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Neuromodulation via spinal stimulation is a promising therapy that can augment the neuromuscular capacity for voluntary movements, standing, stepping, and posture in individuals with spinal cord injury (SCI). The spinal locomotor-related neuronal network known as a central pattern generator (CPG) can generate a stepping-like motor output in the absence of movement-related afferent signals from the limbs. Using epidural stimulation (EP) in conjunction with activity-based locomotor training (ABLT), the neural circuits can be neuromodulated to facilitate the recovery of locomotor functions in persons with SCI. Recently, transcutaneous spinal stimulation (scTS) has been developed as a noninvasive alternative to EP. Early studies of scTS at thoracolumbar, coccygeal, and cervical regions have demonstrated its effectiveness in producing voluntary leg movements, posture control, and independent standing and improving upper extremity function in adults with chronic SCI. In pediatric studies, the technology of spinal neuromodulation is not yet widespread. There are a limited number of publications reporting on the use of scTS in children and adolescents with either cerebral palsy, spina bifida, or SCI.

Objective . To analyze anatomical and anthropometric parameters of vertebrae in children with Lenke type V idiopathic scoliosis using 3D-CT navigation. Material and Methods . The study included 15 patients aged 14-18 with thoracolumbar/lumbar idiopathic scoliosis of grades III and IV according to V.D. Chaklin. Anatomic and anthropometric features of the thoracic and lumbar vertebrae were assessed based on CT data in the navigation system. The total Cobb angle of the scoliotic curve, rotation of the apical and periapical vertebrae, external transverse and longitudinal diameters of the pedicles at the T 2 -L 5 levels, and the coefficients of asymmetry of vertebral bone structures were determined. Results . The angle of scoliosis ranged from 39.8° to 84.3° (average - 59.5°), the angle of rotation of the apical vertebra - from 17.7° to 50.5° (average - 34.6°). Anatomical dimensions of the transverse and longitudinal diameters of the pedicles on the concave and convex sides at the apex of a primary curve exceeded 4.0 mm. A strong correlation between the apical vertebral rotation, the Cobb angle, and the coefficient of asymmetry of longitudinal diameters of the pedicles of the apical vertebra was revealed. The coefficient of asymmetry of pedicle areas is an integral indicator of the severity of asymmetry in scoliosis. Conclusion . A different degree of asymmetry of the bone structures of the main arch apical vertebrae was revealed in the thoracic and thoracolumbar/lumber scoliosis.

STUDY DESIGN: Cohort study. OBJECTIVES: The objectives of this study were examination, observation and surgical interventions of pediatric patients with diastematomyelia, a rare congenital deformity of the spinal cord. SETTING: Spine surgery and neurosurgery clinic under ministry of health, the Russian Federation. METHODS: Twenty children (1–18 years of age) with diastematomyelia participated in this study. Diagnosis was based on subjects’ medical history, results of clinical examination, spine radiography in anteroposterior and lateral views, and neurophysiological examinations. Septum resection surgery was done in seventeen subjects. RESULTS: All the subjects had skin manifestations along the midline of the back. Neurological symptoms were noted in 17 subjects: paraparesis in 11, urinary incontinence in 2, monoparesis in 4, and spasticity in 2 subjects. Three subjects did not show any neurological deficit. Orthopedic examination revealed spinal deformities of various degrees of severity. In 4 subjects, partial restorations of neurological functions were observed; and in 1 subject, bladder incontinence developed after the surgery. CONCLUSIONS: Patients who have limb length discrepancy, congenital scoliosis, skin manifestations should be examined for the presence of diastematomyelia. Patients having neither neurological deficit nor orthopedic deterioration should be monitored, and in case of deterioration, surgical treatment should be reserved. We advocate for performing resection of the septum in patients with diastematomyelia prior to surgical correction of scoliosis or orthopedic correction of lower limb deformities.

Objective. To analyze anatomical and anthropometric parameters of vertebrae measured by a navigation system in children with thoracic idiopathic scoliosis. Material and Methods . A total of 20 patients aged 14-18 years with Grade 3 and 4 (according to V.D. Chaklin classification) right-sided thoracic idiopathic scoliosis were examined. Anatomical and anthropometric features of the thoracic and lumbar vertebrae were assessed using CT data in the navigation system. The total Cobb angle of scoliotic curve, rotation of apical and periapical vertebrae, external transverse and longitudinal diameters of the roots of vertebral arches at the T 2 -L 5 levels, and the coefficients of asymmetry of vertebral bone structures were determined. Results . The angle of scoliosis deformity ranged from 33.7° to 107.9° (mean: 61.4°), the angle of rotation of the apical vertebra - from 9.3° to 40.2° (mean: 21.09°). Positive correlation between the magnitude of scoliotic arch deformity and asymmetry coefficients of longitudinal diameter of the arch roots of the apical vertebrae was found. A pronounced asymmetry of right and left transverse diameters of arch roots of the T 3 -T 4 vertebrae, despite the absence of structural compensatory counter curve and torsional changes in these vertebrae. Conclusion . There are certain regularities and correlations between the type of idiopathic scoliosis and the absolute and relative values of vertebral parameters not only at the top of the curve, but also throughout the whole curvature arch.

Objective. To analyze specific features of thoracoscopic discectomy and results of its application in children with thoracic idiopathic scoliosis. Material and Methods. A total of 42 patients (33 females and 9 males) aged 13 to 18 years who had right-sided thoracic idiopathic scoliosis were operated on. All patients underwent one stage endoscopic discectomy with corporodesis through anterolateral approach, and posterior correction of the deformity with multiple-anchor instrumentation accompanied by intraoperative halo-tibial traction and followed by posterior local fusion. The follow-up period ranged from 6 months to 3 years. Results. Postoperative Cobb angle of residual scoliotic deformity was 10–20° as reported by X-ray study. Deformity correction was 79.9 ± 6.5 %. Patients were verticalized on the 3–6th days and discharged on the 8–10th days after surgery to outpatient treatment. The improvement or complete restoration of the trunk balance was achieved. The pain syndrome intensity was 6–7 scores. Conclusion. Indications for thoracoscopic discectomy are rigid curves less than 90 degrees and unfinished growth in a child. Application of endoscopic discectomy at the anterior stage of surgical intervention in patients with idiopathic scoliosis provided insignificant blood loss during discectomy, decreased intensity of postoperative pain syndrome, and improved cosmetic outcome after the surgery.

IntroductionThe bayonet congenital abnormality of cervical-thoracic spine was previously described as a rarest clinical case under the title “congenital upper spine spondylolisthesis ” (Tokgozoglu AM et all., 1994) or “congenital dislocation of the cervical spine” (Shintaki M et all., 2013) without detailed description of anatomy and principles of surgical treatment. Our series include analysis of 10 CTSI cases from 4 clinics.Material and MethodsClinical, X-ray, CT and MRI peculiarities of 10 patients aged from 1 year 8 mns till 15 years were analyzed. The repeated cervical-thoracic abnormality included antero-posterior and cranial-caudad shift of the spine into the cervical spinal canal. All patients had arcs dysplasia, but any case has a complete posterior segmental defects, MMC or split spinal cord syndrome.ResultsAccording to Frankel scale the neurological status was estimated as a type E in one patient, type D – in 4, type C - in 4 and type B in one, incl. two paraparesis and 7 tetraparesis cases. Cr...