Objective. To perform clinical testing of a pediatric modification of the 18-point Japanese Orthopedic Association (mJOA) scale for assessing pathology of the spine and spinal cord in children.Material and Methods. Functional and neurological status was assessed in 143 pediatric patients with pathology of the spine and spinal cord using the mJOA scale with three age versions (0.5–1.5 years, 1.5–4 years and 4–18 years). The control group included 10 adult patients with a similar pathology profile, who were assessed using the mJOA scale as modified by Benzel.Results. An initial analysis of mJOA scores across five age groups (0.5–1.5, 1.5–4, 4–8, 8–18, and over 18 years) did not reveal significant differences in final scores. Repeat assessment (mean 3.1 years, range 1–10 years) also showed no significant differences either withinor between groups. A secondary analysis was performed in patients with pathology at the cervical, thoracic and lumbar levels of the spinal cord: no significant changes in scale scores were found within the groups over time. At the same time, patients with pathology at thecervical level demonstrated a significantly higher score; they were less likely to have deformity of the lower extremities and dependence on a wheelchair, while sensitivity and movements in the upper extremities were significantly worse than in other groups.Conclusion. The proposed pediatric mJOA scale demonstrated age consistency and utility. The results of assessing the functional and neurological state of patients using this scale, in addition to being comparable with each other, are comparable with the results of the Benzel mJOA scale in adults.

Objective. To evaluate early and medium-term results of surgical treatment of early-onset scoliosis using the principle of growth-friendly systems. Material and Methods. A retrospective analysis of the medical records of 54 patients treated using surgical distractible metal implants was carried out. Patients were divided into 4 etiological groups: congenital (n = 17), systemic (n = 12), idiopathic (n = 16) and neurogenic scoliosis (9). The boy/girl ratio was 11/43. The average age at which patients started treatment was 9.6 years, and at the end of treatment – 13.2 years. Results. Radiometric parameters were assessed during and after completion of treatment. The Cobb angle of the main curve of deformity before treatment averaged 56.1°, after the primary operation – 31.8°, and after completion of treatment – 23.2°. Correction of the main deformity curve for the entire period of multi-stage surgical treatment was 57.8 %. The highest initial magnitude of deformity was noted in the group of neuromuscular scoliosis (67.6°), and the lowest in the group of congenital pathology (50.4°). In the groups of systemic and idiopathic scoliosis, the preoperative values were very close: 53.4° for systemic scoliosis and 57.6° for idiopathic scoliosis. According to the results of staged treatment in the neuromuscular scoliosis group, the residual curvature of the main curve was the lowest, and the percentage of its correction was the highest – 18.9° and 73.6 %, respectively, versus 24.5° and 49.7 % in the congenital scoliosis group. The effectiveness of treatment with an assessment of the percentage of correction after final instrumentation in groups of idiopathic and systemic scoliosis was close: 23,0° and 62.3 %, and 28.5° and 51.5 %, respectively. Identical average values of the main curve angle after final instrumentation were noted in all four etiological groups (on average, 23.2°). Changes in thoracic kyphosis and lumbar lordosis were insignificant. During the treatment, 22 unplanned surgical interventions were performed in 15 patients. Conclusion. This study revealed a number of key points that in the future may help in the formation of clearer algorithms of selecting the most optimal technique: neurogenic scoliosis is most successfully corrected by growing systems, and congenital scoliosis shows less pronounced correction of deformity and a greater relative number of complications per patient with a single use of growing systems, which requires caution during staged surgical treatment.

OBJECT:To evaluate inter- and intra-observer agreement of the proposed diagnostic and treatment classification of degenerative spondylolisthesis. MATERIAL AND METHODS:The proposed diagnostic and treatment classification of degenerative spondylolisthesis was validated according to the GRRAS protocol. For this purpose, we retrospectively analyzed MRI, CT and spinal radiography data in 20 patients. Inter- and intra-observer agreement was carried out by 11 experts from 6 federal institutions of Russia. Fleiss and Cohen's kappas were calculated using the Statistical Package for the Social Sciences (SPSS), version 21.0 (SPSS Inc., Chicago, IL, USA). RESULTS:Validation was carried out in two stages. The first stage (3 experts from one clinical unit): inter-observer agreement k (Fleiss)=0.863 [0.786; 0.939]; intra-observer agreement - Cohen's kappa >0.81 (expert 1 - k=0.931, expert 2 - k=0.908, expert 3 - k=0.862). The second stage was multiple-center and included 11 experts. Inter-observer agreement k(Fleiss) was 0.792 [0.767; 0.817]. We compared agreement among surgeons with comparable experience depending on specialty: orthopedic - k=0.799 [0.774; 0.814]; neurosurgeons - k=0.791[0.769; 0.817] (p=0.687). Surgeon's experience did not affect significance of classification: <10-year experience - k=0.781 [0.767; 0.798], >10-year experience - k=0.808 [0.789; 0.817] (p=0.287). CONCLUSION:The presented diagnostic and treatment classification of degenerative spondylolisthesis has significant inter- and intra-observer multiple-center and multidisciplinary agreement. Integration of classification into clinical practice will allow standardization of surgical tactics for degenerative spondylolisthesis.

The study objective is to study the causes of repeated surgical treatment in patients of an older age group with degenerative pathology of the lumbar spine.Materials and methods. A retrospective analysis of the treatment of 962 patients who underwent surgical treatment of degenerative pathology on the basis of the FCN of Novosibirsk from 2013 to 2017. A total of 360 men, 602 women; average age 66 years. 624 (64.9 %) patients underwent decompression, 338 patients (35.1 %) underwent stabilizing intervention in combination with decompression. The study group consisted of 98 (10.2 %) patients who underwent repeated operations taking into account the inclusion and exclusion criteria. On average, the period after the previous intervention is 17 months (from 1 day to 6 year). 68 patients (69.4 %) previously underwent decompression interventions, 30 (30.6 %) rigid stabilization. The indication for revision treatment was the presence of pain and (or) neurological deficiency, resistant to treatment for at least 6 weeks. Evaluation criteria are described, and the structure of complications is analyzed. The minimum follow-up period after repeated surgery was 1 year, the maximum 6 years.Results. Iatrogenic factors were detected in 39 patients (39.8 %). Progression of degenerative pathology in 59 (60.2 %) patients. More often, repeated intervention was performed at the level of L4–L5 (36.1 %), the cranial adjacent segment was 76.5 %, and the caudal segment was 23.5 %. The minimum period of manifestation of continued degeneration is 3 months. The development of the disease of the adjacent segment after fixation is higher in the period of 3–4 years (p = 0.015). Patients with repeated surgical treatment after decompression for continued degeneration had a higher BMI of 32.3 (p = 0.12), as well as patients with damage to the adjacent segment 32.5 (p = 0.10), compared with the group of primary patients (BMI 30.6 on average). The similar dependance is registered for patients after stabilization: BMI of patients with repeated interventions is 34.5 that is higher than BMI of primary interventions group (on average 33.2, р = 0.13).Conclusions. The main reason for repeated interventions in patients of an older age group is the progression of degenerative pathology on the segments on the segment operated as as well as the adjacent segments (60.2 % repeated interventions, 46.9 % at the adjacent level including).Repeated surgical treatment of patients of an older age group in the early period (for up to 1 year) is most often due to insufficiently effective primary surgical intervention with prevailing early recurrence of disk herniation (1.6 % patients of total number of primarily operated). In the long term (more than 3 years), the reason for repeated surgical treatment is due to the development of an adjacent segment disease where the number of operations of patients with primarily made rigid fixation is increasing progressively in the course of time.High BMI is a predictor of the development of instability of the vertebral motor segment and continued degeneration of the operated one as well as the adjacent level in the long follow-up time.

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

The study objective is to analyze the effectiveness of the use of minimal invasive polyetheretherketone (PEEK) rod systems in the treatment of lumbar spine degenerative diseases.Materials and methods. The minimal invasive semi-rigid stabilization using PEEK rod systems was performed in 24 patients (4 (17 %) male and 20 (83 %) female) patients (mean age 46.3 ± 8.4, ranging from 32 to 63). The average follow-up duration was 15 months. Inclusion criteria: mechanical low back pain, White–Panjabi instability: 5 points, degenerative changes of the disc by C. Pfirrmann scale: II–IV grade. Follow-up at the 6 and 12 months postoperatively.Results. In the postoperative period, the majority of patients had a complete or significant regression of pain (on average, from 6.3 to 1.8 points on the visual analog scale). The Oswestry disability index decreased from 64/66 [64; 68] to 33/34 [32; 36] in 6 months (p <0.001) and 18/17 [16; 18] in 12 months (p <0.001). Before surgery, the height of the operated disk was 0.96 cm, after 1 year decreased to 0.91 cm. Range of rotary motion in the operated segment in all cases did not exceed 6°.Conclusion. The PEEK rod fixation in patients with mechanical low back pain provides good and excellent clinical results on the I. Macnab scale in 83.4 % of cases. Within 12 months, the minimal volume of movements on the operated segment remains, without signs of continued degeneration of adjacent intervertebral discs.

AIM:The study aim was to evaluate the effectiveness of intraoperative monitoring of motor evoked potentials (MEPs) for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period.MATERIAL AND METHODS:The study included 74 patients with intradural cervical spinal cord tumors who were operated on using motor evoked potential monitoring in the period from 2013 to 2016. There were 29 (39%) males and 46 (61%) females. Group 1 included 26 (35%) patients with intramedullary tumors; group 2 included 48 (65%) patients with intradural extramedullary tumors. The neurological status was assessed by using a six-grade muscle power MRC scale; a modified McCormick scale was used to evaluate the functional status. Transcranial electrical stimulation of the precentral gyri was performed. Recording electrodes were located in the peripheral target muscles of the upper and lower limbs. Total intravenous anesthesia with propofol and fentanyl was used.RESULTS:In Group 1, MEPs decreased in 19 (73%) of 26 patients; MEPs remained unchanged in 7 (27%) patients. Among the patients with decreased MEPs, 14 (74%) patients had postoperative deterioration of the neurological status; 6 (32%) patients had a preoperative severe neurological deficit; 4 (21%) patients had no changes in the neurological status. The sensitivity and specificity of MEPs from the upper limb muscles were higher than those from the lower limb muscles. In Group 2, improvement of the neurological status occurred in all 48 patients. There was no case of a true positive decrease in the MEP amplitude.CONCLUSIONS:1. Registration of MEPs is a highly sensitive and highly specific method for diagnosing corticospinal tract dysfunction in patients with intramedullary tumors of the cervical spinal cord. The sensitivity and specificity of MEPs recorded from the upper limbs are higher than those from the lower limb muscles. 2. The sensitivity of MEPs in patients with extramedullary intradural tumors was 0%, the diagnostic effectiveness of MEPs amounted to 86% from the upper limb muscles and 93% from the lower limb muscles. 3. When the MEP amplitude in patients with extra- and intramedullary tumors of the cervical spinal cord decreases, a change in the surgion's approach may reduce or completely eliminate surgically-induced damage to the spinal cord.

In the article, we describe a clinical case of syringomyelia associated with an Arnold-Chiari type 1 malformation, evaluate the efficacy of syringosubarachnoid shunting, and analyze the literature data of domestic and international researchers involved in investigation and treatment of the pathology. Application of syringosubarachnoid shunting in the described case resulted in a clinical improvement in the form of regression of paresis and hypoesthesia, which demonstrated the efficacy of the shunting technique for correction of the syringomyelia symptoms.

INTRODUCTION:As the life span and proportion of people over 65 years increase, the incidence of degenerative lumbar spine stenosis grows proportionally. Various parameters of the spinopelvic relationships are used to predict surgical treatment outcomes in patients with degenerative spine diseases. There are no unified protocols for evaluation, in terms of the sagittal balance, of surgical treatment outcomes in elderly patients. PURPOSE:To study the impact of sagittal balance parameters on the life quality of elderly and senile patients after surgery for degenerative stenosis of the lumbar spine. MATERIAL AND METHODS:The study included 109 patients. Decompression was performed in the first group of 53 patients. Decompression and stabilization were performed in the second group of 27 patients. In the third group of 29 patients, XLIF indirect decompression, scoliosis correction, reconstruction of disturbed spinopelvic relationships, and stabilization were carried out. We evaluated the following sagittal balance parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and PI minus LL (PI-LL). The quality of life indicators were assessed using VAS, ODI, and SF36 scores. RESULTS:In the first group, there were not statistically significant differences for PT≤20° and PT>20°. A statistically significant change in the PI-LL parameter (p=0.0263) was in the first group. A decrease in PI-LL was accompanied by regression of pain (p<10-4). In the second group, comparison of the quality of life indicators revealed no statistically significant differences between PT≤20° and PT>20° as well as PI-LL≤10° and PI-LL>10 in the postoperative period. In the third group, postoperative improvement in PT (p=0.0002) and PI-LL (p=0.0008) parameters was accompanied by a decrease in pain in the legs (p=0.0002) and lumbar spine (p=0.0001). CONCLUSION:Improvement in the quality of life indicators in 48.6% of cases was achieved by decompression only; the sagittal balance parameters had no significant impact on quality of life. In 24.8% of cases, improvement in the quality of life indicators was achieved by decompression and stabilization because the dominant clinical neurological syndrome was instability. Reduced quality of life in 26.6% of patients was caused by disturbed spinopelvic relationships. Application of the XLIF technique in these patients provides statistically significant restoration of the sagittal balance parameters, PT and PI-LL, which improves quality of life.

Degenerative-dystrophic changes in the spine have general nature, which leads to changes in the balance parameters and consequently, other elements of the musculoskeletal systems. This article is devoted to analysis of the literature data, based on which we conclude that changes in the sagittal balance in elderly and senile patients as the restabilization stage still remain unexpected.

Randomized prospective study was performed to compare the treatment results in patients with reflex pain syndromes caused by degenerative dystrophic disorder of the cervical spine using coblation and chemical denervation. Coblation, as well as chemical denervation of disc, is effective and safe method of the treatment for pain syndromes of cervical spine osteochondrosis providing good clinical results with minimal traumatization of surrounding tissues.