Transpedicular screw fixation is the most established means to stabilize the spine. Present study evaluates personalized navigation templates application for vertebral pedicle passage. Navigation templates were used for inserting 35 transpedicular screws in 5 patients with spinal deformity (age 2–16). Each patient underwent computed tomography preoperatively. Acquired data was processed into a virtual 3d-model of target zone. Life size virtual pedicular probes were placed onto transpedicular trajectories determined on multiplanar cross-sections of the model. Navigation template was created by modification and union of geometric primitives. Target zone model and navigation template were made with PLA by 3D-printer. In surgery the template was placed on skeletonized posterior surface of appropriate vertebrae. After confirmation of template stability trajectories were passed to a depth of 20 mm through guiding tubes by pedicular probe. Resulting channels were controlled with ball tip feeler, and the full depth trajectories were made by free hand technique. Postoperatively screws placement accuracy was assessed by plain X-rays in each patient. Two patients (16 screws) also underwent computed tomography. In these patients screw placement accuracy was assessed by system based on 2 mm breach increments. 15 screws (93. 7%) were fully contained within the pedicle (grade 0), 1 screw breached external cortex of the pedicle by 0. 8 mm (grade 1). Efficacy and safety of navigation template for transpedicular screws insertion was demonstrated.

Nutrition is an important problem of palliative care. If oral feeding is not possible, percutaneous endoscopic gastrostomy (PEG) is the method of choice. The wide application of the procedure is limited by the cost of single-use sets produced in other countries. The aim of the study was to review methodic of the PEG and to find an opportunity to reduce its cost. A reusable device was developed for the application of the PEG with use of a Pétzzer catheter. Approbation of the device and methodic was carried out in experiment with 10 rabbits. In 2 cases animals died on the 5th and 6th day after the operation because of acute pneumonia and enterocolitis, complications from the operating wound and gastrostomy were absent. Remaining 8 rabbits were withdrawn from the experiment on the 10-13 day after the operation. In 3 cases purulent infection of the postoperative wound and formation of abscesses of abdominal cavity were revealed, while the gastrostomic fistula was without any signs of failure. In 5 cases were no complications. The gastrostomic fistula was placed next to laparotomic wound and was not complicated in all cases. All the described complications are considered to features of laparotomy and postoperative period in animals. The constructed analogue of the PEG allow significantly reduce costs and increase the economic efficiency of minimally invasive gastrostomy, reduce dependence on foreign materials. Encouraging results obtained in animal experiments allow testing of the technique in clinical settings.

Clinical case of surgical treatment of advanced congenital kyphoscoliosis in 12 years old child is reported. Radiographs and CT at presentation failed to reveal the entire anomaly. By analysis of priorly made radiographs hemivertebra L1 was recognized. At genitourinary assessment L-shaped kidney was detected. A full-size 3D-printed model was used for surgical planning. Vertebral column resection as treatment option was discussed, but due to high neurologic complication rate this approach was refused. After preoperative 35 days halo-femoral traction anterior instrumented fusion was performed. Right ureter was stented for intraoperative urologic injury prevention. Scoliosis correction of 32% and kyphosis of 14% was achieved. 5 months later definitive posterior uninstrumented fusion was performed. Spinal deformities caused by vertebral malformations progress dramatically unless they are treated early. An advanced case is a clinical challenge because of technical difficulties and poor result. Vertebral column resection is a treatment option for severe kyphoscoliosis, but it’s indications should be strictly individualized. Preoperative halo-femoral traction is the most safe correction method in spinal deformity due to prolonged and gradual action. 3d-printed models are practical for surgical planning. The model may be used intraoperatively as a 3D-reference. In congenital scoliosis genitourinary system should be assessed meticulously, and urologist advice in relevant case is necessary.

Clinical case of successful operative treatment of congenital kyphosis is reported. Deformation was caused by multiple lower thoracic and lumbar vertebral body abnormalities. Associated spinal abnormalities were outspread absence of laminae, hydromyelia, and diastematomyelia. Preoperative computed tomography analysis revealed absence of instrumentable bony structures within malformed lower thoracic and lumbar spine. As instrumented fusion procedure was technically impossible anterior fusion without internal fixation was performed. Autogenous rib was used as a bone graft. Bone graft was extended with calcium sulphas (osteoconductive media), demineralized allograft bone matrix (osteoinductive media), and patient’s bone marrow aspirate (osteogenic media). Resulting combined bone grafting material possessed osteoconductivity, osteoinductivity, ostegenicity, and mechanical strength. At 18 months post operation follow-up computed tomography revealed solid bony fusion formation. Some neurologic improvement also was noticed. Congenital kyphosis caused by multiple outspread vertebral malformations remains insufficiently studied clinical problem. Affected children need individual multidisciplinary surgical approach, meticulous surgical planning, and regular neurological, imaging, and orthopedic follow-up until the end of bone growth. Absence of instrumentable bony structures in desired spinal arthrodesis does not preclude successful fusion. Combination of several heterogenous bone grafting materials with different properties provides fusion in difficult clinical setting.

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