Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury.

Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation.

Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations.

Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.

Objective. Basing on experiment biomechanical and clinical studies to determine the optimal method of surgery in patients with vertebral lower thoracic and lumbar fractures using porous NiTi implants.

Material and Methods. A method of modeling of comminuted vertebral fractures has been developed. The outcomes after anterior interbody fusion with both porous NiTi implants alone and in combination with pedicle screw fixation and on-bone screw – rod osteosynthesis for comminuted vertebral fractures in thoracic and lumbar spine were analyzed in 61 patients. An antimigration technique for implant stabilization was developed and successfully used in 5 patients with comminuted vertebral fractures predominantly in the lower lumbar spine. Patients of this group underwent stabilometry and X-ray tomography for objective appraisal of treatment results.

Results. Results of the experimental studies demonstrated that anterior mono- and bisegmental spinal fusion with onbone screw – rod or transpedicular osteosynthesis provides stable fixation, but firmer fixation is achieved by its combination with anterior spinal fusion. Most patients (87.9 %) have good results after anterior interbody fusion with porous NiTi implants.

Conclusion. Combination of anterior interbody fusion with porous NiTi implants and on-bone screw – rod osteosynthesis is advisable for unstable fractures and also for early active rehabilitation of patients without external immobilization. Anterior interbody fusion with titanium antimigration screw is advisable for comminuted vertebral fractures predominantly in lower lumbar spine.

Objective. To analyze results of surgical treatment of patients with thoracic idiopathic scoliosis.

Material and Methods. Fifty-two patients with Lenke type 1 idiopathic scoliosis were operated on. Follow-up periods ranged from 2 weeks to 8 years (mean 1.8 years). Surgical treatment included four types of operation: spine deformity correction with CD instrumentation; supramalleolar-andskull traction and CDI correction; discectomy and interbody fusion with bone autograft and CDI correction; supramalleolar- and-skull traction, discectomy and interbody fusion with bone autograft, and CDI correction. Patients were interrogated with pre- and postoperative SRS-24 questionnaires and examined with Computer Optical Topograph (COMOT).

Results. Scoliosis was corrected from a mean of 67.7° to 26.6°, with a mean deformity value being 30.3° at the last follow-up. Thus, postoperative progression of the thoracic curve with a mean follow-up 1.8 years was 3.7° (9 % from the achieved correction). Anterior fusion provided a threefold decrease in postoperative progression. Sagittal shape of the thoracic and lumbar spine remained within norm limits. The location of the lowest instrumented vertebra (LIV) relative to a neutral vertebra, lower stable vertebra and neutralized disc did not reliably influence on the postoperative course. Postoperative deformity progression was associated only with increase in LIV tilt. SRS-24 data showed a high rate of patients’ satisfaction with the obtained effect of treatment, the rate growing with the extension of follow-up terms. Severe complications were not observed.

Conclusion. Modern 3rd generation segmental instrumentation allows to obtain stable and high results of treatment for single curve thoracic idiopathic deformities, while all regularities of postoperative course are not fully understood yet.

Objectives. To analyze the efficacy of surgery using the original plate endocorrectors for III–IV grade idiopathic progressing scoliosis.

Materials and methods. Two-plate endocorrector was used in surgical treatment of 380 patients. Out of them 171 patients at the age of 13–15 years had vertebral body apophysis ossification of stage 2–3 according to Risser’s test. Scoliosis was congenital in 12 patients (3.2 %) and idiopathic in 368 patients (96.8 %). The smallest coronal angle of curve according to Cobb was 40°, the largest one – 145°. Surgery of severe IV grade scoliotic deformity (curve angle of 60–90°) was performed in 178 patients.

Results. Patients with non-removable instrumentation show the maintenance of post-surgical correction within 75–80% in long-term follow-up period (up to 9 years). Complications related to the plate endocorrector were observed in 9.8 % of cases: aseptic serous reaction induced by instability of the construct elements – in 3.7 %, plate breakage and release of endocorrector locking – in 5.3 %.

Conclusion. Plate endocorrector of the third generation provides effective three-dimensional deformity correction for idiopathic III–IV grade scoliosis. The endocorrector does not prevent further spine growth in children after surgery.

Objectives. To evaluate functional peculiarities of somatic systems in children with initial (I–II) grades of scoliosis living in the European North of Russia.

Material and Methods. Complex examination of 598 schoolchildren (160 with and 438 without scoliosis) aged 7 to 15 years has been carried out. More than 1400 examinations were implemented using orthopedic and radiographic methods, USI, computer spirometry, rheovasography and echocardiography.

Results. It has been determined that indices of volumetric blood flow in children with scoliosis at the age of 7 to 11 years are reduced by 14–15 % (р < 0.001) in upper extremities and 12–16 % (р < 0.01–0.001) in lower extremities as compared to those in children without scoliosis. Mitral valve dysfunction is 3 times more often (р < 0.05) and regurgitation on pulmonary artery valve is 1.7 times (р < 0.05) more often in children with scoliosis than in schoolchildren without pathology of the spine. At the age of 7–11 years functional abilities of the external respiration system in girls with initial degrees of scoliosis were reduced, in children at the age of 7–15 years the speed of air flow along the bronchial tree decreased at the level of average and small bronchi that correlated reliably with scoliosis. Anomalies of gallbladder development, biliary dyskinesia and pancreas pathology occurred reliably more often in the schoolchildren with scoliosis than in those without scoliosis.

Conclusion. The received data allow grounding a wider application of a term «scoliotic disease». This pathologic state involves not only the vertebral column but also the somatic systems of a child organism both with severe (III–IV) and initial (I–II) grades of scoliosis.

Objective. Complex estimation of pulmonary and systemic circulation in patients with various degree of scoliotic disease severity and duration.

Material and Methods.We observed 210 patients at the age of 14 to 38 years with I–IV grade scoliosis. Sex ratio (male/female) was 1:6. All patients were divided in two groups according to the age: Group 1 – patients of 14–18 years old, with the average disease duration being 8.3 ± 3.6 year; Group 2 – 19–38 years old, with the average disease duration – 24.6 ± 1.9 years. Control group cosisted of 60 individuals without scoliotic deformities, heart and pulmonary diseases, and was comparable in age and sex. All groups underwent complex examination including standard Dopplerechocardiography.

Results. Echocardiography demonstrated changes in systolic function of the left ventricle in patients with scoliosis which is naturally accompanied by central hemodynamics impairment. Hyperkinetic type of hemodynamics was revealed in patients with mild scoliosis and hypokinetic type – in patients with severe one. The study revealed pulmonary hypertension, rise of average blood pressure, increase in peripheral and lung vascular resistance in adolescents with clinically apparent scoliotic deformities. Impairment of central hemodynamics and pulmonary blood flow in adult patients with severe scoliosis were less pronounced.

Conclusion. Impairment of systemic and pulmonary circulation has been revealed in patients with thoracic scoliosis, which is more pronounced in adolescents with severe and rapidly progressing forms of the disease. They suffer from early derangement of adaptation mechanism and progressing decrease in stroke and minute cardiac output, in spite of increase in cardiac beat rate; decrease in average hemodynamic pressure and rise of resistance in lesser and greater circulation.

Objective. To describe the microendoscopic discectomy technique by an endospine operating tube assembly for all types of lumbar disc herniations.

Material and Methods. 1562 patients were operated on between April 1999 and December 2001. In order to permit a valid analysis of the results, a study was begun. Before the operation, each patient was given a questionnaire and an explanation of what exactly was being asked.

Results. Of the questionnaires given to 1562 patients, 1156 (74 %) were returned showing excellent results in 1105 cases (95.5 %°), good in 7 (0.6 %), moderate in 1 (0.1 %) and poor in 43 (3.7 %). The complications observed were: discitis in 5 cases (0.32); reoccurrence in 102 (6.5 %), of which 91 (5.8 %) needed a second surgery, 58 (3.7 %) at the same level and side; dural tear in 25 (1.6 %); nerve root injury but of no postoperative sequelae in 7 (0.45 %); and resection of the articular process in 36 (2.3 %). Of the 841 patients who were working before the operation and answered the questionnaire, 795 (94.5 %) were able to return to work within an average delay of 4 weeks. In answer to the questions on global satisfaction and on the accuracy of the information given before surgery, 1132 (97.9 %) responded as satisfied and 1115 (96.4 %) felt the information given was accurate.

Conclusion. The results of this study are comparable to, or even better than those of open and microsurgical discectomy methods. Early post-operative mobilization allows early return to work.

Objectives. To improve diagnosis of a vertebral artery syndrome by combination of a multiplanar functional ultrasonography of the cervical spine and dopplerography of an extracranial segments of the vertebral artery (VA).

Material and Methods. To diagnose a VA syndrome 12 patients with uncovertebral arthrosis and 22 patients with cervical spine instability underwent ultrasound examination. VA was investigated in the mode of energetic dopplerography through anterior-lateral horizontal paratracheal approach, which provides one plane visualization of VA in osseous canal, uncovertebral junction, intervertebral disk and the spinal canal at the disk level. This technique allows direct estimation of interrelations between VA and mentioned above bone and soft tissue structures. To detect cervical spine instability the ultrasonography with functional tests was performed. All patients underwent conventional duplex dopplerography.

Results. The examination revealed changes in a VA blood circulation in the presence of uncovertebral arthrosis and cervical spine instability.

Conclusion. The suggested technique provides more precise diagnosis of VA compression level in the spinal canal in the presence of uncovertebral arthrosis and permits to trace interrelation between changes in arterial blood circulation and instability of intervertebral motional segments.

Objective. The assessment of reliability of data obtained using a firmware domestic complex Spine Scaner.

Material and Methods. Fifty four healthy volunteers have been examined. Criteria for inclusion in the study were the absence of orthopedic pathology, and the Roland-Morris Back Pain Questionnaire and the Oswestry Disability Questionnaire scores being 0. Two independent observers with a different skill level performed the study. Intraobserver and interobserver data repeatability was assessed by the analysis of intraclass correlation coefficient (ICC), standard error of measurement (SEM), and reliability coefficient for each of 31 tested parameters.

Results. The observation without fixation of a patient exhibited a low repeatability, with a correlation coefficient being 0.39. Other observation stages showed the acceptable ICC mean values. The best repeatability was achieved in the study performed by the same observer, with the ICC value beiing 0.86. The interobserver repeatability had the lesser values: 0.61 for independent identification of anatomic references and 0.77 for the references identified by one of the observers.

Conclusion. The Spine Scaner can be used in clinical practice for defining a shape and spatial orientation of the spine under the following conditions: a reliable fixation of the patient’s trunk, wide experience of the observer, and a strict adherence to the study protocol.

Objective. To study specific structural and functional changes in bone tissue in Oxys rats of different age.

Material and Methods. Mineral density of bone tissue in Oxys and Wistar male rats at the age of 2–18 months was examined with x-ray bone densitometer LUNAR-Exert-XL (USA). Bone fragments of vertebral bodies and of forelegs and hind legs were studied by histomorphometric assay with software Motic Images Plus 2.0 ML (Micromed, Russia).

Results. X-ray bone densitometry findings have shown that bone mineral density increase in Oxys rats does not attain the values shown by age-matched control rats, and progressively decreases after the age of 6 months. Data obtained by histomorphometric analysis of vertebral bodies and limbs have reliably demonstrated that there is a change in quantitative and qualitative bone tissue parameters of Oxys rats which is a characteristic of osteoporosis.

Conclusion. Bone tissue changes in Oxys rats correspond to that observed in human osteoporosis, what allows to use rat as a model for the study of osteoporosis pathogenesis and for development of prophylaxis and treatment methods.