Objective. Representation of the algorithm for diagnosis and choice of treatment approach in patients with damage to the spine and spinal cord in concomitant injury.

Material and Methods. Data of complex examination and surgical treatment of 514 patients with concomitant spine and spinal cord injury treated at the NV Sklifosovsky Research Institute of Emergency Care in 2000-2010 were analyzed. The control group included 373 patients with isolated spinal cord injury.

Results. Based on the analysis of clinical data achieved in 2000-2003 the algorithms were developed and introduced to diagnose and treat patients with concomitant spine and spinal cord injury, which allowed reducing the number of complications by 2.5 times and deaths by 2.9 times. Risk factors in the acute period and during the operation were identified.

Conclusion. Compliance with the algorithms of diagnosis and treatment of patients with concomitant spine and spinal cord injury has reduced the number of complications and deaths. Hir. Pozvonoc. 2012;(1):8-18.

Objective. To analyze clinical efficiency of initially stable anterior load-bearing interbody fusion in treatment of thoracic and lumbar spine injuries.

Material and Methods. Anterior interbody fusion for thoracic and lumbar spine injury was performed in 86 patients. Out of them 48 patients underwent fusion with cylindrical porous NiTi implants (control group), and 38 patients - initially stable anterior load-bearing interbody fusion (study group). Patients of both groups were matched by age, sex, and injury nature and localization. Clinical and neurological examinations were supplemented by spondylography in coronal and lateral projections in all patients. CT and MRI studies of the injured spinal motion segment were performed to specify the nature of injury.

Results. Good treatment results were achieved in 32 (100 %) patients from the study group and in 34 (87.2 %) patients from the control group, and satisfactory result - in 5 (12.8 %) patients from the control group. Suggested method of initially stable load-bearing anterior fusion allowed preventing the implant migration in patients with thoracic and lumbar spine injuries of types A2, A3, B1, and B2 (AO/ASIF classification) and avoiding repeat surgical intervention.

Conclusion. Clinical application of initially stable load-bearing anterior fusion proved its high efficiency, allowed preventing the implant migration and avoiding external immobilization even in cases of unstable injury, without increasing surgery time duration and blood loss volume. 

The paper presents the first experience with using of BioScorp implant in the treatment of a patient with unstable compression fracture of the C7 vertebral body. Results demonstrated that BIOSCORP provided reliable stabilization in the motion segment and allowed for early patient mobilization. In the long-term postoperative follow-up the implant lysis and formation of a solid bone block were observed. Hir. Pozvonoc. 2012;(1):26-30.

The team of the Clinic of Children Vertebrology of Novosibirsk Research Institute of Traumatology and Orthopaedics gained considerable experience with surgical interventions on the spine for scoliosis - about 2500 operations. The author, in the form of discussion, offers his own views on a number of vital issues: when to operate, whether to look out for the patient’s age, how to plan an intervention, whether spinal cord monitoring is always required, how and when to evaluate the treatment result, and many others.

The paper presents a clinical case of surgical treatment for kyphoscoliotic spinal deformity complicated by neurological disorders due to multiple developmental abnormalities of the thoracic spine. Surgery included spinal cord transposition and correction with third-generation segmental instrumentation. Transposition of the spinal cord resulted in significant increase in the spinal canal volume and improvement of its shape, and facilitated the elimination of the spinal cord compression and the complete regression of neurological symptoms. This allowed performing the required correction of severe kyphosciliosis and reducing the risk of trunk imbalance, deformity progression and late instrumentation failure after surgery.

Objective. To study an applicability of active optical 3D-CT navigation system for surgical treatment of children with idiopathic scoliosis.

Material and Methods. The study included 12 children aged 14-17 years with thoracic and thoracolumbar idiopathic scoliosis. The magnitude of scoliotic deformity varied from 52° to 80° (average 70°). Correction of deformity was performed using multisegmental pedicle screw instrumentation inserted under the guidance of active optical 3D-CT navigation system. At the stage of navigation an estimation of mean-square registration error, and monitoring of time required for registration and formation of bone canals for pedicle screws were performed.

Results. In 96.6 % of cases the pedicle screws were placed in all preplanned pedicles. In other 9 vertebrae (3.4 %) the screw placement was complicated by pedicle fracture and screw trajectory deviation. There were no cases of neurological and infection complications, and instrumentation loosening in the studied patients.

Conclusion. Active optical 3D-CT navigation using preoperative CT images and anatomical landmark registration is applicable in correction of idiopathic scoliosis in children. Multisegmental transpedicular fixation allows reducing the length of metal fixation zone, and achieving maximum curve correction and reliable stability. 

Objective. Comparative analysis of surgical results in patients with thoracolumbar and lumbar idiopathic scoliosis treated by laminar and transpedicular fixation.

Material and Methods. Two groups of patients with lumbar and thoracolumbar idiopathic scoliosis were operated on. Patients from Group 1 underwent skeletal traction applied to calvarial bones and supramalleolar area, and correction of spinal deformity with third-generation segmental instrumentation using laminar fixation. Patients from Group 2 underwent skeletal traction applied to calvarial bones and supramalleolar area, and correction of spinal deformity with third-generation hybrid segmental instrumentation using laminar fixation in the thoracic spine and transpedicular fixation in the lumbar or thoracolumbar spine.

Results. In Group 1 the scoliotic deformity was reduced from an average of 63.8° ± 21.1° to 24.7° ± 13.7°; postoperative progression was 6.8° ± 1.1° (18.6 ± 2.5 %); and tilt angle of the lower instrumented vertebra before surgery, after surgery, and at follow-up was 9.5° ± 8.4°, 8.2° ± 5.4°, and 10.0° ± 5.9°, respectively. In Group 2 the deformity was reduced from an average of 55.9° ± 16.6° to 13.4° ± 11.2°; postoperative progression was 2.4° ± 0.7° (5.8 ± 1.8 %); and tilt angle of the lower instrumented vertebra before surgery, after surgery, and at follow- up - 17.6° ± 7.6°, 5.2° ± 4.3°, and 5.6° ± 4.5°, respectively.

Conclusion. Transpedicular fixation is more effective technique of surgical treatment for lumbar and thoracolumbar scoliosis than laminar fixation. 

Objective. To evaluate therapeutic feasibility of posterior and anterior decompression-stabilization operations for combined lateral stenosis in the lumbar spine.

Material and Methods. Prospective randomized controlled trial included review of medical records of 96 patients using the method of continuous sampling. Patients with radicular compression syndrome caused by combined lateral stenosis of the lumbar spine were treated in accordance with a single protocol in three specialized neurosurgical clinics. Patients in the first group (n = 47) underwent posterior decompression-stabilization operations with posterior foraminotomy, and patients in the second group (n = 49) - anterior decompression-stabilization operations with anterior foraminotomy.

Results. Assessment of changes in functional ability (Oswestry scale), pain (VAS), and neurological symptoms showed comparable results of posterior and anterior decompression-stabilization procedures in both groups.

Conclusion. Combined lateral stenosis with a prevalence of anterior localization of compression substrates should be preferably treated by anterior decompression-stabilization operation with anterior foraminotomy, whereas the prevalence of posterior root compression by articular processes entophytes or migrating disc herniation requires posterior decompression-stabilization operation. 

Objective. To assess informative value of diagnostic trepan biopsy for differential diagnosis of circumscribed destructive lesions of the spine in patients of different age groups.

Material and Methods. Percutaneous vertebral body trepan biopsy followed by cytological and histological investigations of bioptates was performed in 53 patients (20 adults and 33 children) having destructive lesions confined to a single spinal motion segment and admitted with a suspicion of tuberculous spondylitis. The structure of pathology and possible complications were determined.

Results. Diagnosis was substantiated by findings of cytological and histological investigation of bioptates in 75 % of patients.

Conclusion. Informative value of cytological and histological investigation of trepan biopsy sample may be higher if manipulation is performed earlier, before indication of antibacterial or tuberculostatic therapy. Trepan biopsy should be supplemented by aspiration biopsy with additional bacteriologic and cytological investigation if paravertebral soft-tissue component is available. 

Objective. To analyze results of gastric dysrhythmias intensive therapy including modern techniques for stimulation of the stomach motor-evacuation function, and nutritional maintenance.

Material and Methods. The study included examination of patients with gastric dysrhythmias developed in the early postoperative period after surgical correction of scoliotic spinal deformities. Clinical, laboratory, X-ray, ultrasonic, and endoscopic investigation methods were used.

Results. A complex of diagnostic measures allowing for differential diagnosis of gastric dysrhythmias and rational choice of methods of differentiated pathogenetic intensive therapy was worked out.

Сonclusion. Findings obtained from the study will help to improve the results of treatment for visceral complications in patients who underwent spinal surgery.

The paper presents a review of laboratory investigations for diagnosis of implant-associated infections in patients after orthopedic surgery. The author analyzes the diagnostic value of different tests and peculiarities of parameter dynamics depending on the type of surgical intervention.

Objective. To investigate risk factors for osteoporosis in men and to assess their prognostic value.

Material and Methods. A total of 1141 male residents of Novosibirsk aged 6 to 70 years were examined, out of them 458 men were at the age of 6-20 years, and 683 - at the age of 21-70 years. Clinical, sociological, radiological, densitometric, and statistical methods of investigation were used.

Results. Comparative analysis of the prevalence of risk factors for osteoporosis among men showed that the risk of osteoporosis increases with age. Lack of sufficient physical activity leads to loss of bone mineral density, and smoking is a significant risk factor. Relationship between alcohol abuse and low bone density is evident, and the lack of calcium intake from food results in bone loss. A family and patient’s own history of fractures, reduction in height, frequent consumption of caffeine-containing drinks, and low weight lead to a decrease in bone mineral density.

Conclusion. Knowledge of factors affecting bone mineral density is necessary to work out a framework of primary and population- based prevention of osteoporosis and its complications. 

Objective. Development and substantiation of a model of sustainable development of a public health institution.

Material and Methods. Analysis of the current management system for public health research institution was performed.

Results. The maturity level of the quality management system was scaled in the Novosibirsk Research Institute of Traumatology and Orthopaedics (RITO), its strong and weak aspects were identified, areas for improvements and innovations were determined, priorities in a sequence of actions aimed at perfection were defined, and principles of strategy and policy to achieve sustainable development were worked out for the Novosibirsk RITO.

Conclusion. Implementation of proactive risk-management approach to management will allow predicting the onset of an undesirable event and planning measures for risk reduction, while providing stabilization and enhancement of the institution’s efficiency, safety of diagnosis and treatment process, and satisfaction of needs and expectations of all interested parties.