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Introduction The understanding of the biomechanics of movements in the spinopelvic segment plays an important role in the successful treatment of patients with hip-spine syndrome. Analysis of the biomechanical processes occurring in the biokinematic chain of the spine–pelvis–hip during the transition from standing position to sitting position allows us to conclude that the acetabular axis of rotation of the pelvis in space is not the only one. Classical methods for measuring PI, PT, overhang S1 are applicable for patients in a standing position and use the hip joint as a starting point, since it is the point of rotation of the pelvis in space in a standing position. Previously, using mathematical modeling, we described spatial changes in the pelvis during a given change in the body position and showed the presence of a second point of pelvis rotation in space, which appears in a sitting position. We assumed that in a sitting position, it is necessary to use other methods for calculating indicators of spinopelvic relationships for their determination. Purpose of the study was to evaluate the parameters of patients’ sagittal balance using the proposed alternative method in standing and sitting positions. Materials and methods Medical documentation and the results of X-ray examination of 20 patients with unilateral idiopathic coxarthrosis who underwent total hip replacement surgery were analyzed. The radiographic parameters were calculated: PI, PT, overhang S1 in standing and sitting positions, anterior inclination of the acetabular component; parameters PI ischial, PT ischial, deviation of the ischial tuberosities in standing and sitting positions were proposed and calculated. Results The study shows that there is no statistical difference in the values of the angles PI standard for a standing position and PI ischial for a sitting position. It corresponds to objective data and is generally accepted. Examples of changes in radiographic parameters of the sacral slope and the deviation of the ischial tuberosities were shown reflecting the rotation of the pelvis in space through the second, ischial axis, that confirm the biaxial concept of pelvic rotation. Discussion The calculations demonstrated the possibility of using alternative indicators of spinopelvic relationships (PT, distance of overhang of the sacrum (overhang S1), deviation of the ischial tuberosities). They enabled assessment of the spatial transformation of the pelvis and the ability to predict the spatial position of the acetabulum, which is an important factor for successful treatment of patients with combined pathology of the hip joint and spine. Conclusion Our findings complement the biaxial concept of pelvic rotation. An alternative method for measuring sagittal balance parameters in a sitting position has been proposed. Further research is required to assess the practical significance of this method.

Objective. To analyze the information on spontaneous resorption of lumbar disc herniation. Material and Methods. A non-systematic review of 37 publications on resorption of disc herniation was conducted. The data on the timing, mechanisms and predictors of regression of lumbar disc herniation were summarized. A clinical case is presented illustrating the resorption of a herniated L4–L5 intervertebral disc over 8 months. Results. The frequency and timing of resorption of lumbar disc herniation vary depending on the number of patients, follow-up period, the type and nature of the hernial bulging, and other characteristics of patients. The results of meta-analyses indicate that the average period of spontaneous resorption of lumbar disc herniation is more than 6 months. The main theories of spontaneous resorption of lumbar disc herniation are the dehydration theory, the mechanical theory, and mechanisms associated with inflammatory processes and neovascularization. Currently, predictors of disc herniation resorption include the type and size of the hernia, follow-up period, Modic changes, etc. Existing data on the timing, mechanisms and predictors of resorption of lumbar disc herniation are insufficient to improve treatment tactics for this category of patients. Conclusion. Herniated lumbar intervertebral discs tend to undergo spontaneous regression which, however, is not observed in all patients. The mechanisms of resorption can be different, and the fact of resorption itself can occur in different types of hernia with different frequencies. An analysis of large data sets is necessary to more accurately determine the timing and predictors of resorption of lumbar disc hernias.

Objective. To evaluate the long-term results of surgical treatment of patients with monosegmental stenosis of the lumbar spine after using minimally invasive and standard open techniques. Material and Methods. The open cohort randomized prospective study included 132 patients. Long-term results were assessed in 110 patients, some patients discontinued participation in the study for natural reasons. Patients were operated on in 2009–2011 in the volume of minimally invasive decompression and stabilization surgery (Group 1) and decompression and stabilization surgery through conventional posteromedial approach (Group 2). The following parameters were analyzed: Oswestry Disability Index and VAS pain intensity. Formation of an interbody block was assessed using the Tan scale, and the fatty degeneration of the paravertebral muscles – according to the Goutallier scale. Development or aggravation of the course of degeneration of the adjacent segment was also evaluated. Statistical analysis was performed using the R packages for data processing and plotting. Results. At long-term follow-up (144 months), when assessing back pain according to VAS and ODI, a statistically significant difference p < 0.001 in favor of minimally invasive interventions was revealed. Both surgical methods resulted in high rates of fusion and low reoperation rates. In the group of minimally invasive surgical interventions, there is a lower incidence of fatty degeneration of the paravertebral muscles and damage to the adjacent segment. Conclusions. Open and minimally invasive surgical interventions have comparable long-term clinical and morphological results. Open surgical interventions in the long term are fraught with aggravation of fatty degeneration of the paravertebral muscles and more frequent development of the adjacent level syndrome. Minimally invasive techniques are an effective and safe alternative to traditional open surgery and can reduce trauma, preserve the intact posterior support complex of the spine at adjacent levels, while performing adequate decompression and stabilization, followed by the formation of a bone block.

Objective. To analyze the effect of spinal deformity correction on the parameters of the frontal and sagittal balance in patients aged 15–35 years with Lenke types I and III idiopathic scoliosis. Material and Methods. The dynamics of sagittal and frontal parameters of the spinal balance was assessed in 268 patients aged 15 to 35 years with Lenke type I and III idiopathic scoliosis before and after surgical treatment. The patients’ quality of life and the number of postoperative complications were assessed depending on the imbalance severity. Results. More than half of patients (55.6 %) with Lenke types I and III idiopathic scoliosis have initial balance disorders, and 14.6 % of them have pronounced abnormalities. Significant balance disorders are predicted by severe scoliosis (85.3° ± 30.3°), greater L5 tilt (10.3 ± 7.9 before surgery; 5.3 ± 4.8 after surgery) and initial sagittal imbalance (32.75 ± 27.7), large residual scoliotic curve (43.3° ± 23.1°), large angle of residual thoracic kyphosis (32.3° ± 15.9°), and smaller angle of lumbar lordosis after surgery (52.3° ± 14.1°); p < 0.05. The main compensatory elements, in addition to PT and SS, are the angle of L5 tilt in the frontal plane and the L5–S1 angle in the sagittal plane. In young patients aged 15-35 years, disc mobility at the L5–S1 level is sufficient to achieve a more balanced body position, even with a significant change in the PI-LL ratio. Conclusion. In the long-term postoperative period, a pronounced imbalance of the spine increases the risk of mechanical postoperative complications up to 50 %, while the quality of life of patients does not decrease, and repeated surgical interventions are required in singular cases. Correction of scoliotic deformity allows increasing the number of patients without balance disorders by 6 %, and reducing the number of gross deviations by 2 times.

Introduction The success of the treatment of patients with degenerative diseases of the spine and concomitant damage to the hip joint depends on the understanding of the biomechanics of movements in the spinal-pelvic segment. After a thorough analysis of the biomechanical processes occurring in the spine-pelvis system during the transition from a standing to a sitting position, it becomes clear that the acetabular axis of rotation of the pelvis in space is not the only one. The purpose of the study was to develop and test a virtual model of the pelvis to study the kinematics of the movement of the spinal-pelvic complex with a description of the emergence of the iscial axis of rotation by changing the position from standing to sitting. Materials and methods The problem was solved using the finite element method. The bones were modeled as absolutely rigid bodies. The main ligaments and muscles were modeled using finite element springs: elastic fragments with specified rheological characteristics. The study of contact interaction was carried out for pairs: "femoral head – acetabulum" and "ischial tuberosities - chair surface". Results A new axis of rotation was revealed, the ischial axis, which corresponded to the points of initial contact of the ischial tuberosities with the surface of the chair. The axis of the acetabulum rotated by 7.1° relative to the ischial axis and at the final moment shifted in the horizontal direction relative to the acetabular axis by 8.83 mm. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. Discussion The study shows that the pelvis rotates depending on the position around two axes: acetabular and ischial ones, hence it follows that the acetabular axis oscillates back and forth during anteand retroversion, that is, it is non-static. Shortcomings of the model: 1) muscles and ligaments were modeled using FE springs, the end and beginning of which were set by two points, and the muscles and ligaments in the real body are attached along the entire surface of the bones; 2) soft tissues were not modeled in real volume. The merit of the study is the contact interaction of the pelvis with the chair and its rotation relative to the ischial axis, while other studies consider the rotation of the pelvis only relative to the acetabular axis. Conclusion A new axis of rotation arises due to the contact interaction of the pelvic bone with the surface of the chair when the skeleton moves from a standing position to a sitting position, the ischial axis. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. It is advisable to conduct a clinical study.

Introduction The article presents a case report and a brief literature review of an adverse event of brachial plexus injury associated with prone positioning in spinal surgery. The purpose was to report a case of bilateral brachial plexus injury after correction of Scheuermann's kyphosis. Material and methods Reported is a case of brachial plexus injury in a patient with Scheuermann's kyphosis after surgical correction. Results The patient could completely regain motor function of the left limb at 6 months with palsy scored 3 proximally retained in the right hand. Discussion The literature describes three pathophysiological conditions that predispose to brachial plexus injury in the postoperative period: sprain, compression, and ischemia. The adverse event is reversible in most cases and recovery depends on the degree of neurological deficit at an early stage. Recommendations are offered for surgeons and anesthesiologists to avoid the occurrence of the complication or take timely measures to alleviate the consequences. Conclusion Upperlimb somatosensory evoked potentials, a part of neurophysiological monitoring can be practical for prevention of the complication. Prevention of brachioplexopathy should be part of perioperative care.

Objective. To determine the values of Hounsfield units (HU) of the lumbar vertebrae predicting unsatisfactory radiological results of circumferential interbody fusion at the lumbar level. Material and Methods. The data of patients who underwent a single-level decompression and stabilization intervention at the L4–L5 or L5–S1 level for degenerative diseases of the spine were analyzed. The CT images of the lumbar spine were assessed before surgery with the measurement of HU values of the vertebral bodies at the intervention level, as well as CT images one year after surgery to evaluate the degree of interbody block formation and subsidence of the cage. Three groups of patients were distinguished: patients with a formed interbody bone block and without cage subsidence (control group), patients with failed fusion and patients with cage subsidence. Results. The study presents CT data of 257 patients. The incidence of non-union was 32.3 % (83/257), and of cage subsidence – 43.6 % (112/257). The proportion of patients with reduced bone mineral density (BMD) was 26.1 % (67/257). Patients with non-union and subsidence had higher ODI scores (p = 0.045 and p = 0.050, respectively) compared to controls. The presence of fusion failure and subsidence is associated with reduced BMD (p < 0.05), HU values of vertebrae (p < 0.05), and higher ODI score (p < 0.05). According to the ROC analysis, threshold HU values were determined equal to 127 HU, 136 HU and 142 HU for the L4, L5, S1 vertebral bodies, respectively. Upon reaching these values, the risk of a combination of fusion failure and subsidence increases significantly (p = 0.022). Conclusions. Patients with non-union and cage subsidence have less satisfactory clinical outcomes. The HU values of the vertebral bodies equal to 127 HU, 136 HU and 142 HU for the L4, L5, and S1, respectively, are advisable to use in practice to predict non-union and subsidence after a single-level decompression and stabilization intervention at the lower lumbar levels.

Objective. To analyze clinical and radiological results of corrective fusion in the lumbar spine in the treatment of patients with sagittal imbalance after previous surgical interventions. Material and Methods. A retrospective monocentric study, clinical case series. The data of 18 patients operated on using a combination of surgical methods with obligatory anterior corrective fusion at the L4–L5 and/or L5–S1 levels to achieve optimal parameters of the sagittal balance disturbed or developed after previous interventions were analyzed. Clinical and radiological parameters were assessed during hospital stay and at least 10 months later. Results. The study presents data from 3 (16.7 %) men and 15 (83.3 %) women with an average age of 57.5 ± 9.1 years. Average length of hospital stay was 26.9 ± 10.1 days. In 7 (38.9 %) cases, the deformity occurred at the previously operated level and in 11 (61.1 %) – at the adjacent one. The duration of surgery was 481.4 ± 101.7 minutes, and blood loss was 1028.9 ± 594.9 ml. Back and leg pain VAS scores decreased in 10–19 months after surgery from 6.4 ± 0.9 and 4.8 ± 1.3 to 3.2 ± 1.2 and 0.9 ± 0.8, respectively (p < 0.001). The ODI score decreased from 59.6 ± 5.9 to 39.9 ± 7.7 (p < 0.001). The ideal Roussouly type was restored in 11 (61.1 %) cases, below ideal – in 3 (16.7 %), and overcorrection – in 4 (22.2 %). LL increased from 48.1 ± 13.6 ° to 56.9 ± 11.6 ° (p < 0.001), and LDI – from 40.1 ± 16.9 to 58.8 ± 10.3 (p

Objective. To analyze the influence of sagittal balance parameters on the risk of dislocations of the head of the femoral component of the hip joint endoprosthesis. Material and Methods. A retrospective analysis of medical records of 113 patients with idiopathic coxarthrosis who underwent unilateral total hip arthroplasty was performed. The study assessed the parameters characterizing the sagittal balance in patients without prosthet- ic femoral head dislocation in the postoperative period (Group 1; n = 60) and in patients treated for prosthetic femoral head dislocation (Group 2; n = 53). Comparison of indicators was carried out by non-parametric Mann – Whitney U-test, and identification of dislocation predictors – by building single- and multi-factor logistic regression models. Differences were considered statistically significant at the achieved significance level p < 0.05. Results. In Group 1, the type 3 sagittal balance according to Roussouly prevailed (48 %), in Group 2 – types 1, 2 and 4 (75 %). In patients with types 1 and 2 sagittal balance, the dislocations of the prosthetic femoral head occured 1.84 times more often than in patients with type 3, and that in patients with type 4 – 1.66 times more often. Conclusion. Patients with Roussouly type 3 sagittal balance have significantly lower risks of postoperative dislocation of the prosthetic femoral head, as compared with those with types 1, 2 and 4.

Objective. To analyze the effect of denervation of intervertebral discs in the cervical spine on the results of surgical treatment of patients with injuries to rotator cuff tendons of the shoulder joint. Material and Methods. Study design: descriptive hypothesis-generating study. The study included patients requiring surgical treatment of rotator cuff tear. Two groups were identified: Group A included 28 patients who underwent plastic repair of rotator cuff tear with additional denervation of intervertebral discs, and Group B – 30 patients who underwent only plastic surgery for rotator cuff tear. The intensity of pain according to the VAS, functional activity due to neck pain (NDI), functionality of the shoulder joint (UCLA), and the degree of intervertebral disc degeneration according to MRI were assessed, and the effectiveness of treatment was determined. Statistical calculations were performed using the RStudio program. Results. In the group of patients with denervation of intervertebral discs, a more pronounced decrease in the intensity of pain syndrome at 3, 6, and 12 months (p < 0.001; p < 0.001; and p = 0.002), a more proportion of effectively treated patients at 3 months (p = 0.003), and significant increase in functional activity according to NDI at 3, 6 and 12 months of follow-up period (p < 0.001; p = 0.010; and p = 0.045) were observed. Conclusions. There is an underestimation of the role of degenerative cervical spine pathology in the occurrence of shoulder joint pain. In the case of rotation cuff plasty the additional denervation reduces the intensity of pain syndrome in the shoulder joint in the postoperative period.

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 (= 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 the early clinical and radiological outcomes of lumbar spine fusion in patients with degenerative sagittal imbalance. Material and Methods. The data of 45 patients who were operated on sequentially using a combination of surgical methods for vertebrogenic pain syndrome and (or) neurological deficit and who had a violation of the sagittal balance of degenerative origin were analyzed. All patients underwent anterior spinal fusion at the L4–L5, L5–S1 levels to correct and restore lower lumbar lordosis. The next stage was decompression through posterior approach, if necessary supplemented by interbody fusion at clinically significant lumbar levels above the L4–L5 segment. In all patients, surgical treatment was completed with screw transpedicular fixation at the levels of interbody fusion. Demographic, clinical and surgical data, and radiological parameters were evaluated. Results. The study included data from 6 men and 39 women with an average age of 58.9 ± 7.8 years. Duration of hospital stay was 27.1 ± 7.4 days. The primary surgery was performed in 33 (73.3 %) patients, and the reoperation for pain recurrence after previous surgery at the same lumbar level – in 12 (26.7 %) patients. The duration of surgery was 529.8 ± 117.8 min, the blood loss was 1130.4 ± 560.1 ml. Back and leg pain VAS score decreased after surgery from 6.7 ± 0.9 and 4.7 ± 1.4 to 3.3 ± 0.9 and 0.5 ± 0.6, respectively (p < 0.001). The ideal sagittal type according the Russoly’s classification was restored in 27 (60 %) cases, that below the ideal – in 9 (20 %), and hypercorrection was in 9 (20 %). PT decreased from 26.1° ± 5.7° to 17.4° ± 3.9° (p < 0.001) and SVA – from 6.7 ± 3.5 to 2.7 ± 2.3 cm (p < 0.001). LL increased from 36.3° ± 18.5° to 55.1° ± 11.8° (p < 0.001) and Low LL – from 13.5° ± 9.8° to 37.9° ± 8.2° (p < 0.001). According to GAP, the number of patients with severe and moderate imbalance was reduced (p < 0.001). Surgical complications were observed in 26 (57.7 %) patients. Conclusion. The multi-stage surgical treatment of patients with degenerative spinal deformities using corrective fusion in the lumbar spine significantly improves parameters of the spinopelvic and global sagittal balances in the early postoperative period.

Objective. To analyze the features of the sagittal spino-pelvic balance formation in patients with congenital hip dislocation and its changes after total hip replacement with restoration of the rotation center. Material and Methods. A retrospective analysis of medical documentation of 47 patients with congenital hip dislocation was performed, a total of 62 total hip replacements were performed. Patients were divided into two groups: Group I with unilateral congenital hip disloca- tion (n = 26) and Group II – with bilateral hip dislocation (n = 21). The processing and study of statistical correlation were carried out using the Spearman method at p ≤ 0.05. Results. Patients with congenital hip dislocation had average preoperative value of the global lumbar lordosis of 64.1°, and the excess value of the sacral slope angle of 46.4°, which led to hyperlordosis. After surgery, the average value of the global lumbar lordosis was 57.2°, the sacral slope – 41.5°. There was a close relationship between these parameters (r = 0.787). Conclusions. Restoration of the hip rotation center in patients with congenital hip dislocation contributes to a decrease in the sacrum incidence, pelvic anteversion, and lordosis.

The paper describes a method for three-dimensional printing of сustom-made interbody cages accounting for biomechanical parameters of the intervertebral disc (anteroposterior size, anterior and posterior disc heights), which provides the implant with unique characteristics. An example of using custom-made cages providing optimal conditions for the formation of interbody bone-metal block due to the extra tight fit of the combined implant is given. It is shown that custom-made cages have a beneficial effect on the spine support recovery time, significantly reduce the surgical injury, and shorten the time of surgery. The manufacturing of each developed implant which has its own form and architecture is not a serial but a piece production not requiring additional registration procedure. The use of custom-made spinal cages allows optimizing the process of surgical treatment and improving short- and medium-term results.

Objective.To analyze the features of surgical treatment of children and adolescents with herniated discs and radicular compression symptoms. Material and Methods. A retrospective multicenter study of 34 patients with juvenile osteochondrosis with mean age of 15.4 years was performed. Surgical treatment included disc puncture methods, microdiscectomy through posterior approach, anterior discectomy, dy- namic and rigid stabilization, and replacement of the fibrous ring defect. Results. Positive clinical effect with complete relief of pain was achieved in all cases. Paretic syndrome regressed completely in all patients. All patients regained the level of physical activity in the next 2–3 months. Long-term follow-up was on average 45.5 months. No recurrence of pain was noted during the follow-up period. Conclusion. Surgical treatment of disc herniation in children results in the relief of pain and full functional recovery. Among surgical methods, a preference should be given to microdiscectomy through minimally invasive surgical approaches. In the presence of indications, both rigid stabilization of spinal motion segment at the level of decompression and dynamic stabilization can be performed, and the lat- ter is more preferable.