vertebroplasty – in 9.9 %.

Results. The outcomes after conservative treatment for osteoporotic vertebral fractures was good in 13.0 % of patients, satisfactory in 43.0 %, and nonsatisfactory in 44.0 %. Patients showed a progression of osteoporosis and deformity magnitude between 8 and 36 weeks after the treatment. Surgical treatment of veretbral fractures had excellent results in 27.4 % of patients, good results in 51.6 %, satisfactory in 19.7 %, and nonsatisfactory in 1,5 %. Correction of all deformity components of the injured spine segment was observed in the postoperative period.

Conclusion. Differentiated treatment for osteoporotic fractures of the thoracic and lumber vertebral bodies associated with osteoporosis improves the treatment results and reduces the treatment failure rate.

Objective. To study potentialities of posterior instrumentation for treatment of TB spondylitis in adults.

Material and Methods. Data on the treatment outcomes of 93 adult patients with TB spondylitis at T2–L5, which underwent radical reconstructing and restorative surgeries in the period of active inflammatory process were analyzed. In 40 cases a traditional technique was used (Group 1); in 11 cases this technique was supplemented by posterior fixation with Harrington rods or CITO-plates (Group 2) and in 42 – with CDI (Group 3). Deformity dynamics, character of complications, and changes in neural disorders and pain dynamics defined the operative effect.

Results. The absence of instrumented fixation in Group 1 was accompanied with the most significant decrease in graft sizes and most numerous complications in a zone of anterior fusion. Both these characteristics have least values in Group 3. Use of conventionally semi-rigid constructs in Group 2 caused 7 complications in a zone of posterior fixation out of 11 cases (66.4 %). There were 2 complications out of 42 cases (4.3 %) in Group 3. Short-term pain intensity decrease was achieved in all groups. However augmenting of pain syndrome was registered in a considerable number of patients in Groups 1 and 2 in a long-term period, while there were no negative long-term outcomes in Group 3.

Conclusion. Combination of radical spinal reconstruction and fixation with segmented instrumentation of the third generation for TB spondylitis provides considerable improvement of treatment results and reduction of rehabilitation and in-hospital periods.

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 study the accuracy of 3D surface reconstruction of human body model by computer optical topography as compared to a multislice computed tomography.

Material and Methods. A model of a trunk dorsal surface of a patient with III Grade right side scoliosis in the thoracic spine was used for study. Computer optical topography was performed with a serial installation TODP, METOS Ltd., and multislice computed tomography – with a helical tomograph Siemens Somatom Sensation 4.

Results. Comparison of obtained magnitudes of clinical parameters, which are the most significant for diagnostics of spine deformity, revealed that difference in their meanings did not exceed ±0.5 mm for metrical and ±0.5° for angular parameters.

Conclusion. Computer optical topography ensures the accuracy of 3D surface reconstruction of human body model, which is comparable to that of a multislice computed tomography, and provides noninvasive and reliable assessment of important clinical parameters of a human body dorsal surface.

Objectives. To specify optimal content of the injectable composite material for percutanious vertebroplasty.

Material and Methods. Two sets of experiments were performed. Alimentary osteoporosis was induced in 19 rats and confirmed histologically in 3 rats. Sixteen rats underwent anterior procedure of spherical defect drilling in L6 vertebral body. The defect was filled with bone cement (Osteopol-V) in group I (n = 8) and with composite material (Osteopol-V – 80 %; hydroxiapatite (HAP) – 4 %; tricalcium phosphate (TCP) – 16 %) in group II (n = 8). Vertebral bodies were extirpated three months after vertebroplasty. Four bodies in each group were subjected to biomechanical testing, another four – to hystological one.

Results. The elastic modulus of composite material is most similar to that of the cortical bone when it contains 80–90 % of bone cement with HAP/TCP ratio to be 2:8, as was confirmed by mathematical calculations. Mechanical testing of specimens have shown that the most strong composite contain 80 % of bone cement, 4 % of HAP, and 16 % of TCP. Experimental testing of intact osteoporotic vertebral bodies vs vertebral bodies 3 months after vertebroplasty with bone cement (Group I) and with composite material (Group II) has clearly shown, that composite material provides a higher strength, bone tissue ingrowth into resorbable ceramic, and a solid osteointegration.

Conclusion. New injectable composite material significantly increases the strength and stiffness of both fractured and nonfractured osteoporotic vertebrae. This material can be used for restabilization of osteoporotic compression fracture and for prevention of vertebral body compression in osteoporosis.