Material  and Methods. The  study design is a meta-analysis of publications with levels  1a, b, c, and  2a evidence and  a level A recommendations. An electronic search was conducted in the  PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord  injury (more than 4 months after injury). Exclusion criteria were  topic articles, clinical  cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord.

Results. The  search returned 108 articles with publication date within 1997–2019. The  inclusion criteria was  met  by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open  prospective study was included in the  review due  to the  particular treatment method used. The  greatest evidence base  for the  rehabilitation of patients in the  long-term period after spinal cord  injury is presented for physical methods of rehabilitation. The  most effective are locomotor training to develop skills  of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the  spinal tracts, the  restoration of motor functions occurs due  to the  activation of supraspinal interneuronal connections. Epidural electrical stimulation of the  lumbar thickening of the  spinal cord  activates a generator of voluntary movement of the  limbs  and,  in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The  constant use  of electrostimulation blocks proprioceptive sensitivity and inhibits the  recovery of spinal conductivity. Parameters of clinical  application are not  defined for areas of regenerative medicine.

Conclusion. The  main problem in rehabilitation of patients in late  period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the  initial status and treatment efficiency.

Objective. To  assess capabilities and  advantages of endoscopic transnasal removal of pathological foci in the  region of the  С₂ odontoid process.

Material and Methods. The  study included 3 patients who underwent endoscopic transnasal removal of the invaginated odontoid process accompanied by simultaneously (2 cases) or previously performed (1 case) occipitospondylodesis.

Results. The  pathological focus was  totally removed in all cases. Postoperative complication occurred in one  case  – wound liquorrhea with subsequent development of meningitis which required performing plastic surgery of the  CSF fistula. At follow-up examination, all patients presented with complete regression of symptoms.

Conclusion. Endoscopic transnasal access allows for radical removal of pathological foci of the craniovertebral junction. Endoscopic transnasal approach will not  be able to completely replace a transoral one, but it is a reasonable alternative in experienced hands.

Objective. To assess risk factors for the imbalance of the shoulder girdle and to identify reproducible X-ray criteria for persistent shoulder imbalance after correction of idiopathic scoliosis.

Material  and Methods. A total of 94 patients with idiopathic scoliosis were  included in the  retrospective study. All patients underwent primary posterior correction of the  deformity using pedicle screw instrumentation. Radiography of the  spine throughout its length was performed before surgery, in the  early  postoperative and in the  long-term (at least 12 months after surgery) periods. The  shoulder imbalance was considered clinically significant with radiographic shoulder height difference more than 2 cm.

Results. A significant decrease in the  magnitude of all curves after surgery and in the  long-term period was noted. The  magnitude of the proximal curve decreased from  25.38° ± 15.89° to 14.51° ± 8.17° (p < 0.0001) and  to 14.29° ± 8.25° (p = 0.24); the  main  thoracic curve from  59.33° ± 20.76° to 20.096° ± 9.89° (p < 0.0001) and  to 20.87° ± 9.48° (p = 0.19); and  thoracolumbar curve from  47,20° ± 15,99° to 15.69° ± 8.66° (p < 0.0001) and to 16.98° ± 7.6° (p = 0.01), respectively. The  shoulder imbalance was recorded in 27 patients (28.72 %) after surgery and in 13 (13.83 %) – in the long-term period. In these patients, various Lenke types of deformity were presented. A correlation of the distal adding-on phenomenon with self-correction of the shoulder balance is revealed (r = 0.56; p < 0.005). Persistent shoulder imbalance correlated with presence of a structural proximal thoracic curve (p = 0.041642), residual proximal curve magnitude after surgery (r = 0.22; p = 0.03), and presence of a symptom of double rib hump on radiographs after surgery (r = 0.75; p ≤ 0.005).

Conclusion. The  most characteristic pattern of persistent shoulder imbalance is the  presence of asymmetry in the  proximal and main  regions of the  chest. This sign can be detected by intraoperative lateral radiography of the  spine, which will allow the  surgeon to take measures to eliminate this phenomenon and reduce the  probability of persistent shoulder imbalance development.

Objective. To  perform a systematic review  of publications devoted to the  evaluation of the  results of surgical treatment of adolescents with idiopathic scoliosis aged 10–14 years.

Material and Methods. Publications on surgery for adolescent idiopathic scoliosis for the last 40 years were analyzed taking into account different  treatment approaches. The  long-term results of surgical correction and complications occurred at different stages of the  vertebrology development were reviewed based on the data of 23 publications including data on 826 patients aged 10 to 14 years in the period of active growth.

Results. The  prevalence of anterior interventions such as discectomy and anterior spinal fusion at the early stages of the scoliosis surgery development was justified. This was due  to the  lack of instrumentation at that time to prevent postoperative progression of scoliotic deformity in growing patients. The  occurrence of crankshaft phenomenon was prevented by performing intraoperative spine release and subsequent stabilization owing to the  formation of interbody bone  block.

Conclusion. Despite the  fact that the  method of total transpedicular fixation occupies a leading position at the  present stage of scoliosis surgery evolution, the  anterior spinal release remains relevant and necessary stage of surgical treatment of patients with severe and rigid spinal deformities at any age. The  need for anterior intervention is determined not  by the prevention of possible postoperative progression, but by the  magnitude of spinal deformity, that is, anterior surgery is performed to mobilize severe and rigid scoliotic deformity.

Atlantoaxial dislocation with spinal canal stenosis not associated with craniovertebral junction malformations and traumatic injury is a rare pathology in children and adolescents. A clinical  case of the  diagnosis and surgical treatment of atlantoaxial dislocation of non-traumatic genesis combined with spinal canal  stenosis in an adolescent with juvenile idiopathic arthritis is presented. A minimal instrumental fixation of the  upper cervical spine allowed eliminating stenosis of the  spinal canal, repairing instability of the  upper cervical vertebrae, and jugulating neurological disorders.

The  paper describes a case of successful treatment of a 32-year-old female  patient with idiopathic scoliosis combined with giant paravertebral arteriovenous malformation in the lower  thoracic region, causing the T11  vertebral body  destruction, circular epidural compression, and myelopathy. The  treatment was performed using 3D printing technology and hybrid surgery. The  follow-up period after the first surgery was 26 months. The  case  report is accompanied by a literature review  that analyzes world experience in the  treatment of spinal arteriovenous malformations.

Objective. To assess a potential of using intraoperative rectal ampullar manometry to prevent bladder dysfunction in surgical treatment of the  spinal cord conus lipoma.

Material and Methods. The  results of surgical treatment of 59 children with lipomas of the  spinal cord  conus were studied. The  presence of urological symptoms (urinary retention or incontinence) was  assessed before and  after surgery. Intraoperative rectal ampullar manometry was performed in 22 cases with registration of signs of irritation (increased pressure in the  rectal ampulla) and depression (decreased pressure in the  rectal ampulla) of sacral parasympathetic centers which allowed controlling their proximity and tolerance to the performed manipulations.

Results. Urological symptoms before surgery were  detected in 25 (42 %)  patients: urinary retention in 7 (28 %),  and  incontinence in 18 (72 %).  Symptoms were  significantly more often detected in children older  than 3 years (p < 0.05). Intraoperatively, a transient decrease in pressure in the  rectal ampulla was noted during bipolar coagulation, and a decrease in pressure in the  rectal ampulla was noted during ultrasound disintegration. The  most pronounced changes in pressure were observed during manipulations along the borderline between the lipoma and the spinal cord in the zone of localization of sacral parasympathetic centers. Persistent profound changes in pressure (>3 mm Hg) have precluded from the total removal of lipoma in all 22 patients; subtotal or partial lipoma removal and  release of the tethered spinal cord were achieved in all cases. None of the patients operated on using rectal ampullar manometry presented urinary retention after surgery, these disorders developed in 12 (32 %) children operated on without this procedure (p < 0.05).

Conclusion. Paresis or paralysis of the  bladder detrusor after removal of the  spinal cord  conus lipoma may result from  direct damage to the  parasympathetic sacral centers located at the  borderline between the  lipoma and the  spinal cord.  The  method of intraoperative rectal ampullar manometry allows protecting the  functions of the  pelvic organs and determining the  safe volume of lipoma resection.

Objective. To analyze publications devoted to the  possibility of using bacterial nanocellulose as a plastic material for defects in the dura mater associated with spine and spinal cord pathology.

Material and Methods. The  PubMed database was searched with keywords “bacterial cellulose properties” and “bacterial cellulose”. The search was limited to articles published in English- and Russian-language journals in 2009–2019. The  limitation was caused by the  need for up-to-date evaluation of the properties of bacterial nanocellulose. The  search with keywords “bacterial cellulose properties” returned a list  of 963 articles and with key words “bacterial cellulose” – a list  of 3908 articles. The  Google search engine was also  used, in which articles were found actually reflecting properties of bacterial nanocellulose without which complete understanding of its nature is impossible.   After  assessing the  found data, 76 articles were  selected that reflect this issue to the  fullest extent. More than fifty percent of the reviewed articles were  published within the  last 10 years. Evidence level: IV; recommendation grade: C, though randomized trials with evidence level Ib and recommendation level A are used.

Results. Implants made of bacterial nanocellulose are able to perform the  function of the  extracellular matrix by providing a barrier function, creating conditions for the  circulation of metabolites and oxygen, and preventing the  achievement of excess cell concentration.

Conclusion. The use of bacterial nanocellulose as an implant for closure of the dura mater defects associated with the spinal cord pathology is a promising direction in neurosurgery, since nanocellulose does not cause adhesions to the nervous tissue and performs a barrier function.

Epidural fibrosis is a common cause of a failed  back surgery syndrome. The  current scientific literature proposed many methods for prevention of epidural fibrosis, however, universal methods to fully solve  the  problem was  not  found. Prevention tasks in the  preoperative period include the  identification of risk factors for the  development of epidural fibrosis with the  correction of the  revealed violations. Intraoperative prevention involves the  development of barriers in the  form of natural and synthetic polymeric materials that impede the  formation of epidural fibrosis after laminectomy. The  complex of measures to prevent the  development of epidural fibrosis in the  postoperative period is supposed to include a list of manipulations consisting of epidural blockades with a common complex anti-inflammatory drug therapy. The  study presents an analysis of 63 literary sources from  PubMed, EMBASE, Cochrane Library, and  eLIBRARY databases most fully reflecting the  pathogenetically substantiated prevention of the  epidural fibrosis development in the  preoperative, intraoperative and postoperative periods.