The presented rare clinical case of the development of arteriomesenteric compression of the duodenum is described with the aim of informing a wide audience of specialists (orthopedic trauma surgeons, vertebrologists, neurosurgeons, surgeons, neurologists and pediatricians)  about a rare complication of surgical correction of typical adolescent idiopathic scoliosis intestinal obstruction due to compression of the  lower horizontal part of the duodenum by the superior mesenteric artery. Publications answering two posed questions were analyzed: is  there a correlation between surgical correction of scoliosis and development of abdominal pathology in a patient in the immediate postoperative period, and should the instrumentation be completely or partially removed at the level of the thoracolumbar junction in the case of  formation of duodenal arteriomesenteric compression in a patient operated on the spine? Abdominal visceral complications are extremely rare and represented by a very few publications even in modern electronic databases of medical information, therefore we consider it important to bring a case from our practice to the attention of readers.

Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with  instrumented fixation of the spine.

Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried  out using the χ 2 criterion.

Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use.

Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

Objective. To analyze the presence of infectious pathogens in the intervertebral disc tissues as possible pathogenetic factor in the development of degenerative diseases of the spine.  

Material and Method. In 2017–2018, a prospective exploratory research was conducted, which included 64 patients with degenerative disease of the spine who met the following inclusion criteria: the presence of clinically and instrumentally proven hernias of the intervertebral discs in the lumbosacral spine, the absence of a history of surgical interventions on the spine, non-intake of antibacterial drugs for the  year before surgery, and Modic I and /or II type changes on MRI. All patients underwent interventions with sampling of intervertebral disc material; a total of 80 discs were examined. The obtained materials were subjected to microbiological and histopathological studies.

Results. Out of 64 patients, only 1 (1.6 %) revealed the presence of bacterial flora in the intervertebral disc tissue (Propionibacterium acnes strain). It can be assumed that the identified bacterial flora is the result of contamination. It is also possible that the infectious agent joined already during the development of degenerative disease of the spine. If the bacterial flora was a pathogenetic factor, then it can be assumed that the pathogenesis of the disease is polyetiological and includes the infectious process as a rare event.

Conclusions. Given the high interest of specialists in the pathogenesis of degenerative diseases, it seems appropriate to conduct further studies in this direction using various laboratory diagnostic methods with high sensitivity and specificity.

Objective. To analyze the influence of somatic comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis.

Material and Methods. The study design corresponds to a single-center non-randomized retrospective cohort study with level 3 evidence (OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence). The influence of somatic comorbidity on quality of life after surgery for degenerative lumbar spinal stenosis was analyzed in 962 patients 60–85 years old. Analysis and evaluation of the results of the study was carried out in two groups of patients with radicular compression syndrome: Group 1 (less than 5 points according to White – Panjabi criteria) included 625 (65%) patients, and Group 2 (5 or more points according to White – Panjabi criteria) – 337 (35%) patients.

Results. Body mass index of patients in Group 1 was statistically significantly lower than in Group 2. Repeated surgical interventions performed during the first year after the primary operation were statistically significantly more frequent in Group 1, and those performed after 3–4 years were more frequent in Group 2 (BMI ≥ 30) due to the development of adjacent level disease. In obese patients, the duration of surgery, blood loss and postoperative hospital stay are statistically significantly increased. One year after surgery, a statistically significant negative effect of increase in BMI on the parameters of back pain, lower limb pain, functional adaptation, and quality of life was revealed in both groups of patients. No association of obesity and complication rates was noted. In Group 2, the incidence of adjacent level disease 2–5 years after the primary operation was higher in patients with BMI ≥ 30 compared with patients with BMI < 30 and with patients in Group 1. It was found that somatic comorbidity and the age of patients statistically significantly prolonged postoperative hospital stay in Group 1 and did not affect its duration in Group 2. No effect of the comorbidity index on the quality of life was noted. Osteoporosis was statistically significantly associated with an increase in the frequency of technical complications during surgery (malposition of pedicle screws, cage migration, and damage to the vertebral endplates).

Conclusion. Obesity is statistically significantly associated with an increase in postoperative hospital stay, surgery duration and blood loss, and is a predictor of the development of instability of the spinal motion segment and adjacent level disease. Obese patients have higher levels of back and lower limb pain and worse quality of life parameters after surgical interventions than patients with normal body weight. When using minimally invasive technologies in the surgical treatment of degenerative lumbar spine pathology, the number of complications in obese patients is not higher than in patients with normal body weight. The effect of comorbidity on the results of minimally invasive surgery for degenerative lumbar pathology was not detected. Osteoporosis affects the frequency of technical complications during surgery.

Objective. To analyze distinctions in multidisciplinary approaches with respect to the timing of patients returning to daily physical activity after uncomplicated lumbar microdisectomy and to the readiness of doctors of various specialties to work according consensus guidelines.

Material and Methods. A written questionnaire survey of 60 specialists (20 neurosurgeons, 28 neurologists and 12 rehabilitologists) involved in the management of patients during the first six months after uncomplicated lumbar microdisectomy was conducted. The questionnaire included 12 questions with several answer options on the timing of returning to daily physical activity, and on the need to provide patients with written recommendations on limitations in motion regimen, physical work, sexual activity, and bracing.

Results. Significant dissonance both between doctors of the same specialty and of different specialties was demonstrated in the tactics of postoperative management of patients regarding the recommended terms for returning to daily activity. All respondents found it useful to create unified written recommendations on the motion regime, 90 % of specialists are ready to use the proposed recommendations after some modification. There was a slight increase in the recommended timing for return to daily physical activity compared with the recommendations of doctors in other countries.

Conclusion. The demonstrated interdisciplinary differences in the treatment, rehabilitation and timing of physical activity restriction for patients after lumbar microdisectomy require unification of the tactics of postoperative management.

Objective. To analyze the early clinical and radiological outcomes of lumbar spine fusion in patients with degenerative sagittal imbalance.

Material and Methods. The data of 45 patients who were operated on sequentially using a combination of surgical methods for vertebrogenic pain syndrome and (or) neurological deficit and who had a violation of the sagittal balance of degenerative origin were analyzed. All patients underwent anterior spinal fusion at the L4–L5, L5–S1 levels to correct and restore lower lumbar lordosis. The next stage was decompression through posterior approach, if necessary supplemented by interbody fusion at clinically significant lumbar levels above the L4–L5 segment. In all patients, surgical treatment was completed with screw transpedicular fixation at the levels of interbody fusion.  Demographic, clinical and surgical data, and radiological parameters were evaluated.

Results. The study included data from 6 men and 39 women with an average age of 58.9 ± 7.8 years. Duration of hospital stay was 27.1 ± 7.4 days. The primary surgery was performed in 33 (73.3 %) patients, and the reoperation for pain recurrence after previous surgery at the same lumbar level – in 12 (26.7 %) patients. The duration of surgery was 529.8 ± 117.8 min, the blood loss was 1130.4 ± 560.1 ml. Back and leg pain VAS score decreased after surgery from 6.7 ± 0.9 and 4.7 ± 1.4 to 3.3 ± 0.9 and 0.5 ± 0.6, respectively (p < 0.001). The ideal sagittal type according the Russoly’s classification was restored in 27 (60 %) cases, that below the ideal – in 9 (20 %), and hypercorrection was in 9 (20 %). PT decreased from 26.1° ± 5.7° to 17.4° ± 3.9° (p < 0.001) and SVA – from 6.7 ± 3.5 to 2.7 ± 2.3 cm (p < 0.001). LL increased from 36.3° ± 18.5° to 55.1° ± 11.8° (p < 0.001) and Low LL – from 13.5° ± 9.8° to 37.9° ± 8.2° (p < 0.001). According to GAP, the number of patients with severe and moderate imbalance was reduced (p < 0.001). Surgical complications were observed in 26 (57.7 %) patients.

Conclusion. The multi-stage surgical treatment of patients with degenerative spinal deformities using corrective fusion in the lumbar spine significantly improves parameters of the spinopelvic and global sagittal balances in the early postoperative period.  

Objective. To analyze the results of staged preoperative correction of uncomplicated comminuted fractures in the thoracolumbar spine.

Material and Methods. Retrospective study included data from 51 patients (33 men and 18 women) 17–35 years old with type A3 spinal injuries without urgent indications for surgery. In preparation for a possible operation, patients received a corset treatment with reclination pneumopelot for 2–3 days.

Results. The results were evaluated based on clinical, radiological and CT data. The result after reclination corset treatment was considered good if a restoration of the vertebral height was achieved with its residual deficit of less than 10 % or local wedge shape not more  than 10°; satisfactory – with a residual decrease in vertebral body height from 10 to 30 % or in kyphotic deformity from 10 to 20°; and unsatisfactory – with a decrease in body height of more than 30 %, and in kyphotic deformity of more than 20°. With an average decrease in the height of the fractured vertebral body before surgery by 45 % and the local kyphosis magnitude of 27.0° ± 5.5°, the staged reclination provided complete correction of kyphosis in all cases and restoration of the height of the compressed vertebra to a residual deficit of less than 10 % in 78 % of cases. Neurological disorders were not noted.

Conclusion. In case of incomplete burst vertebral fractures not complicated by compression of the spinal cord, the method of early (in the first 7 days after the injury) corset treatment with staged fracture reclination by a pneumatic chamber can be effectively used to eliminate local kyphotic deformity and restore the height of fractured vertebra.

Non-specific infectious lesions of the spine present a severe clinical problem due to the high risk of the septic complications and possible mortality. The late diagnosis and subjective treatment options could lead to complicated course of disease, progression of vertebral destruction, development of neurological disorders, as well as multi-resistance of bacteria due to the empiric antibacterial chemotherapy.  The modern algorithms of diagnosis and treatment should be aimed at improving the quality of care for patients with infectious spondylitis. A literature review on the current concept of their assessment, including a step-by-step description of the Vertebral Osteomyelitis Guideline Team (VOGT) strategy, and the classifications of Pola (NCPS) and Homagk (SSC) is presented.

Objective. To analyze the effectiveness of conservative treatment and extrafocal transpedicular fixation in patients with uncomplicated hematogenous pyogenic vertebral osteomyelitis (PVO).

Material and Methods. Ninetyseven medical records of in-patients who were treated for hematogenous PVO in 2007–2017 were analyzed.  Among them, men accounted for 73.2 % (n = 71) and women – 26.8 % (n = 26). The acute and subacute forms of the disease were diagnosed in 62 (63.9 %) patients and chronic – in 35 (36.1 %). Type A according to Pola classification totaled 45 patients, type B – 49 and type C – 3.  Sixtyfour (66.0 %) patients were treated conservatively, 33 (34.0 %) – using transpedicular fixation and 25 (75.8 %) – using minimally invasive technique. No fixators were placed in the affected vertebrae. All patients underwent antibacterial therapy lasting 6–12 weeks.

Results. Good treatment results were obtained in 89 (91.8 %) patients. There were no differences in the severity of pain between the comparison groups before the start of treatment and after one year. However, the pain severity was significantly reduced (p = 0.001) over the time of treatment. Positive results of transpedicular fixation were obtained in 28 (84.8 %) cases, and after three repeated interventions – in 32 (94.1 %), and those of conservative treatment – in 61 (95.3 %) cases. The total number of relapses was 8 (8.2 %), of complications –  3 (3.1 %). The risk of relapse among operated drug addicts was significantly higher (p = 0.033). There were no deaths in the comparison groups, which is explained by the study inclusion and exclusion criteria. All discharged patients were followed-up on an outpatient basis for at least a year, and 72.2 % of them – from 1 year to 8 years.

Conclusion. Transpedicular fixation is indicated for uncomplicated hematogenous pyogenic vertebral osteomyelitis, monosegmental lesions and in cases of demands on improved quality of life. The use of such a technique in drug addicts is not recommended.

Objective. To substantiate the protocol for the diagnosis and treatment of deformities of the spine and limbs in patients with spinal muscular atrophy basing on an assessment of the level of evidence of published data.

Material and Methods. Data on foreign protocols and their adaptation for use in Russia and CIS countries were analyzed and summarized.  The main platform was the evidence-based systematization of studies reflecting modern approaches to the diagnosis and treatment (including surgery) of spinal and limb deformities in patients with spinal muscular atrophy. The formulated recommendations are based on literature data and the authors’ own experience. Literature was searched in online databases of Medline, Embase, Web of Science, and Cochrane Library information 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. Search depth was 5 years. Methods used to assess the quality and strength of evidence were expert consensus and significance assessment in accordance with the rating scheme. Methods used to analyze evidence were reviews of published meta-analyzes and systematic reviews with evidence tables.

Results. Various aspects of clinical examination, respiratory support and postural control, conservative and surgical treatment of spinal and limb deformities, preoperative, intraoperative and postoperative management, and anesthetic risk assessment in patients with spinal muscular atrophy are highlighted.

Conclusion. Secondary orthopedic pathology in patients with spinal muscular atrophy causes not only severe violation of the musculoskeletal system functions (support, movement, and verticalization), but also pathological changes in the vital functions of internal organs and systems (respiratory, digestive, cardiovascular). A thorough analysis of the patient’s condition (assessment of general somatic, neurological, and orthopedic statuses) based on the data of preoperative multidisciplinary examination allows assessing the risks of complications and developing individual program of surgical rehabilitation of the patient. Surgical correction of orthopedic pathology in spinal muscular atrophy improves the functional status of the patient, improves the quality of life and the level of self-care, and optimizes the function of external respiration.