Objective. To analyze feasibility and safety of C1, C2 fixation for craniocervical stabilization in patients of different age groups.
Material and Methods. Study design is a retrospective multicenter cohort analysis. Level of evidence – II. The study was based on the diagnosis and treatment data of 43 patients aged 5–74 years who underwent C1, C2 screw fixation.
Results. In most cases, atlantoaxial instability was due to traumatic injuries. Screws were implanted in C1 in 81 cases, and in C2 in 80. Postoperative MSCT data were evaluated in 41 patients. The position of the screws in C1 was defined as ideal in 63,0 % of cases, in the remaining cases there were malpositions, with 6 screws having double malpositions. Out of 80 screws inserted in C2, 64 were implanted transpedicularly. In 59.5 % of cases, a good position was revealed; in other cases different malpositions were noted. In none of the cases neurovascular damage or clinical manifestation occurred.
Conclusion. Analysis of screw fixation of C1, C2 showed that this technique is feasible in patients of different age groups. Duration of surgery and blood loss did not go beyond the conventional values. Postoperative malpositions are not accompanied by neurological disorders, which allows to consider this fixation quite safe.

Objective. To analyze the results of surgical treatment of patients with injuries and diseases of the cervical spine operated on using transpedicular fixation with free-hand technique.
Matherial and Methods. A total of 97 patients with unstable injuries, congenital and acquired deformities, as well as with tumorous lesions of the cervical spine were examined. All patients were evaluated for the stability and reliability of transpedicular fixation in the long-term period, with the analysis of mistakes and complications that arose during treatment.
Results. Positive results were obtained in 94.8 % of cases, and signs of fixation instability were absent in all patients. Despite 125 cases of pedicle wall perforation, only four patients required revision surgeries. A low rate of complications was noted, including no damage to the vertebral artery. The pain syndrome in patients decreased.
Conclusion. The obtained results prove high efficiency and sufficient safety of the free-hand technique for the cervical spine fixation. At the same time, the technique requires careful preoperative preparation and examination of patients, thorough knowledge of anatomy of the operated area, and experience and qualification of the surgeon.

Objective. To assess radiological results of anterior spinal fusion using cylindrical titanium mesh implant for lumbar spine fracture.

Material and Мethods. A total of 74 adult patients with unstable fractures of the L1-L5 vertebral bodies were selected. They underwent posterior instrumental fixation, anterior decompression of the spinal cord and its roots, and anterior interbody fusion with placement of titanium mesh implant. Radiological and CT control was performed immediately and 0.5-2 years after surgery.

Results. The phenomenon of implant penetration into the body/bodies of the cranial and/or caudal fused vertebrae has been revealed. Depending on the nature of penetration, single-level (into one vertebra) and two-level (into two vertebrae) variants of the implant edge penetration were identified. A method for calculating the penetration rate was developed, which value determines three grades of the implant penetration: grade 1 with a rate less than 0.1; grade 2 - 0.1-0.29; and grade 3 - more than 0.3. On this basis, the results of anterior spinal fusion are evaluated as good, satisfactory or unsatisfactory, respectively. If the implant did not penetrate, the result is considered excellent.

Conclusion. The proposed rate of implant penetration allows for objective evaluation of the interbody fusion results, both immediate and long-term. 

A clinical case of surgical treatment of a female adolescent patient with multiple malformations, congenital thoracolumbar kyphoscoliosis, severe lower paraparesis and impaired functions of pelvic organs is presented with a review of the literature on the problem under consideration. During the course of treatment over several years, the patient underwent repeated revision surgical interventions because of implant instability and infectious complications. The last stage of treatment included a three-column osteotomy of the spine at the deformity apex with posterior instrumented fixation. A significant correction of the deformity was achieved. Based on the results of 18-month follow-up, the correction is maintained, the implant is stable. The patient reports a significant improvement in the quality of life.

Objective. To present the features of clinical manifestations, diagnostic aspects and approaches to the treatment of neurogenic deformi- ties of the spine in adults based on the literature data.

Material and Methods. The literature review was performed using PubMed, Medline, Web of Science, Scopus, CrossRef, AOSpine, Clini- cal Key, eLibrary databases and references of key articles published in the period from 06.02.2017 till 04.11.2017.

Results. General trends in the treatment of adult patients with neurogenic deformities of the spine have been determined. Assessment of the risk from performing an intervention, taking into account possible complications and potential outcome, determines the approach to surgery in these patients. It is necessary to develop protocols of management with the definition of the main clinical symptoms, the ratio- nale for the use of non-invasive, minimally invasive or other options for care. Surgical treatment of patients with spinal deformities asso- ciated with neurodegenerative diseases (Parkinson’s disease) is accompanied by a high rate of complications and repeated interventions. Tactical algorithms for these patients should include the consistency of non-surgical and mini-invasive techniques and considering clinical manifestations of myopathy, mielo-, radiculopathy, which, in comparison with diagnostic tests, can determine the indications and volume of decompressive interventions, and the extent and levels of spinal fixation.

Conclusion. The complexity of pathogenetic mechanisms and ambiguous results of non-surgical and surgical treatment determine the need for multidisciplinary approach and the development of protocols for the management of adult patients with neurogenic deformities of the spine. 

Objective. To evaluate the results of surgical correction of idiopathic scoliosis in patients aged 18-50 years, in terms of different age groups.

Material and Methods. A total of 393 patients (348 women, 45 men) with idiopathic scoliosis were operated on during 1996-2015. In all cases, posterior correction of the deformity was performed using segmental third-generation instrumentation. The primary curve and structural countercurve were included in the fusion area. Hook fixation was performed in 298 cases, and hybrid (hooks and pedicle screws) in 95. The period of postoperative follow-up was 4.4 years on average. Analysis of immediate and long-term results was performed using X-ray and computer optical topography in three age groups (age at the time of surgery): 18 to 24 years (274 patients), 25 to 34 years (95 patients), 35 years and older (24 patients).

Results. No statistically significant differences between age groups were revealed, both in initial parameters (magnitude of the primary curve, countercurve, and the apical vertebra rotation) and in surgical results (magnitude of correction, loss of correction and mobility). When interviewing patients with the SRS-24 questionnaire, the best results were obtained in the group of age 18-24, worse in the group of age 25-34, and even worse in the group of age over 35. Computer topography also revealed the absence of statistically significant difference between age groups.

Conclusion. Surgical treatment of adult idiopathic scoliosis provides quite satisfactory results, especially in terms of improving the quality of life, that do not have significant differences when comparing three age groups within the age range exceeding 30 years. 

Objective. To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clinical outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization.

Material and Methods. The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabilization method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed.

Results. A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achieving a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis.

Conclusion. Objective neuroimaging data (grade II-IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV-V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.

Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level.

Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation.

Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac.

Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.

Objective. To analyze mathematical model of the efficiency of the compensatory mechanism of the deformed spine.

Material and Methods. The developed basic kinematic model of the spine was used. The restoration of the position of the projection of the general center of mass (GCM) was mathematically modeled, and mechanogenesis of the spinal deformity and possibility of its compensation were evaluated. To assess the reliability of the mathematical model, spinal skiagrams taken from patients with clinically confirmed pathology and sagittal imbalance were used.

Results. On the basis of quantitative characteristics of the primary spine deformity of a certain clinical case and using the developed algorithm, it is possible to create a model of both a primary deformity and a compensatory response from intact segments of the spine taking into account the influencing factors. This makes it possible to use the proposed kinematic model in scientific research on predicting the course of various types of spinal deformities.

Conclusion. The proposed algorithms simulating the development of spinal deformities based on the restoration of the position of the GCM projection reflect their mechanogenesis and can be used to model various pathological conditions of the spine. A complete correction of the deformity does not mean a complete cure, since the required spinal fusion creates a new, prognostically less significant, but pathological situation.

A modern concept of assessing tumor lesions of the spine, NOMS, adapted to the conditions of emergency care is presented as a part of a systematic review of the literature. Principles of neurological, oncological, mechanical and system analysis of spine lesions in primary and metastatic spinal tumors, which are the basis for step-by-step tactical decisions, as well as methods for analyzing each component are described.

Dumb-bell schwannomas (neurinomas) account for 15 % of the total number of spinal neurinomas. Their surgical removal in the cervical spine is a technical challenge due to intricate anatomical relationships. The paper presents a clinical case of recurrence of the dumb-bell neurinoma at the cervicothoracic level 20 years after its total single-stage removal. The tumor recurrence was confirmed by the data of neuroimaging monitoring. Repeated removal was performed. The paper describes in details the course of the disease, clinical and radiological manifestations, and results of neurophysiological monitoring.