[Necessity of development of Russian vertebrologic registry].

Development of national and international registers for the most socially significant diseases is an important problem of contemporary medicine. Importance and priority of vertebrological register is explained by relatively young age of spinal neurosurgery as specialty, in which many questions concerning indications and optimal methods of treatment remain unsolved, and accumulated experience is quite limited. Nevertheless, vertebrology is on the way from opinions of certain experts to evidence-based scientific proofs. This transition needs generally accepted and convenient instruments for assessment of outcomes of treatment and procedures which should be presented by national vertebrological register. Aims of its development include accumulation of clinically valuable resources and knowledge in vertebrology by means of organization of society of interested professionals and patients. The paper discusses architecture, contents and importance of development of Russian vertebrological register targeted on neurosurgeons, orthopaedic surgeons, vertebrologists and other specialists dealing with this problem. Foreign vertebrological registers are analyzed, their advantages and disadvantages are summarized, requirements for inclusion of criteria in the register are investigated.

[Operative treatment of severe spine deformities].

87 patients with scoliosis, 32 cases with kyphosis of a various etiology were operated. Patients with severe scoliotic deformations (the total angle 75-140 [Russian character: see text]) got 2 types of the treatment. The first group consisted of 18 patients who were operated in two-stage surgery during the same anesthesia. In the second group (69 patients) after anterior diskectomy within 10-20 days preliminary correction of deformation with halo-pelvic traction was carried out followed by main stage of operation the final dorsal correction of deformation with Cotrel-Dubousset instruments. A significant (more than 40%) correction of deformation was achieved in both groups. However in the 2nd group the value of main angle exceeded 90 [Russian character: see text]. There were operated 32 patients with severe kyphotic deformities. Out of them 15 patients had severe posttraumatic vertebral kyphotic deformations (dislocation fractures of III-IV type according to Denis classification), 11 cases had--postlaminectomy kyphoses, 6 patients suffered from Scheuermann-Mau's disease. The patients with dislocation-fractures underwent laminectomy, reposition of dislocation, and transpedicular fixation of the vertebral column. In 14 patients dislocation was reduced completely, in the one case partially, but in all cases stable spondylosyndesis was achieved. In 8 patients dislocation-fractures were complicated by paraplegia or rough paraparesis), the 3 cases showed practically entire regress after operation, in the 5 cases no evident improvement in the neurologic status occurred. Patients with postlaminectomy kyphoses were treated with wedge vertebrotomy at the top of a curve, dorsal correction and fixation of the vertebral column with CDI system. In the 4 cases there was noted significant improvement in the neurologic status. Patients with Scheuermann-Mau's kyphosis were treated with anterior multilevel diskectomy, followed by halo-pelvic traction, and later dorsal correction of deformation with CDI system. Treatment resulted in significant correction of deformation was achieved and physiological or close to physiological sagittal profile of spine was restored.

[Tactics of surgical treatment for an inflammatory process of C0-C(I)-C(II) segments in the craniovertebral joint instability].

Pathological processes of C0-C(I)-C(II) segments, such as the clivus, atlas arch, dens, and body of the C, vertebra pose major problems for diagnosis and treatment. On removal of a sizable pathological focus, there may be instability of the craniovertebral segment, secondary displacement, and spinal compression syndrome. Therefore these patients frequently need stabilization of the craniovertebral transition. Patients with initial instability of the craniovertebral junction and subluxation of C(I)-C(II) segments are an intricate problem. The authors describe a rare case of an inflammatory process of C0-C(I)-C(II) segments with craniovertebtal junction instability. A differential diagnosis was made between chordoma, osteoblastoma, and an inflammatory focus at the above site. The following tactics was undertaken: the first stage was occipitospondylosynthesis with "Vertex" system with osteoplasty under Halo-traction; the second stage included transoral removal of a pathological removal of the dens and body of the C(II) vertebra, left lateral mass of the CI vertebra, and lower clivus. After removal of the pathological focus, there were portions of the abnormally changed bone with rarefaction without tumor tissue. Histologic studies revealed the signs of a chronic inflammatory process. A five-month follow-up showed that neurological symptoms and craniovertebral junction instability regressed. The control computed tomography made 5 months after surgery demonstrated the radical elimination of the pathology and the absence of C, vertebral subluxation. Thus, there is evidence for the tactics of successive operations (a stabilizing operation--posterior occipitospondylosynthesis (desirably under Halo-traction), followed by removal of a pathological focus via transoral access) in pathological processes of the craniovertebral C0-C(I)-C(II) in cases of initial craniovertebral junction instability.

[Vascular disturbances in craniovertebral pathology in children and adolescents]. / Sosudistye narusheniia pri kraniovertebral'noi patologii u detei i podrostkov.

The peculiarities of craniovertebral abnormalities and dysplasias in children and adolescents have been studied. Different diagnostic methods (dopplerography of spinal arteries, ultrasonography, remote infrared thermography, laser doppler flowmetry, etc) were compared. The outlines for treatment the patients with cervical dysplasias are described.

[Diagnosis and treatment of paretic forms of lumbar osteochondrosis]. / Diagnostika i lechenie pareticheskikh form poiasnichnogo osteokhondroza.

This study was based on the analysis of the results of examination and treatment of 85 patients with lumbar osteochondrosis with paretic disturbances. The degrees of neurological disorders were analyzed by distributing these patients into three groups including patients with monoradicular, polyradicular motor disorders and circulatory disturbances in the caudal portions of the spinal cord. The informative value of the performed techniques (X-ray study, MRI, myelography, myelography with computed tomography, electroneuromyography) and the necessity of their combination for increasing the quality of diagnosis were determined. Criteria for choosing this or that treatment were defined. Indications for surgery, the time of its performance, and its efficiency were investigated. Surgical outcomes were analyzed by the groups of patients. The paper shows it necessary to use metallic fixing devices in some cases in order to stabilize an altered segment degeneratively, which allows improve the outcome of a surgical intervention. Postoperative rehabilitative treatment is also outlined.

[Halo-traction efficacy in surgery on the cervical spine]. / Effektivnost' galotraktsii v khirurgii sheinogo otdela pozvonochnika.

The paper deals with the use of a halo-apparatus in lesions and diseases of the cervical vertebra. The halo-apparatus was used in 70 patients. It was most commonly employed in lesions of the upper cervical vertebra, such as fractures of the odontoid process and C2 vertebral arches. Analyzing the clinical findings showed halo-traction to be highly effective.

[The pathogenesis of elevated intracranial pressure in children and adolescents with craniovertebral pathology]. / O patogeneze povysheniia vnutricherepnogo davleniia u detei i podrostkov pri kraniovertebral'noi patologii.

The paper deals with intracranial hypertension in children and adolescents. Thirty-six patients with the upper cervical dysplasia and identified associated intracranial hypertension were examined. Magnetic resonance imaging and functional tests were used. Some patients were diagnosed as having a thickened ligamentous apparatus at the level of craniovertebral junction, which was a cause of spinal fluid dynamic disorders and led to elevated intracranial pressure.

[Diagnostic value of myeloscintigraphy in lesions and diseases of the spine]. / Diagnosticheskaia tsennost' mielostsintigrafii pri nekotorykh povrezhdeniiakh i zabolevaniiakh pozvonochnika.

Twenty-seven myeloscintigraphic examinations were carried out in 24 patients aged 6 to 66 with various diseases and involvements of the spine. Seven patients suffered from scoliosis complicated by neurologic symptoms, 2 from compression fractures of the L2 vertebra, 1 from a benign tumor of the spinal cord, 13 from various dislocations of the upper cervical segments of the spine, and 1 from a chronic fracture of the spinous process of C2 vertebra. Myeloscintigraphic examinations revealed different disorders of the spinal cord subarachnoidal space patency. The findings evidence higher diagnostic potentialities of myeloscintigraphy in a number of cases as against x-ray contrast myelography, for it permits the detection of patency disorders in the spinal subarachnoidal space, undetectable by x-ray contrast myelography.

[Atlanto-axial instability in injuries of the ligament system in children and adolescents]. / Atlantoaksial'naia nestabil'nost' pri povrezhdeniiakh sviazochnogo apparata u detei i podrostkov.

There has been carried out an experiment with 6 craniovertebral blocks with contrasting of the vertebral arteries and studying of the influence of different damages of ligamentous apparatus on blood flow in vertebral arteries. In all cases there has been discovered significant vertebrogenic influence. Experimental data have been corroborated with clinical material. There have been examined 31 patient with different damages of ligamentous apparatus of craniovertebral segment, with 21 of them has been detected significant vertebrogenic influence at ultrasound dopplerography of vertebral arteries.

[Functional computed tomography in the diagnosis of injuries to the ligamentous apparatus of the upper cervical spine in children and adolescents]. / Funktsional'naia komp'iuternaia tomografiia v diagnostike povrezhdenii sviazochnogo apparata verkhnesheinogo otdela pozvonochnika u detei i podrostkov.

Altogether 40 children and adolescents were investigated after injuries of the upper cervical spine using radiograms through the open mouth, functional radiograms of the cervical spine, and functional CT. Various injuries of the ligamentous apparatus of the upper cervical spine were revealed in 31 patients.

[Clinical aspects, diagnosis and surgical treatment of developmental anomalies of the cervical spine]. / Klinika, diagnostika i khirurgicheskoe lechenie anomalii razvitiia sheinogo otdela pozvonochnika.

The examination of 20 patients with abnormal cervical spine has identified Klippel-Feil disease in 12 of them, isolated vertebral synostoses of the cervical spine in 8. In 2 patients with Klippel-Feil anomaly neurovascular syndrome was reported which resulted from compression of the neurovascular bundle by extra cervical ribs. Indications to surgical treatment in Klippel-Feil disease are specified. The authors performed operations to correct the cosmetic defect and relieve compression of the neurovascular bundle in neurovascular syndrome.