Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

A clinical case of treatment of lumbar scoliotic deformity combined with false congenital diaphragmatic hernia in a 17-year-old patient is presented. Stage surgical solution to the problem was achieved using dynamic scoliosis correction system installed through the anterior approach.

Objective. To assess the correctness of transpedicular screw insertion in thoracic and lumbar vertebrae using two-level navigation templates for narrow pedicles.

Material and Methods. Two-level navigation templates were used in surgical treatment of four patients aged 14–17 years with scoliotic deformity and multiple pedicles of small width (less than 4.35 mm). In each patient, the least favorable zones were selected for implantation using navigation templates. The rest of planned pedicle screws were inserted using free-hand technique. All patients underwent CT scanning postoperatively. Screws inserted to pedicles less than 4.35 mm in width  were classified as correctly placed if they did not extend beyond the medial cortical layer by more than 2 mm.

Results. Out of 68 pedicles planned for screw placement, 42 were narrower than 4.35 mm. In the pedicles difficult for implantation, 29 screws were inserted using navigation templates and 13 by free-hand technique. Screws classified as correctly placed were 28 from those inserted with navigation templates and 9 from those implanted by free-hand technique. Difference in results of screw placement in narrow pedicles with navigation templates and by free-hand technique was statistically significant (exact Fisher test, p < 0.05).

Conclusion. Transpedicular screw placement with two-level navigation templates in narrow pedicles is more correct than insertion by free hand technique.

Objective. To compare the effectiveness of surgical methods for treating patients with recurrent lumbar disc herniation.

Material and Methods. The sample consisted of 160 patients operated on in 2014–2019 for recurrent lumbar disc herniation by percutaneous endoscopic discectomy (Group 1), microsurgical discectomy (Group 2), single-level transforaminal interbody fusion (Group 3) and single-level total intervertebral disc replacement (Group 4). The effectiveness of surgical treatment was evaluated using the NRS-11, ODI, and MacNab questionnaires.

Results. Assessment of the pain syndrome severity and the vital activity level of patients revealed significant (p < 0.05) differences in favor of total intervertebral disc replacement. Excellent and good outcomes after arthroplasty according to MacNab criteria were noted in all patients in this group. Similar outcomes were reported in 77.5 % (31/40) of patients in the TLIF group, in 75.1 % (24/32) of patients in the percutaneous endoscopic discectomy group and in 72.6 % (45/62) of patients in the microdiscectomy group. The operation time and length of hospital stay were shorter in the endoscopic and microsurgical discectomy groups (p < 0.001). However, the lower incidence of complications and reoperations was observed in groups of posterior interbody fusion and arthroplasty (p > 0.05).

Conclusion. Arthroplasty with the M6-L implant expands the possibilities of surgery for recurrent lumbar disc herniation. Total intervertebral disc replacement and posterior interbody fusion for recurrent lumbar disc herniation are more effective in comparison with decompressive operations, which is reflected in the improvement of clinical treatment outcomes, reduction of perioperative complications and frequency of repeated interventions.

Objective. To analyze the nearest clinical and radiological results of simultaneous and staged surgical treatment of patients with degenerative sagittal imbalance.

Material and Methods. Retrospective monocentric cohort study included analysis of data from 54 patients who underwent simultaneous combination of surgical methods with obligatory corrective anterior fusion at the L4–L5 or at L4–L5 and L5–S1 levels (Group I, n = 27) or similar surgical intervention though divided into stages with an interval of 5 days or more (Group II, n = 27). A comparison of clinical, radiological, and operational data during inpatient treatment was carried out.

Results. The duration of surgery was 410.93 ± 76.34 minutes in Group I and 594.63 ± 102.61 minutes in Group II (p = 0.000001); the  blood loss was 926.67 ± 378.63 ml versus 1345.19 ± 522.97 ml, respectively (p = 0.001575). Postoperative clinical and radiological parameters did not differ between groups: VAS back (p = 0.248647), VAS leg (p = 0.196140), PT (p = 0.115965), SVA (p = 0.208449), LL (p = 0.023654), LDI (p = 0.931646), PI-LL (p = 0.693045), GAP (p = 0.823504), and restoration of the ideal Russoly type (p = 0.111476). The incidence of perioperative complications in groups was comparable: 17 (62.96 %) in Group I and 15 (55.56 %) in Group II (p = 0.583171). Patients with a high Charlson comorbidity index had a significantly higher incidence of complications (p = 0.023471). The index of surgical invasiveness in Group I had a significant correlation with the total number of complications (r = 0.421332).

Conclusion. Clinical and radiological results and the incidence of complications are comparable between single- and multistage approaches to correct sagittal balance disorders. In staged treatment, the total duration of surgery and the volume of blood loss are significantly higher. With a high Charlson comorbidity index and Mirza surgical invasiveness index, a multistage approach to the treatment of patients with sagittal imbalance is preferred.

Objective. To analyze surgical technique and possibilities of using bilateral laminoplasty technique with simultaneous foraminotomy for extended stenosis of the cervical spine.

Material and Methods. The analysis included results of surgical treatment of 26 patients (18 males and 8 females, mean age 60.2 ± 1.3 years) operated on by the method of bilateral laminoplasty with simultaneous foraminotomy from January 2016 to April 2020. Pre- and postoperative clinical condition of patients was assessed, including using VAS, JOA and Nurick scales. An objective assessment of stenosis degree (linear dimensions, areas, volume of the stenotic spinal canal) was performed using standard measuring tools of the RadiAnt DICOM Viewer software. To assess the statistical significance of the obtained results, nonparametric Wilcoxon-T and Mann – Whitney-U tests were used. Differences were considered significant at p < 0.05.

Results. Upon admission to the hospital, all patients had specific neurological symptoms with varying degree of pain, myelopathic and radicular symptoms. According to neurovisualisation, the average number of involved in the process levels (stenotic) was 3.2 ± 0.1, (the average length of stenosis was 5.1 ± 0.2 cm). In the postoperative period, all patients showed positive dynamics in the form of a decrease in the severity of neurological disorders and pain (from 7.2 ± 0.1 to 5.07 ± 0.1 according to VAS, p < 0.001). The manifestations of myelopathy decreased according to Nurick scale from 2.08 ± 0.71 to 1.84 ± 0.10 points (p < 0.05). According to MRI data, the average area of the dural sac objectively increased from 1.25 ± 0.30 cm² to 2.26 ± 0.27 cm² (p < 0.001), and the volume of spinal canal in the area of stenosis increased from 7.2 ± 0.2 cm³ to 13.4 ± 0.1 cm³ (p < 0.001). Patients were mobilized on the 2nd day after surgery. The duration of inpatient treatment ranged from 4 to 17 days (on average, 7.1 ± 0.4 days). Intraoperative complications were not observed in the presented series. Mild postoperative complications were detected only in two out of 26 operated patients.

Conclusion. Bilateral laminoplasty with simultaneous foraminotomy using titanium miniplates and osteoinductive material has a number of advantages and can be the surgery of choice in the treatment of patients with extended cervical stenosis complicated by myelopathy and radicular pain syndrome.

Surgical intervention remains the cornerstone of the treatment of patients with spinal tumors. The presented literature review includes also the authors’ personal experience in the treatment of tumors. Pain relief, local control of a neoplasm growth and preservation of body functions are the main goals of this pathology treatment.

Treatment of spinal tumors is based on the biology, location and extent of the neoplasm. If surgical treatment is indicated, en-bloc resection is the preferred method. This operation is based on the complete removal of the tumor in a single block entirely covered by a shell of healthy tissue. This surgical procedure can be challenging due to the proximity of the neural structures. Moreover, achieving clean resection margin around the tumor often requires the sacrifice of adjacent anatomic structures. A more comprehensive approach requires a combination of surgery, systemic therapy and radiotherapy to improve outcomes in patients with advanced spinal tumors.

The fulfillment of oncological principles is fundamental to achieving best treatment outcomes for spinal tumors.

The characteristics and principles of surgical treatment of giant presacral neurogenic tumors are analyzed on the example of authors’ own series of cases and based on the literature review. Three clinical cases of surgical treatment of patients with giant presacral neuromas are presented. Besides routine preoperative clinical examination, 3D-printed models of pelvic bones, tumors and blood vessels were made based on CT-angiography data. In two cases, giant L5 root neuromas with presacral extension were removed through retroperitoneal approach, and in one case, two-stage removal of the giant presacral neurofibroma through the median laparotomic and dorsal approaches was performed. Giant presacral neurogenic tumors are the rare pathology in the practice of spinal surgeons. Surgical treatment should be carried out by a multidisciplinary surgical team. It should be borne in mind that life-threatening complications are common in the early postoperative period. Application of customized 3D-printed models is an additional useful tool of perioperative planning.

The paper is a review of the current literature data on the use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis. Literature searches were performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. The formation and growth of fibrous tissue in the epidural space, followed by tissue adhesion to the dura mater, is the leading cause of pain afferentation in the lumbar spine and/or lower extremities. Several molecular and cellular mechanisms play an important role in the pathophysiology of connective tissue formation in the epidural space. An analysis of experimental and clinical studies examining the effectiveness of various materials and drugs is presented. The authors present the current data on new therapeutic approaches to the prevention of postoperative epidural fibrosis. Topical, unresolved issues which necessitate further research on the pathophysiology of epidural fibrosis are indicated.

The main idea of the paper is that any scoliotic deformity of the spine is a deformity primarily occurring in the sagittal plane. This
statement is confirmed by anatomical and clinical data, results of the use of imaging techniques, and biomechanical data. The proposed concept significantly affects the solution of strategic and technical problems in the course of both conservative and surgical treatment of patients with scoliosis. It should be realized that scoliotic deformity is a compensatory response within the balance chain to a rotational phenomenon occurring in the frontal plane. The goal of the doctor is to achieve the balance of the patient's body through understanding its three-dimensionality and realizing the importance of taking into account the horizontal plane.

Nikolay Gavrilovich Fomichev

Aleksandr Georgyevich Aganesov

Meeting for spine specialists

Novelty books

Information for Authors