The aim of the study was to assess the efficacy and safety of direct posterior transpedicular osteosynthesis in traumatic spondylolisthesis of C 2 vertebra. Materials and Methods The present study is an observational retrospective analysis of the results of surgical treatment of 19 patients operated on in 2014–2020 using the posterior transpedicular osteosynthesis technique with Herbert’s compression screws for a Hangman’s fracture type II according to Levine–Edwards classification. After the operation, the follow-up period lasted for 22 [10; 36] months. Results The study group of patients (n=19) made 2.48% of all patients operated on for traumatic injury of the cervical spine (n=766) in the period from 2014 to 2020. In all cases, the surgical treatment was successful; there were no intraoperative complications in the form of damage to the vascular and nerve structures. The average duration of surgery was 70.8±24.5 min, and intraoperative blood loss was 92.9±41.8 ml. The length of hospitalization stay was 7 [5; 17] days. On the postoperative CT scans, no significant screw malposition (>2 mm) was found. Conclusion Transpedicular osteosynthesis with compression screws in C 2 traumatic spondylolisthesis is a safe and sparing operation with a short duration and insignificant blood loss. Thorough preoperative planning and knowledge of the anatomic landmarks make it possible to perform this operation effectively under the C-arm X-ray system control without any navigation system.

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.

Aim. To determine the clinical effectiveness of anterior stabilization in the surgical treatment of patients with traumatic injuries of the thoracic and lumbar spine with reduced bone mineral density. Materials and methods. The study included 238 patients with thoracic and lumbar vertebral fractures with reduced bone mineral density (BMD). The age of patients is from 48 to 85 years. There are following types of fractures according to F. Magerl (1992): A1.2, A1.3, B1.2, B2.3. BMD of the vertebrae was decreased (T-score from 1.5 to 3.5). Results. All patients underwent short segment transpedicular fixation (TPF) with four-screw systems. In group 1 were included 68 patients who underwent TPF without cemented augmentation of screws. Group 2 included 170 patients who underwent TPF reinforced with a cement. Both groups were divided into 2 subgroups. Subgroup 1.1 included patients, which were operated on in two stages. The first stage is TPF. The second stage is the anterior stabilization. Subgroup 1.2 included patients who underwent only TPF. Patients in group 2 were divided into two subgroups in a similar way. The results and complications according to clinical and spondylometric criteria were studied. Correlation analysis was performed between surgical technique, surgical tactics and the treatment results in the four selected subgroups. The observation period is at least 2 years. Conclusion. 1. When using TPF with cement augmentation for the treatment of patients with fractures of the thoracic and lumbar spine with reduced BMD, the anterior stabilization of injured spinal motion segment as a second stage of surgical treatment does not provide clinical advantages compared to the use of only TPF with cement augmentation. 2. In case of cementless TPF in patients with reduced BMD, anterior stabilization of the injured spinal motion segment is necessary. Only when anterior stabilization is performed, the stability of fixation is ensured. It is sufficient to preserve the anatomical relationships restored during the operation and functional adaptation of patients in the long-term period after surgery.

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre & Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (>2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.

Objective. To analyze dynamics of vertebrogenic pain syndrome and quality of life after transpedicular decompression in patients with depressed fractures of the thoracic and lumbar spine.Material and Methods. An observational prospective pilot study included 10 patients with AO Spine type A1 fractures of the thoracic and lumbar spine operated on in 2020–2021. All patients underwent transpedicular decompression. Severity of pain syndrome according to VAS, ODI score, and the magnitude of apical kyphosis were studied in the preoperative period and at 3 day, 1, 3, 6 and 12 month postoperative follow-up.Results. The age of patients was 35–70 years (median 46). The ratio of men and women was 1 : 4. By localization, the fractures were distributed as follows: T10 – 1 patient (10 %), T11 – 1 patient (10 %), L2 – 2 patients (20 %), T12 – 3 (30 %) and L1 – 3 patients (30 %). Statistically significant regression of pain syndrome according to VAS from 9.5 (7.3; 10.0) to 2 (1.0; 2.0) scores during the year (χ2 = 35.5, df 4, p < 0.001) was observed. Noteworthy was a rapid regression of the pain syndrome 3 days after decompression from 9.5 (7.3; 10.0) to 4.5 (4.0; 6.0) and a decrease of ODI score and improvement in the quality of life of patients from 69.0 (58.5; 82.0) to 9.0 (4.8; 10.8):  χ2 = 36.8, df4, p < 0.001. During the follow-up period, an increase in the Cobb segmental angle from 5.3º°(4.1°; 6.7°) to 9.7°(8.4°; 12.5°) (p = 0.005) was observed in all patients. However, this did not affect the intensity of back pain or the quality of life of patients. Newly occurring fractures, Kümmel’s disease and postoperative complications were not identified. Instrumental diagnostics revealed spontaneous fusion at the fracture level during the first year after transpedicular decompression in all cases.Conclusion. Transpedicular decompression is an effective, safe and pathogenetically substantiated method of treating vertebrogenic pain syndrome associated with spinal fracture.