Various options for medical treatment of children with compression fractures of the thoracic and lumbar spine include unloading of damaged segments by simultaneous or gradual reclination (e.g., functional traction and reclination of the spine); measures aimed at building and strengthening the muscular “corset” of the back; and the use of orthotic devices of various designs (e.g., fixating-discharging, fixating-correcting corsets, orthoses on a modular basis). Questions regarding the early and late use of orthotics in patients with compression fractures of the vertebral bodies are discussed. Literature analysis, considering different methods used in the treatment of these patients in terms of their effectiveness to restore the height and shape of the damaged spinal segment revealed the absence of a differentiated approach for choosing treatment and selection criteria for orthopedic management.

The authors presented an example of a complex treatment of pediatric patient with multiple fractures of the vertebrae in the thoracic spine. The child was operated on the burst fracture of a Th5 vertebra. Due to the presence of vertebral compression fractures Th8 a course of conservative treatment by the orthosis in hyperextension brace. Follow-up was 15 months.

Introduction. New questions of indications and methods of surgical treatment of children with congenital spinal deformity are covered in detail. However, straightening deformed segment of the spine and fixing with metal construction is not sufficient, and conditions for its retention and prevention of migration must be created. The expediency of the study is relevant because of lack of systematic review of the results of orthotic support as complex treatment of this group of patients, both in Russia and abroad. The problems faced by vertebral surgeons are the following: the tendency of deformation relapse as the child grows, tendency of deformation of unfixed (lower and upper) segments of the vertebral column. Clinical case. For observation, we selected an 11-year-old patient. The diagnosis was congenital scoliosis on posterolateral hemivertebra Th4, dysplastic course of congenital spinal deformity. The surgical treatment performed was extirpation of hemivertebra Th4(S) and the correction of local congenital deformity with multicore corrective system in combination with bone grafting. We achieved complete correction of congenital local curve at the level of the posterior lateral hemivertebra and reduction of compensatory curves in the thoracic and lumbar spine. In the postoperative period, the patient was provided with corrective brace, with the aim of influencing on the compensatory curve. Discussion. This clinical observation aimed to determine the different approaches to treatment of children with congenital deformities of the thoracic spine, which consists of surgical correction of local congenital curvature curve with subsequent correction of compensatory curves by using a correcting brace. Conclusion. As a result of the surgical intervention, correction of congenital spinal deformity was achieved, and the use of a corrective brace in the postoperative period allowed the correction of compensatory curves and maintained the achieved result until the end of the patient’s growth.

Background. A large number of studies have focused on automating the process of measuring the Cobb angle. Although there is no practical tool to assist doctors with estimating the severity of the curvature of the spine and determine the best suitable treatment type. Aim. We aimed to examine the algorithms used for distinguishing vertebral column, vertebrae, and for building a tangent on the X-ray photographs. The superior algorithms should be implemented into the clinical practice as an instrument of automatic analysis of the spine X-rays in scoliosis patients. Materials and methods. A total of 300 digital X-rays of the spine of children with idiopathic scoliosis were gathered. The X-rays were manually ruled by a radiologist to determine the Cobb angle. This data was included into the main dataset used for training and validating the neural network. In addition, the Sliding Window Method algorithm was implemented and compared with the machine learning algorithms, proving it to be vastly superior in the context of this research. Results. This research can serve as the foundation for the future development of an automated system for analyzing spine X-rays. This system allows processing of a large amount of data for achieving 85% in training neural network to determine the Cobb angle. Conclusions. This research is the first step toward the development of a modern innovative product that uses artificial intelligence for distinguishing the different portions of the spine on 2D X-ray images for building the lines required to determine the Cobb angle.

BACKGROUND: Despite more than 60 years of screening for adolescent idiopathic scoliosis, it is still a controversial issue in the scientific literature. There are both opponents and supporters of the intervention, represented by government agencies, medical organizations, and individual researchers. Several countries have rejected national scoliosis screening, although some medical associations in these countries believe that screening based on the Medical Home model is feasible. By contrast, school-based scoliosis screening has been implemented nationally in a few countries. Given the lack of consensus on this issue, it is useful to systematize conflicting views on screening for adolescent idiopathic scoliosis. AIM: This study aimed to review publications presenting information on the status of screening for juvenile idiopathic scoliosis to identify unresolved organizational issues. MATERIALS AND METHODS: Data were searched in the open electronic scientific literature databases (eLIBRARY, PubMed, and Cochrane Library) using the following keywords and phrases: scoliosis screening; screening for adolescent idiopathic scoliosis (AIS); school screening for scoliosis; school scoliosis screening program. The depth of the search was 30 years. RESULTS: Arguments for focus on the need for the early detection of AIS through screening in terms of the effectiveness of timely treatment, proven efficacy of conservative treatment of scoliosis, and reduction of surgical interventions among screened adolescents. The arguments against are related to the lack of a unified methodology for screening, high rate of false-positive and false-negative results, unproven effectiveness of screening in reducing the frequency of surgical interventions, economic efficiency, and psychological effect on adolescents and violation of their rights during the event. CONCLUSIONS: Several organizational issues should be addressed with regard to screening. These include the training of staff who conducts the screening and development of a referral and follow-up system. The screening scheme and methods should be unified through the introduction of noninvasive screening methods to standardize the results and their subsequent uniform interpretation. The referral process for further examination should be standardized according to a defined protocol. The development of a special computer program to assist medical decision-making is relevant.