Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.

Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.

Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.

Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctional
angle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.

Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.

The experience of using the method of 3D design and prototyping is examplified in a clinical case of surgical treatment of a six-year-old patient with kyphoscoliotic deformity of the spine due to congenital malformation of the L1 vertebra. At the stage of diagnostics and preoperative preparation, a created model of the deformed spine was used in the form of a breadboard variant made according to the data of spiral X-ray CT on a 3D printer from a plastic polymer material. The use of the created model of the deformed spine made it possible to additionally visualize and touch the pathological object in full size, to really assess the anatomical features and parameters of the interested vertebral segments and the altered spinal canal, which provided significant constructive assistance in planning surgical intervention and its immediate technical implementation.

Objective. To analyze the results of a multimodal approach in intraoperative neurophysiological monitoring during surgical correction of spinal deformities.

Material and Methods. The paper describes a variant of intraoperative neurophysiological monitoring of the spinal cord and nerve root functions which was used in the correction of scoliotic deformity of the spine in 138 patients. Surgery was performed in 83 patients aged 10 to 17 years and in 55 patients older than 17 years. The average age of patients was 20.23 ± 8.3 years. There were 41 male and 97 female patients. The primary scoliotic curve was localized in the thoracic spine in 90 cases, in the thoracolumbar spine in 27 cases, and in the lumbar spine in 21 cases.

Results. In the early postoperative period, two patients developed neurological deficit, the electrophysiological predictors of which were recorded during intraoperative neurophysiological monitoring. In one case, the deficit gradually regressed completely due to the measures taken by the operating team during surgery; in the second case, a persistent neurological deficit in the form of lower paraplegia persisted, despite the measures taken during the surgical treatment. In other cases, intraoperative neurophysiological monitoring did not reveal any changes in the spinal cord and nerve roots, which in the early postoperative period would lead to the appearance or aggravation of motor deficit.

Conclusion. A multimodal approach to intraoperative neurophysiological monitoring provides an operating surgeon with an objective assessment of the state of the spinal cord and nerve roots at any stage of surgery, which allows timely identification and elimination of the causes of their damage, thereby reducing the likelihood of neurological deficit development or aggravation in the postoperative period.

Objective. To analyze the effect of denervation of intervertebral discs in the cervical spine on the results of surgical treatment of patients with injuries to rotator cuff tendons of the shoulder joint.

Material and Methods. Study design: descriptive hypothesis-generating study. The study included patients requiring surgical treatment of rotator cuff tear.  Two groups were identified: Group A included 28 patients who underwent plastic repair of rotator cuff tear with additional denervation of intervertebral discs, and Group B – 30 patients who underwent only plastic surgery for rotator cuff tear. The intensity of pain according to the VAS, functional activity due to neck pain (NDI), functionality of the shoulder joint (UCLA), and the degree of intervertebral disc degeneration according to MRI were assessed, and the effectiveness of treatment was determined. Statistical calculations were performed using the RStudio program.

Results. In the group of patients with denervation of intervertebral discs, a more pronounced decrease in the intensity of pain syndrome at 3, 6, and 12 months (p < 0.001; p < 0.001; and p = 0.002), a more proportion of effectively treated patients at 3 months (p = 0.003), and significant increase in functional activity according to NDI at 3, 6 and 12 months of follow-up period (p < 0.001; p = 0.010; and p = 0.045) were observed.

Conclusions. There is an underestimation of the role of degenerative cervical spine pathology in the occurrence of shoulder joint pain. In the case of rotation cuff plasty the additional denervation reduces the intensity of pain syndrome in the shoulder joint in the postoperative period.

One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

Objective.To analyze results of open vertebroplasty for aggressive hemangioma of the cervical spine.

Material and Methods. Surgical treatment was performed in 12 patients with aggressive hemangioma of the cervical spine. Vertebroplasty was performed through an open anterolateral approach under the control of an image intensifier.

Results. Pain intensity was 7.0 ± 1.0 on VAS before surgery and 1.8 ± 1.2 immediately after surgery. Neck disability index (NDI) was 17.5 ± 6.5 before surgery and 4.3 ± 1.7 after surgery. One month after surgery VAS and NDI scores were 0. There were no complications in the postoperative period. A control study visualized from 82 % to 98 % completeness of filling the bone defect with polymethyl methacrylate. Bone composite migration outside the vertebral body was not detected in any of the operated patients. Control images taken 6 and 12 months after surgical treatment did not reveal continued tumor growth and signs of any osteonecrotic processes in bone tissue as a response to PMMA bone cement in any case.

Conclusion. Despite the widespread and rather long period of using vertebroplasty, the issues of the choice of approaches when performing it on the cervical spine are still debatable. In order to reduce the risk of iatrogenic complications in cervical vertebroplasty, the open approach can be used which increases the treatment effectiveness.

Objective. To analyze the outcomes of posterior approach in the surgery of intradural extramedullary meningiomas located ventrally and dorsally in relation to the spinal cord denticulate ligaments.

Material and Methods. The study included 29 patients with spinal intradural meningiomas operated on using posterior approach. Patients were divided depending on the tumor location relative to the denticulate ligaments into ventral (n = 13) and dorsal (n = 16) groups. The surgery duration, the degree of tumor resection, clinical outcomes, the presence and nature of complications, and the frequency of recurrence were assessed.

Results. The average follow-up period was 29 (6 to 61) months. Total tumor removal was performed in 93.1 % of cases: 11 cases (84.6 %) in ventral group and 16 cases (100.0 %) in dorsal group. The average duration of surgery was 136 minutes for dorsal meningiomas and 181 minutes for ventral meningiomas (p < 0.05). Complications in the form of CSF leakage were registered in two patients (6.9 %). In 11 (84.6 %) patients with ventral meningiomas and 15 (93.7 %) patients with dorsal meningiomas, an improvement or preservation of neurological functions at the pre-surgery level was observed. Recurrences were observed in two patients (6.9 %).

Conclusion. Patients with spinal meningiomas have a favorable neurological outcome and a low recurrence rate. Surgery is more complicated in patients with ventral meningiomas. In most cases, unilateral posterior approach is applicable for both ventral and dorsal meningiomas.

The literature review is devoted to the history of the development of endoscopic surgery of the lumbar spine: from open surgical interventions and puncture procedures – to percutaneous intracanal endoscopic operations, combining interventional and video endoscopic technologies and referred to in the English literature as “full-endoscopy”. The article also touches upon the historical aspects of fibroendoscopic and laparoscopic interventions on the lumbar spine. In conclusion, the principle of classification of endoscopic techniques is proposed.

In accordance with almost 55 years of experience in pediatric spine surgery, it is easy for me to describe the evolution of surgical technique, as well as indications for surgical interventions that were initially performed without the use of any instrumentation (which now are still occasionally considered as useful) through the anterior and posterior approaches, and with postoperative immobilization with plaster braces. The first types of really effective instrumentations were created sequentially by Harrington and Luque, and in parallel with their development, the pedicle screws (Roy-Camille) were introduced into practice. We had to wait another 20 years before the segmental 3D strategy and CD instrumentation appeared, which remain the basis of  modern spinal technologies to this day, regardless of the type of anchoring elements (hooks, screws, universal clamps or hybrid structures). For the present and the future, early interventions remain indicated for local pathological foci, which are usually the result of congenital anomalies with or without spinal cord compression. But for extended deformities, especially of thoracic localization, plaster and removable braces remain a good choice, regardless of the etiology and the presence or absence of pelvic tilt. When such methods did not give the desired result, a lot of efforts were made using various technologies to preserve the growth potentials of the spinal column without impairing respiratory function. At the same time, it was obvious that the incidence of complications was high, and the need for a final fusion was often stated. Hence the emergence of bipolar minimally invasive technologies with very promising results and significant number of patients who developed a spontaneous bone block, made the fusion surgery meaningless. As for older children and adolescents, the race to achieve maximum Cobb angle correction is becoming more controversial. It has been convincingly shown that it is much more important for the future, from the point of view of spinal function, to achieve 3D dynamic balance, which is determined by intervertebral discs located cranial and caudal to the area of surgical fusion.

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