Objective. To analyze the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoracolumbar junction, which influenced the study of this problem. Material and Methods. The Web of Science database was searched for keywords to detect articles related to thoracolumbar junction surgery. Articles were selected taking into account the title, abstract and the used methods, and then evaluated by the total number of citations to identify the fifty most cited. Characteristics of publications were analyzed. Results. The United States of America, Thomas Jefferson University and A.R. Vaccaro were the most productive country, institution and author, respectively, dealing with the subject. The 2000s was the most active decade in terms of the number of publications. The greatest attention of scientists dealing with the problems of thoracolumbar injury was attracted by the article by McLain et al. analyzing the causes of the failures of short-segment transpedicular systems in the early postoperative period. The article by Laursen et al. presenting the results of using recombinant bone morphogenetic protein-7 in combination with metal fixation is at the top of the list in terms of average citation index. Most articles are well-designed randomized studies with the evidence level II. Conclusion. Citation analysis allowed to identify the most relevant articles, the authors of which have made a significant contribution to the problem of surgery of the thoracolumbar junction. Study of the information field through the prism of the most cited articles allows seeing the mainstream and future development of diagnostics, classification and treatment of the injuries of this localization.

Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system. The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary. Materials and Methods. DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method. Results. The values of stress and displacement fields for spine-hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153-161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine-hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws. Conclusion. The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.

Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.

The main surgical treatment technique of thoracic and lumbar spine acute injuries is transpedicular fixation, the failure of which, according to the literature data, occurs in 1015% of cases. There are no common views on tactics and the surgical technique used to deal with the consequences of unstable transpedicular spondylosynthesis. And the publications devoted to the use of isolated anterior interventions are the least common. We present a case study of the surgical management of the 71 years old patient with secondary thoracolumbar kyphosis that progressed after failed transpedicular fixation of Th12 fracture. The deformity was corrected with one-stage anterior approach and ventral crew system.

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