Objective. To substantiate the principles of context-based optimal decision-making and technical choice in instrumental fixation of the spine in trauma patients with neurologically uncomplicated isolated burst fractures of the thoracic and lumbar vertebrae.

Material and Methods. A comparative retrospective analysis of treatment outcomes of 206 trauma patients was performed. Patients of Group 1 (n = 17) underwent anterior spinal fusion with anterior instrumental fixation through isolated open anterior approach, those of Group 2 (n = 80) – open pedicle screw fixation, of Group 3 (n = 70) – posterior mini-invasive percutaneous pedicle screw fixation, of Group 4 (n = 20) – open pedicle screw fixation with the extended laminectomy and reconstruction of the anterior column, and of Group 5 (n = 19) – open pedicle screw fixation and anterior fusion through an open approach. Non-parametric statistical methods were used.

Results. Open or minimally invasive posterior instrumental fixation of the spine with instrumentation systems including 6 screws for incomplete burst fractures and 8–10 screws for complete burst fractures should be considered the best operative option in the immediate post-traumatic period (up to 7 days) both from the point of view of convenience and safety of the patient and from the standpoint of maximally effective use of any hospital resources. The use of open anterior approaches for the reconstruction of the anterior spinal column can be justified only when the time from injury exceeds 7 days, as a part of combined procedure, primarily in combination with minimally invasive posterior pedicle screw fixation.

Conclusion. To date, decision-making and technical choice in instrumental fixation for neurologically uncomplicated isolated burst fractures of the thoracic and lumbar vertebrae should be context-based. The decision-making algorithm should be built on the basis of the experience of the operating surgeon, the time from injury, the trauma patient’s state of health, as well as the administrative and logistical context of provision of the specialized medical care.

Objective. To analyze the results of the removal of thoracic intervertebral disc hernia through posterior surgical approach using intraoperative neuromonitoring.

Material and Methods. A total of 14 patients aged 43–64 years (M = 53.9) were operated on through posterior approach for symptomatic hernia of the thoracic intervertebral discs, with myelopathy (isolated or in combination with radiculopathy) in seven cases, and with isolated radiculopathy in another seven cases. Hernia were ossified in 6 cases. Operations were performed using intraoperative neuromonitoring. In 11 cases, unilateral or bilateral laminectomy and facetectomy were performed to remove a hernia; in three cases – laminectomy with resection of the facet joints and pedicles (in two of them, with ossified large and giant hernias, radiculotomy was performed to mobilize the dural sac).

Results. The long-term clinical results of surgical interventions were evaluated 1–4 years after the surgery using VAS-10, ODI, and Frankel scales. VAS scores decreased by 2–6 points In 11 patients, and remained at the same low level characterized by mild pain (1–2 points) in three patients. In patients with myelopathy, the Frankel scale showed a positive trend in six out of seven cases. Two patients showed an increase in neurological deficit in the postoperative period. In one case, neurological disorders regressed within a short period of time, in the other one, they became permanent. Damage to the dura mater was observed in two cases.

Conclusion. Intraoperative neuromonitoring allows the surgeon to act more actively and confidently in the area of disco-medullar conflict and thereby avoid excessive expansion of surgical approach without compromising the surgical result. A small number of observations does not allow making evidence-based conclusion.

Objective. To analyze immediate and long-term results of percutaneous endoscopic and microsurgical discectomy.

Material and Methods. A prospective cohort study in two groups of patients was conducted in 2015–2018. The observation period was 6–42 months. Group 1 included 110 patients who underwent percutaneous endoscopic lumbar discectomy, and Group 2 – 331 patients who underwent microdiscectomy. Efficiency was assessed using NRS-11, ODI, SF-36, and MacNab questionnaires.

Results. The operating time, bed day number, and disability period were shorter in Group 1 (p < 0.001). The average effective dose of radiation exposure to the patient was 4.4 mSv in transforaminal endoscopy, and 0.8 mSv in interlaminar and microsurgical discectomy. There were no significant intergroup differences in frequency and types of complications and reoperations. The portion of symptomatic hernia recurrence in Group 1 was 10 %, in Group 2 – 4.8 %. Significant differences in neurological outcomes and quality of life were not revealed. Good and excellent outcomes according to MacNab criteria were noted in 78.2 % and 84.9 %, in Groups 1 and 2, respectively.

Conclusion. The percutaneous endoscopic discectomy allows reducing hospital stay length and disability period, while having clinical efficacy equal to that of other disectomy methods. A statistically insignificant increase in the risk of hernia recurrence after percutaneous endoscopic discectomy was noted.

Objective. To analyze the safety and accuracy of pedicle screw placement in the subaxial cervical and upper thoracic spine using patient-specific 3D navigation templates.

Material and Methods. The study included 16 patients who underwent transpedicular implantation of screws in the subaxial cervical and upper thoracic vertebrae using patient-specific 3D navigation templates. A total of 88 screws were installed. All patients underwent preoperative CT angiography to assess visualization of the vertebral artery. Customized vertebral models and navigation templates were created using 3D printing technology. Models and templates were sterilized and used during surgery. The results of screw implantation, as well as the safety and accuracy of the placement, were assessed by postoperative CT.

Results. The average deviation from the planned trajectory was 1.8 ± 0.9 mm. Deviation was estimated as class 1 (<2 mm) for 57 (64.77 %) screws, class 2 (2–4 mm) for 29 (32.95 %), and class 3 for two (2.27 %). The safety of screw implantation of grade 0 (the screw is completely inside the bone structure) was in 79 (89.77 %) cases, of grade 1 (<50 % of the screw diameter perforates the bone) – in 5 (5.68 %), and of grade 3 – in 2 (2.27 %).

Conclusion. Using 3D navigation templates is an affordable and safe method of installing pedicle screws in the cervical and upper thoracic spine. The method can be used as an alternative to intraoperative CT navigation.

Objective. To analyze clinical manifestations of cervicobrachial syndrome and identify their relationship with sagittal imbalance using data of MRI and radiological examination.

Material and Methods. Clinical manifestations of cervicobrachial syndrome associated with degenerative changes in the spine were studied in 22 patients. Clinical examination, radiography of the cervical spine, electroneuromyography of the upper extremities, and MRI study were performed. The intensity of the pain syndrome was assessed by VAS, and the quality of life – by the NDI questionnaire. The sagittal balance of the cervical spine was evaluated according to the following characteristics: angle of T1 slope, atlantoaxial (C1–C2) angle, degree of shift of the center of gravity of C2–C7, and Cobb angle.

Results. The pain intensity in cervicobrachial syndrome correlates with sagittal balance changes in the C2–C7 Cobb angle (r = 0.656; p < 0.05), the angle of T1 vertebra slope (r = 0.520; p < 0.05), and in the degree of shift of the center of gravity of C2–C7 (r = 0.756; p < 0.02). Differences between MRI and radiological results of the sagittal balance measurement are not significant (p < 0.04).

Conclusion. The study of the sagittal balance can be included in the algorithm for diagnosing osteochondrosis of the cervical spine. The MRI, along with spondylography, can be used to assess the state of sagittal balance. Understanding the identified relationships can help in determining the program of etiopathogenetic treatment of patients with cervicobrachial syndrome with obligatory including the sagittal balance correction in the program.

Publications on aneurysmal bone cysts of the spine in children for the last 20 years were systematized taking into account different treatment approaches. The results of radiation therapy, local puncture interventions, surgical removal of the tumor, selective embolization, and of their combinations were reviewed based on the data of 19 publications representing 165 pediatric patients.

A clinical case of a single-step transoral removal of C₂ and C₃ vertebral bodies with subsequent stabilization of the C₁–C₄ spinal segment through the same approach (with additional submandibular approach to insert screws into the C₄ vertebra body) without dissection of the mandible and tongue is presented. The first experience of anterior stabilization of the C₁–C₄ spinal segment using a custom-made instrumentation system demonstrated its effectiveness. It was shown that, taking into account the length of the cervical spine resection, the anterior stabilization with a custom-made plate should be combined with standard methods of posterior fixation. Innovative surgical technologies allow optimizing the surgical technique of cervical spine stabilization and provide earlier rehabilitation of a patient.

Objective. To analyze personal resources in adolescents with idiopathic scoliosis at the stage of preparation for surgery.

Material and Methods. The study involved 29 adolescents aged 12–17 years (7 boys and 22 girls) with grade III–IV idiopathic scoliosis. The survey was conducted within the first days of admission. The control group consisted of 30 adolescents aged 12–17 years without serious somatic diseases. The following diagnostic methods were used: analysis of medical records (case histories), semi-structured interview to assess the severity of traumatic experiences in children and adolescents, the Life Style Index questionnaire, the Coping Strategies Questionnaire, a self-assessment scale, and self-test questionnaire.

Results. In adolescents with idiopathic scoliosis, events associated with the disease and preparation for surgery are accompanied by extreme level experiences manifested in medium and medium-high values of post-traumatic stress. Moderate symptoms of avoidance, hyperarousal and obsessive reproduction of traumatic episodes predominate in the structure of stress. Positive self-attitude indicators contribute to the activation of effective coping strategies and can be considered as an adaptive personal resource in a difficult life situation associated with a serious illness and the upcoming surgery.

Conclusion. Understanding of personal resources that contribute to the formation of effective coping behavior in a difficult life situation associated with the disease and complex surgical treatment will optimize psychological preparation of adolescents with idiopathic scoliosis for surgery.

Objective. To determine possible effect of the preparation of an incomplete polyacrylic acid silver salt on the volume of intraoperative and postoperative blood loss in open posterior surgery on the spine involving up to three segments.

Material and Methods. Study design: randomized prospective multicenter cohort analysis. Level of evidence – IIb. The study was based on 90 patients aged 27 to 65 years who underwent decompression and stabilization surgical interventions on the lumbar spine through posterior median approach using transpedicular fixation system with fixation of up to three vertebrae. A comparison of perioperative blood loss volume in patients with local application of polyacrylic acid silver salt and without it was performed.

Results. The volume of inraoperative blood loss (the sample was described using the mean value and standard deviation M ± σ) in the study group was 258.1 ± 164.5 ml (min 90; max 890), in the control group – 405.5 ± 157.9 ml (min 190; max 950). The postoperative blood loss through drainage (M ± σ) was 81.500 ± 77.046 ml (min 20; max 400) in the study group, 151.560 ± 74.745 (min 20; max 600) in the control group. Comparison of both intraoperative and postoperative blood loss according to the Mann-Whitney U-test confirms the high statistical significance of differences (p < 0.01), which suggests the effectiveness of the preparation.

Conclusion. The use of incomplete polyacrylic acid silver salt in decompression and stabilization interventions on the lumbar spine involving 1 to 3 segments can effectively reduce the volume of blood loss both during surgery and in the postoperative period.

The paper presents recommendations on the assessment and treatment of vertebral pathology in patients with various types of mucopolysaccharidosis. The recommendations are based on literature data and the authors’ own experience. The purpose of the publication is an invitation to the discussion in the format of an expert consensus.

Sagittal Balance of the Spine: From Normal to Pathology. A key for treatment strategy Сагиттальный баланс позвоночника: от нормы до патологии. Ключ к стратегии лечения P. Roussouly, J.L. Pinheiro-Franco, H. Labelle, M. Gehrchen;

Surgery of the Thoracic Spine: Principles and Techniques Хирургия грудного отдела позвоночника: принципы и методы A.A. Baaj, U.K. Kakarla, H.J. Kim