Objective.To analyze the features of surgical treatment of children and adolescents with herniated discs and radicular compression symptoms. Material and Methods. A retrospective multicenter study of 34 patients with juvenile osteochondrosis with mean age of 15.4 years was performed. Surgical treatment included disc puncture methods, microdiscectomy through posterior approach, anterior discectomy, dynamic and rigid stabilization, and replacement of the fibrous ring defect. Results. Positive clinical effect with complete relief of pain was achieved in all cases. Paretic syndrome regressed completely in all patients. All patients regained the level of physical activity in the next 2-3 months. Long-term follow-up was on average 45.5 months. No recurrence of pain was noted during the follow-up period. Conclusion. Surgical treatment of disc herniation in children results in the relief of pain and full functional recovery. Among surgical methods, a preference should be given to microdiscectomy through minimally invasive surgical approaches. In the presence of indications, both rigid stabilization of spinal motion segment at the level of decompression and dynamic stabilization can be performed, and the latter is more preferable.

To analyze results of multimodal surgical treatment of patients with severe scoliosis involving concave thoracoplasty. Material and Methods. A total of 40 patients aged from 12 to 31 years with spinal deformities of 70-150° were operated on with posterior CD instrumentation combined with elevating thoracoplasty on the concave side of the thorax deformity. Mean follow-up period was 2 years. Dynamics of the respiratory function was studied. Patients underwent X-ray and CT examinations of the spine, and appearance assessment. Results. The mean preoperative Cobb angle of the major thoracic curve was 101° (range: 70-150°), and postoperative-47°; postoperative correction was 54° (53 %). The loss of correction was not practically registered at the immediate and long-term follow-up. The mean preoperative Cobb angle of the compensatory lumbar curve was 50.5°, and postoperative-20.6°. The mean thoracic kyphosis was 51° before surgery and 28.7° after surgery. The mean lung vital capacity was 56.3 % before surgery, and 66.5% in 12 months after surgery. Conclusion. Concave thoracoplasty provides increased mobility of the deformity, and improvement of stabilization, cosmetic and functional results of surgical treatment of patients with severe scoliosis.

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

The paper presents a review of three clinical cases of treating patients with chronic fractures of the odontoid process of C2 vertebra using various combinations of surgical techniques. In all cases, complete decompression of the spinal cord and stabilization of the upper cervical segment of the spine were achieved. A decrease in the range of motion in the cervical spine was observed, which did not affect patient satisfaction. A gradual regression of the neurological status and increase in muscle strength were recorded. Comparative analysis of the neurological status was carried out before and after surgical treatment. When assessing the general condition of patients using the index of disability due to pain in the neck (NDI), an improvement in the quality of life was noted. These data show the opportunities and peculiarities of methods for treating patients with chronic C2 odontoid fractures.Type of publication: description of clinical cases. Evidence level: IV.

The experience of surgical treatment of lumbar disc herniation in adolescents using annuloplasty: analysis of a small clinical series