Objective. To analyze the efficacy of single-step early surgical interventions for the treatment of patients with concomitant injuries to the spine and calcanea.

Material and Methods. Forty three patients at the age of 18–55 years (mean age 36.5 years) with concomitant injuries to the spine and calcanea were operated on. The study group included 31 (72.1 %) patients, and the control group – 12 (27.9 %) patients. Groups were formed basing on surgical technique used for calcaneum injury treatment while the spine injury was treated by the same technique in both groups. Patients from both groups were examined using similar clinical, radiological, and statistical methods. The spine was assessed for the presence of kyphosis, pain, and neurologic symptoms, the feet – for skin integrity, edema degree, motion disorders in foot joints, and sensitivity disorders.

Results. One year results of surgical treatment were assessed as good in 2 (16.70 %) control and 14 (45.6 %) study-group patients; as satisfactory in 2 (16.70 %) control and in 14 (45.60 %) study-group patients; and as unsatisfactory in 8 (66.70 %) control and in 3 (9.68 %) studygroup patients. Oswestry Index was 76.0 ± 6.6 in the control group, and 82.0 ± 7.6 in the study group.

Conclusion. Early single-step and one-stage surgical treatment of spine and foot injuries allows reducing hospitalization time, preserving feet function in calcaneum fracture, shortening rehabilitation period, and eventually improving the treatment outcome.

Objective. To analyze adaptation of shape-memory dynamical clamps to anatomical and morphological features of the cervical spine.

Material and Methods. Fifty five patients with lower cervical spine dislocations were operated on by posterior fixation with tightening clamps. In 14 (25.0 %) patients the open reduction of dislocated vertebra and posterior clamp fixation were accompanied by the anterior fusion with a porous NiTi implant, while 42 (75.0 %) patients underwent only posterior operation. The treatment results in patients with spinal cord injury were evaluated using A.H. Martins criteria and ASIA/IMSOP scale. Delayed results were estimated 1–5 years after operation in 42 (75.0 %) patients.

Results. Treatment results were assessed as good in 88.1 % of cases. Radiological examination revealed a decrease in disc height at injured and adjacent levels not more than 1 mm; instability, or kyphotic deformity were not registered. Implant area did not include the signs of resorption or osteosclerosis. Neurological disorders caused by posttraumatic spinal cord cyst were observed in one (2.4 %) patient in 1.5 years after surgery. In 4 (9.5 %) patients who underwent anterior and posterior fixation the treatment results were assessed as fair. Patients disability period was 96 ± 38 days.

Conclusion. Two-axial fixation with coupled tightening clamps of shape-memory material provides the reliable stabilization of the injured vertebral motion segment. Preliminary posterior fixation for unstable injury facilitates the optimal performing of anterior interbody fusion with porous implants and ensures its absolute stability.

A clinical case of severe L5 spondyloptosis treated by three-stage operation is reported. The patient presented with static disorders and neurological deficit. The treatment resulted in restoration of normal anatomical relations and spine balance, in reduction of pain syndrome and neurological deficit, and in bone-metal block formation at L5–S1 level.

Objective. To analyze clinical features, X-ray anatomy and dynamics of deformities of the spine and thorax in newborns and infants of the first half-year of life with vertebral segmentation disorders.

Material and Methods. Twenty four children in neonatal period and 8 children in the first 5 months of their lives were examined. X-ray anatomy of malformation, dynamics of congenital spinal deformity, intervertebral disc and spinal canal status were studied. Thorax development pattern, and dynamics of congenital vertebral block and spinal deformity were followed in 15 children for 2 to 8 years.

Results. Most of children with vertebral segmentation disorders were born with grade III–IV spinal deformity. An asymmetric congenital block was detected almost in 70 % of patients. This malformation enables a rapid progression of scoliosis in more than 1/3 of patients. True bone block was observed in 3 % of cases, other patients of this age group had either fibrocartilaginous or combined block. Gradual maturation and ossification of this block is observed. Asymmetric growth of the spine with extended congenital vertebral block (five or more segments) results in formation of grade III–IV spinal deformity in most newborns.

Conclusion. Spinal deformity associated with vertebral segmentation disorder in infants of the first weeks and months of life offers a challenge of passing from passive observation of such patients to active orthopedic treatment at an early age.

Objective. Complex evaluation of specific neurohumoral regulation in children with grade I–II scoliosis depending on a plasticity of neurodynamic processes of the CNS.

Materials and Methods. Forty nine children at the age of 15–18 years with I–II grade scoliosis were examined. Functional status of cerebral hemisphera cortex was evaluated by the EEG of frontooccipital lead. Data processing was performed using computer procedure. Registration and mathematical analysis of variability of cardiac rhythm were conducted in a compliance with international standard.

Results. Neurohumoral regulation in scoliosis patients with low plasticity of neurodynamic processes is characterized by chaotic alteration of RR-intervals in the rhythmogramm, by significant fluctuations in variational distribution of RR-intervals duration, and by significant nonrespiratory arrhythmia. Neurohumoral regulation in patients with moderate plasticity is characterized by slow and super-slow waves on rhythmogramm, by prevailing, with sporadic deviations, of one parameter value in variational distribution of RR-intervals duration. Neurohumoral regulation in patients with high plasticity of neurodynamic processes is characterized by strongly expressed respiratory undulation, by coupling of dominant values and deviations of the interval in variational distribution of RR-intervals duration, by ellipse shape of point distribution along bisector in scattergram, and by respiratory arrhythmia complemented by some amount of nonrespiratory one.

Conclusion. Plasticity of neurodynamic processes of the CNS in children with grade I–II scoliosis correlates with parameters of neurohumoral regulation.

Objective. To analyze results of surgical treatment of patients with various diseases of the lumbar spine, to specify indications and contraindications for surgery, to substantiate the choice of optimal approach modification depending on the form and nature of compression.

Material and Methods. Results of surgical treatment of 680 patients with osteochondrosis complicated by disc-radicular conflict (n = 330), with spinal canal stenosis (n = 270), and with spondylolisthesis (n = 80) were analyzed. Patient examination included clinical evaluation, full-scale neurological study, and radiological diagnostic methods (spondylography, MRI, CT, and in some cases saccoradiculography). Surgical treatment was performed through posterior abdominal approaches of various modifications.

Results. Good and excellent results were reported in 95.2 % and satisfactory ones – in 4.8 % of patients with osteochondrosis. Stenosis patients showed good and excellent results in the early postoperative period in 84.9 % of cases, and in the late period (1–4 years) – in 94.6 %. Sixty five patients (89.8 %) with spondylolisthesis had good and excellent results, and 7 cases (10.2 %) were estimated as satisfactory.

Conclusion. Posterior surgical approaches provide optimum conditions for spinal canal decompression. Modified laminectomy technique is an operation of choice for treatment of spinal canal stenosis, large intervertebral disc hernia, and spondylolisthesis with spinal cord compression.

Neurosurgical methods of chronic neuropathic pain reduction are used in cases when conservative multimodal treatment is ineffective. Nowadays invasive techniques for peripheral pain reduction are used only in exceptional cases due to the high rate of neurological complications. Neuromodulation therapeutic intervention including electric spinal cord neurostimulation and intrathecal (epidural) opioid administration ensure a stable reduction of pain syndrome and does not exert cyto- and neurotoxic effect.

Objective. To analyze results of microsurgical and endoscopic discectomy and to estimate potentialities of low invasive endoscopic surgery for various forms of lumbar intervertebral disc hernia.

Material and Methods. Microsurgical discectomy was performed in 37 patients (mean age 43.4 ± 1.9 years), and Destandau endoscopic discectomy – in 31 patients (mean age 38.7 ± 1.7 years). All patients had intervertebral disc hernia in the lumbar-sacral spine. Diagnosis was based on complex examination results including dynamic clinicalneurological examination, radiography, CT, MRI, and electromyography. The intensity and dynamics of radicular pain syndrome were assessed using the Pain Audit Scale, and patient’s quality of life – using the Euro-QUAL-5D scale.

Results. Regression of clinical symptoms was the same in both groups. Postoperative quality of life in patients operated on by microsurgical technique was essentially lower than in patients operated on endoscopically. Activation and rehabilitation periods were much shorter in the endoscopic group.

Conclusion. Endoscopic discectomy having a number of advantages is a technique of choice for treatment of intervertebral disc hernia in the lumbarsacral spine with the efficacy equal to that of microsurgical discectomy.

Objective. To define age-related dynamics of bone tissue mineralization in children, adolescents, and young people residing in Novosibirsk city.

Material and Methods. A total of 1226 patients at the age of 6 to 23 years were examined. Bone mineral density (BMD) was evaluated by dual x-ray absorptiometry (DEXA) with bone densitometer and using pediatric software version and US sex and age reference database.

Results. According to DEXA data the bone mineral accumulation in children spine tissue proceeds non-uniformly in different age periods. During the age period of 6 to 23 years the lumbar spine BMD increases by 0.525 g/cm2 (50.3 %) in males and by 0.454 g/cm2 (45.6 %) in females. In females a spine bone mineralization peak occurs at the age of 20–21, and in males – 22–23. Bone mineral density values directly correlate with sex and age parameters both in females and in males, and reliability of correlation ratios widely varies depending on the period of physiological development.

Conclusion. The revealed patterns of spine bone mass accumulation in the growing children and adolescents should be accounted in diagnostics of osteopenia.

Objective. To analyze the effect of osteoplastic materials Kollapan and Kostma on the processes of bone tissue regeneration in experiment.

Material and Methods. Experiments were performed in 135 mature laboratory male rats of the Wistar line. The first series of the experiment included the study of osteogenesis processes in induced bone defects without application of osteoplastic material; the second one – with application of Kollapan; and the third one – of Kostma. Experimental, radiological, and morphological methods of investigation were used in study. Osteogenesis process was studied in histological specimens in 14, 30, and 90 days after operation.

Results. Kollapan granules are decreasing in size with time, which is a sign of its biodegradation and, as a consequence, of its bioactivity with osteointegrative potential. A thin connective- tissue capsule is observed at the surface of Kollapan granules, which is a criterion of its biocompatibility. In some sites this capsule acquires the character of osteoid tissue, which is evidence of existence of osteogenic properties. Signs of osteoclastic bone resorption and osteoblastic bone formation are observed when Kostma is used for vertebral body defect reconstruction. This confirms the existence of osteogenic activity and capacity for biodegradation (resorption) which has been designed for this material. Osteoblasts form a newly generated bone tissue around Kostma fragments. The absence of connective tissue capsule testifies to a high degree of the material biocompatibility.

Conclusion. The studied composite osteoplastic materials Kollapan and Kostma are biodegradable and bioactive, possess osteogenic properties and are able to serve as a matrix for bone formation.

Infection complications associated with spine surgery and related to interior orthopaedic devices and implants are rare (1–2 %) but severe. They decrease the quality of life of patients and result in significant financial expenses. The prevention of infection complications demands creation of an infection control system in a hospital and infectionmonitoring of a surgical site. The objective of the study was a consideration of successful two-year implementation of a model of infection control system for high tech medical care with application of interior orthopaedic devices and implants at Novosibirsk Research Institute of Traumatology and Orthopaedics.

Objective. To study the influence of connective tissue dysplasia on the development of spine pathology, cardiovascular system, primary juvenile glaucoma, and myopia basing on a multimodal orthopaedic, pathomorphological, and ophthalmological examination for optimization of diagnosis and treatment.

Material and Methods. The multimodal examination of 50 patients with spine pathology combined with a primary juvenile glaucoma and acquired progressing myopia was performed. All patients passed through ophthalmologic, clinical-genealogical, orthopaedic, and cardiologic examination, with biochemical and pathomorphological investigation of surgical specimens. Spine pathology was assessed by a computer optical topography method.

Results. Connective tissue dysplasia in patients with spine pathology is associated with ophthalmopathology and anomalies of cardiac valve and notochord. Structural metabolic changes of connective-tissue components of juxtacanalicular zone and sclera cause degenerative-dystrophic process accompanied by a dysfunction of eye drainage system synchronized with optic atrophy.

Conclusion. Patients with spine pathology, with outer and innate phenotypic signs of connective tissue dysplasia should be referred to diagnostic ophthalmologic examination for detection and early treatment of acquired myopia and primary juvenile glaucoma.

Anatomical and biomechanical features of the thoracic and lumbar spine are discussed in the paper. Clinical and radiological manifestations of spine injuries, and potentialities of MRI in estimation of the spinal cord and its membranes are described. Comparative analysis of existing classifications for thoracic and lumbar spine injuries is presented. A choice of conservative or surgical treatment basing on pathogenetic diagnosis is reasoned with the account of fractured vertebra morphology, injury mechanism, presence or absence of spine column integrity, neurologic deficit, and quantitative estimation of injury severity and instability degree.