Objective. To analyze complications of vertebroplasty for pathologic vertebral fractures associated with osteoporosis.

Material and Methods. Vertebroplasty was performed in 19 women with a mean age of 56.0 ± 6.5 years. The intervention was carried out under fluoroscopic control.

Results. The rate of clinically relevant complications was 13.6 %, and total rate of complications was 31.8 %. Complications included transient increase in pain syndrome and fever; acute coronary syndrome; and cement extravasation.

Conclusion. Transient increase in pain syndrome and fever are clinically relevant complications and show favorable dynamics at expectant treatment. Acute coronary syndrome is a rare but most severe complication. Cement extravasation is frequent and clinically irrelevant complication. Their prevention requires preoperative computed tomography evaluation of patients, careful adherence to intervention technique, injection of small volumes of high-viscosity cement, and predominant use of unilateral approaches.

Objective. To assess short-term results of a VEPTR instrumentation application for treatment of juvenile malignant progressing scoliotic deformity of the spine associated with neurofibromatosis type 1.

Material and Methods. Three patients aged 5.5 to 7 years were operated on for severe deformity of the spine associated with neurofibromatosis type 1. The mean age at the time of deformity detection was 3.5 years. Average magnitude of the primary scoliotic curve was 89.3°. Device configuration was varied depending on nature of the deformity.

Results. Primary scoliotic curvature was reduced after surgery down to 67°. Correction was 22.3° (25 %). Complications were not recorted.

Conclusion. The VEPTR instrumentation is a method of choice for controlled correction of infantile and juvenile deformities of the spine and thorax of various etiology.

Objective. To assess the results of surgical treatment of children with congenital deformities of the upper thoracic localization associated with vertebra formation failure.

Material and Methods. Eighteen patients aged one year and four months to nine years with isolated congenital malformations in the upper thoracic spine were operated on. Six patients had lateral hemivertebrae, and 12 patients – posterolateral hemivertebrae. All patients underwent posterior surgical approach for extirpation of hemivertebra and adjacent discs, deformity correction with posterior instrumentation, corporodesis, and posterior local fusion with bone autograft.

Results. Scoliosis angle after surgical treatment ranged from 0° to 6°, and correction degree – from 86% to 100%. After extirpation of posterolateral hemivertebra the mean angle of residual scoliotic component was 2.5°, and that of the kyphotic component – 8.2°, the degree of correction ranged from 62% to 80%. Formation of solid fusion was observed in all patients within 1.5–2 years after surgery. There were no early or late postoperative complications and neurological disorders.

Conclusion. Posterior surgery for congenital malformation in the upper thoracic spine associated with vertebra formation disorders provides radical correction of the existing deformity with minimum number of fixed spinal motion segments, prevents deformity development and progression in the dysplastic type, and does not hamper a further growth of the spine as a whole.

Objective. To study clinical and radiological signs, and outcomes of treatment of giant cell tumor (GCT) of the spine in children.

Material and Methods. Clinical and radiological features, therapeutic approach, and results of treatment of six children aged from 10 to 15 years with GCT of the spine were analyzed.

Results. All patients underwent radical reconstruction of the spine with singlestep tumor removal. Shortterm surgery outcomes demonstrate reduction of pain, regression of neurological disorders, and restoration of the spine support. Five children have an ordinary lifestyle without subjective complaints. Recurrence of GCT was diagnosed in one case.

Conclusion. Clinical and radiological signs of GCT are not specific in comparison with other monosegmental destructivelytic vertebral lesions. Pain and neurological disorders are typical clinical manifestations of GCT of the spine. СТ and MRI examinations are highly informative methods for determination of the tumor dissemination and aggressiveness, and percutaneous biopsy – for its preoperative verification. Radical GCT removal with spine support restoration is the only justified method for GCT treatment in children.

Objective. To analyze the advantages of ultrasound-guided catheterization of the internal jugular vein in patients with scoliotic deformity.

Material and Methods. Patients with scoliotic deformity (n = 366), aged 16 months to 18 years were divided into two groups. The study group included patients (n = 128) in whom ultrasound guided approach to the internal jugular vein was used. Out of them 79 patients underwent classical catheterization over the guidewire with aspiration sample, and 49 – intravasal insertion of J-guidewire without aspiration sample. The control group included patients (n = 238) who underwent catheterization without ultrasound control with aspiration sample over the guidewire.

Results. Ultrasound-guided puncture and catheterization of the internal jugular vein decreases complication rate and shortens the time of preoperative preparation.

Conclusion. The study showed that puncture in Trendelenburg’s position improves verification of the internal jugular vein. Ultrasound control allows performing catheterization over guidewire without aspiration sample with low rate of complications.

Objective. To analyze diagnostic potential of impedance cardiography (ICG) and impedance plethysmography (IPG) in high-risk spine surgery.

Material and Methods. Monitoring of hemodynamic status using ICG and IPG methods was performed in staged surgical treatment with consecutive anterior and posterior approaches to the spine in a single operation in 30 patients with scoliosis and 15 patients with traumatic injuries to the thoracolumbar spine. Surgery was performed under total intravenous multicomponent anesthesia with hypnotic drug propofol and artificial lung ventilation.

Results. There were no reported deviations of analyzed parameters beyond the allowable limits, which testifies to the efficacy and adequacy of both anesthetic and infusion-transfusion management of the performed surgeries. ICG monitoring provided the assessment of hydration state of the lung interstitial space during surgical intervention associated with considerable intraoperative blood loss. Application of ICG and IPG methods allowed raising a safety level for operated patients.

Conclusion. ICG method allows getting full information on the nature of changes in general circulation due to specific features of spine surgery. IPG method may be used in performing multimodal intraoperative spinal cord monitoring.

Objective. Scientific-practical and economical substantiation of the expedience of urgent spine surgery centre organization in megalopolises for the admittance of patients not only with acute spine and spinal cord trauma, but also with other urgent spinal pathologies.

Material and Methods. Authors performed retrospective analysis of work of neurosurgical departments in large municipal hospitals of St. Petersburg during the last two years.

Results. It was found out that almost all neurosurgical departments in municipal multi-field hospitals, except for the St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze, do not provide a modern level of specialized medical care to patients with urgent surgical pathology of the spine.

Conclusion. Working experience of the Centre for Urgent Spine Surgery created on the base of St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze demonstrated that such organizational pattern allows for improving the quality of specialized medical care and more effective municipal healthcare utilization.