The paper presents analytical review of literature on surgical correction of scoliotic deformity of the spine using transpedicular fixation. Analysis included Russian and foreign medical publications.

Objective. To analyse the outcomes of surgery for severe idiopathic scoliosis. Material and Methods. Seventy nine patients at the age of 12 to 20 years (male and female ratio is 8:71) with spine deformity more than 90° operated on with CDI with ventral fusion (72 patients) and without it (7 patients) were examined. Average follow-up is 1.3 years. Data of X-ray, COMOT examination, intervertebral disk morphological study and Russian version of SRS-4 questionnairy were analyzed. Results. Average correction was 55.0°. Postoperative progression was 3.4°. CDI correction with previous intervertebral disk excision at the apex of scoliotic arch added 26.5° to preoperative correction in lateral bending, and in combination with skeletal traction – 40.6°. Counter-curvature initially averaged 69.7°, correction was 36.5°, and postoperative progression – 4.0°. Preoperative thoracic kyphosis was 59.6°, postoperative – 33.8°, lumbar lordosis was decreased from 68.1° to 48.7°. Patient’s satisfaction was 100.0 % and did not decline in time. Positive dynamics was noted in all parameters of dorsal trunk shape. Conclusion. Contemporary segmental instrumentation for treatment of severe idiopathic scoliosis allows achieving and reliably retaining substantial correction of deformity. Various types of preoperative traction can be replaced by intraoperative release of the deformed spine including discectomy.

To analyze the expression of candidate genes presumably responsible for the development of idiopathic scoliosis. Material and Methods. The study subjects were vertebral body growth plates of children aged 11-15 years suffering from Grade III-IV idiopathic scoliosis. Real-Time SYBR Green PCR assay was used to investigate the expression of genes responsible for growth regulation, chondrogenic differentiation, matrix formation and synthesis, and sulfation and transmembrane transport of sulfates. Results. Comparative analysis of gene expression did not give a clear answer. On the background of representative morphological and biochemical data including violation of the structural organization of cells and matrix on the concave side of deformity, presence of poorly differentiated chondroblasts, and lack of differentiation in columnar and hypertrophic structures, a sharp decline in synthetic potency of cells contradicted the data on high expression of IHH, TGFBR1, and EGFR genes, matrix proteoglycans genes ACAN, LUM, and VCAN, collagen types I and II, and of sulfation and sulfate transmembrane transport genes DTDST, CHST1, and CHST3. Expression of growth hormone receptor gene, differentiation genes SOX9 and PAX9, and link protein gene was reduced. Factor analysis of the studied genes has shown significant difference between gene expression in chondroblasts of patients with idiopathic scoliosis and that in controls. Conclusion. Complex interaction of genes under the control of the central regulatory mechanisms coordinates the periodization of gene turning on, thereby integrating the process of the spine growth. Violation of any of the factors in the complex system of morphogenesis regulation causes asymmetric growth resulting in scoliosis development.

Quantitative estimation of intraoperative blood loss volume in surgical correction of idiopathic scoliosis with patient's positioning ensuring complete decompression of the anterior abdominal wall. Material and Methods. Results of surgical correction of idiopathic scoliosis in 122 patients who underwent surgery involving skeletal traction and posterior correction with hybrid instrumentation in the prone position were analyzed. Posterior correction in 60 patients from Group I was performed on a standard orthopedic table, and in 62 patients from Group II-on a modular operating table for spinal surgery providing complete decompression of the anterior abdominal wall. Results. The studied parameters in groups were as follows: deformity magnitude-54.7° ± 16,3° in Group I vs 61.5° ± 19.4° in Group II, the length of the posterior spinal fusion-12.5 ± 1.1 vs 12.8 ± 0.9 segments, the number of levels in transpedicular fixation-4.1 ± 1.1 vs 4.2 ± 1.8, and surgery duration-169.4 ± 30.3 min vs 159.0 ± 31.6 min, respectively. The volume of intraoperative blood loss showed significant difference between groups: 1024.9 ± 409.2 ml (28.6 ± 12.3 % of circulating blood) in Group I, and 595.2 ± 208.6 ml (16.7 ± 6.2 % of circulating blood) in Group II. Conclusion. Complete decompression of the anterior abdominal wall during surgical correction of idiopathic scoliosis allowed reducing intraoperative blood loss by 41.6 % and ensuring the absence of indications for blood transfusion in 48.4 % of operated patients.

Цель исследования. Анализ эффективности дорсальной и вентральной многоуровневой вертебротомии у подростков с идиопатическим сколиозом типов 1 и 2 по Lenke, оперированных с применением педикулярных и гибридных конструкций с различной степенью Implant Density (ID). Материал и методы. Ретроспективно изучены непосредственные и отдаленные результаты хирургического лечения 271 подростка с идиопатическим сколиозом типов 1 или 2 по Lenke (с основной грудной дугой), оперированных с применением трех вариантов хирургической техники: инструментальной коррекции и дорсального спондилодеза (n = 212) либо той же методики, дополненной дискэктомией и межтеловым спондилодезом (n = 30) или дорсальной вертебротомией (n = 29). Изучена связь показателей возраста, исходного угла Cobb, мобильности и ID с исходами лечения, оцененными по данным рентгенографии и анкеты-опросника SRS-24, в том числе с построением моделей линейной регрессии. Результаты. Во всех группах значимыми предикторами коррекции деформации являются величина ее начального угла и ID, в то время как показатели мобильности и возраста значимости не продемонстрировали. Показано отсутствие влияния вентральной и дорсальной вертебротомии на величину коррекции и ее сохранение в отдаленном периоде, а также на анализ результатов, оцененных путем анкетирования больных (SRS-24). Совокупность всех показателей в модели объясняет от 51 до 74 % изменчивости значений достигнутой коррекции. Объяснительная способность достигнутой коррекции ID минимум в три раза меньше объяснительной способности исходного угла Cobb. Заключение. Вентральная дискэктомия с межтеловым спондилодезом и дорсальная вертебротомия как методы мобилизации позвоночника при идиопатическом сколиозе подростков не обеспечивают дополнительной коррекции сколиозов грудной локализации. При этом количество используемых при полисегментарной фиксации опорных элементов, характеризуемое показателем ID, не играет роли в сохранении корригирующего эффекта. Ключевые слова: идиопатический сколиоз подростков, транспедикулярная фиксация, вентральный релиз, дорсальный релиз.