To analyze results of surgical correction of spinal deformity using transpedicular instrumentation in children with idiopathic scoliosis. Material and Methods. A total of 106 patients aged 13 to 18 years with Cobb angle of 40º to 136º were operated on. Out of them 56 (52.8%) patients had Lenke I deformity, 23 (21.7%)-Lenke III, 15 (14.2%)-Lenke V, and 12 (11.3%)-Lenke VI scoliosis. Results. The deformity correction achieved after surgery was 48 % to 100 % in patients with Lenke I, 72 % to 100 %-with Lenke III, 81 % to 100 %-with Lenke V, and 75 % to 100 %-in patients with Lenke VI scoliosis. Derotation of the apical vertebra varied between 0 % and 77 % in Lenke I scoliosis, between 10 % and 79 % in Lenke III, between 9 % and 57 % in Lenke V scoliosis. In patients with Lenke VI idiopathic scoliosis the apical vertebra derotation was 10 % to 58 % in the thoracic spine and 7 % to 50 % in the lumbar spine. Extension of the fixation region ranged from 10 to 14 vertebrae in Lenke I idiopathic scoliosis, from 7 to 12-in Lenke III, from 5 to 9-in Lenke V, and from 11 to 14 vertebrae-in Lenke VI idiopathic scoliosis. Conclusion. The total transpedicular fixation along the curvature length allows performing effective correction, true derotation of apical vertebral bodies, and stable preservation of the achieved results postoperatively.

Objective. To assess the rate of gastrointestinal tract disorders in children with spinal deformities in the early postoperative period after surgical intervention, and to compare results of different diagnostics schemes and preventive treatment. Material and Methods. The treatment outcomes in 125 patients aged 13 to 18 years admitted for surgical treatment of scoliosis and Scheuermann's disease were analyzed. In Group I endoscopic examinations were performed in all patients before surgery and only in those with clinical manifestations in the postoperative period. In Group II examinations were performed in all patients before and after surgery regardless of clinical signs. Prevention of gastrointestinal complications was standard in Group I and extended in Group II. Results. The incidence of gastrointestinal tract pathology was 98 % in Group I and 86 % in Group II. Patients in Group II had no severe (grade 3 and 4) erosive lesions in the postoperative period, the rate of grade 2 lesions decreased to 31 %. Erosive lesions were more frequent in patients with low body mass index (53.8 %). Conclusion. Gastrointestinal tract disorders are a common problem in patients with spinal deformity after corrective interventions. It is advisable to carry out endoscopy and ultrasound examinations in the postoperative period to optimize preventive and curative measures for avoidance of severe lesions of the gastrointestinal tract. Key Words: gastrointestinal tract, gastric mucosa, stress ulcers, superior mesenteric artery syndrome, scoliosis, children. Цель исследования. Оценка частоты нарушений со сто-роны желудочно-кишечного тракта, возникающих в ран-нем послеоперационном периоде у детей с деформация-ми позвоночника после хирургического вмешательства, сравнение результатов различных схем диагностики и профилактического лечения. Материал и методы. Проведен анализ результатов лечения 125 пациентов 13-18 лет, поступивших на оперативное лечение по поводу идиопатического сколиоза и болезни Шейерманна. В первой группе эндоскопические иссле-дования проводили всем пациентам до операции и при наличии клинических проявлений в послеоперационном периоде, во второй группе -всем пациентам до и после операции, вне зависимости от клиники. В первой группе профилактику осложнений со стороны ЖКТ проводили по стандартной схеме, во второй -по расширенной. Результаты. Патология со стороны ЖКТ встречалась в 98 % случаев в первой группе и в 86 % во второй. У па-циентов второй группы в послеоперационном периоде тяжелых поражений 3-го и 4-го уровней не наблюдалось, поражения 2-го уровня снизились до 31 %. Эрозивные поражения чаще встречались у пациентов с низким ин-дексом массы тела -53,8 % случаев. Заключение. Нарушения со стороны желудочно-кишеч-ного тракта у пациентов с деформацией позвоночника после корригирующих вмешательств являются частой проблемой. Целесообразно проводить эндоскопическое исследование и УЗИ в послеоперационном периоде для оптимизации профилактических и лечебных меро-приятий по предотвращению тяжелых поражений же-лудочно-кишечног...

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.

The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion. Materials and Methods The study included 26 patients aged from 11 to 17 years. The follow-up period lasted from 1 to 7 years. Two groups were formed: in group 1 (n=6), segments L 5 –S 1 were stabilized using the traditional technique; in group 2 (n=20), the arch of the L 5 vertebra was reconstructed by means of minimally invasive surgery. The pain syndrome was assessed in each study group using the visual analogue scale and Macnab criteria before and after surgery; blood loss, duration of surgery in minutes, and hospitalization in days were also measured. Results According to the Macnab scale, the two presented techniques did not show any statistically significant differences; however, when the arch synthesis technique was employed the spinal motion segment remained intact. Furthermore, in group 2, the volume of blood loss was smaller (44.0±19.6 compared to 300.0±130.4 ml, p<0.0001), the duration of the operation was 176.0±41.6 compared to 349.2±93.2 min, p<0.0001, and hospital stay was 6.9±1.6 compared to 10.0±2.1 days, p=0.0025 in the control group. Conclusion The technique of vertebral arch reconstruction by a minimally invasive access gives the possibility to stabilize the spinal motion segment and to preserve biomechanics and movements in the spine. This technique allows for shorter inpatient stays for patients as well as earlier recovery and rehabilitation due to reduced surgery time and blood loss.

Idiopathic scoliosis is a large etiological group in the structure of early scoliosis which requires the use of modern effective surgical methods for correction of deformity, in particular, using various structures with possible staged distraction (growing structures). Dysplastic changes in the musculoskeletal tissue are very important in the pathogenesis of scoliosis. Active correction of the tone of the muscular-ligamentous system of the spine in the postoperative period is of great importance in the recovery of such patients. Individual rehabilitation programs are aimed at consolidating the result of the operation (correction of the sagittal profile and normalization of the body balance), improving respiratory function, fast recovery of motor activity (in order to prevent hypostatic and thromboembolic complications), increasing self-esteem and patient satisfaction with the results of the operation. The purpose of the study is to assess the effectiveness of an integrated approach to the rehabilitation of patients with early scoliosis after correction of spinal deformities by growing systems. Materials and methods. A retrospective analysis of the results of a comprehensive rehabilitation of patients (n = 15) with idiopathic infantile scoliosis (mean age 8.6 ± 1.0 years) was performed. This group of patients was operated using a growing system with stepwise corrections using the Growing Rods, VEPTER technique. The algorithm of rehabilitation of the studied group of patients using the parameters of activity, participation, degree of dysfunction in accordance with the International classification of functioning (ICF) is presented. Evaluation of the effectiveness of the results carried out taking into account the criteria of the pain scale (VAS), verticalization time, indicators of walking, coordination, support capacity, balance of body and strength (on the CSBS platform), self-perception, psychological comfort, functions, satisfaction with the treatment. Results and discussion. In all patients, a normal sagittal profile was formed, satisfactory correction was achieved, and body balance was normalized. After a comprehensive rehabilitation course, we observed statistically significant improvements in balance, balance and load distribution, and postoperative pain was stopped. Early verticalization was successfully carried out, walking indicators reached values exceeding the conditional "norm". Assessment of coordination, support ability, balance of the body and strength on the CSBS platform showed a uniform improvement in the index of symmetry, the average value of the load on the limbs. Patients' self-perception and the level of psychological comfort before discharge were rated at 3 points, patients evaluated spinal function after surgery at 2.7 points, satisfaction with treatment was 3.5 points. Characteristics of signs of activity and participation, the degree of dysfunction within 6 months after surgery went from a score of 3-4 to a score of 0-2 (dynamic improvement). Conclusions. Correction of scoliotic spinal deformity with the help of growing systems due to improved respiration function, correction of the sagittal profile and body balance, restoration of motor activity and increased self-esteem and satisfaction with the results of the operation improves the quality of life of the patient. Due to the lack of clinical recommendations for rehabilitation in the postoperative period of patients with scoliosis (with early development), taking into account the age characteristics of this group of patients, the algorithm for their rehabilitation used in the Center shows good results in the restoration of functions and satisfaction with the treatment.