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Objective. To determine the predictors of complications of surgical treatment of patients with spinal cord injury (SCI) in the lower thoracic and lumbar spine using various options for performing decompression and stabilization surgeries. Material and Methods. A total of 240 patients with spinal cord injury in the lower thoracic and lumbar spine were operated on in 2010–2021. All patients were divided into 3 groups depending on the tactical option of surgical treatment performed. In Group 1, patients (n = 129) underwent two-stage surgical intervention through combined approach: the first stage included transpedicular fixation (TPF) supplemented with posterior decompression options and the second stage – fusion through anterior approach, in Group 2 (n = 36) – TPF and decompression through posterior approach, and in Group 3 (n = 75) – one-stage surgical intervention including TPF, decompression and fusion through extended posterior approach. An analysis of surgical complications was carried out, and factors that increase the likelihood of their development were identified. Comparison of groups according to quantitative indicators was carried out using single-factor analysis of variance (with normal distribution), and Kruskal-Wallis test (with distribution other than normal). Comparison of percentages in the analysis of multifield contingency tables was performed using Pearson’s χ2 test. Results. A total of 130 cases of postoperative complications were identified that corresponded to the grade 2 or 3 of the Clavien – Dindo classification, including respiratory, infectious processes in the surgical site, iatrogenic neurological complications, intraoperative damage to the dura mater, and instability of metal fixation. In two-stage surgery through combined approaches, the most common were respiratory complications (17.1 %), intraoperative damage to the dura mater (9.3 %) and surgical site infection (7.0 %). Predictors of these complications included the severity of preoperative neurological deficit of ASIA grade A or B, the patient’s preoperative condition corresponding to the average risk of death according to the modified SOFA score, and the performance of extended laminectomy. In isolated TPF with reposition and stabilization without fusion, the most common complication was instability of metal fixation in the long-term period (47.1 %), the predictors of which were incomplete reposition of the fractured vertebral body and performing two-segment TPF. In one-stage decompression and stabilization interventions with TPF and fusion through the extended posterior approach, the most common complications were intraoperative damage to the dura mater (26.7 %), respiratory complications (18.7 %), infectious processes in the surgical site (10.7 %), iatrogenic neurological complications (12.0 %), and instability of metal fixation (16.1 %). Predictors of these complications were the severity of the patient’s condition before surgery, corresponding to the average risk of death according to the modified SOFA score, neurological deficit of type D or rapidly regressing neurological deficit of type C, A or B according to ASIA scale, and bisegmental fusion when the injury was located at the lumbar level. Conclusion. Analysis of the causes of complication development contributes to their prevention, and can also form the basis for algorithms to choose tactics and technology for performing decompression and stabilization operations.

The objective of this systematic review was to analyze the clinical efficacy of various technical options for surgical treatment of patients with injuries to the lower thoracic and lumbar spine. The review includes 57 studies published in 2001–2022, which were selected from the main medical databases – PubMed, Medline, and The Cochrane Database of Systematic Reviews. In these publications, five options for surgical intervention were identified, the clinical effectiveness of which was determined by the degree of regression of neurological disorders, the quality of the achieved reposition, the amount of loss of correction within two years after surgery, the number of complications, the duration of operations, and the amount of blood loss. For pairwise comparison between groups, the Kruskal – Wallis test was used for several independent samples, based on the initial determination of the normality of data distribution in groups. To determine the differences between the parameters before and after the operation, the Wilcoxon test was used for two dependent samples. Differences were considered statistically significant at p < 0.05. An analysis of the literature data showed that there are no differences in the dynamics of neurological recovery in patients with spinal cord injury in the thoracic or lower lumbar spine when using five different types of surgical treatment. There are also no differences in the quality of correction of kyphotic deformity of injured spinal motion segments between all studied groups. Statistically significant lower loss of deformity correction is noted in patients who underwent one-stage circumferential decompression through posterolateral approach and decompression through combined approaches. Notably, operations performed through isolated posterior or anterior approaches have comparable values of correction loss. Operations with decompression of the dural sac through the posterior approaches are characterized by a significantly shorter time of surgical intervention than operations with decompression through the anterior and combined approaches. The smallest volume of blood loss is observed during surgery with decompression through isolated posterior approaches. The largest volume of blood loss is in the group with posterolateral approach and one-stage circumferential decompression. Surgical interventions through posterior approach have a statistically significant lower complication rate than operations that include the anterior stage.

Objective. To conduct a comparative analysis of the effectiveness of various options for the prevention of proximal junctional kyphosis (PJK) in the surgical treatment of adult patients with deformities of the lumbar spine, including taking into account the degree of correc- tion of the lumbar lordosis. Material and Methods. The results of instrumental fixation of the spine performed in 140 adult patients with severe frontal spinal defor- mity and/or sagittal imbalance corresponding to types III and IV according to Berjano and Lamartina were studied. The patients were divided into 4 clinical groups depending on the methods of surgical treatment: in 36 cases, correction of lumbar lordosis of no more than 30° was performed without the use of PJK prevention methods (Group I); in 24 – the same correction was supplemented with laminar fixation of the vertebra above the fusion zone (Group II); 20 patients underwent complete restoration of the sagittal and frontal balance with prophylactic vertebroplasty of the superjacent vertebra above the zone of instrumental fixation (Group III); and in 60 – the same intervention was performed without the use of the PJK prevention methods (Group IV). Results. Statistically significant differences in lumbar lordosis, difference in the pelvic angle and lumbar lordosis, and displacement of the sagittal vertical axis were found between the pairs of groups I and II, and III and IV. Postoperative values of the index of the proximal junctional angle (PJA) in patients of Group II differed significantly from the corresponding indicators of other groups. A statistically sig- nificant increase in the PJA after surgery was found in patients of groups III and IV. There was a statistically significant decrease in PJK cases in Group II in comparison with other groups (p = 0.001), as well as more pronounced trend to decrease in pain intensity and ODI score. Laminar fixation of the superjacent vertebra leads to a decrease in local kyphosis over the area of instrumental fixation and reduces the load on the ventral parts of the vertebra. Prophylactic vertebroplasty (Group III) provides better results compared to a comparable cohort (Group IV). Conclusion. Partial correction of lumbar lordosis (no more than 30°) and preventive laminar fixation of the superjacent vertebra showed significantly better clinical results (by more than 50 %; p = 0.001) compared with the other three clinical groups in terms of reducing the level of pain and improving the quality of life, as well as of decrease in number of cases of PJK development – by 16–28 % (p = 0.001).

Objective of the review was to identify, basing on literature data, the most reliable X-ray and CT signs of damage to the posterior ligamentous complex (PLC) in fractures of the vertebral bodies of the thoracolumbar junction, initially interpreted as type A according to the AOSpine classification. The systematic review was carried out according to the recommendations of PRISMA. The search in PubMed, MEDLINE and Cochrane Library databases revealed 491 articles on relevant issues. Once the inclusion and exclusion criteria have been met, 7 original articles from peer-reviewed scientific journals for the last 10 years were selected for a systematic review, 6 of which were included in the meta-analysis. In all articles, the authors identified two groups of patients: with and without damage to the PLC. The PLC damages were confirmed by MRI and intraoperatively. Radiographic and CT spondylometric parameters were identified, which had statistically significant differences between the groups. To determine predictors of PLC damage, the values of these parameters were subjected to regression analysis. This was followed by a meta-analysis of random and fixed effects models depending on the homogeneity of the data. Statistical heterogeneity was assessed using the X-square test with the null hypothesis of the absence of significant differences in all studies, as well as the heterogeneity index – I2. For the graphical display of the results, forest plots were built. Local kyphosis angle >25°, Cobb angle >16° and difference between interspinous distances >2.54 mm are CT scan predictors of PLC damage. The parameters characterizing the interspinous relationship were studied in no more than two studies, but at the same time they always had statistically significant differences between the groups with and without PLC injuries, therefore, they cannot be ignored during diagnosis. Anterior/posterior vertebral height ratio, anterior vertebral height ratio, sagittal index and suprajacent/subjacent parameters are not the predictors of PLC damage.

Objective. To analyze the results of treatment of patients with implant-associated surgical site infection after decompression and stabili- zation surgery performed for lumbar spinal stenosis. Material and Methods. Results of treatment of 43 patients with early (up to 90 days after the operation) suppuration of the surgical wound after decompression and stabilization operations for lumbar spinal stenosis were analyzed. Results. A total of 4033 operations for lumbar spinal stenosis with implantation of stabilization systems were performed from 2015 to 2019. There were 43 (1.06 %) cases of early suppuration of the surgical wound with the installed instrumentation. Out of them seven (16.27 %) cases were superficial and 36 (83.78 %) – deep. In all cases, the wound revision, surgical debridement and installation of a vacuum assisted closure (VAC-dressing) were performed. The treatment of superficial suppuration was accompanied by a single installation of a VAC-dress- ing before wound closure, and in deep suppuration from 2 to 8 (on average 4.10 ± 1.73) VAC-dressings were changed. Wound healing was achieved in all patients within 14–55 (average 29.10 ± 10.06) days. Timely diagnosis of the complication and application of negative pres- sure therapy allowed arresting the inflammatory process and preserving the implants in all patients with a follow-up period of 12 months. Conclusion. In the case of development of early suppuration of the surgical wound, the patient needs an urgent sanitizing operation. Nega- tive pressure treatment with VAC-dressings is an effective and safe way to relieve this complication. This method combined with etiotropic antibiotic therapy makes it possible to quickly cleanse and heal the wound while preserving the implanted instrumentation.

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 the neurosurgical department specializing in the treatment of patients with injuries and diseases of the spine is presented. The paper describes the links of regional and in-hospital reorganization of the current system of spine pathology care that provided the increase in the efficiency of medical care and improvement of treatment outcomes.

Objective To explore causes of proximal junctional kyphosis (PJK) following instrumented fixation of lumbar spine in patients with degenerative scoliosis due to mineral bone density deficiency. Material and methods A retrospective analysis was conducted on 308 patients with degenerative lumbar scoliosis surgically treated with decompression of neural elements, deformity correction and stabilization of FSU using rigid transpedicular fixation systems. The patients were followed up for 2 years of surgery and were subdivided into 2 groups, those who developed PJK (n=132) and those who did not (n=176). Variable risk factors for PJK described in the literature were analyzed. They could be categorized into patient related factors (age, gender, osteoporosis, body mass index (BMI), smoking habits), surgical factors (type of osteotomy performed, a magnitude of lordosis correction, long fixation to the sacrum) and radiographic parameters (PI, TK, LL, SVA, PI-LL, PJA). Results Osteoporosis (53–33 %, p = 0.032), BMI >25 (51–37 %, p = 0.042) and greater than 30° lordosis correction (51–34 %, p = 0.038) were found to be statistically significant for PJK. Lumbar lordosis restored in more than 30% increases the risk of PJK by 2.3 times. The proximal junctional angle (PJA) ≥ 11° is a statistically significant risk factor for PJK and associated with increased occurrence of PJK by 2.9 times (p = 0.022). An increase in PJA by 1° increases the risk of PJK by 11.8 % (making the risk 1.118 times higher). Osteoporosis coupled with PJA entails a statistically significant impact on PJK (p = 0.002) with PJA increased by 1° in osteoporosis scenario increasing the risk of PKJ by 66.4 % (making the risk 1.664 times higher). Conclusion Osteoporosis, body mass index > 25 and a surgical correction of lumbar lordosis by more than 30° have been shown to be significantly associated with PJK in patients with lumbar curves. PJA of 11° is the significant risk factor for PJK making the occurrence of PJK 2.9 times higher (p = 0.022). Osteoporosis coupled with PJA entails a statistically significant impact on PJK (p = 0.002) with PJA increased by 1° in osteoporosis cases increasing the risk of PKJ by 66.4 %.

The aim is to develop and propose a scale for assessing the risk of neurological complications as a result of surgical treatment in patients with the post-traumatic deformations of the thoracic and lumbar spine.Materials and methods. An analysis of the treatment of 124 patients (70 men and 54 women) aged 18–54 with post-traumatic deformations of the thoracic and lumbar spine was carried out. The patients were operated during the 2003–2017 period. Repeated surgeries were performed after the period from 6 months to 14 years after injury. In 63 cases, spinal deformation was the result of unsuccessful surgical treatment, while 61 cases were due to diagnostic errors and/or inadequate conservative treatment.Results. The analysis of the clinical data identified factors affecting the manifestation of neurological complications, as well as 46 assessment options for risk gradation.Conclusion.The proposed scale can be used for a rapid assessment of the risk of neurological complications of surgical treatment of patients with the post-traumatic deformations of the thoracic and lumbar spine.'Conflict of interest: the authors declare no conflict of interest.

Objective. To analyze the working classification of post-traumatic deformities of the thoracic and lumbar spine taking into account the main characteristics of pathological condition of the injured spinal motion segments, spinal cord and roots, affecting the choice of tactics and techniques of surgical treatment. Material and Methods. The clinical material for the classification development included 124 patients with post-traumatic deformities of the thoracic and lumbar spine operated on after 6 months to 14 years from the time of injury during 2003–2017. Results. The proposed working classification is based on the systematization of the three orthopedic features. It offers 120 variants of post- traumatic deformities of the thoracic and lumbar spine, each designated by three symbols: a digit, a letter, a digit (for example, 4.B.1 or 2.E.3). An additional option is the four surgical risk gradation of neurological status denoted by the Latin letter N with a digit from 1 to 4. Conclusion. The classification clearly systematizes numerous variants of post-traumatic deformities of the thoracic and lumbar spine based on the most clinically significant signs. Its application allows justifying the choice of a patient-specific tactical and technical option of surgical treatment.

Objective. To study the structure of complications after surgical treatment of degenerative lumbar stenosis and to analyze their influence on outcomes and indications for revision. Material and Methods. A total of 513 patients with degenerative lumbar stenosis underwent decompression and stabilization of stenotic spinal motion segments including transpedicular fixation and fusion (TLIF or PLIF). All complications both during operations and in the early and late periods of follow-up were systematized. Results. The total rate of complications was 26.51 %. The rate of early complications, including intraoperative ones was 12.67 %, and of late complications – 13.84 %. Conclusion. Unsatisfactory outcome in the early postoperative period was associated with pulmonary embolism and suppuration of postoperative wound with generalization of the infection process. Unsatisfactory long-term results of treatment were most often caused by loosening of instrumentation and late suppuration.

Objective. To substantiate experimentally a method for preventing adjacent vertebra fractures during cement transpedicular fixation of vertebral fractures in osteoporotic patients. Material and Methods. An experimental study included the assessment of overall strength of 10 cadaver blocks of T10–L4 vertebral segments with simulated Magerl’s type A fracture at the L1 level and transpedicular fixation at the T12–L2 levels with four-screw system and cement augmentation. In five control blocks, only cement augmented transpedicular fixation was per- formed after the L1 fracture simulation. In five blocks of the study group it was supplemented by vertebroplasty at T11 and L3 levels cranial and caudal to the level of fixation. Load testing of the blocks was carried out by destruction under the influence of a vertically directed force. Results. Vertical loading of anatomical specimens in the control group (average of 0.84 kN) caused Th11 vertebral body fractures. In the study group, the vertebrae augmented by vertebroplasty were resistant to loading. Fractures occurred in the T10 vertebral bodies (over the vertebra with vertebroplasty) under the average load of 1.91 kN. Conclusion. Vertebroplasty of the vertebra overlying the level of transpedicular fixation is an effective way to prevent its fracture.

Objective. To analyze clinical effectiveness of repositioning decompression of the dural sac and to justify a differentiated ap- proach to the decompression for traumatic spinal stenosis caused by damages of lower thoracic and lumbar vertebral bodies. Material and Methods. A total of 103 adult patients with injuries of the lower thoracic and lumbar spine accompanied by traumatic spinal canal stenosis were treated: 76 patients were included in the study group and 27 – in the control group. All patients underwent decompressive-stabilizing surgery with transpedicular fixation. In the study group, the priority was given to indirect repositioning decompression (more 50 %), in the control group – decompressive laminectomy (100 %). Results. In the study group, long-term results of treatment were assessed as good in 38 (79.2 %) cases, satisfactory – in 8 (16.7 %), and poor – in 2 (4.2 %). In the control group, good results were obtained in 13 (72.2 %) patients, satisfactory – in 4 (22.2 %), and poor – in 1 (5.6 %). Conclusion. Differentiated approach to decompression of the dural sac in patients treated for lower thoracic or lumbar spine injuries and traumatic spinal canal stenosis allowed avoiding laminectomy in 53.9 % of patients in the study group and per- forming anterior decompression consisting of subtotal corpectomy 1.9 times less often than in the control group.

Objective. To systematize technical and tactical options of revision procedures in the surgical treatment for lower thoracic and lumbar spine injuries in order to reduce their invasiveness and technical complexity and to improve vertebral metric parameters of correction of injured spinal motion segments. Material and Methods. Treatment results of 62 patients re-operated on for injuries of the lower thoracic and lumbar spine were examined. Results. Good long-term results of treatment were obtained in 72.7 % of patients, and satisfactory ones, in 27.3 %. Conclusion. The proposed differentiated tactics of revision surgery in the treatment of injuries of the thoracic and lumbar spine allowed to reduce invasiveness and technical difficulty of revision surgery as well as to improve vertebral metric parameters of correction of injured spinal motion segments.

ABSTRACT Objective: To analyze the structure of degenerative lumbar stenosis surgical treatment complications and to analyze their effect on the results and indications for revision operations. Methods: Between 2009 and 2013, 513 patients with lumbar stenosis of degenerative etiology were surgically treated. There were 205 men, 308 women, aged 23 to 74 years. The main clinical manifestations were persistent compression radiculopathy, chronic pain in the back and lower limbs, and difficulty walking. The intensity of the pain was assessed by the VAS. At the time of hospitalization, VAS was 55-90 points. Results: Of the 513 operated patients, 65 (12.67%) had complications in the early postoperative period (up to three months after the operation); intraoperative complications occurred in 26 (5.1%) patients; intraoperative dura mater injury occurred in 24 (4.67%); pulmonary embolism (PE) occurred in 2 (0.39%) patients; 39 patients had early postoperative complications; acute radiculopathy occurred in 22 patients (4.28%); and 17 patients (3.31%) had surgical wound complications. Conclusions: Liquorrhea, postoperative hematomas and acute radiculopathy had no negative effect on the results of treatment in any of the cases. In the early postoperative period, 4 (0.77%) deaths were recorded intraoperatively and in 2 (0.39%) cases, intraoperative PE occurred. Two cases (0.39%) resulted in sepsis and multiple organ failure. In eight (1.55%) patients, the results of the treatment were unsatisfactory: in 4 (0.77%) cases due to death, and in a further 4 (0.77%) due to elimination of the system by the spinal column as a result of suppuration. Level of Evidence IV; Therapeutic studies - Investing the results of treatment.