Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation.

Material and Methods. The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis.

Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation.

Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.

Objective. To evaluate the results of surgical correction of scoliotic deformities in patients with spondylolisthesis.

Material and Methods. A total of 51 patients with scoliosis and spondylolisthesis were observed in 1998–2016. Spondylolisthesis was asymptomatic in 49 cases. Most patients had grade I spondylolisthesis. Surgical correction of scoliotic deformity of the spine with segmental instrumentation was performed in 31 cases.

Results. The average magnitude of the initial scoliotic curve before surgery was 67.2°, after surgery – 33.4°, and correction was 50.3 %. The magnitude of countercurve before surgery was 28.1°, after surgery – 11.1°, and correction was 35.5 %. In all cases, the L₅ vertebra was not included in the spinal fusion zone. Progression of the degree of the L₅ vertebra displacement in the postoperative period was not revealed. Neurological deficit was not observed. The average follow-up period was 5.4 ± 3.3 years.

Conclusion. Correction of idiopathic scoliosis in the presence of L₅ spondylolisthesis can be carried out with good and satisfactory results and minimal risk of listhesis progression, and with preservation of the achieved result in the long-term period.

Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis.

Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83.

Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1-CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the vertebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon.

Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.

Objective. To analyze clinical and radiological features of congenital atlantoaxial dislocations (AAD) in congenital craniovertebral junction malformations.

Material and Methods. The data of 26 patients with AAD associated with congenital pathology of the craniovertebral junction, who applied to the Ilizarov Center in 2012–2017, were analyzed.

Results. Patients were divided into three groups: with nonsyndromic AAD – 6 (23.1 %) patients, with AAD associated with Klippel – Feil syndrome – 11 (42.3 %) and with syndromic AAD – 9 (34.6 %). Odontoid anomalies were observed in 15 (57.7 %) patients, the magnitude of dislocation was determined from the C₁ facet displacement relative to that of C₂ in different planes. Patients with non-syndromic AAD had local pain syndrome (VAS score 4.20 ± 2.64) accompanied by torticollis and restriction of head movements, and myelopathy. In patients with AAD associated with Klippel – Feil syndrome, the local symptoms prevailed: restriction of neck movements, torticollis, neck pain (VAS score 2.40 ± 2.01), and myelopathy. Myelopathy and unpronounced pain syndrome (VAS score 2.30 ± 1.94) were leading symptoms in patients with syndromic AAD.

Conclusion. Patients with syndromic AAD more often have myelopathy, whereas AAD with the Klippel-Feil syndrome and non-syndromic AAD are often manifested by local symptoms.

Objective. To analyze the effectiveness and features of microsurgical discectomy of herniated intervertebral discs in patients with excessive body weight.

Material and Methods. A total of 104 patients (37 men and 67 women) aged 24–58 years with intervertebral disc hernias in the lumbar spine accompanied by compression of neural structures and radicular pain syndrome were operated on. The study group consisted of 48 obese patients who underwent microdiscectomy at the lumbar level. The control group included 56 non-obese patients operated in the same way. The level of the pain syndrome was assessed using the VAS and Oswestry’s functional activity questionnaire.

Results. Preoperative pain intensity was slightly higher in patients with obesity than in those with normal body weight. Six weeks after the microdiscectomy, the radicular pain syndrome was arrested. The clinical effect of microdiscectomy persisted after 6 and 12 months. By the end of the follow-up period, some patients with excessive body weight had a tendency to have pain in the back and lower extremities. Also, patients with obesity had slightly greater intraoperative blood loss, the incidence of superficial infectious complications, the duration of the operation, and the length of hospital stay.

Conclusion. The overweight factor should be considered when planning anesthesia and microsurgical discectomy in the lumbar spine.

Objective. To evaluate the influence of facet joint tropism on the formation of intervertebral disc hernias in the lumbosacral spine, and to determine the relationship between facet joint asymmetry and the type of hernia of the lumbar intervertebral discs.

Material and Methods. Sixty-four patients aged 23–47 years with herniated lumbar intervertebral discs at one level (L₃–L₄, L4–L₅ or L₅–S₁) were examined. Calculation of facet angles was performed on MRI axial slices. Tropism was verified when the difference between the angles of the right and left joints exceeded 10°.

Results. When calculating the facet joint angles, tropism was detected in 22 (34.3 %) cases. One-factor analysis of the effect of facet joint tropism on the intervertebral disc hernia formation at all three levels revealed its significant influence (p = 0.0017; OR 7.416; 95 % CI 3.11–22.64). Analysis of the effect of facet joint tropism on the formation of intervertebral disc hernias at each level has shown that statistically significant effect is exerted only on L₅–S₁ intervertebral discs (p = 0.0224; OR 13.537; 95 % CI 2.419–98.475).

Conclusion. Facet joint tropism significantly influences the formation of intervertebral disc hernias at all three levels of the lumbosacral spine as a whole but does not affect the type of lumbar intervertebral disc hernia.

Objective. To present comparative analysis of mid- and long-term results of surgical treatment in patients with hip-spine syndrome operated on using conventional approaches and the developed algorithm.

Material and Methods. The study included 175 patients aged 54.4 ± 12.7 years with grade III coxarthrosis combined with degenerative disease of the spine and vertebrogenic pain syndrome, who were admitted at the clinic for hip replacement. The study (n = 94) and comparison (n = 81) groups were identified. In the study group, the developed algorithm of rational surgical tactics was applied, and in the comparison group, standard approaches to the choice of surgical tactics were used. Results of surgical treatment in 134 patients were achieved, on average, in 9 months after surgery. Long-term results were evaluated in 55 patients, on average, in 61 months after hip replacement.

Results. Using the developed algorithm allowed to increase the number of patients with good clinical and functional results, and to achieve better performance of the hip joint. The analysis of changes in patients’ satisfaction with the results of treatment demonstrated significantly higher rating of long-term outcomes as compared to mid-term. Analysis of pelvis-spine relationships confirmed the effect of hip replacement on the sagittal and frontal trunk balance.

Conclusion. The developed approaches to the choice of rational surgical tactics in patients with hip-spine syndrome allows reliable improving of mid- and long-term results of surgical treatment.

The paper describes a method for three-dimensional printing of сustom-made interbody cages accounting for biomechanical parameters of the intervertebral disc (anteroposterior size, anterior and posterior disc heights), which provides the implant with unique characteristics. An example of using custom-made cages providing optimal conditions for the formation of interbody bone-metal block due to the extra tight fit of the combined implant is given. It is shown that custom-made cages have a beneficial effect on the spine support recovery time, significantly reduce the surgical injury, and shorten the time of surgery. The manufacturing of each developed implant which has its own form and architecture is not a serial but a piece production not requiring additional registration procedure. The use of custommade spinal cages allows optimizing the process of surgical treatment and improving short- and medium-term results.

The paper presents a clinical case of ineffective one-stage surgical treatment of disseminated tuberculous spondylitis. Female patient with extensive destruction of the vertebrae was treated by simultaneously performed posterior decompression and drainage of the abscess and short posterior fixation using dynamic titanium nickelide implant. After 4 months, inadequate primary surgical sanitation of the inflammation focus through posterior approach resulted in the progression of tuberculosis lesions of the spine. After repeated staged surgical treatment, the patient achieved favorable outcome of the disease. A review of the literature on disseminated forms of tuberculosis spondylitis has shown that at present there are staged and singlestep approaches to the treatment of this disease. Most modern researchers of tuberculosis spondylitis tend to single-step combined operations.

Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas.

Material and Methods. The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery.

Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values.

Conclusion. Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.

Objective. To analyze the frequency and types of microbial infection of the intervertebral disc in degenerative diseases of the spine and to compare the obtained data with the results of pathohistological, X-ray and MRI studies to determine tactical approaches to surgical interventions on the spine.

Material and Methods. The study was performed in 97 patients who underwent surgical treatment for degenerative spine disease. Discectomy was performed in 48 patients, and single- or multilevel decompression and stabilization in 49. Microbiological (117 samples) and pathohistological (73 samples) studies of disc material, clinical and neurological examinations of patients, and evaluation of X-ray and MRI findings were carried out.

Results. Bacterial culture of the disc material was positive in 27.0 % of cases of discectomy and in 30.6 % of decompression and stabilization cases. The most frequent pathogens were obligate-anaerobic gram-positive bacteria (P. acnes) and epidermal staphylococci (S. epidermidis), in 42.8 % and 31.4 % of cases, respectively. The mixed microflora was detected in 20.0 % of observations. Pathohistological study revealed the signs of chronic inflammation in 42.8 % of patients with disc infection and in 5.7 % of patients without infection. There was no significant correlation between infection of the disc and chronic diseases, clinical manifestations, sequester, Modic type 1 changes in MRI, segment instability, and changes in CT.

Conclusion. The probability of disc infection is higher in repeated operations and in degenerative lesion of discs with pain and radicular syndrome. The most reliable mechanism of intervertebral disc infection is the theory of microbial biofilms.

Achieving harmonious correction of scoliotic deformity requires a clear understanding of this condition with respect to the spinal column. Achieving harmony is not a pursuit of mandatory reduction of the Cobb angle. The main goal of the treatment is to achieve alignment, balance and stability of the spine. This goal should be taken into account both in the planning of surgical intervention, and at all its stages. It is very important to correctly determine the extent of the spinal fusion zone, to select an adequate type of endocorrector fixation and the nature of corrective maneuvers. Intraoperative achieving of harmony is aimed at correct distribution of body masses and their position relative to the load axis. The harmony of the human spine is hardly described mathematically, but it is achievable when using some benchmarks: alignment, body mass distribution, and 3D static and dynamic balances