Objective. To analyze the results of surgical treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions from the point of view of surgical safety, and to study the structure, frequency and nature of intra- and postoperative complications and intraoperative blood loss.
Material and Methods. A retrospective analysis of data of 212 patients for 2015–2018 was performed. Inclusion criteria were: age over 18 years, staged surgical interventions including anterior spinal fusion and posterior internal fixation performed in one surgical session for post-traumatic deformities of the thoracic and lumbar spine. Patient demographic data and surgical intervention protocols were studied taking into account surgical approaches, duration of operations and blood loss. Intraoperative and postoperative complications up to 6 weeks after surgery were taken into account. Intraoperative blood loss was studied both as the absolute volume and as the percentage of circulating blood volume (CBV).
Results. Complications after staged surgical correction of post-traumatic deformities were recorded in 14.2 % of patients, including intraoperative complications in 3.3 % of cases, and postoperative complications in 10.9 %. The most common complications were surgical site infections, usually after posterior approach, and pneumonia. The number of neurological complications was 1.4 %. Complications were more frequent after three-stage surgical interventions than after two-stage ones. The lumbar spine deformity correction was associated with higher complication rate than that in the thoracic spine. Intraoperative blood loss in the study group was 562.2 ± 504.7 ml. The most significant blood loss, over 30 % of the СBV, was noted in 13 (6.1 %) patients. Using of minimally invasive transpedicular fixation during the staged surgical intervention provided the least number of infectious wound complications and the smallest amount of intraoperative blood loss.
Conclusion. Staged surgical intervention for the correction of post-traumatic deformity of the thoracic and lumbar spine is a safe method of surgical treatment.

The paper presents an unsystematized review of technologies, techniques and options for surgical treatment of congenital spinal deformities in children over the past 40 years. The main trends in the surgery of spinal deformities are highlighted: evolution of methods of visual diagnostic, treatment planning, and surgeon action control, introduction of adapted functional status scales and questionnaires for quality of life, hybridization of surgical techniques, evolution of spinal implants and instruments, and progress of anesthetic management. At the same time, new clinical and scientific problems are also discussed in the paper: questions of unifying terminology, planning the volume of treatment, the difficulty of comparing treatment methods and technologies, education, and integration.

The objective of the review is to provide multifaceted information on the treatment of young children with severe onset scoliosis using magnetically-controlled growing rods (MCGR). This promising though controversial method is not yet well known in our country. The review presents the history of the development of the method, surgical technique, the frequency of etiological forms of spinal deformities, and describes in detail the results of scoliosis correction including the most severe cases. Quantitative and qualitative data describe complications that arise during the treatment including those characteristic only for this method (for example, slippage phenomena). The problem of repeated operations is separately discussed, and the capabilities of MCGR and other techniques based on the principle of distraction are compared. The review presents features of the use of MCGR in adult patients, the dynamics of the primary curve in the postoperative period (does the Sankar’s law work?), the possibilities of ultrasound when monitoring the effectiveness of magnetic rods, the use of MRI simultaneously with MCGR, and the comparative cost of the method. Particular attention is paid to the problem of a uniform protocol of staged extension of rods. It seems that the initial enthusiasm has somewhat decreased. It is commonly agreed that new research is needed.

Objective. To analyze the advantages of additive technologies and 3D modeling in surgery for severe congenital spinal deformities caused by mixed and non-classified developmental anomalies, including assessing the quality of transpedicular screws.
Material and Methods. A total of 20 patients with complex spinal anatomy caused by congenital vertebral anomalies were treated. Nine patients had complex unclassifiable anomalies of the spine, 11 had mixed anomalies, 3 of them had aplasia of the structures of the spinal column. In order to assess the results, patients were divided into two groups of 10 people. In Group I, standard preoperative preparation was performed according to X-ray, CT and MRI data. In Group II, preoperative preparation was accompanied by the use of a prefabricated 3D model of the patient’s spine. CT data were used to create STL-models which were printed using 3D printer. To analyze the effectiveness of 3D prototyping in preoperative planning, a survey among surgeons specializing in pathology of the spine was conducted.
Results. Survey results demonstrated that there were cases of changes in surgical treatment tactics after the 2nd stage of the survey, based on the results of applying standard methods of radiation diagnostics and 3D model of the entire spine with prototyping of the thoracic, lumbar, and sacral spine. In 25.3 % of cases, tactics were changed. Significant improvement in surgical treatment results were observed in Group II with preoperative 3D modeling (94.9 % without screw malposition), compared to Group I in which surgical correction was performed using standard methods of imaging (78.1 % without screw malposition).
Conclusion. 3D modeling allows increasing the accuracy of the placement of transpedicular screws and reducing the risk of malposition, which favorably affects the biomechanical properties of the instrumentation and reduces the risk of damage to neural structures. The use of 3D modeling can statistically significantly reduce the time taken to install one screw, and the number of x-rays required. Reducing the number of images allows you to reduce radiation exposure not only to the patient, but also to the staff of the department.

Objective. To assess efficacy and safety of using a three-level navigation template in the surgical treatment of congenital spinal deformities.
Material and Methods. Three-level navigation templates were used in surgical treatment of four consecutively operated 10–17-year-old patients with congenital scoliosis associated with thoracic hemivertebrae. The correctness of screw position was evaluated according to CT data using a 2-mm increment method: class 0 – intraosseous screw position; class 1 – the screw extends beyond the pedicle cortex by less than 2 mm; class 2 – by 2–4 mm; and class 3 – by more than 4 mm. Preoperative DICOM data were processed with free software. The model of target zone and navigation template were 3D printed and used in surgery.
Results. Four of 16 (25 %) pedicles were narrower than 4.35 mm and were estimated as difficult for implantation with a planned violation of the integrity of the endplate. Perforation of the outer cortical layer took place in all these cases, and screw position corresponded to class 2 only in pedicle width of 1.9 mm. In pedicles wider than 4.35 mm, 11 of 12 (91.7 %) screws were implanted intraosseously. One screw extended beyond the pedicle cortex by 0.8 mm (class 1).
Conclusion. Three-level navigation template can be considered as an effective means of positioning transpedicular screws in secondarily changed segments adjacent to anomalous one and confounding implantation. Free software is sufficient for preparing 3D-model of target zone and navigation template, and such a model is a highly informative reference object that is convenient to use during the operation. A navigation template made using 3D printing does not require the use of expensive equipment, which can make surgery for congenital scoliosis more accessible.

Objective. To develop an algorithm for the diagnosis and treatment of orthopedic syndrome in patients with Duchenne muscular dystrophy (DMD) based on an assessment of the evidence level of published data.
Material and Methods. Consensus is a version of the main foreign protocols adapted for use in post-Soviet countries (the basis of consensus is the TREAT NMD protocol: treatnmd.ncl.ac.uk/care/dmd/diagnosis-management-DMD), as well as of works systematized on the basis on evidence level and reflecting modern approaches to the diagnosis and rehabilitation (including surgical) of spinal and limb deformities in patients with Duchenne myodystrophy. The recommendations are based on literature data and the authors’ own experience. Search in electronic databases was performed on the Medline, Embase, Web of Science and Cochrane Library platforms. Preference was given to studies that could be classified as evidence level 2+ and higher according to the ASMOK system. References are given in the order of their mention in the text. The search depth was 5 years. Methods used to assess the quality and strength of the evidence were expert consensus and assessment of significance in accordance with the rating scheme. Methods used to analyze evidence were reviews of published meta-analyzes and systematic reviews with evidence tables.
Results. The consensus reflects aspects of clinical examination, respiratory support and postural control depending on the functional level, conservative and surgical treatment of spinal and limb deformities, anesthesia-related risk assessment, and preoperative, intraoperative and postoperative management of patients with DMD.
Conclusion. Deformities of the spine and lower extremities in DMD are frequent manifestation of the natural history of the underlying disease with the development of secondary orthopedic pathology, causing not only a severe violation of the function of movement and support, but also a violation of the function of internal organs. This requires a detailed assessment of the general somatic and neurological status in general, and the characteristics of the damage to the axial skeleton and extremities in particular. This is achieved by a detailed preoperative multidisciplinary examination to thoroughly assess the risks of complications and to skillfully follow-up a patient depending on functional status and regardless of age. The use of surgical treatment techniques for orthopedic pathology in DMD with proven effectiveness significantly improves self-care, the quality of life of patients and their closest persons, improves the balance of the body, and helps to maintain the function of external respiration and the possibility of verticalization.

Objective. To assess feasibility, safety and effectiveness of a device for annular defect closure in surgical elimination of radicular compression syndrome in adolescents with degenerative disc disease.
Material and Methods. Five 11–17-year-old patients underwent disc hernia removal and root decompression followed by annuloplasty with a Barricaid implant in 2012–2016. Clinical and radiological (CT, MRI) techniques were used to assess the pain intensity on VAS, the degree of intervertebral disk degeneration according to Pfirrmann, the orientation of the facet joints and the cartilaginous surface, and the severity of sclerosis. The long-term follow-up period averaged 57 months (from 40 to 62 months). Surgical results were evaluated in accordance with the modified MacNub scale at 3 months and 3 years after surgery.
Results. In all cases, surgery had positive clinical effect with complete relief of the pain syndrome, including complete regression of distal paresis of the lower limb. In all patients, the 3-month result of surgery was rated on the MasNub scale as good and 3-year result – as excellent. The position of implants was stable, with no signs of further disc degeneration and decrease in interbody space.
Conclusion. Closure of the annular defect after lumbar microdisectomy provides excellent long-term results in adolescents with radicular compression syndrome associated with herniated discs. However, convincing and reliable assessment of the method requires further studies with a comparative analysis using sufficient clinical material.

Objective. To evaluate the effectiveness of a multivariate logistic regression model for the predicting surgical treatment results in patients with lumbar disc herniation.
Materials and Methods. Study design: monocentric retrospective study. The study included patients operated on for lumbar disc herniation at levels L4–L5, L5–S1, with a 3-year follow-up. Two groups were identified: Group I included 350 patients (their data served as a basis for creation of multivariate logistic regression predicting model), and Group II – 514 patients (in this group, the effectiveness of the model was evaluated). Group II was divided into two subgroups: Subgroup IIa (recurrence probability 50 %) – 17 (3.3 %) patients. Patients in Subgroup IIa underwent microdisectomy, and in Subgroup IIb – spinal fusion. In order to obtain homogeneous pre-operative indicators of both group parameters, the PSM method was used. Statistical calculations were performed in the RStudio program.
Results. In Group II, significant differences in indicators in the subgroups were noted for the following parameters (p < 0.05): smoking, disc height index, segmental volume of movement, lumbar lordosis angle, type of intervertebral hernia (except for sequestration), Modic changes, and stage of intervertebral disc degeneration according to Pfirrmann. In Subgroup IIa, 8 (1.6 %) reoperations were performed, in Subgroup IIb – 2 (0.4 %). Using the PSM method, the data of groups I and II were flattened out for significantly different indicators. The sample size was 37 patients in each group. The number of reoperations in the groups differed statistically significantly: Group I – 35 % [22 %; 51 %]; Group II – 5 % [1 %; 18 %]. The risk of reoperation in Group II is 0.13 [0.03; 0.58] times lower than in Group I (p = 0.002).
Conclusions. The proposed system for predicting the results of surgical treatment of patients with intervertebral disc hernia can be used as a tool to determine the surgical tactics aimed at reducing the frequency of reoperations.

Objective. To determine how the presence of comorbidity, including the fact of the presence of HIV infection, affects the risks of developing infectious postoperative complications in patients with tuberculous spondylitis.
Material and Methods. A monocenter comparative retrospective analysis of 116 HIV-infected patients and 158 HIV-negative patients operated on for tuberculous spondylitis was carried out, with an analysis of risk factors for postoperative complications – concomitant diseases, the Charlson comorbidity index, the anesthesia-related and operative risk according to the ASA scale.
Results. Concomitant pathology and classes 3 and 4 according the ASA criteria were observed in 88.3 % of patients in the general cohort. In class 4 patients, infectious complications occurred 1.5 times more often, primarily due to early complications of immunodeficiency, while in the group of HIV-negative patients, the frequency of complications did not differ significantly between these classes. In HIV-infected patients with a moderately higher operative and anesthesia-related risk (risk increase factor = 1.19), the risk of postoperative complications increased by 1.76 times. Specific postoperative complications in HIV-infected patients were more common than in the control group (2 = 4.53, OR = 2.76).
Conclusion. The presence of HIV infection in patients with tuberculous spondylitis in comparison with HIV-negative patients is a risk factor that significantly increases the risk of early (occurring up to 1 year after surgery) postoperative complications, such as postoperative pneumonia, exacerbation (progression) of spondylitis and the development of tuberculous meningitis. At that, the risk of developing late postoperative complications does not depend on the fact of HIV infection.

Objective. To analyze clinical picture and composition of pathogens of hematogenous pyogenic vertebral osteomyelitis (PVO) based on the records of a regional clinic admitting patients with this disease.
Material and Methods. A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006–2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains – from aspiration biopsy in 32 patients, 21 strains – from blood in 20 patients.
Results. The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora.
Conclusion. The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common in lesions of the cervical spine in comparison with the thoracic (p = 0.003) and lumbar (p = 0.001) spine. There is a tendency to an increase in peptostreptococci in lesions of the lumbar spine (p = 0.09). S. aureus is significantly more often isolated in acute in acute form of the disease than in subacute (p = 0.009) and chronic (p = 0.012) forms, and peptostreptococci – in subacute (p = 0.001) and chronic (p = 0.003) forms of the disease.