Objective. To analyze immediate and long-term results of surgical correction of spinal deformity in patients with neurofibromatosis type I. Material and Methods. A total of 24 patients (14 boys, 10 girls), mean age 14.2 years, were operated on during the period of 1996–2007. Out of them 16 patients had a rightsided curve, and 8 patients — left-sided one. Spinal deformity correction was performed with Cotrel — Dubousset instrumentation. In 14 cases main intervention was preceded by discectomy and interbody fusion with bone autograft at the apex of the primary scoliotic curve. In 10 cases both procedures were conducted under a single anesthetic event. Mean postoperative follow-up term was 1.4 years. Results. Mean initial value of the primary scoliotic curve was 102.6°, after surgery — 61.3°, and at final follow-up — 67.9°. Thoracic kyphosis before operation was 82.5°, after operation — 51.2°, and at final follow-up — 64.0°. The tilt of the lowest instrumented vertebra before operation was 16.7°, after operation — 9.5° and at final follow-up — 10.9°. Only mechanical complications were noted: rod fracture in 3 patients, and cranial hook dislocation in 1 patient. Histological analysis of surgical material showed that NF-I gene mutation led to the disturbance of organospecific differentiation of chondroblasts and to staging process of chondroblast — chondrocyte — osteoblast — osteocyte differentiation, which explains postoperative progression of the spinal deformity and formation of pseudoarthroses in the fusion mass. Conclusion. Spinal deformities associated with neurofibromatosis are rare but due to specificity of their pre- and postoperative course present significant challenge.

According to their own experience and literature evidence the authors suggested to divide unstable cervical spine abnormalities in children into two groups: primary or secondary unstable ones. Primary unstable cervical spine abnormalities require maximally early surgical treatment. Secondary unstable cervical spine abnormalities require outpatient observation and preventive conservative treatment. Surgical fixation is indicated in case of inefficacy of conservative treatment or development of neurological instability.

Objective. To analyze the efficacy of multimodal treatment of patients with grade II—III idiopathic scoliosis comprising artificial correction of movements (ACM) by means of functional electric stimulation (FES) of muscles during walking in a correcting brace. Material and Methods. The subjects of examination and treatment were 50 patients with idiopathic scoliosis, among them 20 patients with grade II spinal curvature, and 30 — with grade III. Brace therapy was performed with a functional frame-type brace modified by adding lateral pelottes attached with springs. All patients received 15‑day course of FES during walking in a functional correcting brace. Electric stimulation was applied to trunk muscles of both sides: sacrospinous, intercostal, rhomboidal, trapezius, as well as greatest and medium gluteal muscles at the concave side of the curvature. Results. The study showed that multimodal treatment facilitates significant correction of different types of spinal deformity and normalization of biomechanical and innervation structure of walking. Long-term outcomes were evaluated in 36 patients during a 3‑year follow-up period. With the adherence to a prescribed orthopedic treatment regimen and repeated FES courses each 8—10 months the long-term outcome was good in 29 cases and satisfactory in 8 cases. Conclusion. The effect was achieved by reduction of scoliosis, essential intensification of the activity of symmetric trunk and leg muscles, and improvement of their functioning during walking.

Objective. To analyze emotional features and compensatory mechanisms of personality in adolescents with severe spinal deformity. Material and Methods. A total of 120 girls between 13 and 17 years of age were examined. Among them, 60 patients had grade III–IV spinal deformity: 45 idiopathic scolioses and 15 congenital spinal deformities. The control group included 60 healthy age-matched girls. All examined adolescents were intellectually safe. The examination of intellectual status was performed in two stages. The first stage included investigation of emotional features of girls with severe spinal deformities, the second – of compensatory manifestations of personality at psychological and social-psychological levels. Results. Adolescents with severe spinal deformities have more profound emotional problems when compared to healthy girls of the same age. Ordinary life situation makes them anxious and cause emotional overwork. The high level of anxious, reticent-inimical and aggressive reactions was accompanied by alexithymial characteristics of personality manifesting as problems of consciousness and of emotion differentiation and expression. The quality-of-life indices in all spheres of life were decreased in adolescents with severe spinal deformities as compared to the control group. Conclusion. The obtained data can serve as a basis for development of differential psycho-correction approaches within the frame of multimodal medical, psychological, and educational rehabilitation of adolescents with severe spinal deformities.

The paper presents analytical review of literature on perfection of technologies for surgical treatment of lumbar spine stenosis. Data for the study were the abstracts of papers from MEDLINE database, publications in periodicals of Russia and Ukraine, in the “Spine”, “European Spine Journal”, and other sources of medical information published during recent 15 years.

Objective. To study the influence of complex conservative teratment on severity of pain at rest, on movement, and at night in patients with hip-spine syndrome. Material and Methods. Severity of pain was assessed in 18 patients with hip-spine syndrome. Examination was conducted before and at different terms after the complex conservative treatment. Severity of pain syndrome was assessed using digital rating and visual analogous scales. Results. Complex conservative therapy was found to considerably reduce pain at rest, on movement, and at night in the first group of patients with hip-spine syndrome, and this effect remained unchanged at long-term follow-up. In the second group the reduction of pain on movement was rather limited, and pain severity returned to the initial level in a year and a half after the treatment. Conclusion. Complex conservative treatment significantly influences the severity of pain in patients with hip-spine syndrome suffering from coxarthrosis grade 1 and 2 and lumbar osteochondrosis without severe neurological symptoms. The group of patients with coxarthrosis grade 3 and lumbar osteochondrosis with chronic lumbar ischialgia showed lesser reduction in pain scores after the treatment, especially for pain on movement, therefore this group of patients requires more radical treatment.

Objective. To analyze results of surgical treatment of patients with complicated injury of thoracolumbar spine using effective techniques of anterior spinal cord decompression and the injured spine stabilization with the account for economic possibilities of the Kyrgyzstan health system. Material and Methods. The paper presents results of surgical treatment of 43 patients with complicated injuries of the spine who have undergone reconstructive surgery in thoracolumbar spine including widening of the spinal canal and supporting stabilization with bone autofraft. Results. The treatment results were assessed on the basis of clinical information and radiological findings and considered as good and satisfactory in 95.7% of cases. The method of anterior decompression with intracanal widening of the spinal canal has been proved effective in the treatment of thoracolumbar spine. Conclusion. In situation when the choice of optimal surgical method is limited by economic conditions the developed technique may be sufficiently effective in the treatment of complicated fractures of the thoracolumbar spine.

The paper presents clinical cases of neurofibroma of the lumbar spine treated surgically with consequent posterior and anterior stabilization of the spinal column. Long-term treatment outcomes were analyzed for follow-up periods of five and twelve years.

Objective. To assess the efficacy of Nd-YAG laser application in microsurgical treatment of intramedullary tumors. Material and Methods. Eighty patients with intramedullary tumors were surgically treated. In 50 patients the tumor was resected using Nd-YAG laser under intraoperative spinal cord monitoring using somatosensory evoked potentials (SSEP), in 30 – it was removed by standard microsurgical techniques. Results of surgical treatment were assessed on the basis of findings of clinical neurological control, MRI, CT, and spinal cord sensory pathway intraoperative monitoring. Results. The study showed the advantages of laser over conventional methods of surgical treatment. Safe and effective application of Nd-YAG laser at final stages of intramedullary tumor resection, avoiding undesirable thermal effect on the spinal cord, suggests a power parameter to be set to 5–10 W. The action of laser irradiation in coagulation mode on an unremovable portion of the tumor under SSEP monitoring, apart from reduction of surgery traumaticity, provides increase in radicality of tumor removal, decrease in ongoing growth incidence, prolongation of recurrence-free period, and improvement of long-term postoperative quality of life. Conclusion. The obtained results permit to recommend the developed laser technology for further clinical application.

Objective. To specify the MRI abilities in differential diagnosis of vertebral wedge deformity. Material and Methods. The study is based on the analysis of MRI findings in 43 patients aged from 24 to 64 years with a preliminary clinical and radiological diagnosis of pathologic fracture and wedge deformity of vertebral bodies. Results. MRI study revealed vertebral metastases in 31 (72.1 %) patients; inflammatory disease (spondylitis) in 8 (18.6 %), vertebral osteoporosis in 3 (7.0 %), and traumatic vertebral fracture in 1 (2.3 %) patient. Diagnosis in all patients was confirmed by surgical treatment results and clinical examination data. Conclusions. MRI is an informative method for differential diagnosis of the vertebral wedge deformity which provides reliable identification of main pathological processes causing the occurrence of wedge vertebral deformity, decrease in duration of patient’s preliminary examination, and timely choice of the appropriate treatment.

Objective. To study pathogenetic mechanisms of the development of spinal deformity in neurofibromatosis. Material and Methods. Structural components of the spine were presented as specimens obtained after surgical correction of spinal deformity performed in 10 children with III–IV grade scoliosis associated with neurofibromatosis. Tissues were investigated by conventional histochemical and ultrastructural methods. The levels of aggrecan and lumnican gene expression were studied using PCR method. Results. Etiologic factor of the development of spinal deformity in neurofibromatosis is a mutation of the NF-1 gene in cells of ganglious lamella. Migration of cells carrying mutant gene into one of the sclerotome zones results in oncogene activation and intensive proliferation of chondro-, osteo-, and fibroblasts in the growth plate, intervertebral disc, and vertebral body. Since the mutation involves the earliest stages of embriogenesis, the formation of definitive structural components in pathologically altered zones is disturbed. Conclusion. Progressive development of the spinal deformity after surgical intervention is accounted both for proliferation of chondro- and fibroblasts in the vertebral body and intervertebral disc and for disturbance of the lumnican gene expression.

Objective. Experimental dynamical reproduction of morphofunctional alterations in musculoskeletal system, particularly in neck muscles, after rotational subluxation of the atlas to study pathogenetic peculiarities of the development of myofascial pain syndrome and scoliotic spinal deformity. Material and Methods. Posterior rotational subluxation of the atlas was induced in 60 laboratory animal models. Blood supply of epaxial muscles and their fascial envelope was measured by the method of water suspension of black ink (1:3) injection into vessels. Objectivization of the obtained findings was performed by means of complex morphological analysis of hemomicrocirculation channel parameters. Light-optical investigation was carried out between 5 to 360 days after surgery to study the course of morphological changes in myofascial structures adjacent to the skull joints after the induced atlas subluxation. Sections were stained with hematoxilin and eosin. X-ray image of the spine was taken in two projections. Results. The changes in hemomicrocirculation channel due to experimental myogelosis occurs in two stages – functional and organic ones. The rebuilding of hemomicrocirculation channel causes changes in morphological structure of fasces and muscles. The revealed disorders in tissue-capillary exchange can be presented as a syndrome of capillary-trophic insufficiency. Conclusion. The study revealed the influence of rotational subluxation of the atlas on the development of typical scoliotic deformity of the spine.