Objective. To study acute pathological conditions of the cervical spine in children. Material and Methods. 200 case records of patients with acute torticollis were analyzed. Majority of patients having neck pain and abnormal head position were not diagnosed with C1 subluxation. MRI investigation performed in 4 patients one day after the disease onset has shown changes in uncovertebral joints of C2–C3 or C3–C4. Results. A forced position of the head in 182 children (91.0 %) was characterized by predomination of head bending over neck rotation. Out of 149 children with predomination of bending 89 patients (49.0 %) complained of right-sided neck pain accompanied by left-sided head bending; 41 (22.5 %) had a contrary situation – left-sided neck pain and right-sided head bending; and 19 (10.4 %) had a fixed head position and neck movement incapability. Disorders of sagittal profile of the spine with loss of lordosis or significant kyphotization were detected in more than 70.0 % of children. Conclusion. The obtained findings along with the absence of changes in atlantoaxial segment require further investigations of causes of acute torticollis in children.

Objective. To study plastic anatomy in patients with severe scoliotic curvature of the spine. Materials and Methods. A total of 731 patients with idiopathic scoliosis were examined. All patients at initial examination at the age of 4 to 20 years were diagnosed with grade IV deformity of the spine. Examination included clinical and X- ray methods with the assessment of limb-to-trunk length proportions according to plastic anatomy canons. Results. Progressive spinal deformities are associated with disorders in proportions between anatomic parts of the trunk. The revealed process of changes in plastic anatomy has been termed a “scoliotic disproportion syndrome”. This process is divided into four severity stages depending on the magnitude of the spinal deformity. These stages reflect a progression of the disease severity. Conclusion. The presented scoliotic disproportion syndrome and stages of its development can be useful as additional diagnostic information in determining the nature of scoliotic deformity and prediction of probable development of the pathology.

The paper presents a clinical case of female patient with right lower limb monoparesis associated with L5 spondyloptosis treated with single-stage surgery through a posterior-only approach. The surgery resulted in restoration of spinal canal anatomy, normal physiological relations within L5–S1 segment, and trunk balance, and in reduction of neurological deficit.

Objective. To assess the treatment of patients with compression and reflex pain syndromes of cervical spine osteochondrosis. Material and Methods. The authors studied 410 patients operated on for compression syndromes of cervical spine osteochondrosis. Treatment and diagnostic disc punctures were performed in 600 patients suffering either from reflex pain syndrome or from that combined with compression syndrome. Results. Reflex pain syndromes are characterized and classified into 6 groups: local, reflrected, reflective myodystonic, dystrophic, angiopathic, and discogenic pathobiomechanical syndroms. The leading role of clinical neurologic diagnosis of cervical spine compression pain syndromes is shown. Disc puncture facilitates better diagnosis of reflex pain syndromes which can be evoked and abolished by dereception performed on impaired discs. Differential performing of decompressive, decompressive-plastic, or decompressive- stabilizing operations provided good surgical outcomes in most patients. Conclusion. Patients with combined reflex and compression pain syndromes of cervical spine osteochondrosis require a multimodal treatment approach.

Objective. Comparative assessment of the influence of dynamic implants COFLEX, DIAM, and DYNESYS on a mobility of lumbar spinal segments in vitro. Material and Methods. Fifteen unfreezed human spine specimens each including L2—L3, L3—L4, and L4—L5 segments were studied. Muscle tissues were removed, while ligaments, facet joints, and intervertebral disc were retained. Segmental motion was tested using a device equipped with tensometric sensors recording the applied force and linear motion of vertebra along three mutually perpendicular axes. The range of linear flexion/extension and lateral motions of vertebrae was measured under the load of -120 to +120 N, and the size of neutral region was determined. Measurements were performed at intact segment after resection of posterior supporting complex, and after placement of dynamical implants. Results. The range of linear flexion/extension motion was reduced by 57 % in specimens with COFLEX, by 32 % — with DIAM, and by 69 % — with DYNESIS implants. All three devices decreased the volume of flexion in a sagittal plane — by 70, 57, and 87 %, respectively. Linear extension was significantly reduced by COFLEX and DYNESIS, and insignificantly — by DIAM. Essential decrease in motion range in lateral bending (25 %) was detected only in specimens with DYNESIS implant. Conclusion. Interspinous implants COFLEX and DIAM limit the motion of spinal segment only in a sagittal plane, though transpedicular system DYNESIS reduces it in sagittal and coronal planes.

Objective. To study the effect of therapeutic exercise with biological feedback on a functional status of back muscles in patients with myofascial pain syndrome. Material and Methods. Twenty patients (16 females, 4 males) aged 19 to 56 years having back pain of different localization were examined. Clinical neurological examination was performed with the assessment of psychic sphere, sleep quality and vegetative disorders, social adaptation, stress level, and pain. All patients were administered monotherapy (therapeutic exercise with biological feedback) 20–40 minutes daily during four weeks. After the treatment course completion, all patients underwent repeated and catamnestic (three weeks later) examination. Results. Apparatus therapeutic exercise with biological feedback reduced the intensity of pain syndrome and muscle tension level which had a positive effect on patients’ quality of life. Subjective estimate of treatment was good in 11 (55 %) and satisfactory in 9 (45 %) patients. Conclusion. Therapeutic exercise with biological feedback should be included to multimodal therapy of myofascial pain syndrome, especially in the initial stage.

The paper presents a review of current knowledge on symptomatic vertebral hemangiomas. The review has shown that hemangiomas in some cases require surgical correction to stabilize the injured spinal motion segment, to prevent vertebral body fracture and tumor invasion into the spinal canal. Percutaneous vertebroplasty, along with open surgical treatment, endovascular embolization, and ethylene injection into hemangioma, is a method of choice due its safety and efficacy in the treatment of symptomatic vertebral hemangiomas.

Clinical cases of surgical treatment of suboccipital tuberculosis in two children 7.5 and 12 years of age are presented. Clinical, X-ray, CT, and MRI findings and peculiarities of surgical intervention and postoperative follow-up are described. The application of comprehensive technologies for craniovertebral region stabilization was shown to increase the efficacy of suboccipital tuberculosis treatment.

Objective. To study the effect of transpedicular fixation (TPF) on treatment results in tuberculous spondylitis and chronic hematogenic osteomyelitis of the spine. Material and Methods. A total of 99 patients aged 18 to 72 were operated on for tuberculous spondylitis and hematogenic osteomyelitis involving Th1 to S1 vertebral bodies. The patients were divided into three groups based on the type of the surgical intervention: group I included 37 patients who underwent radical reconstructive surgery without posterior fixation; group II included 24 patients with radical reconstructive surgery complemented with semi-rigid fixation; and group III – 33 patients with radical reconstructive surgery combined with TPF. The treatment efficacy was estimated on the basis of kyphotic deformity dynamics, autograft length, neurological status, pain syndrome, anterior fusion rate, and nature of complications. Results. Treatment results were assessed as good, satisfactory and unsatisfactory in 18 (48.6 %), 4 (10.8 %) and 15 (40.5 %) patients of group I, respectively. In group II the estimates were 15 (55.5 %), 8 (29.6 %) and 4 (14,8 %), and in group III – 32 (91,4 %), 3 (8,6 %) and 0 (0,0 %), respectively. Conclusion. The use of transpedicular fixation in addition to radical reconstructive surgery in tuberculous spondylitis and hematogenic osteomyelitis provides the improvement of treatment results including prevention of graft height decrease and kyphosis correction loss, reduction of postoperative complications, and intensification of patient’ rehabilitation.

Objective. To assess diagnostic possibilities of registration of spontaneous bioelectric activity of the spinal cord from the skin surface and to study variability of the spinal cord functional state at different stages of spinal injury. Material and Methods. Results of dynamical examination of 12 patients with spinal cord injury (SCI) at acute and intermediate stages were analyzed. A functional state of the spinal cord was assessed by simultaneous recording of electrospinogram (ESG) and direct current potential (DCP) from the skin surface in accordance with unipolar technique using 6-channel DC amplifier. Results. In all patients with acute SCI negative DC shifts (18.73 ± 2.47 mV) were registered in the injury region with respect to cephalad recording channels. In caudad channels a DC potential was more positive, on average by 4.26 ± 0.53 mV. Changes in slow electrical activity of the spinal cord were less specific and reflected its current functional state. In patients with acute SCI a decrease in ESG amplitude by 30–50 % was recorded in all recording channels. In patients with intermediate- stage of SCI statistically significant increase in ESG amplitude was recorded in the region of injury and caudad recording channels. Conclusion. Procedure of simultaneous DC and ESG recording provides identification of the level of electrophysiological disturbances and estimation of function changes in the injured and adjacent regions of the spinal cord which is necessary for the assessment of disease course and therapy efficacy.

At present time scoliotic deformities of different etiology are considered basing on the concept of scoliotic disease. Correctness of this concept is evident since the symptom complexes registered in clinic is eridensed by musculoskeletal system involvement and clinically significant changes in vitally important organs and systems. Such pathophysiological abnormalities become particularly apparent in patients with severe scoliosis. The review of recent literature presents data on the severity of anatomical-functional lesions in severe scoliosis relevant to the practice of anesthetist-resuscitator.

The paper presents a literature review and an analysis of available classifications of spondylolisthesis, description of the N.I. Khvisiuk classification, and comparison of terms and definitions used in different classifications. According to classification developed by N.I. Khvisiuk spondylolisthesis etiologically can be divided into 5 types: dysplastic, degenerative, post-traumatic, pathological, and iatrogenic, with subtypes within each type. The given classification can be easily modified with gaining of new knowledge on spondylolisthesis.