Objective. To perform comparative assessment and identification of determinants of efficiency of the centralized system for delivery of specialized medical care to victims with acute spinal cord injury in the modern metropolis.

Material and Methods. The results of specialized medical care delivered to 2283 victims with acute spinal cord injuries were studied. The comparison group (decentralized system: treatment in several multidisciplinary hospitals in St. Petersburg) included 306 patients, and study group (centralized system: treatment in a specialized urban center for emergency spinal surgery) – 1977. Comparative analysis of the results of surgical treatment included 44 patients from comparison group and 223 patients from the study group (p > 0.05). The methods of non-parametric statistics were used.

Results. The centralized treatment system is characterized by a statistically significant increase in the rate of surgical activity, a manifold increase in the proportion of emergency spinal surgery (p < 0.01) and the mandatory use of modern technologies for surgical stabilization of the spine, shortening the hospital stay, as well as higher values of all indicators characterizing the results of treatment (p < 0.01).

Conclusion. In a large city, the centralized system of treating victims with spinal cord injury is characterized by more efficient use of urban health resources and better treatment outcomes. The key to its successful creation and subsequent operation, in addition to the centralization of medical care with the reasonable formation and distribution of the incoming patient flow, adequate logistic support for the treatment process and the presence of highly qualified medical personnel, is the availability of modern surgical technologies in delivering specialized emergency care.

The paper presents a review of three clinical cases of treating patients with chronic fractures of the odontoid process of C2 vertebra using various combinations of surgical techniques. In all cases, complete decompression of the spinal cord and stabilization of the upper cervical segment of the spine were achieved. A decrease in the range of motion in the cervical spine was observed, which did not affect patient satisfaction. A gradual regression of the neurological status and increase in muscle strength were recorded. Comparative analysis of the neurological status was carried out before and after surgical treatment. When assessing the general condition of patients using the index of disability due to pain in the neck (NDI), an improvement in the quality of life was noted. These data show the opportunities and peculiarities of methods for treating patients with chronic C2 odontoid fractures.

Type of publication: description of clinical cases. Evidence level: IV.

A clinical case of surgical and multimodal conservative treatment of an 11-year-old female patient with Hajdu – Cheney syndrome with multiple vertebral fractures in the thoracic and lumbar spine is presented. The main and significant manifestations of this syndrome are osteoporosis and acroosteolysis. After the injury, the child underwent correction of posttraumatic spinal deformity and stabilization of spinal motion segments by a placement of multi-anchor instrumentation through a posterior approach. The long-term postoperative period was characterized by the absence of bone block formation, development of distal junctional kyphosis and scoliotic deformity, which required additional surgical intervention in the amount of elongation of instrumentation and correction of the developed curvature. The paper describes in detail the clinical manifestations of the syndrome, the results of surgical treatment, and clinical and radiological characteristics.

The paper presents a completed case of the surgical treatment of a 10-year-old female patient with progressive grade IV idiopathic scoliosis who underwent surgical correction using total transpedicular fixation. The paper demonstrates long-term results of treatment of idiopathic scoliosis in the actively growing patient without the use of epiphyseodesis and staged surgical interventions.

Objective. To analyze epidemiological and clinical features of degenerative disease of the spine complicated by radicular syndrome in children, as well as the effectiveness of its treatment on the example of one of the largest regions of the Russian Federation.

Material and Methods. Design of the study corresponds to a retrospective cohort clinical and epidemiological study for 17 years. The study included 201 patients aged 10–17 years with degenerative changes in the spine complicated by radicular syndrome. An epidemiological analysis included the assessment of the regional incidence of degenerative diseases of the spine in children, and clinical analysis – the effectiveness of conservative and surgical treatment. The age and sex structure of the cohort, the level of pathology, the effectiveness of surgical treatment, and age-related features of early spinal discosis in children as compared with degenerative lesions of the spine in adults were analyzed.

Results. The epidemiological frequency of degenerative diseases accompanied by clinical manifestations and requiring special treatment in the Leningrad Region was assessed as 8.7 per 100 thousand children aged 10–17 years. Conservative treatment was effective in 172 patients, and 29 patients were treated with surgery. Surgical results were followed up for 1 to 16 years after surgery and were evaluated as excellent, good, and satisfactory respectively in 4 (14 %), 20 (69 %), and 5 (17 %) cases. Complications were reported in two cases: migration of the interbody stabilizing implant and positional neuropathy of the peroneal nerve associated with the position on the operating table.

Conclusion. The epidemiological analysis conducted on a regional cohort of the Leningrad Region can be used in assessing the potential need for conservative and surgical treatment of children with degenerative pathology in other regions of Russia. Conservative treatment of this pathology is quite effective, and surgical decompression of nerve roots was required only in 14.4 % of cases.

Objective. To perform comparative analysis of the long-term results of using the methods of total cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in the surgical treatment of patients with single-level degenerative diseases of cervical intervertebral discs.

Material and Methods. The study included 186 patients aged 21–60 years. Independent sequential randomization (1:1) of 173 patients was performed using software. The following parameters were used to evaluate patients: the VAS score of pain syndrome severity in the cervical spine and upper extremities, the Neck Disability Index (NDI) score of the quality of life, the amplitude of movements of the operated segment, the frequency of adjacent discs degeneration and of repeated surgical interventions and adverse events.

Results. In the long-term follow-up, the best clinical outcomes according to VAS and NDI data were recorded in patients from the CDA group. Their amplitude of movements in the segment remained in the physiological volume. In the ACDF group, a complete fusion was verified in 83 (93.3 %) cases. A significantly higher degree of degenerative disease of superjacent intervertebral discs was revealed in ACDF group (p < 0.01), while no significant degenerative changes were recorded in the subjacent discs (p > 0.05). The number of intraoperative and early postoperative complications did not have a statistically significant intergroup difference (p > 0.05). Symptomatic degeneration of adjacent segments was verified in 2 (2.4 %) respondents from the CDA group and in 8 (9.0 %) from the ACDF group (p < 0.001). Symptomatic adverse effects were found in 3 (3.6 %) CDA patients in the form of heterotopic ossification and in 6 (6.7 %) ACDF patients in the form of pseudoarthrosis.

Conclusions. The operations of total disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) are safe and effective methods of surgical treatment of patients with single-level degenerative diseases of cervical intervertebral discs. In CDA patients, significantly better clinical results were noted, as compared with the ACDF group. The CDA method allowed preserving the normal biomechanics of the cervical spine and preventing the development of degenerative disease of adjacent segments.

Objective. To analyze the immediate and long-term results of denervation of facet joints for facet syndrome in the lumbar spine.

Material and Methods. The immediate and long-term results of the treatment of 59 patients with severe pain in the lumbar spine who underwent facet joints denervation were studied.

Results. On a MacNab scale, 39 (66.1 %) patients rated the treatment results as good, and 20 (33.9 %) as mediocre. According to the Nurick scale, the 2nd level results of treatment (improvement) were recorded in 55 (93.2 %) cases, the 3rd level ones (unaltered) – in 4 (6.8 %). The follow-up data were collected on 37 (62.7 %) patients from 1.7 months up to 1.5 years after surgery: 13 (35.2 %) of them rated the long-term treatment results as good, 8 (21.6 %) – as mediocre, and 16 (43.2 %) – as bad.

Conclusions. Denervation of facet joints is an effective minimally invasive method for treating facet syndrome caused by spondyloarthrosis. It allows significantly reducing pain and improving the quality of life of patients in the early and long-term postoperative period.

Objective. To determine the correlation between the data of sagittal radiography of the spine and computer optical topography (COMOT) results.

Material and Methods. The study included 47 patients (5 men, 42 women) who underwent the treatment for hip dysplasia in 2010–2018. The patients were divided into two groups: Group I included 26 patients with unilateral congenital hip dislocation, and Group II – 21 patients with bilateral dislocation. All patients underwent hip replacement with corrective osteotomy.

Results. An average value of the sacral slope was 46.4° ± 9.9°, which reflects the excessive sacral slope and exceeds the norm (39.6° ± 7.9°) by 10° in cases of maximum values. Global lumbar lordosis has an average value of 64.1° ± 13.5° and directly depends on the sacral slope. The COMOT parameters showed that physiological curves were less pronounced in patients of Group I (the height of the lumbar lordosis (HIL), 2.4 ± 0,7 sm, the height of the thoracic kyphosis (HIK), 2.7 ± 0.6 sm) than in patients of Group II (HIL, 3.0 ± 0.5 sm, HIK, 3.2 ± 0.5 sm). In Group II, there was an excessive inclination of the sacrum anteriorly (-33.9° ± 4.5°). In both groups, anterior torso inclination was observed, with greater statistical differences in Group I than in Group II: in Group I, the anterior inclination was -3.5° ± 3.6°, in Group II, -0.4° ± 2.7°.

Conclusion. The average correlation was found only between the parameters of the sacral slope and the integral index of the posture state in the sagittal plane (r = 0.513); in all other cases, only a moderate correlation was found.

The presented review of scientific publications from the Medline (PubMed) and Scopus databases considers modern surgical approaches used to remove intervertebral hernias in the thoracic spine. The advantages and disadvantages of anterior and posterior approaches are analyzed. It has been revealed that the anterior approaches, providing a good opportunity to remove a hernia, are associated with the risk of serious complications, including pulmonary ones, and often lead to the formation of a post-thoracotomy pain syndrome. Mini-thoracotomy and percutaneous thoracoscopy, although less invasive, do not exclude the development of complications inherent in conventional thoracotomy. Modern posterior approaches are less traumatic and allow, with minimal contact with the spinal cord, to successfully remove not only soft tissue, but also ossified disc herniation. The choice of the optimal method of discectomy remains an unsolved problem and depends on practical skills, experience and preferences of the surgeon. For an objective and reliable assessment of the efficiency of surgical technologies and the determination of optimal indications for each of them, a prospective multicenter study is necessary.

The paper presents a rare clinical case of surgical treatment of a patient with a giant invasive schwannoma of the thoracolumbar spine. A single-stage en block resection of the tumor through a combined posteroanterior approach was performed followed by replacement of post-resection interbody diastasis with a carbon implant and by posterior instrumental fixation of the spine. The pain syndrome regressed from VAS scores 7 and 8 (back, lower limbs) to scores 4 and 1, respectively. The follow-up examination was conducted at 6 and 12 months after surgery: there were no signs of relapse. Publications on giant invasive spinal schwannomas were analyzed.

Implementation of the Decree of the President of the Russian Federation of May 7, 2018, No. 204 “On the national goals and strategic tasks of the development of the Russian Federation for the period up to 2024” assumes that Russia should move from 8th to 5th position in the world for the number of patent applications for inventions during 6 years. The paper analyzes the patent activity of inventors in the field of medicine on the example of spinal neurosurgery. Analysis of patent documents demonstrates that developments in the field of spinal neurosurgery have currently a high potential for commercialization throughout the world. However, domestic developers should pay due attention to the full scope of legal protection of their inventions to take a leading position in the world market.

Spine medicine patent news.

Meeting for spine specialists.

Congress on Early Onset Scoliosis.

Surgical Care of the Painful Degenerative Lumbar Spine: Evaluation, Decision-Making, Techniques Хирургическое лечение болезненного поясничного остеохондроза: Обследование, принятия решения, методы лечения E.N. Weaver, Jr. Thieme, 2018 152 с.

Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations Cпорные вопросы хирургии позвоночника, сравнение минимально-инвазивной и открытой хирургии: Доказательные рекомендации Ed. by: A.R. Vaccaro, R.G. Fessler, F.A. Sandhu, J.M. Voyadzis, J.C. Eck, C.K. Kepler Thieme, 2018 264 с.