Clinical observations of 13- and 15-year-old patients with severe (118° and 133°) idiopathic scoliosis, subjected to operative correction with the use of segmental instrumentation are presented. Intraoperative monitoring of the spinal cord function was performed by recording motor potentials of the brain and skin thermometry from the lower limbs (authors’ technique). During the operation, there was a gradual decrease in potentials in one case and sharp in another, with no changes in cutaneous temperature. Based on the data of skin thermometry, surgeons decided not to remove the implant and to bring the operation to completion in both cases. In the postoperative period, neurological complications were not revealed. The conclusion is made about the advisability of including the skin thermometry in a complex of intraoperative monitoring of spinal cord function in patients with spine deformities.

The paper presents a case of rapidly developing severe cervical kyphosis in a 5-year-old child which was the first clinical manifestation of type I neurofibromatosis (NF1). Surgical correction was carried out in two stages with preliminary hardware halo-traction and subsequent reconstruction of the spine using titanium mesh cage with bone autograft and posterior instrumentation. The deformity was corrected from the magnitude of 79° to the restoration of physiological lordosis. Long-term results were followed-up for 2.5 years with full maintenance of the achieved deformity correction. A 15-year literature review on the cervical spine lesions in NF1 is presented.

Objective. To analyze complications developing during multistage correction of early severe spinal deformities of various etiologies using VEPTR instrumentation.

Materials and Methods. The study included prospective group of 76 patients treated for early-onset scoliosis (EOS) with the VEPTR and VEPTR II instrumentation. Patients were classified using a randomized Classification of Early-Onset Scoliosis (C-EOS) system. In accordance with scoliosis etiology the cases were distributed as follows: 28 idiopathic, 26  congenital, 20 syndromic, and 2 neuromuscular scoliosis cases; and ratio of boys to girls was 32 : 44. The average age at the beginning of treatment was 5.4 ± 2.1 (1.6 to 9.8) years. The average follow-up period since the first stage was 2.2 (2 to 2.5) years.

Results. Twenty three complications were revealed in 15 (19.7 %) patients. According to the C-EOS system, the patients with complications were referred to normo- and hyperkyphotic groups. The most common complication was migration of the cranial point of implant fixation. Most complications were eliminated during the planned stage of deformity correction. In two cases, the complication resulted in cessation of the VEPTR technique using.

Conclusions. The use of VEPTR instrumentation for the treatment of EOS is associated with a rather high risk of complications. This is most likely in patients with normokyphotic and hyperkyphotic deformities. Most complications are eliminated during stage correction. The need to abandon the further use of the VEPTR instrumentation is rare.

Objective. To  analyze the working classification of post-traumatic deformities of the thoracic and lumbar spine taking into account the main characteristics of pathological condition of the injured spinal motion segments, spinal cord and roots, affecting the choice of tactics and techniques of surgical treatment.

Material and Methods. The clinical material for the classification development included 124 patients with post-traumatic deformities of the thoracic and lumbar spine operated on after 6 months to 14 years from the time of injury during 2003–2017.

Results. The proposed working classification is based on the systematization of the three orthopedic features. It offers 120 variants of post-traumatic deformities of the thoracic and lumbar spine, each designated by three symbols: a digit, a letter, a digit (for example, 4.B.1 or 2.E.3). An additional option is the four surgical risk gradation of neurological status denoted by the Latin letter N with a digit from 1 to 4.

Conclusion. The classification clearly systematizes numerous variants of post-traumatic deformities of the thoracic and lumbar spine based on the most clinically significant signs. Its application allows justifying the choice of a patient-specific tactical and technical option of surgical treatment.

Objective. To prove the effectiveness of 3D computer modeling and printing of patient-specific templates for cervical spine screw fixation.

Materials and Methods. Based on the MSCT data of three patients, 3D models of cervical vertebrae and guiding templates were produced. The screws were inserted transpedicularly into 3D-printed models of C₂–C₇ vertebrae and C₁ lateral masses using standard cervical instrumentation. This technology was then clinically tested in a patient with C₂ tumor, in whom posterior stabilization of C₁–C₃ vertebrae was performed using guiding templates. In the postoperative period, MSCT was performed to monitor the position of screws.

Results. When implanting screws into 3D-models, technical difficulties were not revealed. After insertion of screws, a visual assessment of the 3D vertebra model was made. Malpositions in models were not detected. Based on the proven technique, a clinical approbation was performed in a patient with normal cervical spine pattern. MSCT study revealed the deviation of screws relative to the planned trajectory by no more than 2 mm, with no malpositions.

Conclusion. The first domestic description of the technique of navigation using guiding templates is presented. Of all the existing methods, this is the most reliable way of screw positioning in the cervical spine. The possible insertion error does not affect the quality of positioning.

Objective. To assess the effectiveness of the application of adhesion barrier gel Antiadgezin to prevent the development of cicatricial adhesive process and its complications in the spinal canal after decompression surgery for degenerative disease in the lumbar spine.

Material and Methods. An open-label comparative randomized prospective clinical trial was conducted. The study involved 30 patients with degenerative lumbar spine disease who underwent decompression surgery. Patients were divided into two groups: in Group 1, gel Antiadgesin was injected during the spinal canal decompression, and in Group 2, the saline solution was injected. The severity of adhesive process was assessed according to MRI findings, and the severity of the pain syndrome and the degree of vital activity limitation were assessed by VAS and the Oswestry questionnaire in 2 weeks, 2 months and 1 year after surgery.

Results. Application of gel Antiadgesin allows reducing the probability of cicatricial process development in the spinal canal up to 35 % in comparison with the control group. The intensity of the cicatricial adhesive process development decreases by more than 3 times with the application of gel Antiadgesin. Reduction of pain syndrome according to VAS and restoration of physical activity are significantly more pronounced during the first weeks in Group 1. Infectious complications or allergic reactions in the study groups were not noted.

Conclusion. The use of adhesive barrier gel Antiadgesin during surgery reduces the likelihood of cicatricial adhesive process development in the spinal canal, which allows decreasing pain intensity and preventing disability in the postoperative period.

Objective. To analyze dynamic changes in the average F-wave latency in non-operated and operated patients with disc herniation and radicular compression syndrome.

Material and Methods. A total of 81 patients were examined including 29 with non-operated nerve root compression, 32 with remaining pain syndrome (failed back surgery syndrome) and recurrent disc herniation after surgery, and 20 control patients. All patients underwent electroneuromyographic study of the average F-wave latency using a functional test in the supine and sitting positions.

Results. There was no significant change in the average F-wave latency in non-operated patients with radicular syndrome, in the group of operated patients with failed back surgery syndrome and in the group of operated patients with recurrent disc herniation. The average F-wave latency decreased in the group of operated patients with instability of the spinal motion segment and in the group of operated patients with soft-tissue compression of the nerve root.

Conclusion. The study of the late neurographic phenomenon of Fwave can be performed not only in the classical static position of a patient, but also in functional tests. The absence of significant changes in the average F-wave latency in a dynamic study indicates organic nerve root compression, while its decrease serves as an indicator of functional compression.

Objective. To analyze the effectiveness of methods for the prevention of cicatricial adhesive epiduritis (CAE) after lumbar microdiscectomy.

Material and Methods. The results of treatment of 108 patients with herniated intervertebral discs at the lumbosacral level were analyzed. Cicatricial adhesive epiduritis was prevented using 4 % sodium carboxymethylcellulose gel in Group I (n = 36), by placing autograft from the internal leaf of the lumbar fascia into the space between the vertebral arches in Group II (n = 32), and prevention of CAE was not carried out in Group III (n = 40).

Results. Complete examination of patients after microsurgical removal of the herniated lumbar intervertebral disc revealed cicatricial adhesive changes in the epidural space in all studied groups, though the degree of their expression was different: in Groups I and II, cicatricial adhesive epiduritis was insignificant without clinical manifestations, in Group III, clinical manifestations were observed.

Objective. To specify the extent of preoperative examination of patients with lumbar degenerative diseases and to study the effect of examination results on the tactics of surgical treatment.

Material and Methods. The study included retrospective analysis of 1340 patients with lumbar degenerative diseases treated in the Neurosurgical Department No. 2 of Novosibirsk RITO n.a. Ya.L. Tsivyan during 2017.

Results. The average height of the intervertebral disc as evaluated with MRI was 7.4 ± 1.8 mm, and that evaluated with MSCT – 4.9 ± 1.5 mm, with a statistically significant difference between them (p < 0.05). Immediate preoperative examination of patients with lumbar disc herniation showed reduction or lysis of the hernia fragment in some of them. Reduction of the leg pain and hernia size (by more than 50 %) and lysis of the herniated disc fragment evidenced by MRI were observed in 21 (3.2 %) patients. Comparison of the preplanned and actually performed extent of decompression and stabilization interventions showed that tactics and/ or extent of surgical treatment changed in 37.6 % of cases.

Conclusion. The complex of instrumental radiological and neuroimaging studies, as well as methods of provocative procedure in the lumbar spine performed immediately before the planned surgical treatment allow choosing the proper treatment tactics, specifying or correcting the volume of surgical treatment, and to prognosing its outcome in lumbar degenerative diseases.

Objective. To analyze the types and frequency of adverse drug reactions to local intrawound application of vancomycin powder in patients after posterior decompression and stabilization in the lumbosacral spine.

Material and Methods. Clinical series published in 2011–2017 were analyzed. At the first stage, Medline and PubMed databases were searched for English-language literature sources using the keywords «intrawound vancomycin», «surgical site infection», and «posterior lumbar fusion», and e-Library for Russian-language sources using «local application of vancomycin powder», «infection in the surgical site», and «posterior decompression and stabilization». At the second stage, abstracts of articles were examined, and publications that did not meet the research criteria were excluded. At the third stage, the full texts of the selected articles were reviewed for compliance with inclusion criteria, as well as references for relevant studies.

Results. Nineteen clinical studies (16 retrospective and 3 prospective) with a total of 13,077 patients were selected for a systematic review. In 55.3 % (7,236) of posterior lumbosacral surgery cases, vancomycin powder was applied locally to prevent surgical site infection. Among the entire cohort of patients, unwanted drug reactions were detected in 2.19 % of patients.

Conclusions. Local application of vancomycin powder is associated with a low incidence of unwanted drug reactions.

Objective. To analyze prognostic factors for the development of surgical site infection following spine surgery and evaluate rating values for each of them.

Material and Methods. The data on 325 patients who underwent spinal surgery were analyzed. Data on 177 patients of the retrospective group who underwent spinal surgery without infectious complications were compared with the data of patients who had local complications of infectious genesis within one year after the operation (36 observations).

Results. The study resulted in creation of a learning matrix which became the basis for mathematical prediction and algorithm for the prevention of local infectious complications in patients who underwent spinal surgery. Seventeen criteria for predicting the development of surgical site infection were identified.

Conclusion. Approbation of the program in a prospective study (112 cases) with a follow-up period of 12 months after surgery demonstrated significant decrease in the incidence of surgical site infection  as compared with that in the retrospective study group (from 16.9 to 9.8 %).

The paper presents results of the author’s multi-year research in the field of cellular technologies. The differentiation stages of the chondro-osseous graft are described based on the findings of morphological, ultrastructural, and molecular genetic studies. The stages of cell transformation, dynamics of synthetic processes and matrix formation are identified. Hypotheses of the histogenesis of initial stages of different types of bone tissue, and the formation of microcirculatory and vascular beds in the process of osteogenesis are suggested. Experimental testing of regenerative potentialities of the bone graft in animals has shown that it is a primitive bone tissue with a high potency to proliferation, formation and differentiation into definitive bone tissue within a transplant zone.