Objective. To analyse the outcomes of surgery for severe idiopathic scoliosis. Material and Methods. Seventy nine patients at the age of 12 to 20 years (male and female ratio is 8:71) with spine deformity more than 90° operated on with CDI with ventral fusion (72 patients) and without it (7 patients) were examined. Average follow-up is 1.3 years. Data of X-ray, COMOT examination, intervertebral disk morphological study and Russian version of SRS-4 questionnairy were analyzed. Results. Average correction was 55.0°. Postoperative progression was 3.4°. CDI correction with previous intervertebral disk excision at the apex of scoliotic arch added 26.5° to preoperative correction in lateral bending, and in combination with skeletal traction – 40.6°. Counter-curvature initially averaged 69.7°, correction was 36.5°, and postoperative progression – 4.0°. Preoperative thoracic kyphosis was 59.6°, postoperative – 33.8°, lumbar lordosis was decreased from 68.1° to 48.7°. Patient’s satisfaction was 100.0 % and did not decline in time. Positive dynamics was noted in all parameters of dorsal trunk shape. Conclusion. Contemporary segmental instrumentation for treatment of severe idiopathic scoliosis allows achieving and reliably retaining substantial correction of deformity. Various types of preoperative traction can be replaced by intraoperative release of the deformed spine including discectomy.

The choice of optimal surgical approach to congenital spinal deformities involving abnormally developed vertebrae outside the apical region. Material and Methods. Twelve patients with progressive scoliotic deformities and neutral abnormalities located at the least two segments cranial or caudal to the apical vertebra or intervertebral disc. The mean follow-up period was 2.1 years. Results. In the first group (n = 7) of patients with inclusion of all abnormal vertebrae in the fusion area the mean major curve decreased from 73.8° to 17.6° immediately after surgery. In 2 years this magnitude increased by 2.5° and achieved 20.1°. A mean magnitude of a secondary curve decreased from 44.2° to 22.6° immediately after surgery, and in 2 years remains practically unchanged-21.8°. In the second group (n = 5) of patients the abnormal vertebrae were left beyond the fusion area. Immediately after surgery a primary curve decreased from 76.2° to 23.4° and in 2 years increased only by 1.2°. Different dynamics was observed in the secondary curve: initial correction from 45.2° to 26.2°, and significant augmentation of deformity during postoperative period up to 36.2°. Conclusion. Congenital vertebra abnormalities located outside the apical area of progressive scoliotic deformities should not be considered as neutral, since not being included in the fusion they cause severe progression of the secondary curve, i.e. they are active. Scoliotic deformities, similar in appearance to idiopathic ones but including abnormal vertebrae outside the apical region should be considered as congenital.

Objective. To analyze results of surgical treatment of patients with thoracic idiopathic scoliosis. Material and Methods. Fifty-two patients with Lenke type 1 idiopathic scoliosis were operated on. Follow-up periods ranged from 2 weeks to 8 years (mean 1.8 years). Surgical treatment included four types of operation: spine deformity correction with CD instrumentation; supramalleolar-andskull traction and CDI correction; discectomy and interbody fusion with bone autograft and CDI correction; supramalleolar- and-skull traction, discectomy and interbody fusion with bone autograft, and CDI correction. Patients were interrogated with pre- and postoperative SRS-24 questionnaires and examined with Computer Optical Topograph (COMOT). Results. Scoliosis was corrected from a mean of 67.7° to 26.6°, with a mean deformity value being 30.3° at the last follow- up. Thus, postoperative progression of the thoracic curve with a mean follow-up 1.8 years was 3.7° (9 % from the achieved correction). Anterior fusion provided a threefold decrease in postoperative progression. Sagittal shape of the thoracic and lumbar spine remained within norm limits. The location of the lowest instrumented vertebra (LIV) relative to a neutral vertebra, lower stable vertebra and neutralized disc did not reliably influence on the postoperative course. Postoperative deformity progression was associated only with increase in LIV tilt. SRS-24 data showed a high rate of patients’ satisfaction with the obtained effect of treatment, the rate growing with the extension of follow-up terms. Severe complications were not observed. Conclusion. Modern 3rd generation segmental instrumentation allows to obtain stable and high results of treatment for single curve thoracic idiopathic deformities, while all regularities of postoperative course are not fully understood yet.

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Objective. To substantiate the efficacy of scoliotic deformity diagnosis by quantitative parameters. Methods. The examination is performed with spine scanner. The spine is assessed separately in each plane: frontal, sagittal and horizontal. Each parameter is evaluated in automatic mode with developed program and a code is assigned to it depending on its magnitude. Results. Basing on data received by spine scanning the criteria for estimation of various pathologic conditions in spine scoliosis using biomechanical parameters were developed. Formalized signs of scoliotic deformities in three planes are defined with corresponding diagnostic codes necessary for detection of scoliotic deformity type. Both an existing scheme of orthopaedic examination and parameters received at scanning of scoliotic spine are reported. Conclusion. The advantage of spine scanning over clinical and radiological techniques consists in assessment of a shape and a spatial orientation of the spine by several quantitative parameters without radiography, and in ability to formulate diagnosis within several minutes.