To assess possibilities of surgical treatment of patients with super severe (Cobb angle of 120 degrees and more) idiopathic scoliosis. Material and Methods. Surgical treatment was performed in 15 patients (14 females, 1 male) with idiopathic scoliosis with Cobb angle exceeding 120 degrees. Patients were followed up during 2 years and more. The mean age of patients was 16.1 years. Preoperative examination included plain and functional radiography of the spine, and traction radiography. All patients before and after operation were examined with computer optical topography and answered the SRS questionnaire. A primary method of treatment included correction of spinal deformity with segmental Cotrel-Dubousset instrumentation and posterior fusion with local bone autograft. Results. The primary curve was reduced from 129.9° to 72.5°(44.2 %). Postoperative progression was 5.9° (10.2 % of the achieved correction). Trunk imbalance was 31.2 mm before surgery, 23.2 mm just after surgery, and 15.5 mm at last follow-up. The tilt of the lowest instrumented vertebra was 26.0° before surgery, 10.7° at two weeks, and 16.7° at long-term follow-up. Thoracic kyphosis was 88.5° at initial examination, 48.1° after surgery, and 59.3° at last follow-up. The mean body height increased by 11 cm. Spirometry test showed mean respiratory volume 1357.1 ml before surgery, and 1690.0 ml at last follow-up. Conclusion. Surgical treatment of patients with super severe idiopathic scoliosis using modern instrumentation is not only possible but also necessary since it allows for radical changing in shape of the spine and the trunk, normalization of position and functions of interior organs, and improvement of patient's quality of life.

Literature review on surgical treatment of spinal tumors is presented. One-stage spondylectomy was described and spinal tumor resection through a total en block spondylectomy was presented in details based on the results of scientific studies performed between 1953 and 2007.

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.

Regional specialty care system for children with spine deformities T.N. Sadovaya Objective. To analyze the roll-out of regional specialty care system for children with orthopaedic pathology and quality management system suitable for screening and diagnostic programs. Material and Methods. Diagnostic audit of the implementation of screening and diagnostic programs and medical care using procedures prescribed by ISO 9001 requirements was performed in Pediatric Orthopaedic Centre (POC). Results. The adoption of quality management system into the practice of regional Pediatric Orthopaedic Centre (POC) allowed to optimize screening programs and stages of medical care delivering and make them valid and structured. Conclusion. The extension of quality management system principles on the direct care process enables the obtaining of effective results of specialty medical care and warranting the quality of medical care delivered to customers.