Objective. To compare the results of simultaneous and staged corrective surgical interventions for congenital spine deformities associated with intracanal anomalies.

Material and Methods. Design: retrospective mono-center observational case-control study. The study included the results of 127 surgeries performed in 49 patients aged from 4 months to 17 years at the time of surgery (mean age 9.2 years). The average follow-up period was 49 months. The study group included 33 patients who underwent simultaneous (in one surgical session)   removal of the intracanal component and correction of spine deformity. In the control group (16 children), these interventions were performed in stages. The analysis criteria were: the comparability of groups: the structure of anomalies of the spine, spinal canal and spinal cord, concomitant maldevelopment of organs and systems, and the presence of skin markers; and the comparison of groups: the total volume of blood loss, the duration of surgery, the magnitude of the spine deformity and the neurological status of patients assessed before and after corrective surgery, and complications.

Results. Spine pathology was predominantly represented by variants of segmentation failure  in 41 (59.0 %) patients and multiple vertebral malformations with a leading component of segmentation failure in 22 (33.0 %) patients. Among pathologies of the spinal canal, Arnold-Chiari malformation (17 patients, 25.0 %) and type 1 diastematomyelia (22 patients, 32.0 %) dominated. In the neurological status, Frankel types D and E prevailed at baseline, accounting for 27.3 % and 42.4 % in the study group, and 25.0 % and 37.5 % in the control group, respectively. Skin markers were detected in 34 (69.0 %) patients. The scoliotic component of the deformity prevailed; the kyphotic component was detected in 17 (35.0 %) cases. The mean magnitude of scoliotic deformity before surgery was 28° (min 20°; max 105°), after surgery 10° (min 0°; max 70°). Correction in the study group was 68 %, in the control one – 57 %.  The average duration of surgery in the study group was 227 min, in the control group – 198 min for the first operation and 204 min for subsequent ones. The average volume of blood loss in the study group was 286.6 ml, in the control group – 247.5 ml during the first operation and 266.6 ml during the subsequent ones. There were no significant changes in neurological status after surgery in both groups. Transient neurological complications were observed in 2 (4.5 %) patients of the study group and in 1 (4.0 %) in the control group. It was statistically proven that simultaneous intervention provides significantly lower blood loss with a comparable orthopedic result of surgery, which indicates the preferred use of a combined surgical technique.

Conclusion. Performing neurosurgical and orthopedic (correction) stages in children with congenital spine deformities and spinal canal malformations in one surgical session is not statistically associated with a greater surgical aggression and complication rate, but is accompanied by a significantly lower total blood loss. Simultaneous intervention provides somewhat better initial correction of the deformity, eliminates the need for staged interventions, and also reduces the likelihood of complications  potentially associated with each surgery.

Objective. To detect and summarize the existing data on the prevalence, diagnostic methods, prevention and treatment strategies of the thoracolumbar kyphotic deformities in patients with achondroplasia.

Material and Methods. Study design: literature review. The literature search was conducted in electronic databases: PubMed, CrossRef, Google Scholar and eLIBRARY.ru. The review includes articles in English and Russian languages. There were no limitations regarding the level of evidence and the year of publication.

Results. The selected 22 articles included 13 retrospective studies and 9 case reports. After dividing all studies into categories related to methods of diagnosis, prevention and treatment of thoracolumbar kyphosis, the following results were obtained: the definition of the border between the norm and pathology was reported only in two articles, and the prevalence rates could be counted based on the data of four articles. The identification of risk factors for the progression of deformity based on statistical analysis was presented in two articles. Three articles were devoted, among others, to the risk of neurological deficit. The description of brace treatment was found in four studies, and six retrospective studies and all selected case reports described surgical treatment.

Conclusion. There are very few publications devoted to the problem of thoracolumbar kyphosis in achondroplasia, despite possible poor prognosis of such deformities. Further research should be aimed at searching a consensus among experts in all issues concerning this type of deformity, from prevention to surgical correction of this pathology.

Objective. To analyze possible radiological and clinical risk factors for syringomyelia in patients with scoliotic deformity.

Material and Methods. An analysis of data from 3,285 patients with idiopathic scoliosis treated from 1997 to 2020 was performed. Syringomyelia was detected in 38 (1.16 %) cases. In 26 cases, syringomyelia was combined with Chiari malformation. In order to search for information on the topic under discussion, the international databases (Scopus, Medline, and GoogleScholar) were used. Additional search for publications listed in the article references was carried out. According to the literature data, possible risk factors for the presence of syringomyelia have been identified.

Results. Among patients with confirmed syringomyelia, a left-sided thoracic scoliotic curve was found in 23.7 % of cases, a double thoracic curve in 18.4 %, an upper thoracic scoliotic curve in 7.9 %, an increase in thoracic kyphosis in 60.5 %, and initial neurological deficit in 47.4 %, which is significantly higher than the same indicators in the entire group of patients. The ratio of male and female patients in the entire group was 1.0 : 6.7, in the group with syringomyelia – 1.00 : 1.71.

Conclusion. According to the literature review and statistically significant factors identified in the analysis of the monocentric group, it can be said that the left-sided thoracic scoliotic curve, upper thoracic curve, double thoracic curve, increased thoracic kyphosis, initial pyramidal insufficiency in the lower extremities, male sex, and a decrease in the initial somatosensory evoked potentials are risk factors for syringomyelia. If the above factors are present in a patient, the MRI study may be recommended to determine further treatment tactics. Before surgical correction of scoliotic deformity, MRI is recommended for all patients.

Objective. To analyze clinical and radiological outcomes of minimally invasive bilateral decompression through a unilateral approach in the treatment of patients with degenerative grade I spondylolisthesis combined with lumbar spinal stenosis.

Material and Methods. A total of 28 patients with degenerative grade I lumbar spondylolisthesis combined with spinal stenosis at one or several levels with clinical manifestations of neurogenic intermittent claudication and low back pain were operated on using the method of bilateral microsurgical decompression through a unilateral approach. The minimum follow-up period was 1 year. Clinical outcomes was assessed using VAS, Oswestry and MacNab questionnaires. Central stenosis of the spinal canal was graded according to Shizas classification based on MRI data, and the degree of segment stability according to Hanley and progression of spondylolisthesis in a neutral position were assessed by a functional lumbar spondylograms before surgery and in the long-term period.

Results. The average hospital stay was 3.07 ± 0.26 days. The average duration of the operation was 145.07 ± 44.67 minutes. When assessing pain by VAS questionnaire, a significant decrease in the median value of the intensity of pain was noted: in the leg – from 7.0 [7.0; 8.0] to 1.0 [1.0; 2.0], in the back – from 5.0 [4.0; 5.0] to 1.0 [1.0; 2.0]. The ODI questionnaire showed a decrease in the median indicator of disability from 60.0 [56.0; 64.0] to 15.0 [12.0; 19.0]. Assessment of radiological outcomes showed a slight increase in the parameters of anteroposterior translation (on average +0.42 mm) and segmental rotation (on average +1.03 degrees) of the operated segment during functional tests, and a slight increase in spondylolisthesis (on average by 1.42 %), which in general did not affect clinical outcomes.

Conclusion. Retrospective analysis of minimally invasive bilateral decompression through unilateral approach in patients with degenerative grade I lumbar spondylolisthesis combined with spinal stenosis without segmental instability provided the evidence of significant clinical efficacy of the method with a low risk of iatrogenic segment instability in the late postoperative period.

Objective. To analyze the dynamics of neurological symptoms and the structure of complications when using methylprednisolone and the method of maintaining target values of mean arterial pressure during surgical treatment of patients in the acute period of spinal cord injury (SCI).

Material and Methods. The study included 110 patients in the acute period of SCI with compression of spinal cord segments who were admitted to the clinic from January 2012 to March 2018 and underwent decompression and stabilization surgery within the first 2–3 hours after admission. In order to improve the blood supply to the damaged segments of the spinal cord and to prevent multiple organ failure, the main direction of intensive care in two groups of patients was to maintain the target blood pressure at the level of 85–90 mm Hg during the first 7–10 days. The MPD group included 43 patients who received methylprednisolone as a neuroprotector at a dose of 30 mg/kg bolus within the first hour after admission, followed by infusion at a dose of 5.4 mg/kg/h for 23 hours; and the MAP group included 67 patients who did not receive methylprednisolone. Non-invasive monitoring of central hemodynamic parameters was carried out on the basis of impedance cardiography data. The objective status of patients and data of X-ray diagnostics at the time of preoperative examination and during instrumental studies, as well as in 3–14 day intervals and in the mid-term (up to 4–6 months) postoperative period were analyzed.

Results. In the MPD group, 22 patients had ASIA type A neurological deficit, and an increase in ASIA grade was observed only in 4 (18 %) of them. There were 18 patients with incomplete injury in this group, and 9 of them (50 %) had a positive trend. In the MAP group, 38 patients had ASIA type A, out of them 11 (29 %) improved, and 28 patients had ASIA type B, C or D, out of them 17 (61 %) showed positive dynamics of neurological symptoms. No statistically significant differences were found. In the MPD group, complications such as nosocomial pneumonia and acute endobronchitis were observed three times more often, pulmonary embolism and decubital soft tissue ulcers – four times more often, and sepsis, acute respiratory distress syndrome and surgical site infection – two times more often. There were statistically significant differences in the incidence of nosocomial pneumonia and acute endobronchitis between MPD and MAP groups (p = 0.004 and p = 0.002, respectively.)

Conclusion. Maintaining mean arterial pressure at 85–90 mm Hg during the first 7–10 days after admission to the hospital allowed achieving a greater number of cases of improvement in the neurological status of patients, in contrast to the use of methylprednisolone. The use of methylprednisolone in patients with acute SCI increased the risk of nosocomial pneumonia or acute endobronchitis by 2.91 times (p = 0.003).

Objective. To evaluate the effectiveness of complex rehabilitation with walk training induced by powered exoskeleton ‘ExoAtlet’ for the patients with severe chronic paraplegias caused by thoracic or upper lumbar spine injuries.

Material and Methods. Design: prospective monocenter study. Fifty patients with severe  spinal cord injuries (ASIA: A – 36, B – 10, C – 4; Frankel: A – 24, B – 16, C – 10) from  6 months to 23 years after complicated thoracic or upper lumbar spine injury underwent two intensive courses of complex neurorehabilitation including 36 sessions/hours of powered exoskeleton-induced walk training. Three areas mostly important for the patients were chosen for the analysis: changes in patient independence (assessed by the SCIM III scale), locomotor capabilities (Hauser’s Ambulation Index and tetrapedal tests), and strength and sensitivity indicators (AIS scales). Testing was carried out before and one month after the end of the second course. The frequency of positive changes in each area and their dependence (ANOVA) on the completeness of the spinal cord injury and the duration of the injury were studied.

Results. The increase in independence was observed in 46/50 patients, including by 1–3 SCIM points in 14 (28 %), by 4–9 points in 20 (40 %), and by 10 points and above in 12 patients (24 %). Locomotor capabilities improved in 84 % of patients due to reducing test execution time and the need for care. Progress in sensitivity below the affected area by at least 1 point was detected in 80 % of patients (on average by 6 AIS points), including in 68% in tactile and in 54 % in pain sensitivity. The muscle strength gain was recorded in 7 (14%) patients with incomplete paraplegia (on average by 3.5 AIS points). Within the study group, it was found that the progress achieved in independence, locomotor capabilities and sensitivity did not depend on the completeness of the spinal cord injury as well as on the period after injury.

Conclusion. Rehabilitation with repeated intensive courses of powered exoskeleton-induced walk training increases independence, expands locomotor capabilities and improves sensitivity below the affected area in most patients with complete and incomplete spinal cord injury at different periods after injury.

Objective. Evaluation of the effectiveness and safety of exoskeleton in rehabilitation programs for patients with spinal cord injury.

Material and Methods. A clinical study of the effectiveness of a rehabilitation program based on training in an exoskeleton was carried out on the basis of the Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. L.Ya. Tsivyan in the period from 2017 to 2019. Rehabilitation trainings were conducted using Russian hardware and software complex. The study involved 80 people (57 men and 23 women) with spinal cord damage caused by the thoracic and lumbar spine injury. The duration of the injury ranged from 1 to 15 years, the average duration of the post-traumatic period was 73.4 ± 5.31 months.

Results. The rehabilitation program for each participant consisted of 2 sessions of 20 days each held in hospital setting and included training in ExoAtlet exoskeleton (at least 15 trainings, 30 minutes each during each hospital stay), specialized exercise therapy and physiotherapy procedures. The break between sessions was 1 month. The results of the SCIM III assessment showed a change in the level of active functioning towards improvement in half of the patients who underwent rehabilitation in the exoskeleton. Taking into account that patients with complete conduction disturbances (66.3%) and injury duration of more than three years (73.7 %) prevailed among the study participants, such results indicate the effectiveness of rehabilitation measures based on walking in exoskeleton, not only in recovery, but also in the late period of the injury, even with severe neurological deficit.

Conclusion. The obtained results allow recommending walking in an exoskeleton for inclusion in the rehabilitation programs for patients with paraplegia and paraparesis in the recovery and late periods of spinal cord injury.

Objective. To analyze the technique of traction bipolar coagulation dissection (strip technique), to assess its effectiveness and safety in surgery for removal of lumbosacral lipomas of various types.

Material and Methods. The study involved 39 patients (the follow-up period was 1 year) operated on for removal of lumbosacral lipoma using the method of traction bipolar coagulation dissection. The 3D models of lumbosacral lipomas before and after surgery were created based on neuroimaging data, the neurological status before and after surgery was assessed using the SBNS scale, and the results of intraoperative neurophysiological monitoring were analyzed.

Results. A decrease in the volume of lumbosacral lipomas by 95.0 % was achieved in all patients, the volume after surgery was less than 1 cm³ (p < 0.01). Positive dynamics of neurologic status according to the SBNS scale was observed in 94.9 % of patients (p < 0.01). Motor evoked potentials remained unchanged throughout surgery in most patients. No false negative results of intraoperative neurophysiological monitoring were obtained.

Conclusion. Traction bipolar coagulation dissection is an effective and safe method of surgical treatment of lumbosacral lipomas allowing the safest and most complete removal of lipomatous tissue, as well as improving the functional state of patients.

Objective. To perform a comparative analysis of experimental pedicle screw placement using custom-made 3D-printed navigational templates and using O-arm (cone-beam computerized tomograph, CBCT) and navigation station.

Material and Methods. The experiment was performed on five fresh anatomical specimens of the lamb thoracic and lumbar spine. In Group 1, 44 screws were inserted using O-arm and Stealth Station S7 navigation system, and in Group 2, 72 screws were inserted using 3D-printed navigational templates. The main comparison criterion was the safety of implantation assessed based on a grade (0 to 3) of cortical bone perforation on postoperative CT. The extra comparing criteria were the time of implantation and summary radiation exposure required for screw placement. In Group 2, the accuracy of implantation was analyzed by assessing the deviation (mm) of the actual screw trajectory from the planned one at the point of entry into the vertebra and at the intersection of the screw axis with the anterior cortical layer of the vertebral body (end point), and by measuring the angles between the trajectories. The results were evaluated for normal distribution and subjected to statistical analysis for paired independent groups using the Kruskal-Wallis test and Chi-square in the Statistica 10 software.

Results. Analysis of the safety revealed significant difference between the groups (p < 0.0001). In Group 2 there were not any cases of cortical bone perforation, in Group 1 (O-arm) grade 0 was registered for 28 (64 %) screws, grade 1 for 7(16 %) screws, grade 2 for 4 (9 %) screws, and grade 3 for 5 (11 %) screws. The average time of one screw placement was 81.00 (64.50; 94.00) sec in Group 1 and 40.75 (33.50; 52.25) sec in Group 2, p < 0.001. In Group 2, the mean deviation of the entry point was 0.50 (0.34; 0.87) mm, and of the end point – 1.10 (0.66; 1.93) mm. The mean angle between the planned and actual trajectories was 2.76 (0.80; 4.89) degrees in the axial plane and 2.62 (1.43; 4.35) degrees in the sagittal plane. The average design time for one template was 8.75 (8.00; 9.75) min, and 3D printing time – 60 (57; 69) min. The approximate material cost for one template printing was 45 rubles, for one anatomical specimen of lamb thoracic and lumbar spine – 390 rubles. The CT dose index (CTDI) for the O-arm was 8.99–9.01 mGy, and dose length product (DLP) for one model (3 scans) was 432 mGr ´ sm. In Group 2, there was no intraoperative X-ray control, the CTDI for preoperative CТ was 10.37–10.67 mGy, and DLP was 459–477 mGr ´ sm.

Conclusion. The results of the experiment on a lamb spine biomodel showed that pedicle screw placement with 3D custom-made navigational templates is associated with better results of the safety and the speed of implantation as compared to that with intraoperative
O-arm navigation. This justifies the 3D-printed template using in case of increased mobility of the spine during implantation, where the accuracy of CT navigation is significantly reduced. In clinical practice, these conditions correspond to transpedicular fixation of the cervical spine and screw fixation of the C1–C2 vertebrae.

The review is devoted to various aspects of the reparative regeneration of the vertebral bodies  studied in researches of professor Yakov Leontievich Tsivyan and his apprentices. Part of them is animal experiments for partial or complete replacement of vertebral bodies with auto-, allo-, and xenografts preserved in various ways. Other studies are based on the analysis of clinical cases with various vertebral pathologies, but also contain an assessment of the timing of the bone block formation when using auto- and allografts. The decisive factors for the successful outcome of posterior osteoplastic fixation of the spine are described. These are careful preparation of the maternal bed, reliable fixation of the graft, and perfect external immobilization in the postoperative period. The autograft most successfully combines plastic and mechanical properties. In the experimental plasty of partial defects of the vertebral bodies, a compact cancellous allograft is rearranged in the same way as an autograft, but the processes of resorption and replacement are less harmonious and take a longer time. When using preserved xenografts, resorption processes prevail, while the processes of replacing xenografts with newly formed bone are poorly expressed, they are mainly replaced by connective tissue. The review allows chronological tracing of fundamentals of reparative regeneration in vertebrology.

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