Contrary to the conventional view of their functional autonomy, the skeletal and nervous systems exhibit unique molecular, physical, and ontogenetic similarities. This review considers selected aspects of the mechanisms of bidirectional regulation, within which the nervous system actively controls bone tissue metabolism and structural remodeling by regulating the differentiation of mesenchymal stem cells into osteoblasts, activation of osteoclasts, and the functional activity of skeletal system cells. In turn, bone tissue performs not only a supporting function but also acts as an endocrine organ capable of modulating the expression of neuronal genes and the synthesis of key neurotransmitters, thereby influencing cognitive functions, memory, and learning ability. Despite promising results, research into the bidirectional interaction between the skeletal and nervous systems remains at its conception stage. Further identification of shared biomarkers and signaling pathways will make it possible to develop fundamentally new approaches to the prevention and treatment of skeletal system disorders as well as neurodegenerative diseases. This perspective not only challenges classical concepts of physiology but also opens interdisciplinary avenues for biomedical research.
BACKGROUND: One of the most important tasks and challenges of modern vertebrology is determining optimal approaches to the surgical treatment of children with congenital spinal deformities. The relevance of this issue is associated with characteristic features of the disease, including the formation and progression of pathological curvature, rapid and steady deterioration of the spinal column during the child's growth and development, formation of compensatory counter-curves, and a substantial reduction in quality of life and life expectancy in this category of patients. AIM: This work aimed to evaluate the efficacy and accuracy of patient-specific 3D-printed guide templates in the surgical correction of congenital thoracic and lumbar spinal deformities in preschool-aged children. METHODS: A comparative analysis of surgical outcomes was performed in 40 patients (aged 3–7 years) with isolated vertebral formation defects. The patients were divided into two groups: the main group (n = 20), in which pedicle screws were inserted using patient-specific 3D-printed guide templates, and the control group (n = 20), in which the freehand technique was used. The following parameters were assessed: operation duration, extent of fixation, accuracy of screw placement according to the Gertzbein–Robbins scale, and the degree of deformity correction measured using the Cobb method. RESULTS: In the main group, a significant reduction was observed in the time required for pedicle canal preparation (29.7 ± 4.2 s vs. 72.4 ± 6.8 s; p = 0.027) and screw insertion time (36.3 ± 3.5 s vs. 49.2 ± 5.2 s; p = 0.039), as well as a reduction in the extent of fixation (1.4 vs. 2.05 segments; p = 0.013). Accurate pedicle screw placement (grade 0) was achieved in 64.6% of cases in the main group and 23.3% in the control group (p 0.0001). Correction of kyphotic deformity was significantly greater when guide templates were used (p = 0.024). CONCLUSION: The use of patient-specific 3D-printed guide templates improves the accuracy of pedicle screw placement, reduces operation time and the extent of fixation, and ensures the safety and reproducibility of surgical correction of congenital spinal deformities in young children.
BACKGROUND: There is a need to identify new promising methods for the functional assessment of the muscular system in young athletes, the implementation of which may improve monitoring of the training process. AIM: This work aimed to study the parameters of the vertical component of the ground reaction force in young athletes at different levels of physical load. METHODS: The amplitude-frequency characteristics of ballistograms, specifically the parameters of the vertical component of the ground reaction force, were analyzed in 16 male football players aged 8–10 years. Inclusion criteria were children systematically engaged in sports (football) 3 times per week for 1 year or longer. Exclusion criteria were children engaged in sports for less than 1 year and those not adhering to a regular training regimen. Using two stabilometric platforms, oscillations of the vertical component PZ of the ground reaction force, total and those of the contralateral lower extremities, were recorded alternately for 1 s in tests performed in the child’s calm standing position and under load, namely in the standing heel-rise position. Peak amplitudes of PZ oscillations: MLF, MMF, and MHF, and their corresponding frequencies were measured in the low-frequency FLF (1–3 Hz), medium-frequency FMF (3–7 Hz), and high-frequency FHF (7–12 Hz) ranges. The control group consisted of the same number of boys of similar age with ordinary physical activity. RESULTS: In both groups of children, the mean spectral frequency of the vertical component of the ground reaction force, regardless of load level, was 4.0 Hz in the athlete group and 5.0 Hz in the non-athlete group (p = 0.001). Ballistography made it possible to assess muscle activity in the athlete group that differed remarkably from that of their non-athlete peers. Analysis of the parameters of the vertical component of the ground reaction force in the athletes indicates increased skeletal muscle strength and the absence of muscle imbalance and also demonstrates signs of favorable adaptive changes in motor units. Preservation of muscular stability in young athletes undergoing regular, high-intensity training reflects both the high adaptability of the child’s body and the effectiveness of a properly organized training process. CONCLUSION: Considering the need to take into account the functional immaturity of the movement control system, it is advisable to provide systematic instrumental monitoring of their muscular state in the training process of young athletes. To improve the effectiveness of children’s training, the amplitude-frequency characteristics of their ballistograms should be considered, which may help avoid the development of muscle imbalance due to fatigue and, consequently, prevent injuries.
BACKGROUND: Pathology of the craniovertebral junction in children is rare; however, its delayed diagnosis and treatment may lead to severe, potentially life-threatening conditions. Understanding age-related changes in the dimensions of anatomical structures of the craniovertebral junction in healthy children is critically important for determining surgical indications, selecting the optimal surgical technique, implant sizes, and screw trajectories. AIM: This work aimed to obtain objective data on the dimensions of anatomical structures of the C1–C2 vertebrae and the occipital bone used for craniovertebral fixation in healthy children of different ages. METHODS: Computed tomography scans of the craniovertebral junction from 170 patients aged 1 to 17 years without the pathology at this level were analyzed to determine morphological parameters of the C1–C2 vertebrae and the occipital bone. Linear and angular parameters used for craniovertebral fixation were assessed, including their age-related changes. The data were processed using nonparametric statistical methods. RESULTS: Age-related changes in the length and width of anatomical structures occur up to the age of 10–12 years, and then they become individualized. Changes in structural height were observed in boys up to 18 years and in girls up to 13–14 years. The highest risk of implant malposition due to size mismatch occurs before the age of 2 years. From 3–5 years of age, the dimensions of craniovertebral structures typically allow for the placement of standard implants. From the age of 13 years, the osseous structures of the craniovertebral junction are almost indistinguishable from those of adults. The optimal angle of screw insertion through the lateral masses of the atlas was found to change from a right angle to 70–65° by the age of 5–6 years, which had not been described before. CONCLUSION: We obtained data characterizing the anatomical features of osseous structures of the craniovertebral junction in children, and identified critical age periods for planning different fixation techniques in this area. The use of these data may improve the safety of craniovertebral fixation in children.
The effectiveness of conservative treatment of developmental dysplasia of the hip in infants during the first year of life directly depends on strict adherence to the prescribed orthotic regimen. Parental adherence remains a relevant issue in clinical practice, and its causes are often underestimated or interpreted in an oversimplified manner. This review analyzes current publications addressing factors that influence parental adherence to orthotic treatment in the conservative management of developmental dysplasia of the hip in infants. Analysis of the published data made it possible to identify three key groups of factors shaping adherence: medical, socioeconomic, and psychological. It is shown that parents’ subjective perception of disease severity and the risks of its long-term consequences often has a stronger influence on adherence to the treatment regimen than objective clinical and radiographic data. A U-shaped relationship is described for the risk of treatment refusal, characteristic of both mild and severe forms of the condition. Special attention is given to the identified adherence paradoxes, which have not previously been discussed in the Russian publications. In particular, it is shown that a high level of parental awareness and education is not always accompanied by strict compliance with medical prescriptions and, in some cases, may contribute to increased anxiety, selective adherence to recommendations, and the phenomenon of doctor shopping. In conclusion, it is emphasized that adherence to the treatment in infants with developmental dysplasia of the hip is a multifactorial phenomenon extending beyond the purely clinical characteristics of the disease. This review offers a new perspective on the causes of ineffective conservative treatment and substantiates the need to take the psychosocial profile of the family into account when choosing a patient management strategy and the type of orthopedic device.
