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The paper summarizes the results of surgical treatment in 25 patients with atlantoaxial spondylitis, including 15 with spondylitis of tuberculous etiology and 10 with nonspecific etiology. Ten patients were found to have severe neurological disorder requiring application of skeletal traction behind the malar arches in 5 cases and that of a halo-apparatus to 2 cases in order to eliminate the occurred dislocation and to relieve neurological symptoms. According to the P. Denis concept adapted for the craniovertebral region, all the patients were divided into 3 groups in relation to the degree of anatomic and biomechanical changes. Group 1 patients received medical treatment with firm collar fixation. Group 2 patients with anterior pillar injury underwent transpharyngeal sanitation of an infectious focus and occipitospondylodesis. Decompressive stabilizing operations were performed in all the patients, which consisted of two stages: 1) occipitospondylodesis made, by using a titanium wire and No. 91/198 Simplex bone cement (Howmedica, United Kingdom); 2) transoral access with abscess cavity sanitation; removal of necrotic tissues; thrifty resections of bone tissue portions within the intact tissues; anterior stabilization of the affected portion with an autologous bone graft. Postoperatively, the cervical spine was fixed with a head holder for as long as 3-5 months (until there were clear X-ray signs of bony ankylosis (block) in the area of osteoplasty). Quaternary antituberculous therapy was compulsorily made for 6-9 months. The described procedure for surgical treatment of craniovertebral spondylitis could yield positive results in all cases, by abolishing neurological symptoms and forming bony ankylosis in the atlantoaxial area to restore the supporting capacity of the cervical spine.

To evaluate the effectiveness of rehabilitative measures, comprehensive studies have been conducted in 37 patients with sequels of tuberculous and nonspecific gonitis, who underwent primary total endoprosthetic repair of the knee joint with an Osteonics-7000 cement fixation prosthesis (USA) in 1996 to 2002. After discharge from hospital, 18 patients received a complete course of rehabilitation, 19 patients refused it for different reasons. The results were assessed just after completion of the course of rehabilitation (3 months after surgery), following 1 year and on the last examination (on the average 45.2 months later). Statistically significant advantages in the function of the knee joint and in the force of its extensors were observed in the group of patients undergoing a complete course of postoperative rehabilitation just after completion of the course and a year after surgery. The last examination revealed a great difference between the patients who had undergone a complete course of rehabilitation and those who had refused it.

The paper presents the results of endoprosthesis of the hip joint in 6 patients with destructive tuberculous coxitis. In 2 patients, the process was bilateral. All the patients received preoperative antituberculous therapy with 3-4 drugs (isoniazid, rifampicin, pyrazinamide, streptomycin) for 14-12 weeks. Within the first 6 weeks, isoniazid and rifampicin were given intravenously. A clinical stabilization was achieved in all cases, which permitted total endoprosthesis of the hip joint. In postoperative period, the patients began to be active on days 10-12 of antituberculous therapy that lasted as long as 6 months in their local dispensary. The follow-ups of the patients ranged from 1 to 5 years. The support capacity and function of the joint operated on were recovered in all cases. There was no recurrence of a tuberculous process at the site of endoprosthesis. Thus, the developed tactics of preoperative preparation and post-operative management permits endoprosthesis of the hip joint in patients with destructive tuberculous coxitis and recovery of articular support capacity and function. At the same time it is necessary to define clinical indications for this operation in each specific case.

The paper analyzes endoprosthesis of the knee joint in sequelae of tuberculous gonitis in 19 patients and in 10 patients after nonspecific gonitis. The patients' age was 32 to 73 years. Clinically, all the patients third- and fourth-degree gonarthrosis with significant pain and a 15-25 degrees restriction of articular function. X-ray and computed tomographic data indicated destructive changes in the condyles of the femur and tibia, osteoporosis, cysts and cavities, these are typical residual sequelae of sustained tuberculous gonitis. In all cases, endoprosthesis of the knee joint was made by using Johnson-Johnson and Osteonix prostheses. Clinical and functional assessments showed that excellent and good results were obtained in 17 (58.6%) patients, satisfactory results were seen in 11 (37.9%). In one case there was a poor outcome with fibrous contracture of the knee joint after prior nonspecific gonitis with valgus deformity.

The paper deals with surgical treatment in 452 patients with tuberculous spondylitis. The process involved the cervical, thoracic, thoracolumbar, and lumbar parts in 40 (8.8%), 185 (41.0%), 75 (16.8%), and 11 (2.5%) cases, respectively. The active process was found in 125 (27.6%) patients, its loss was detected in 131 (29.1%) cases; the process abated in 196 (43.3%) patients. There were its complicated forms in 341 (75.4%) patients, para- and prevertebral abscesses in 183 (40.4%), epidural abscesses in 26 (5.6%), pareses and paralyses in 71 (15.7%), fistulas in 38 (8.4%), and membranous symptoms in 23 (5.1%). The diagnosis of tuberculous spondylitis was established up to month 3, in 109 (24.1%) patients, up to month 6 in 208 (46.0%), at months 9-12 in 74 (16.4%), at month 12-18 in 61 (13.5%). The concomitant tuberculous involvement of the lung, pleura, kidneys, joints, lymph nodes, and genitals was observed in 139 (30.7%) patients. The resistance of Mycobacteria tuberculosis to antituberculous drugs (streptomycin, isoniazid, and rifampicin) was detected in 139 (30.7%) patients. Of them, 40 (28.8%) patients were unresponsive to two drugs or more. This group of patients received a combined therapy with lomefloxacin and mycobutin on an individual basis. Surgery was made in all the patients; posterior approaches were applied to 44 (9.7%) patients, in 368 (81.4%) anterior approaches were applied to extrafocal apparatus fixation in combination with autograft corporadesis (n = 70), in combination of an autograft and a biocompatible implant with benemycin application (n = 298). The use of these new technologies may expand the scope of operability, reduce surgical traumaticity, initiate early (at day 7-12) rehabilitation of patients, achieve good and satisfactory clinical and functional results by months 4-8 in 81.1% of cases.

The paper summarizes the outcomes of surgical treatment in 6 patients with nonspecific and tuberculous spondylitis of the craniovertebral area. These patients underwent decompressively stabilizing operations that consists of two steps: at first occipitospondylodesis was performed with a wire and protacryl then via transpharyngeal access with sanitation of the abscess cavity, by removing necrotic tissues--a saving resection of bony tissue sites within the healthy tissues, anterior stabilization of an affected part with an osseous autograft. The above procedure of surgical treatment along with bactericidal therapy yielded positive results by recovering spinal cord function, by forming a bony unit at the site of spinal inflammatory lesion.

The case histories of 452 patients with tuberculous spondylitis whose age ranged from 20 to 78 years are analyzed. The site of the process is given by the portions of the spine. Different events occurring in 40.4% of the patients are outlined. A correct diagnosis was established only in 24.1% of the patients in the first 3 months of the onset of a disease. It required a longer time in the remaining patients and this amounted to over 12 months in 13.5%. In the preoperative period, all the patients received chemotherapy in terms of the sensitivity of a causative agent. Surgical treatment involved resection of a vertebral lesion area and replacement of vertebral bodies with an autograft or an implant. Chemotherapy was continued in the postoperative period.

The paper analyzes the outcomes of surgical treatment in 19 patients with tuberculosis of the cervical part of the vertebral column. All the patients had surgical treatment: abscessotomy, sparing resection of a destruction area, decompression of the spinal cord, removal of kyphotic deformity by restoring the axis of the vertebral column. The existing defect was filled with an autograft in 7 cases, with a biocompatible implant by applying benemycin to its surface in 12 cases. Posterior fixation of the diseases part of the spinal apparatus was made in 8 cases. Good outcomes were followed up 8 months to 7 years after surgery. At X-ray study, the bony block formed between the resected vertebral bodies within 3 to 7 months. Neurological symptoms were arrested in all cases, except 4 ones. One patient was found to have a slight lower extremity weakness and 3 patients had correctable radicular symptoms.

The paper analyzes total endoprosthesis of the hip joint due to tuberculous coxitis sequelae in 54 patients. Two patients underwent bilateral endoprosthesis. Histological findings confirmed the tuberculous etiology of prior coxitis and provided the policy of pre- and postoperative antituberculous therapy. The supportability and function of the joint recovered 3-4 months after surgery. Arthralgia occurred in 2 patients 4 and 5 years following surgery. In sequelae of tuberculous coxitis, hip joint endoprosthesis by the procedure developed in the clinic yielded good results.

Endoprosthetic surgery on the head of the femur to correct aftereffects of tuberculous coxitis has been conducted in 23 patients. A combined preoperative preparation implying normalization of external respiration and cardiovascular function, x-ray examination of the proximal femur and cotyloid cavity specified indications for endoprosthetics, method of the pedicle fixation and the scope of the intervention. 6-month to 8-year outcomes are available. Overall functional results are satisfactory: all the patients but 2 (aged 64-66, underwent unipolar endoprosthetics) could walk without support.

The paper deals with the experimental and clinical study of a new implantable therapeutical means based on biocompatible implants containing the antituberculous agent benemycin. The developed implantant having 4 coatings releases within 10 days as high as 37% of the applied drug benemycin. Then within further 30-70 days, release of the drug is 0.7% a day. The parallel bacteriological studies with the operative material placed in agar made 30-60 days after surgery have indicated that growth retardment in rabbits is 17-30 mm, which corresponds to the levels of rifandin (0.125-1.0 microgram/g tissue. The developed implantant has been used in 130 cases of the surgical treatment of tuberculous spondylitis in order to replace a defect of the body of a vertebra and to make a depot for the antituberculous drug just in the focus. Formation of the pulley at the site of intervention was noted in 57 (43.8%) cases within 5 months and in 62 (47.7%) cases within 10 months. The developed implantant has no toxicity and produces no allergic reactions. The position results of the treatment allows it to be recommended for use in clinical practice.

The analysis of 30 cases of intraoperative autohemotransfusion performed in surgical treatment of destructive pulmonary spondylitis demonstrated that such transfusions with controlled hemodilution provide uncomplicated anesthesia, stable hemodynamics in reduced quantities of donor blood.

The author summarized the data on experimental application of biocompatible implants IIIIIM-1 covered with benemycin as a treatment modality in spondylitis. The polymer implanted into the disease focus is able to maintain high concentration of the drug for 60 days. The implants were inserted in 120 tuberculous and 27 nonspecific spondylitis patients. Surgical intervention performed in 147 patients comprising radical resection of the destruction focus and vertebral defect replacement with biocompatible implant in combination with extrafocal apparatus fixation decreased the operation trauma++, secured stability of the anterior and posterior parts of the operated spine and allowed early active rehabilitation of postoperative patients, 2-3 months after the surgery the author observed good spinal stabilization and definite signs of clavus formation in the resection zone.

Causes responsible for invalidity were analysed in 167 patients with a circumscribed form of tuberculous spondylitis. The causes were divided into 4 groups: diagnostic errors; errors in treatment; prognostic errors (late indications to surgical treatment); organizational errors. Heightening of the quality of early diagnosis of tuberculous spondylitis at a primary application to a medical institution and timely high-quality specific therapy in the antituberculous institutions will contribute to an increase in treatment effectiveness and invalidity reduction.

A total of 78 cases with acute hematogenic vertebral osteomyelitis are analyzed. Diagnostic errors at the prehospital and hospital stages are specified in 42 cases (53.8 percent), that resulted in late start of adequate treatment. Preoperative antibacterial therapy was carried out 1 to 1.5 months before surgery consisting in radical resection of the focus with replacement of the defect with autotransplant and extra-focal++ fixation with Byzov's apparatus. After surgery the patients started exercises on days 5-10. This treatment resulted in formation of osseous block at the site of vertebral body resection in 3-4 months in 30.8 percent of cases, in 5-6 months in 57.7 percent, and in 10-12 months in 11.5 percent of patients.

Analysis of treatment of 123 patients with disseminated forms of tuberculous spondylitis is presented. Among the patients 67 (54.4%) subjects were over 55 years of age. The main cause of disseminated spondylitis forms was ungroundlessly prolonged conservative treatment under bed regime. As a result, symptoms of low cardiac activity were seen in 79 (64.2%), lymphovenous stasis in 22 (17.8%) and osteoporotic signs in 38 (30.8%) patients. Complications and concurrent diseases in 41 (33.3%) of the cases prompted surgery from the posterior approach, in 82 (66.7%)--from the anterior approach with replacement of the defect by an autograft or biocompatible implant with extrafocal posterior fixation of the operated segments by Byzov's apparatus. The patients became active beginning on days 7-12 of postoperation, which promoted reparative process normalization in the operative area. The late therapeutic results were studied in 117 patients. Support capacity recovered in 99 patients and improved in 18. The method used is functionally justified, well tolerated by patients and highly effective in treating the abnormality.

The complex procedure for treating tuberculous spondylitis involving a short-term (1-2 months) antibacterial therapy and early functional resection of the diseased vertebral bodies with defect replacement by an autograft and extra-focal fixation of the resected spinal portion by Byzov's apparatus applied in 492 patients proved to be highly efficacious. The reliable apparatus fixation of the spinal zone operated on allows early (on day 7) activation of patients which promotes functional normalization of organs and systems, activation of reparative processes, shortening of treatment duration and reduction of disabled cases. Clinical and X-ray findings show that a bone block formed 4-6 months after surgery and 67% of the patients finished their therapy during a year. Introduction of the procedure into the treatment of spinal injuries and diseases will be of the socioeconomical value.

The authors analyze the results of treatment of 358 patients with specific and nonspecific spondylitis and with aftereffects of unstable fractures of the vertebrae proper, who have been operated on the spine destruction or instability area with the extrafocal fixation of the operated on segments by means of the Byzov apparatus. This method has yielded good clinical and functional results, effected the stability of the anterior and posterior portions of the operated on sites; it permits early (starting from the 5th-10th day postoperation) exercise of the patients, helps normal functioning of the body organs and systems, and activates the repair processes in the operated on sites. The incidence rate of the postoperative complications drops drastically, the patients rapidly recover their working abilities, and the invalidism is more rare.

An experience with the treatment of 27 patients with hematogenic osteomyelitis of the spine is presented. Seventeen of the patients have completed the treatment and began working, 7 patients are invalids of the II or III groups, 3 patients still continue their treatment.