Objective. To assess clinical reproducibility and practical usability of four most popular current classification systems for subaxial cervical spine injuries.

Material and Methods. Prospective and retrospective analysis of medical records of 58 patients with injuries to the cervical spine was performed. To study the structure of injuries the Allen-Ferguson, AOSpine, SLIC, and CSISS classification systems were used.

Results. The Allen-Ferguson classification allowed to verify the type of injury in 49 (84.5 %) patients, AOSpine - in 34 (58.6 %), and SLIC and CSISS - in 58 (100.0 %) patients.

Conclusion. In subaxial cervical spine injuries the SLIC classification system is the most optimal and clinically acceptable one since it includes a detailed medical and tactical algorithm taking into account the severity of both osteoligamentous and neurological injuries.

Hir. Pozvonoc. 2012;(2):8-15.

Objective. To investigate strength characteristics of the bone-implant system for anterior intervertebral fusion and of the implant-bone contact zones of standard and innovative vertebral body implants by analysis of stress testing data.

Material and Methods. Standard and modified mesh implants for anterior fusion were prepared for the study. Samples were placed between polyurethane vertebra models and fixed in accordance with principles of anterolateral fixation. Compression tests were performed with universal dynamometer. The experience of surgical treatment of 12 patients with comminuted fractures of the thoracic and lumbar spine using modified mesh implants was analyzed.

Results. Application of modified mesh interbody implant for anterior fusion statistically reliably increases the implantbone system stability. It provided good results after surgery in 100 % of patients.

Conclusion. Design features and bioactive properties of the modified fixator optimize and accelerate formation of a solid bone-metal block of the operated segments. This improves surgical results of anterior fusion for comminuted fractures of the thoracic and lumbar spine. Hir. Pozvonoc. 2012;(2):16-23.

Objective. To analyze the efficacy of the method for selecting the distal level of fusion in treatment of thoracic hyperkyphosis in Scheuermann’s disease.

Material and Methods. Treatment results in 36 patients operated on in the Department of Children and Adolescent Spine Pathology during 2007-2010 were analyzed. Patients were divided into two groups: in Group 1 (n = 29) a lower instrumented vertebra corresponded to the sagittal stable one, and in Group 2 (n = 7) this vertebra located proximally.

Results. The mean preoperative magnitude of kyphosis was 79.3° ± 11.6°, postoperative - 40.6° ± 11.9° (correction 49.9 %), and loss of correction was 4.9° ± 7.0°. Sagittal balance changed from -0.3 ± 3.2 cm before surgery to -1.7 ± 2.1 cm. Distal junctional kyphosis developed in 1 case (4 %) in Group 1, and in 5 cases (71 %) in Group 2.

Conclusion. Distal level of instrumentation ending at the first lordotic vertebra is not justified and causes violation of sagittal balance and development of distal junctional kyphosis. Including sagittal stable vertebra in fusion prevents the development of distal junctional kyphosis. Hir. Pozvonoc. 2012;(2):24-29.

Objective. To analyze results of surgical correction of thoracic idiopathic scoliosis in children using the system of active
optical 3D-CT navigation and preoperative CT images with
anatomical landmark-based registration.

Material and Methods. Eighteen patients aged 15 to 17 years (14 girls and 4 boys) with thoracic idiopathic scoliosis were operated on. The Cobb angle of the primary curvature ranged from 55 to 90 degrees. The surgery was performed through a posterior approach with simultaneous halo-tibial traction using multi-anchoring metal device with pedicle screws. Canals for screw insertion were formed under 3D-CT navigation control in accordance with preoperative planning.

Results. The extension of fixation for thoracic type of deformity varied between 10 and 13 vertebrae (from T2 to L4). The number of pedicle screws per patient ranged from 19 to 26 (average 24 screws). Thus, 429 screws were placed in 18 patients: 305 in thoracic spine and 124 in the lumbar spine. Postoperative correction of the coronal plane deformity ranged from 92 % to 99 %, and derotational correction of the apical vertebra - from 72 % to 94 %.

Conclusion. Intraoperative optical 3D-CT navigation with the processing of preoperative CT images and registration based on anatomical landmarks ensures the accuracy of pedicle screws placement, which allows using this type of correction devices even for severe thoracic deformities. Hir. Pozvonoc. 2012;(2):30-36.

Objective. To analyze results of multimodal surgical treatment of patients with severe scoliosis involving concave thoracoplasty.

Material and Methods. A total of 40 patients aged from 12 to 31 years with spinal deformities of 70-150° were operated on with posterior CD instrumentation combined with elevating thoracoplasty on the concave side of the thorax deformity. Mean follow-up period was 2 years. Dynamics of the respiratory function was studied. Patients underwent X-ray and CT examinations of the spine, and appearance assessment.

Results. The mean preoperative Cobb angle of the major thoracic curve was 101° (range: 70-150°), and postoperative - 47°; postoperative correction was 54° (53 %). The loss of correction was not practically registered at the immediate and long-term follow-up. The mean preoperative Cobb angle of the compensatory lumbar curve was 50.5°, and postoperative - 20.6°. The mean thoracic kyphosis was 51° before surgery and 28.7° after surgery. The mean lung vital capacity was 56.3 % before surgery, and 66.5% in 12 months after surgery.

Conclusion. Concave thoracoplasty provides increased mobility of the deformity, and improvement of stabilization, cosmetic and functional results of surgical treatment of patients with severe scoliosis. Hir. Pozvonoc. 2012;(2):37-43.

CLINICAL AND RADIOLOGICAL CHARACTERISTICS OF PATIENTS WITH IDIOPATHIC SCOLIOSIS IN A SPECIALIZED DEPARTMENT OF SPINE PATHOLOGY Mikhailovsky M.V., Sergunin A.Y., Udalova I.G., Kimetova I.S. Objective. To analyse clinical and radiological characteristics of patients with idiopathic scoliosis. Material and Methods. The study included a total of 2688 patients with spinal deformities of various etiology surgically treated in the Department of Children and Adolescent Spine Pathology of Novosibirsk RITO from September 23, 1996 to September 14, 2011. Out of them 1680 (62.5%) patients had idiopathic scoliosis. Quantitative clinical and radiographic characteristics were obtained from the electronic database. Results. The obtained quantitative characteristics of patients in the studied group included the following parameters: total number, sex composition, age, distribution of scoliosis according to the primary curvature location, the number and location of countercurves, sagittal contour of the spine, the nature of deformity progression and mobility, the state of the trunk balance, the primary curve magnitude, neurological symptoms, comorbidities, previously underwent interventions, their number and type. Conclusion. The achieved data characterizing certain aspects of activity can help in planning works and consumables, and perfecting patient flow in highly specialized spine pathology clinic. Hir. Pozvonoc. 2012;(2):44-49.

Objective. To study the features of sagittal posture formation and the structure of postural disorders in children and adolescents with due account for gender and age basing on data of computer optical topography (СOMOT).

Material and Methods. Results of posture screening in children and adolescents using СOMOT method were incorporated into the clinical database including more than 33,000 patients with approximately uniform distribution by age. The study was carried out in 13 age groups generated from this database and including boy and girls aged 5-17 years.

Results. The age changes in the structure of sagittal postural disorders significantly differ between boys and girls and strictly correspond to age changes in mean heights of the lumbar lordosis and thoracic kyphosis, and in the index of their balance. Postural features in five-aged children have minimum gender differences with a prevalence of kyphosed postures, and later differences accrue with a trend towards kyphosis in boys and towards lordosis in girls, achieving maximum by the age of 17 years.

Conclusion. The study allowed to reveal objective quantitative picture of the posture formation in children and adolescents, as well as demonstrated the unique capabilities of optical topography for population studies of the posture status. Hir. Pozvonoc. 2012;(2):50-62.

The paper discusses controversies of scientific achievements of domestic vertebrologists in the study of osteochondrosis. Authors argue that ICD-10 sections can not incorporate all the syndromes of osteochondrosis, especially multiple noncompressive or reflectory (myodystonic, neurodystrophic, and angiopathy) ones. Russian classification of osteochondrosis syndromes is presented. Hir. Pozvonoc. 2012;(2):63-69.

Objective. To perform quantitative assessment of intraoperative blood loss volume and severity during stages of idiopathic scoliosis surgical correction.

Material and Methods. Data of intraoperative blood loss during stages of surgical correction of idiopathic scoliosis were analyzed in 1241 operated patients. Multi-stage surgical interventions were performed in 581 (46.8 %) patients, posterior fusion - in 660 (53.2 %), and multilevel corrective vertebrectomy - in 72 (12.4 %) patients. Two methods of general anesthesia were used: TIVA with propofol, fentanyl, tracrium, and with inhaled sevoflurane, fentanyl, and tracrium. Volumes of intraoperative blood loss were assessed at main stages of surgery.

Results. Total intraoperative blood loss during multistage surgical treatment with segmental hook instrumentation was 967.4 ± 43.6 ml, and with hybrid instrumentation - 1135.9 ± 139.5 ml. Blood loss during posterior only fusion procedure was 865.5 ± 40.1 ml with segmental hook instrumentation, and 1049.9 ± 75.5 ml with hybrid instrumentation. Multilevel vertebrectomy was associated with maximum intraoperative blood loss of 1242.9 ± 121.8 ml.

Conclusion. Intraoperative blood loss during surgical correction of idiopathic scoliosis varies considerably and averages from 20.0 to 40.0 % of the circulatory blood volume. The duration of surgical intervention is the main proved factor influencing the volume of blood loss. Hir. Pozvonoc. 2012;(2):70-78.

Objective. To study gas composition and acid-base balance of blood in the course of multistage surgical intervention for traumatic spine injury.

Material and Methods. Gas composition and acid-base balance of blood were analyzed in 51 patients with traumatic spine injuries during multistage surgical treatment in a single operation. Patients were divided into two groups: Group 1 included 26 patients operated on under TIVA with propofol, fentanyl, and еsmeron; and Group 2 included 25 patients operated on under general anesthesia with sevoflurane in low-flow ventilation mode, fentanyl, and еsmeron.

Results. In both groups acid-base balance parameters in blood were characterized by unidirectional changes depending on the state of compensated metabolic acidosis. More essential fluctuations in pH, and in the excess or deficit of buffer bases depended on the type of surgical intervention. They were more statistically significant during anterior procedures in condition of open pneumothorax requiring changes in lung ventilation parameters. Values of paO2 and paCO2 remained relatively stable in both groups at the study stages.

Conclusion. Main factors determining changes in blood gas parameters during spine surgery are specific features of the anterior fusion procedure and its succession in the course of multistage surgical intervention. Hir. Pozvonoc. 2012;(2):79-86.

Objective. To study biochemical changes in proteoglycans (PGs) of intervertebral disc tissues and stages of their degeneration in patients with recurrent disc herniation.

Material and Methods. A retrospective analysis of biochemical and radiological parameters of primary hernias of intervertebral discs from 16 patients who were reoperated on at the same level within three years was performed. Degenerated discs were classified according to the Pfirrmann’s criteria. The quantity of glycosaminoglycans (GAGs) in the hernia and surrounding annulus fibrosus tissues was determined by analytical biochemistry methods. The properties of PG in the hernia tissue were studied using composite gel electrophoresis.

Results. Two types of primary hernias were identified. The tissues of Type 1 hernias were characterized by high content of water, total GAG, and PG. But the number of GAGs lying in the deeper layers of tissue is extremely low. The tissues of Type 2 hernias showed reduced water content, GAG number, degree of their sulfation, and increased content of neutral hexoses. These hernias contain a large proportion of non-aggregated PGs and more than half of all GAGs are found in deeper layers of tissue. On MRI evidence Type 1 hernias corresponds to Grade III degeneration, and Type 2 - to Grade IV. Grade III degeneration predominates among the hernias, which recurrent within the first year after surgery.

Conclusion. The structure of tissue of primary disc hernias recurring after surgical removal demonstrates regular biochemical changes in PGs and GAGs, which are registered by MRI with different signal intensity. Hir. Pozvonoc. 2012;(2):87-93.

Objective of the study was scientific rationale for principles and methodological approaches to organization of rehabilitation service as a part of specialized medical care of traumatological, orthopedic, and neurological profiles.

Results of domestic and foreign literature analysis and application of methods of statistical analysis and organizational modeling served as a basis to formulate principal approaches to organization and a concept of rehabilitation service management in providing specialized medical care of traumatological, orthopedic, and neurological profiles focused on satisfaction of patients’ needs.

The model of rehabilitation service organization including structural subdivisions consolidated under a single diagnostic and treatment doctrine and common managerial approaches, optimal set of equipment, staffing with differentiated resource allocation within the service, and innovative medical management technologies with the elements of process management is the optimal one for implementation of closed-loop complex specialized medical care of traumatological, orthopedic, and neurological profiles. Hir. Pozvonoc. 2012;(2):94-101.

The lecture describes the intricate pathway of scoliosis investigation. Factual material presented in the lecture is an attempt to reproduce the consistency of the research process, and to argue the choice of techniques for investigation, analysis, and theoretical generalization based on the obtained facts. Hir. Pozvonoc. 2012;(2):102-110.