Objective. To analyze the efficacy of various methods for treatment of children with compression fractures of the thoracic and lumbar spine on the basis of literature data.
Material and Methods. A systematic review of the literature on methods for the diagnosis and treatment of compression fractures of the spine in children was carried out. PubMed, Science Direct, and Google Scholar databases were searched for literature sources for analysis.
Results. A significant number of discrepancies between the approaches used in the treatment of compression fractures in children and the available literature data were noted. In particular, not any diagnostic protocol includes MRI as a tool to confirm the presence of a fracture, due to the high cost of the method and its low influence on the treatment tactic choice. The data of biomechanical studies cast doubt on the feasibility of long-term bed rest compliance and restrictions on sitting. As for bracing of patients with compression fractures, it has been demonstrated that wearing of rigid brace does not allow achieving better results in comparison with its absence. The child’s ability to remodel residual deformations of vertebral bodies ensures the restoration of their height and shape in the vast majority of cases. Currently, there is no data confirming the fact of earlier development of degenerative diseases and back pain in children who sustained compression vertebral fractures.
Conclusion. The review results allow to analyze the efficacy of various treatment methods and can be the basis for reviewing the existing treatment tactics for children with compression fractures of the vertebral bodies.

Objective. To assess inter-expert agreement among spine surgeons having different levels of clinical experience when working with the AOSpine classification (TLCS, 2013).
Materials and Methods. The study involved nine surgeons divided into three equal groups depending on work experience. All respondents were asked to classify the MSCT data of 50 patients with acute injuries to the thoracic and lumbar spine pursuant to TLCS (2013) classification. To evaluate inter-expert agreement, a Kappa coefficient interpreted according to Landis – Koch criteria was used.
Results. The overall coefficient of inter-expert agreement for all observations among all groups of respondents was 0.43, which reflects a moderate level of agreement. Moderate inter-expert agreement was revealed for injury types A (0.45) and C (0.56), and satisfactory – for type B (0.34). The highest levels of agreement were obtained for subtypes A1 (0.67) and A4 (0.80) in the group of advanced specialists and for type C (0.70) in the group of specialists with a basic level of experience.
Conclusion. The study demonstrated predominantly moderate level of inter-expert agreement when working with the AOSpine classification (TLCS, 2013). The accuracy of its use increases with a gain in practical experience of a surgeon.

Objective. To assess the information value of comparing the results of formalizing intraoperative changes in transcranial motor evoked potentials during surgical correction of spinal deformities of various etiologies.
Material and Methods. Study design: analysis of monocentric retrospective unselected cohort over 5 years, evidence class 2b. Surgical correction of spinal deformity under neurophysiological control was performed in 364 patients (mean age 12.80 ± 0.40 years). The scores of changes in motor evoked potentials were used to compare the pyramidal system response to surgical aggression in patients with congenital spinal deformities, idiopathic scoliosis, and systemic skeletal diseases.
Results. Basic motor responses in patients with systemic diseases of the axial skeleton are to a greater extent depressed and unstable than in those with congenital deformity and idiopathic scoliosis. On surgery completion, these differences are exacerbated. Five identified types of response of the spinal cord conduction pathways to surgical correction of spinal deformity allow comparing intraoperative  neuromonitoring results in different groups of patients. The most dangerous types of response are observed more often in patients with congenital and systemic pathologies than in those with idiopathic scoliosis.
Conclusion. The proposed method for the rank assessment of intraoperative changes in motor evoked potentials during surgical correction of spinal deformity allows comparative studies of patients’ reactions to surgical intervention in different etiological and age groups. The greatest risk of iatrogenic motor disorders in the postoperative period is observed in patients with systemic skeletal pathology.

Objective. To assess the effect of endocorrector rod fractures on the final result of treatment and the quality of life of patients operated on for spinal deformities of different etiology.
Material and Methods. The study included 3833 patients older than 10 years who were operated on for spinal deformities of various etiologies and had not been subjected to spinal surgery before admission to the clinic. In the pre- and postoperative periods, spondylograms in frontal and lateral projections in the standing position were studied using the Cobb method, the apical vertebra rotation was determined in accordance with the method of Sullivan et al. Patients answered questions of the SRS-24 questionnaire in the immediate and long-term follow-up periods.
Results. In total, fractures of metal implant rods were detected in 85 (2.2 %) patients. The average scoliotic deformity in these patients was 84.5° before surgery, 49.9° after surgery, and 53.7° at the end of the follow-up period (postoperative progression was 3.8°). Thoracic kyphosis was 61.5° before surgery, 44.3° after surgery, and 48.7° at the end of the follow-up period; lumbar lordosis – 68.4°, 54.8°, and 56.5°; and apical vertebra rotation – 55.8°, 33.2° and 35.8°, respectively. According to the questionnaire data, patients estimated their appearance after surgery and general appearance  somewhat lower and pain as less intense. Indicators of activity and function of the spine after the rod remounting were slightly lower than after the primary surgery. Remounting did not significantly affect the indicator of “consent to surgical treatment under the same conditions” – 80.6 and 80.0 %.
Conclusion. Complications in the form of rod fracture do not have a significant negative effect on the treatment result from the standpoint of assessing the quality of life, provided that the corrective effect of the surgical intervention is maintained in the horizontal, frontal and sagittal planes.

Objective. To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine.
Material and Methods. Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods.
Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The following types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively.
Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.

Objective. To identify the risk of the spinal motion segment instability after local foraminotomy in elderly and senile patients with lumbar spinal stenosis associated with degenerative scoliosis.
Material and Methods. A prospective study included data on 50 patients treated by surgery and 50 patients who underwent conservative treatment in 2013–2017 for leg pain associated with degenerative scoliosis and secondary spinal stenosis. All patients were older than 60 years. Conservative treatment was carried out using vascular drugs, NSAIDs, analgesics, decongestants, and various blockades. In surgery group, patients underwent local foraminotomy for decompression at the involved levels. The average postoperative follow-up period was 3.8 years (from 6 months to 4 years). The study was performed using four-field tables to determine the relative risk.
Results. The performed studies showed that there is no statistically significant risk of instability of the spinal motion segment after foraminotomy in the lumbar spine.
Conclusion. Local foraminotomy in the lumbar spine is not a risk factor for instability in the spinal motion segment. Local foraminotomy in the area of lumbar spinal stenosis combined with degenerative scoliosis can be recommended for the treatment of patients only in the absence of proven instability in the involved spinal motion segment at the preoperative stage.

Objective. To demonstrate opportunities of minimally invasive surgery in the treatment of deformities in patients with degenerative disease of the spine.
Material and Methods. The clinical case of a 53-year-old female patient with adult degenerative scoliosis accompanied by foraminal stenosis and foraminal disc herniation at the L4–L5 level on the left with L5 root compression was considered. The clinical picture of the disease was carefully analyzed for compliance with the criteria for possibility of minimally invasive intervention as opposed to reconstructive surgery using instrumentation. The nature of the pain syndrome and its intensity according to VAS were determined, preoperative CT and MRI studies were carried out, and functional radiographs to detect signs of instability and the whole spine radiographs to calculate sagittal and coronal balance parameters were taken. A retrospective dynamic assessment of radiological data throughout the disease course was carried out to determine the dynamics of the deformity development. Postoperative follow-up was performed during 6 months. Pain syndrome was assessed according to VAS, and quality of life – according to Oswestry questionnaire. Postoperative CT and MRI studies were performed, and spinal radiographs were taken to calculate sagittal and coronal balance parameters. PubMed data and a number of meta-analyzes were considered to substantiate the choice of treatment.
Results. Six months after surgery, the patient does not complain, is physically active, fully resumed work. She has not pain syndrome (VAS score 0), the Oswestry index is 8 points, neurological and static-dynamic statuses are without negative dynamics. The parameters of coronal and sagittal balance are stable.
Conclusion. Endoscopic foraminal decompression may be the method of choice in the treatment of patients with adult degenerative scoliosis with a dominant clinical picture of monoradicular syndrome and compensated sagittal balance.

Russian Association of Spine Surgeons
Russian Association of Neurosurgeons
National Association of Phthisiologists
Russian Society of Phthisiologists
A draft national clinical guidelines for spinal infectious lesions are submitted for discussion. Clinical guidelines are intended to optimize the diagnosis and treatment of infectious spondylitis and based on modern information about the pathology under consideration. The authors invite interested professionals to the discussion.

Objective. To perform comparative analysis of safety and accuracy of pedicle screw placement in the cervical and thoracic vertebrae using custom-made 3D-printed navigation templates of various designs.
Material and Methods. The study was performed on three cadaver preparations. A total of 60 pedicle screws were placed in C2–T4 using navigation templates of different designs. Three types of templates were used to install 20 screws in each group: monolateral templates in group A, bilateral templates in group B, and bilateral three-point templates supported by the spinous process in group C. The safety and accuracy of screw placement were evaluated by CT with following comparative evaluation.
Results. Three-point templates (group C) demonstrated the highest implantation safety, only one screw (5 %) perforated pedicle’s wall with grade 1, 19 screws (95 %) were completely surrounded by bone tissue. In group A, three screws (15%) were placed with grade 1, two screws (10 %) with grade 2, and one screw (5 %) with grade 3. In group B, two screws (10 %) were placed with grade 1, and one screw (5 %) – with grade 2.The average deviation at the screw entry point was 5.0 ± 0.5 mm in group A, 1.7 ± 0.3 mm in group B, and 0.35 ± 0.05 mm in group C. The average deviation at the end point was 5.1 ± 0.7 mm in group A, 3.5 ± 0.6 mm in group B, and 0.53 ± 0.05 mm in group C. Differences between groups in terms of implantation safety and accuracy are statistically significant (p < 0.05).
Conclusion. Bilateral three-point navigation templates supported by spinous process are recommended for pedicle screw placement in the cervical and thoracic spine.

The lecture discusses in detail the issues related to the EOS system, which allows scanning a patient’s skeleton from head to feet in two standard projections with x-rays perpendicular to the surface they reach. At the same time, the radiation load is reduced by a factor of 10 compared with routine spinal radiography. The EOS system is unique: simultaneous 3D study with image acquisition in any plane, including a top view, gives a real three-dimensional assessment of the spine or its deformity. Further, it is possible to carry out measurements in all planes and in all directions. To quantify spinal deformity in three planes using EOS, the Vertebral Vector Projection program has been developed. The principle is the replacement of each vertebra with an anteroposterior vector starting dorsally at the midpoint between pedicles, reaching the midpoint of the ventral surface of the vertebral body and running parallel to its cranial end plate. Thanks to the capabilities of EOS, the severity index was developed – a formula based on x-ray data. For small deformities (less than 15°), the Cobb angle, the torsion index of the curve, axial rotation of the apical vertebra, intervertebral rotation at the upper and lower ends of the curve, and apical lordosis are taken into account. The value of the index varies from 0 to 1. If it does not exceed 0.4, the deformity will not  progress, and if it exceeds 0.6, the deformity will increase in 100 % of cases. The geometric and mechanical personified 3D model allows preoperative planning for severe deformities: it helps in choosing the level and direction of the section, the magnitude of the resected angle, and in computer modeling of the closure of bone surfaces to obtain a new type of spinal alignment. The EOS imaging system helps to understand the need to distinguish between alignment (statics) and balance (dynamics) of the spinal column.