Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with  instrumented fixation of the spine.Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried  out using the χ 2 criterion.Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use.Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

Objective. To analyze the leading pathogens of implant-associated infection (IAI) after spinal surgery and identification of trends in the change in the pattern of microorganisms at the stages of treatment using the negative pressure method (NPWT systems).Material and Methods. The results of microbiological cultures of 25 patients with IAI of the spine were studied. The frequency of occurrence of Gram-positive and Gram-negative pathogens was estimated. The leading pathogens in the species spectrum were identified. Changes in the structure of identified microorganisms were studied at various time intervals of treatment.Results. A total of 136 microbiological studies were performed in 25 patients at the stages of treatment with the negative pressure method, with the identification of microorganisms in 127 (93.3 %) cases. The frequency of gram-negative microflora was 50.0 %, gram-positive – 42.6 %, Candida sp. – 0.7%, in 15.4 % microbial associations with the dominance of gram-negative microflora were identified at all periods of treatment. Not only the diversity of the isolated flora was noted (E. faecalis – 16.5 %, P. aeruginosa – 14.2 %, K. pneumoniae – 11.0 %, S. aureus and A. baumannii – 9.4 % each and S. epidermidis – 8.6 %), but also changes in the spectrum of flora at the stages of treatment: on the 1st and 2nd weeks from the first debridement intervention and the installation of the NPWT system, E. faecalis was most often detected, on the 3rd and 4th weeks – P. aeruginosa and A. baumannii, during the 2nd month – E. faecalis and P. aeruginosa, later – gram-negative bacteria against the background of an increase in the incidence of K. pneumoniae. The frequency of verification of other species of microorganisms had no statistically significant differences. Microbial associations were found from the 2nd month of treatment. The change in pathogens was noted in 72 % of cases during the treatment of IAI of the spine. On average, this treatment required 7–8 NPWT dressing changes per patient. This method of treatment made it possible to achieve both negative results of microbiological examination and stable relief of the infectious process.Conclusion. IAI, which complicates surgical interventions on the spine, is characterized by a change in pathogens during treatment, which requires not only multiple debridement with the replacement of the NPWT dressing, but also adequate long-term rational (etiologically justified) antibacterial therapy, based on the control of data on both the spectrum and on microbial resistance.

Introduction: Chronic post-traumatic osteomyelitis is a complex problem of modern traumatology and orthopedics, affecting, in addition to medical, social and economic aspects of healthcare. When planning treatment, it is necessary to take into account the metabolic state of the bone tissue, since the effect of an infectious pathogen goes far beyond the classical lytic process, disrupting the balance of bone formation and bone resorption in various ways. The study is devoted to the study of the dynamics of parameters reflecting the metabolism of bone tissue in patients receiving complex therapy for chronic post-traumatic osteomyelitis of long bones. Aim: To study the dynamics of metabolic disorders of bone tissue in patients with orthopedic infection of long bones and large joints under conditions of ongoing complex etiotropic and compensatory therapy for 6 months, the timing of bone tissue consolidation within 2 years from the moment of surgery. Materials and methods: The study was prospective, observational, comparative, exploratory, involving 138 patients with post-traumatic chronic osteomyelitis of the long bones. Complex therapy included a combination of surgical treatment with antibacterial, anti-inflammatory therapy and drug correction of the revealed disorders of bone metabolism. The timing of the consolidation of bone defects after treatment and the dynamics of indicators of bone metabolism were studied. Results: The similarity of the periods of consolidation of different segments in the conditions of the described therapy was shown; the time period corresponding to the most pronounced dynamics of changes (correction) of violations was determined (3 months from the beginning of treatment); shows the effectiveness of metabolic therapy for the treatment of osteoarticular infections in various anatomical segments of the extremities. The results corresponds both to the results of the previous study and to the pathophysiological aspects of bone metabolism described in the literature. Conclusion: the timing of consolidation in the treatment of metabolic disorders is generally similar; the greatest changes in the parameters of bone metabolism are recorded within 3 months after the start of therapy. Also, the metabolic therapy regimen can be considered as universal for all segments.