Study design Cohort study.Objectives The objectives of this study were examination, observation and surgical interventions of pediatric patients with diastematomyelia, a rare congenital deformity of the spinal cord. Setting Spine surgery and neurosurgery clinic under ministry of health, the Russian Federation. Methods Twenty children (1-18 years of age) with diastematomyelia participated in this study. Diagnosis was based on subjects' medical history, results of clinical examination, spine radiography in anteroposterior and lateral views, and neurophysiological examinations. Septum resection surgery was done in seventeen subjects. Results All the subjects had skin manifestations along the midline of the back. Neurological symptoms were noted in 17 subjects: paraparesis in 11, urinary incontinence in 2, monoparesis in 4, and spasticity in 2 subjects. Three subjects did not show any neurological deficit. Orthopedic examination revealed spinal deformities of various degrees of severity. In 4 subjects, partial restorations of neurological functions were observed; and in 1 subject, bladder incontinence developed after the surgery. Conclusions Patients who have limb length discrepancy, congenital scoliosis, skin manifestations should be examined for the presence of diastematomyelia. Patients having neither neurological deficit nor orthopedic deterioration should be monitored, and in case of deterioration, surgical treatment should be reserved. We advocate for performing resection of the septum in patients with diastematomyelia prior to surgical correction of scoliosis or orthopedic correction of lower limb deformities.

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INTRODUCTION. Biomechanical abnormalities caused by limb length discrepancy are controversial problems of pediatric orthopedics. AIM. To assess the influence of limb length discrepancy and its compensation in children on the amplitude of pelvic motion in the frontal plane during walking. MATERIAL AND METHODS. We examined the study group of 21 patients with (the average discrepancy was 2,86% (from 0,23% to 6,12%). Biomechanical examination consisted of dynamic optical computed topography. The study was carried out in standard shoes and in shoes with compensation. The average compensation was 14 mm (from 5 to 45 mm). The comparison group consisted of 19 healthy children without limb length discrepancy. The angle of frontal asymmetry of the pelvis was calculated as the absolute difference in inclination. RESULTS AND DISCUSSION. When compensation was used, the amplitude of pelvic movements changed insignificantly, by an average of 1.84°, in children with discrepancy of the lower limbs. In the comparison group (healthy children), we also did not observe any changes in frontal pelvic oscillation when imitating variability compared to tests without compensation. The most obvious explanation for this phenomenon is the formation of additional compensation mechanisms for different lengths of the lower limbs. CONCLUSION. Compensation of limb length discrepancy requires an individualized approach and additional walking examinations of the patient. Further research will expand our understanding of the role of compensation for limb length discrepancy both in conservative treatment and in planning for surgical interventions.

To analyze present-day variants of surgical treatment of L5 spondylolisthesis in children. Material and Methods. The outcome analysis of surgery for L5 spondylolisthesis in 26 patients aged 10 to 17 years was performed. Two patients had Grade I spondylolisthesis, 7 patients-Grade II, 6-Grade III, 7-Grade IV, and 4 patients had spondyloptosis. The paper presents variants of surgical treatment for spondylolisthesis in children depending on a degree of L5 displacement, clinical manifestation of disease, and neurological disorders. The posterior approach was used in all patients. The surgery restored spinal canal anatomy, physiological relations within impaired segment, and trunk balance, reducted clinical manifestations, and eliminated neurological disorders. Results. Complete reduction of L5 vertebra was achieved in patients with Grade I-III spondylolisthesis, reduction to Grade II-III-in patients with Grade IV and spondyloptosis. Pain and radicular syndromes regressed in 2-3 days and 2-3 weeks after surgery, respectively. Patients with lower limb monoparesis and contractures showed a regression of neurological deficit and restoration of phisiological range of motions within 1-1.5 months after surgery. Conclusion. The choice of treatment technique for L5 spondylolisthesis depends on vertebra displacement degree, occurrence of segmental instability, intensity of clinical manifestations and neurological symptoms.

The case of surgical treatment of a patient with scoliotic deformity of the spine and abnormality of the spinal cord (diastematomyelia) is presented. The first surgical stage included elimination of anatomical pathology and fixation of the spinal cord, and the second -correction of the spinal deformity.