Objective. To study the possibility of application of anterior decompressive and stabilizing operations in patients with complicated thoracic and thoracolumbar spine and spinal cord injury without prior posterior intervention.

Material and Methods. Anterior decompressive and stabilizing operations in the thoracic and thoracolumbar spine were performed in 82 patients. Transpleural approach was used in 26 patients, transpleural transdiaphragmatic - in 46, and retroperitoneal subdiaphragmatic approach - in 10 patients. Decompression of the spinal cord was accomplished by means of subtotal resection of damaged vertebral bodies. The defect after removal of the fractured vertebral body was filled with a porous NiTi implant in 41 cases, with reinforced NiTi implant in 27 patients, and with the unique expandable NiTi implant - in 14 patients. The Vantage fixation plate added in all cases allowed manipulation of vertebrae along all axes in all directions.

Results. A good regression of neurological symptoms was obtained in 28.0 % of patients, and satisfactory - in 48.9 %. Neurological deficit remained unchanged in 23.0 % of operated patients. No technique-related complications were registered. Reinforcement of porous implant with titanium rod signifi- cantly increased the interbody fusion solidity.

Conclusion. Anterior decompressive and stabilizing surgery for thoracic and thoracolumbar spine and spinal cord injury provides complete decompression of the spinal cord, one-stage reduction, reclination of the spine and correction of its axis, and complete interbody fusion with porous titanium-nickel implants in combination with the Vantage fixation plate.

Objective. Investigation of specific features of the attitude toward disease in adolescents with different grades of idiopathic scoliosis.

Material and Methods. Sixty adolescents with scoliotic deformity of the spine were examined, out of them 32 patients had Grades I and II scoliosis, and 28 - Grades III and IV scoliosis. The features of the attitude toward disease were studied using the Test for Attitude toward Disease and the Incomplete Sentence Test.

Results. Adolescents with idiopathic scoliosis, regardless the disease severity, predominantly have mixed and diffusive types of the attitude toward disease. In patients with Grades I and II scoliosis the negative feelings associated with orthopedic pathology and need for treatment may contribute to a harmonious version of the attitude toward disease which provides appropriate behavior in condition of disease and situation of treatment. Responses to disease in adolescents with Grades III and IV scoliosis more often relate to neurasthenic and sensitive types. This is expressed by depressive mood and excessive anxiety about the danger of treatment, and by a fear of unfriendly attention from others. Apparent negative feelings in connection with upcoming surgery in adolescents with severe spinal deformity may contribute to maladaptive behavioral responses.

Conclusion. Strategy of medical and psychological consulting of adolescents suffering from severe scoliosis should include various tactics of conducting a talk and therapeutic techniques aimed at relieving excessive emotional tension, and providing an adolescent with information on positive and effective treatment results. 

Objective. To evaluate the results of surgical treatment of children with congenital deformity of the lumbar and lumbosacral spine associated with isolated failures of vertebra formation.

Material and Methods. A total of 37 patients aged 1 year 6 months to 8 years 4 months having isolated vertebra formation failures in the lumbar and lumbosacral spine were treated. In three patients with lateral hemivertebrae the angle of scoliosis before surgery varied from 19° to 35° (average 29.2°); in 34 patients with posterolateral hemivertebrae - from 18° to 51° (average 30.1°), and the angle of kyphosis - from 10° to 34° (average 18.4°). Surgical treatment was performed through combined approach in patients with lumbar hemivertebrae, and through posterior approach in patients with lumbosacral hemivertebrae. It included extirpation of the abnormal vertebra with adjacent discs, deformity correction with posterior instrumentation, interbody fusion, and posterior local spinal fusion with bone autograft.

Results. The angle of scoliotic deformity in patients with lateral hemivertebrae after surgery varied from 0° to 6°, the degree of correction ranged from 94 % to 100 %. After extirpation of posterolateral hemivertebrae and deformity correction the residual angle of scoliotic deformity varied from 0° to 4° (average 2.5°), the degree of correction ranged from 95 % to 100 %, and the kyphotic angle - from 9° to -6° (average 2.2°). The formation of solid bone block was noted in all patients at 1.5-2 years after surgery.

Conclusion. Complete correction of congenital deformity in children contributes to the formation of a proper frontal and sagittal spine alignment, and provides conditions for normal spine development during the child’s growth. Hir. Pozvonoc. 2012;(3):33-37.

Objective. To study gender and age characteristics of posture formation in the horizontal plane and structure of postural disorders in children and adolescents basing on computer optical topography (СOMOT) data.

Material and Methods. Results of the СOMOT screening among children and adolescents formed a clinical database of more than 33,000 patients approximately evenly distributed through age. The study included 13 age groups of boys and girls aged from 5 to 17 years.

Results. The structure of postural disorders in the horizontal plane and its age dynamic without regard to the direction of the trunk twisting are sufficiently similar in boys and girls. Taking into account the direction of the trunk twisting, the age dynamics of posture disorder structure has significant gender differences due to the phenomenon of alteration in the prevailing direction of the trunk twisting in girls firstly revealed in this study.

Conclusion. The study allowed revealing of objective quantitative picture of the posture formation in children and adolescents in the horizontal plane and demonstrated the unique capabilities of optical topography for population studies of the postural status. 

Objective. To study the effect of varicose veins in the epidural space on the generation of compressive pain in patients with lumbar disc herniations.

Material and Methods. A total of 382 patients operated on for complications of lumbar disc herniations were examined. The study group included 207 (54.2 %) patients with herniated lumbar intervertebral discs combined with varicose veins in the epidural plexus. The control group included 175 (45.8 %) patients with intervertebral disc herniations without pathological changes in the venous pool.

Results. Patients from the study group had intraoperative complications. They were associated with bleeding from varices in the epidural space in 97 (46.9 %) patients and with violation of the integrity of the dura mater in 22 (10.6 %) patients.

Conclusion. Varices of the epidural plexus in the lumbar spine, along with herniated intervertebral disc, is one of the components exerting the compressive action on spinal nerve roots. Intraoperative bleeding and inadequate hemostasis in late postoperative period are the causes of adhesive epiduritis. 

Objective. To analyze the effect of transosseous osteosynthesis on the reparative regeneration of spondylo-epiphysiolysis in the experiment.

Material and Methods. Experimental studies were carried out on 48 mongrel dogs aged 3.5-10 months with spondyloepiphysiolysis achieved by hyperextension of the spine with the external fixator. The method included fixation of the lumbar spine and pelvis with wire apparatus, hyperextension of the spine, followed by reduction and fixation of the broken vertebrae.

Results. According to radiological and morphological studies full bony union of the vertebrae in transosseous osteosynthesis occurs in 21-28 days of fixation. In this case the deformity of the spine is absent and the physiological growth of the vertebra continues.

Conclusion. Developed and experimentally based technical procedures of vertebral body integrity restoration could be applied in clinical practice, taking into account the adaptation of technical means to the anatomical and functional features of the human spine.