Objective. To analyze the effectiveness of intraoperative traction in the treatment of adolescent idiopathic scoliosis, including in relation to the initial magnitude of scoliotic curve.

Material and Methods. Data on patients meeting the following criteria were selected from the electronic database and analyzed: idiopathic scoliosis (Lenke types I, III, V); age 10 to 20 years; surgery performed through posterior approach; hook or hybrid (using of pedicle screws only in the lumbar spine, at 2-4 levels) fixation; no previous history of spine surgery; and follow-up period at least two years.

Results. Flattening of thoracic kyphosis and alignment of lumbar lordosis during surgical correction were significantly more pronounced in the traction group. Postoperative changes in the sagittal contour of the thoracic and lumbar spine did not differ significantly between the traction and no-traction groups. Intraoperative traction was associated with significantly reduced blood loss, though operation time decreased statistically insignificantly. Normalization of the frontal imbalance in the immediate and long-term postoperative periods was different in the two groups, but these differences were insignificant. Intraoperative traction was most effective in the group with deformities of 50° to 75°, although it also increased the achieved correction in patients with scoliosis of a smaller and greater magnitude.

Conclusion. The operation performed with intraoperative traction allows achieving greater correction during an intervention and smaller loss of correction during a long follow-up period than that without a distraction influence. This applies equally to both primary and secondary curvatures. 

The tactics of surgical treatment of patients with spinal deformities associated with multiple malformations is of great importance because of aggressive course of disease, limited opportunities for radical correction of deformity, and a high risk of complications. The review analyzes the literature devoted to this problem. The theoretical basis behind the need for surgical treatment is considered. The current methods of surgical intervention are presented, and their principal ideological and practical differences are demonstrated. Surgical treatment of patients with spinal deformity associated with multiple malformations is of particular interest in the practice of a spine specialist. Most patients at an early age require multi-stage surgical treatment which threatens to entail serious complications. In order to minimize risks and improve the final result of treatment, it is necessary to apply existing surgical techniques, as well as correctly arrange a sequence and frequency of their implementation.

Objective. To analyze the long-term results of surgical correction of idiopathic scoliosis in the lumbar and thoracolumbar spine with anterior instrumentation.

Material and Methods. A total of 24 patients (mean age - 18.2 years, male/female ratio - 3/21) were operated on using anterior two-rod instrumentation system. The mean operating time was 170 minutes, and the mean blood loss - 374 ml. The average postoperative follow-up period was 50 months.

Results. The primary curve was reduced from 48.7° to 14.8°º (69.6 %). Postoperative progression was 6.4°. Thoracic counter-curve underwent self-correction from 27.7° to 14.7°, postoperative progression was 3.0°. The thoracic kyphosis and lumbar lordosis remained within the normal ranges. Rotation of the apical vertebra before the operation was 27.8 %, immediately after the intervention - 17.5 %, at the end of the follow-up period - 17.1 %. Coronal imbalance before surgery was 24.7 mm, immediately after the intervention - 27.5 mm, at the end of the follow-up period - 7.1 mm. The patients’ self-evaluation of treatment outcomes was carried out using the Russian version of the SRS-24 questionnaire. At the first follow-up visit, patients reported expectedly lower postoperative function score and gave middle scores for the remaining domains. Later, there was a positive dynamics in all assessed parameters, most pronounced in pain syndrome, function and overall activity after surgery.

Conclusion. Correction of idiopathic scoliosis of lumbar and thoracolumbar localization using anterior instrumentation is a highly effective method of treatment, which in most cases gives a stable positive result. However, the development of pronounced trunk imbalance in some patients requires the continuation of studies in order to optimize the technique for determining the optimal extent of the instrumented fusion. 

Objective. To analyze the clinical approbation of the Russian-language version of the SRS-22 questionnaire for adult patients with scoliosis, to assess its reliability using Cronbach’s alpha criterion for internal consistency, and to determine its efficacy and specificity by correlation matching with the ODI results and numerical pain scale’s scores.

Material and Methods. A survey of 196 patients aged over 18 years with spinal pathology was carried out using the SRS-22 questionnaire. The questionnaire results were compared with the Oswestry Disability Index and numerical pain scale. Cronbach’s alpha reliability index was used to measure internal consistency of the questionnaire. Variation statistics method was used: calculation of the arithmetic mean and the mean deviation, Pearson correlation coefficient with evaluation according to the Chaddock scale. To evaluate consistency of mean differences, the Student t-test with determination of statistical consistency index was used.

Results. The Cronbach’s alpha reliability index within domains in adult scoliosis patients was more than 0.7 and demonstrated satisfactory internal consistency of the questionnaire. Comparative analysis of SRS-22 scores revealed that scores of deformity-specific domains (Function, Self-image, Mental health, Satisfaction with management) were higher in patients with scoliosis. High correlation between the SRS-22 Function domain and the ODI was detected. Correlation between the SRS-22 Pain domain and numerical pain scale was moderate.

Conclusion. The proposed Russian version of the SRS-22 questionnaire is reliable, specific and effective tool for self-assessment of health status in adult scoliosis patients and can be further used to evaluate the results of surgical treatment. 

Objective. Comparative assessment of the effectiveness of the centralized system of specialized surgical care for patients with acute non-traumatic spine pathology in the modern metropolis.

Material and Methods. The results of treatment of 1336 patients with acute spine pathology of degenerative-dystrophic, tumorous metastatic and infectious nature were analyzed. Patients of the control group (n = 471) were treated in several multidisciplinary hospitals in St. Petersburg, and 865 patients included in the study group - in a specialized city centre for emergency spine surgery. A comparative analysis of a number of medico-statistical and clinical indicators was performed using nonparametric statistics methods.

Results. The centralized system of treatment provided statistically significant (p < 0.05) increase in the level of surgical activity and stabilization of the spine, reduced length of stay in a hospital, as well as higher values of all indicators characterizing the results of treatment.

Conclusion. In large cities, the creation of a centralized system for the delivery of specialized medical care to patients with acute non-traumatic spine pathology is an effective organizational solution. 

Objective. To conduct a retrospective analysis of staged surgery in patients with tandem stenosis of the cervical and lumbosacral spine, to identify causes of poor outcomes.

Material and Methods. The study included 190 patients with tandem stenosis of the cervical and lumbosacral spine. Out of them 72 had symptomatic cervical and asymptomatic lumbosacral tandem stenosis (Group 1), 67 - symptomatic lumbar and asymptomatic cervical tandem stenosis (Group 2), and 51 - compression with neurological manifestations in both spine departments (Group 3). Patient’s anthropometric data, initial clinical symptoms, and duration of disease were analyzed. The intraoperative characteristics of surgical interventions and features of the postoperative period, clinical parameters and the existence of complications were evaluated.

Results. Excellent and good postoperative outcomes were achieved in patients of Groups 1 and 2 with monosymptomatic tandem stenosis, in patients of Group 3 with symptomatic tandem stenosis, and in patients of all groups who underwent laminectomy and bilateral foraminotomy for bilateral symptomatic foraminal stenosis, and minimally invasive bilateral foraminotomy through unilateral approach in case of radiographic evidence of foraminal stenosis without symptoms.

Conclusion. Symptomatic tandem stenosis of the cervical and lumbosacral spine is a severe nosological entity requiring meticulous removal of pathological substrate primarily in the cervical spine. The early implementation of the second stage of surgery significantly reduces neurological symptoms, relieves pain and improves quality of life in patients. 

The presented literature review highlights epidemiological aspects of the unfavorable outcome following surgical treatment of patients with herniated lumbar intervertebral discs, the risk factors for hernia recurrence, and the annuloplasty as one of the methods to prevent recurrent herniation. The concept of the annuloplasty is based on a number of favorable factors: maintaining the height of the intervertebral disc, preventing the hernia recurrence due to the barrier function, reducing lumbodynia due to limited microdiscectomy, and slowing down the degenerative cascade both in the intervertebral disc and facet joints. The study material included abstracts from the Scopus and PubMed databases, articles published in Spine, European Spine Journal, and in Russian periodicals over the past 10 years, as well as publications of the previous years, when required.

The paper presents a clinical observation of a child with lymphangiogenic form of spontaneous osteolysis (Gorham - Stout disease) associated with massive destruction of the rib cage and progressive kyphoscoliotic deformity. Staged surgical treatment under the therapy with osteoclast inhibitors resulted in the deformity correction and significant improvement in the quality of life. The prognosis remains unclear due to the risk of osteolysis progression.

The paper presents a clinical case report. Level of evidence - V. Surgical treatment of osteoblastoma of the lateral mass of C₃ vertebra was performed in a 6-year-old child. Follow-up period was 9 months after radical operation including tumor en block resection and local screw fixation of C₂-C₃ vertebrae. The principles of differential diagnosis of small-sized osteoblastoma (1.5 cm) with nonspecific clinical and radiological symptoms are described.

Objective. To assess the incidence of early infectious complications after spine surgery and to study the structure of risk factors in patients with surgical site infections.

Material and Methods. Early infectious complications after spine surgery were evaluated in 77 patients. The underlying pathology, comorbidities and surgical factors that caused the infection were analyzed.

Results. Over the 10-year observation period, the frequency of early postoperative infectious complications was 1.4 %. The main microorganisms causing infectious complication after spine surgery are methicillin-resistant S. aureus and S. epidermidis strains. The study revealed a direct correlation between obesity and surgical site infections. Such surgical factors as metal fixation, duration of operation and spinal fusion also contributed to the development of the inflammatory process in the early postoperative period.

Conclusion. Difficulties with the arrest of the infectious process require the development of methods for predicting the risk of complications and measures to reduce it. For this it is necessary to conduct comparative analysis of the frequency of occurrence of various risk factors in groups of patients with surgical site infections and of those with normal course of the postoperative period. 

The data presented in the lecture are based on the modern concept of diagnosis and treatment of spinal tuberculosis in children and on the last 25 years’ experience of surgical treatment of more than 350 such patients aged 8 months to 17 years. Being the head of the Clinic of Pediatric Surgery and Orthopedics (formerly the Children’s Bones and Joints Tuberculosis Surgery Department) of the St. Petersburg Institute of Phthisiopulmonology for the past 17 years, the author expresses gratitude to his teachers and colleagues - surgeons, anaesthesiologists, phthisiatricians, rehabilitologists, pediatricians, surgical and desk nurses, without whom the results would hardly have been achieved, which allow considering the national experience in the surgical treatment of bone tuberculosis in children one of the most successful in the world today.