The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.

Objective. To carry out a retrospective analysis of the restoration of the anterior and posterior vertebral body heights and the elimination of deformation of the anterior spinal canal wall caused by thoracic and lumbar spine injury, based on the data of spiral computed tomography (SCT). Material and Methods. The study analyzed SCT data and case histories of 50 patients with thoracolumbar spinal cord injury operated on at different times after injury: up to 10 days – Group 1 and 11–30 days – Group 2. All patients underwent spinal reposition using a transpedicular device. The preoperative and postoperative SCT parameters were compared with the initial ones, which were calculated. The restoration of vertebral body heights and the elimination of deformation of the anterior spinal canal wall were compared in two groups depending on the distraction of interbody spaces and changes in the angle of segmental deformity. Results. In Group 1, the anterior and posterior dimensions of the vertebral body were restored, on average, by 95.3 ± 1.9 and 96.9 ± 1.4 % of the initial height; in Group 2 – by 87.4 ± 4.2 and 96.6 ± 1.8 %, respectively. The maximum restoration of the anterior dimensions of the vertebral bodies was achieved with distraction of the anterior interbody spaces closer to 100 % of the original size in the first and second groups. The maximum recovery of the posterior dimensions of the vertebral bodies was obtained by distraction of the posterior interbody spaces by 97 % or more of the original dimensions. The maximum elimination of the displacement of bone fragments from the spinal canal was obtained by distraction of the interbody spaces to a distance close to 100 % of the initial one, and when the obtained angle of segmental deformity coincided with the initial one. Conclusion. In the first 10 days after the injury, a greater percentage of the restoration of the anterior and posterior vertebral body heights and a decrease in the deformation of the anterior wall of the spinal canal were obtained. It was possible to maximally eliminate the deformation of the anterior wall of the spinal canal and restore the height of the anterior and posterior walls of the damaged vertebra by approaching the obtained dimensions of interbody spaces and the angle of segmental deformity to the initial ones.

Introduction The more accurate is the measurement of the parameters for correcting the deformity of damaged spinal segments the more accurate will be the restoration of the sagittal profile and original anatomy of the spine. Purpose Substantiation of calculated indicators for deformity correction in one or two damaged spinal motion segments in the thoracic and lumbar spine according to spiral computed tomography. Material and methods The material for the study was the results of spiral computed tomography (SCT) of an anatomically unchanged thoracic and lumbar spine in 25 patients (12 women and 13 men aged 18 to 60 years). The study model consisted of three vertebral bodies and four adjacent discs from T4 to L4. Anterior and posterior dimensions of the vertebral bodies, intervertebral discs, and segmental deformity angle α (formed by the lower endplate of the overlying vertebra and the upper endplate of the underlying vertebra) were measured using RadiAnt computer software in the midsagittal projection. Damage to the body of the middle vertebra with adjacent discs was modeled, the dimensions of which were calculated from the adjacent vertebral bodies and adjacent discs. Statistical processing of the material was carried out using the computer software SPSS Statistics. Results The measurement error of the anterior interbody spaces was 1.4 ± 0.4 mm, the posterior interbody spaces were 1.3 ± 0.5 mm, the error in calculating the segmental deformation angle α was 2.5 ± 0.6 degrees, what indicates the high accuracy of the proposed method. Discussion The use of absolute deformity values as a standard for surgical intervention in the treatment of vertebral fractures is complicated by varieties of normal anatomy. Conclusion The proposed calculations for the restoration of the anterior and posterior interbody distances, as well as the angle of segmental deformity α after a spinal cord injury of the thoracic and lumbar spine provide an approach to the target individualized anatomical dimensions.

The 329 patients with the old vertebral and spinal cord injuries have been treated surgically in 6 month - 18 years after injury. Tactics of surgical treatment of patients was based on fracture type, degree of neurological deficit and rigidity of deformation. The combination of neurosurgical and orthopedical principles of surgery lets us to achieve an improvement in live quality in 92,7% of cases.

Results of surgical treatment of 80 patients with ischemic spondilolistesis were analyzed. All patients were divided in two groups. All patients were treated surgically with reduction, TLIF and posterior transpedicular fixation. Differences in groups depended from volume of decompression and size of a reduction of a vertebra. The results have shown that effective treatment with good correction, decompression and stabilization can be archived from posterior approach. Using NEMG reduced neurological complication in correction of severe segmental deformation.

The article demonstrates the outcomes of operative treatment of 190 patients with spinal cord injuryof thoracic and lumbar spine for 10 years. Associated injuries were revealed in 96 patients, the mean ISS score being27.5. All patients underwent decompressive and stabilizing interventions using a transpedicular system of “Synthes” production (Saint Petersburg). Ventral interventions were performed in 27 (14.2%) patients. In all cases, decompression of the spinal canalcontents at the level of damage was achieved. In those patients who were operated within two weeks after trauma, transpedicular system allowed for recovery of a form and size of the spinal canal and the damaged vertebral body. The fractures of transpedicular system were observed in patients operated both with only rear and with combined access. The errors and complications, which happened during surgery, did not influence the outcomes of treatment. The outcomes of treatment were assessed according to the neurological statusdynamics (ASIA score), recovery of support ability of the spine, the presence of pain, and patients’ recovery (Е Denis score). Favorable outcomes were achieved in 114 (61.3%) patients, satisfactoryin 53 (28.5%),and poor in 19 (10.2 %).

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. Authors carry out the review of literature data, consider various approaches of surgical treatment depending on a stage of a disease and extent of deformation, including a decompression, instrumented posterior spinal fusion, an anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. Authors carry out the review of literature data, consider various approaches of surgical treatment depending on a stage of a disease and extent of deformation, including a decompression, instrumented posterior spinal fusion, an anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

The possibility of the spinal stabilization in patients with a history of somatic diseases and contraindications to general anesthesia is discussed. As an example, the authors have given the histories of two patients with vertebral pathological fractures against a background of the osteoporosis and metastatic gastric cancer who underwent transpedicular fixation of the spine under local anesthesia. In both cases good results of treatment were received.

The possibility of the spinal stabilization in patients with a history of somatic diseases and contraindications to general anesthesia is discussed. As an example, the authors have given the histories of two patients with vertebral pathological fractures against a background of the osteoporosis and metastatic gastric cancer who underwent transpedicular fixation of the spine under local anesthesia. In both cases good results of treatment were received.

The analysis of results of surgical treatment of 154 patients with a vertebral and spinal trauma of chest and lumbar departments of a backbone aged from 16 till 75 years is carried out. All patients were operated in Bryansk city hospital N 1. The volume and sequence of surgeries, and existence were defined with the combined damages, character of an injury of a backbone and a spinal cord or absence free part bone bodies of the injured vertebra compressing a spinal cord defined different accesses on a backbone. So, surgeries at 125 (81,2 %) patients were carried out from one back access, at 23 (14,9 %) patients - to the combined back and lobbies and at 6 (3,9 %) patients - front and back access. In all cases for fixing of a spine implants “Sintez” firm (St. Petersburg) were used. Results of treatment were estimated on neurologic dynamics, restoration of an axis of a backbone, a gleam of the vertebral channel and restoration possibility of a support of a backbone. Good results of treatment are received at 87 (56,5 %), satisfactory - at 55 (35,7 %) and unsatisfactory - at 12 (7,8 %) patients.

Purpose Assessment of effectiveness of spinal fixation in conditions of general osteoporosis. Material and methods of studies 112 patients with multiple osteoporotic pathological vertebral body fractures were surgically treated. Multilevel laminar or transpedicular instrumentation with or without ventral stabilization (group A) was used on 64 of them. The cemented polyaxial screws were used in 48 cases (group B). The patients treated with multilevel transpedicular fixation with cemented screws were included in B-I subgroup. The patients treated with monosegmental fixation (around fractures) with same screws were included in B-II subgroup. The parameters of stability (bone resorption around screws and cement, dislocation of implants, clinical symptoms) were studied in both groups. Outcome results and discussion: In group “A” the parameters of stability were the purest. The displacement of instrumentation with lost of correction has been revealed in 21% of cases. The reoperations were done in 17% of them. In groups B-I and B-II the parameters of stability were the same. There were no clinical signs of instability up to2 years of supervision. In 75% of cases the bone resorption around bone cement has been revealed after 3–6 months. But there were no cases of instrumental displacement. Spinal fixation in treatment of multiple pathological vertebral body fractures in conditions of general osteoporosis using the vertebroplasty with cemented screws provide good stability of the spine for long outcome. This method allows to achieve the clinical result with less invasive approach by shortening of extent of fixation.

Results of surgical treatment of 80 patients with ischemic spondilolistesis were analyzed. All patients were divided in two groups. All patients were treated surgically with reduction, TLIF and posterior transpedicular fixation. Differences in groups depended from volume of decompression and size of a reduction of a vertebra. The results have shown that effective treatment with good correction, decompression and stabilization can be archived from posterior approach. Using NEMG reduced neurological complication in correction of severe segmental deformation.

The article is dedicated to the vital problem of the consequences caused by negligent surgical treatment of those who suffered spinal and vertebral trauma. The authors carried out a cooperative survey of the results of the previous treatments of patients with traumas with and without complications and they came up with the algorythm of surgical methods, based on the data analysis. Vast database of 614 clinical case treatments with post-operative observations of 1 to 10 years long have been used. The work is aimed at raising the standarts of surgical treatments and improvement of neurological & anatomo-functional results.

The 329 patients with the old vertebral and spinal cord injuries have been treated surgically in 6 month - 18 years after injury. Tactics of surgical treatment of patients was based on fracture type, degree of neurological deficit and rigidity of deformation. The combination of neurosurgical and orthopedical principles of surgery lets us to achieve an improvement in live quality in 92,7% of cases.

The 571 patients with the tumors of cervical, thoracical and lumbar spine (159 patients with benging tumors, 35 - with primary malignant tumors and 377 - with metastatic lesion of the spine) have been treated surgically in 1997-2009. Tactics of surgical treatment of patients with a tumoral lesion of a column was based on an individual approach to each case of disease and depend on histological type of a tumor, localization, a degree of diffusion of process, presence of complications, age, a somatic state of the patient and sensitivity of a tumor to conservative methods of treatment.

The stability of cemented and noncemented transpedicular screw implantations in vertebra with low mineral bone density was studied in experiment. We analyzed the destabilization of screw under distraction load, attached along longitudal axis of the screw on universal servo-hydraulic test machine «Walter+bay ag» LFV-10-T50. The factors of bone-cement-metallic block rigidity of cemented screw was in 2,10-2,38 times more then in situation with traditional transpedicular screw.

The results of surgical treatment of adult patients with scoliosis in the form of different fixation of L5-S1 segment. The best results were obtained in patients who underwent combined spinal fixation (transpedicular system and the system interspinous dynamic stabilization). In this group good indicators of quality of life of patients in the form of lack of pain and preservation of the normal volume movements in the lumbar spine were received.