Objective. To analyze the content and results of specialized medical care delivered to patients with adverse consequences of spine and spinal cord injury. Material and Methods. The retrospective analysis included 307 patients treated for adverse consequences of the spine and spinal cord injury. Main reasons for low quality of life of patients and basic pathological conditions causing poor anatomical and functional results in them were studied. Results. Rational volume of surgery based on the clinical and X-ray data included decompression of the spinal cord and its roots, the spine release, correction of post-traumatic spinal deformities, anterior column reconstruction, and spinal fusion. Out of 257 patients with neurological disorders the regression was achieved in 156 (60.6 %) cases. Correction of posttraumatic deformity was 28.2° in the thoracic, 17.7° in the cervical, and 23.4° in the lumbar spine. Conclusion. Surgical treatment of the spine and spinal cord injury, even in its late period, is very effective and allows achieving partial or complete regression of neurological deficit and pain, permanent stabilization of the spine, correction of posttraumatic deformity, and significant improve in the function and quality of life of patients.

Objective. To perform validation study of the E. Pola classification (2017) and to assess expert consensus on the diagnosis and treatment of infectious lesions of the spine in the national professional community.Material and Methods. A clinical and radiological database on 15 cases of infectious spondylitis, as well as the information about original article by Pola and a Russian translation of the classification and tactical tables from this article, were distributed to 408 orthopedic traumatologists, neurosurgeons and radiologists who have experience in treating patients with spinal pathology and whose data are available in the registers of the relevant professional associations of the Russian Federation. The coincidence/difference in the responses concerning the definition of lesion types and the choice of treatment tactics, as well as proposals for the use of classification were assessed.Results. Answers were obtained from 37 respondents from 11 regions of the Russian Federation. The general interobserver agreement index (Fleiss kappa) for all types of spondylodiscitis was 0.388 (95 % CI 0.374–0.402), including for lesion types: type A – 0.480 (95 % CI 0.460–0.499, type B – 0.300 (95 % CI 0.281–0.320), and type C – 0.399 (95 % CI 0.380–0.419). Agreement levels were higher among radiologists (type A – 0.486, type B – 0.484, and type C – 0.477), orthopedic traumatologists (type A – 0.474, type B – 0.380, and type C – 0.479), and specialists with clinical experience less than 10 years (type A – 0.550, type B – 0.318, and type C – 0.437). The pooled data for all 12 lesion subtypes showed general poor agreement (k = 0.247, CI 0.240–0.253), satisfactory level was found for B3.2 type (k = 0.561, CI 0.542–0.581), good agreement (k > 0.61) was achieved between orthopedic traumatologists for type B3.2 and between radiologists for B3.1 and B3.2 lesion types. Respondents refused to use basic treatment options for type A in 15.1 %, type B in 7.5 % and type C in 3.2 % of answers, while indicating the need for interventions through anterior approach in 24.7 %, 43.0 % and 46.2 %, respectively. Limitations of the classification use depending on the localization and etiology of spondylitis were noted. Authors recommended taking into account the presence of systemic inflammatory response syndrome, mandatory CT scanning, clarification of spinal instability criteria, and the addition of anterior surgical interventions to the treatment algorithm.Conclusion. The Pola classification of spondylodiscitis is currently considered the most successful for tactical algorithms and implementation in broad clinical practice for spondylodiscitis. However, at the stages of its clinical application, there is an unsatisfactory interobserver expert consensus on the types of lesions, and there are limitations related to the etiology, localization and severity of the disease. A modified classification taking into account the identified limitations and including anterior procedures in the tactical options is advisable.

A modern concept of assessing tumor lesions of the spine, NOMS, adapted to the conditions of emergency care is presented as a part of a systematic review of the literature. Principles of neurological, oncological, mechanical and system analysis of spine lesions in primary and metastatic spinal tumors, which are the basis for step-by-step tactical decisions, as well as methods for analyzing each component are described.

Resume. Purpose. To assess the relationship between the duration of pathological symptoms developed due to tumor or infectious destruction of the spine, and the medium-term (3 months after surgery) and long-term (1-year) outcomes of operations performed according to urgent indications. Study design: two-center cohort retrospective; level of evidence IIC [1]. Material and methods. 84 patients with tumor (group 1, n = 43) and infectious (group 2, n = 41) lesions of the spine underwent decompression and stabilization operations according to urgent indications in the period from 2016 to 2018. Neurological status (evaluation method -Frankel scale), pain intensity (evaluation method - visual analogue scale, VAS) and functional independence of patients (evaluation method - Karnofsky scale) were assessed before intervention, 3 months and 1 year after surgery. Statistical relationship between treatment outcomes and duration of the prehospital delay has been studied. Results. Only 11 out of 84 patients (13.1%), operated on for urgent indications, were hospitalized in the first 72 hours from the onset of vertebral syndrome; 6 (7.1%) of them had neurological disorders. At the time of surgery, 23 patients in each group had neurological disorders (53.5% and 56.1%, respectively), while the average duration of the prehospital period in both groups (Me) was 14.0 days. In patients without neurological disorders, the duration of the prehospital pause for the group of tumor lesions was 22.5 (14.0; 40; 0), for infectious - 14.5 (6.3; 30.0) days (data format - Me (Q25; Q75). After decompression and stabilization operations, positive neurological dynamics observed in patients with tumor lesions both in plegia and paresis (types B - D according to Frankel), while in infectious destruction - only in patients with mild paresis. An inverse correlation dependence of high strength between the duration of neurological disorders and the possibility of their improvement by 3 months after surgery was revealed in both groups (rs1 = -0.793 and rs2 = -0.828; p 0.001), as well as there was no connection between such outcomes and the duration of the hospital period (the urgency of the operation) (rs1 = -0.257; p = 0.283 and rs2 = -0.218; p = 0.330). When hospitalized for more than 14 days from the onset of pathological symptoms, the possibility of neurological improvement after surgery ceases to be statistically significant (p1 = 0.083, p2 = 0.157 for both groups, respectively), while the likelihood of a decrease in pain syndrome and functional dependence on others remains independent of the duration of the prehospital period. Conclusion. In case of tumor and infectious destruction of the vertebrae, urgent decompression and stabilization operations lead to a significant reduction in pain syndrome and an improvement in the functional independence of patients 3 and 12 months after the operation, regardless of the duration of the prehospital period. The duration of prehospital period of more than 2 weeks is critical for a reliable prognosis of improvement in neurological disorders after urgent surgeries in patients with neoplastic and infectious lesions of the spine.

Publications on aneurysmal bone cysts of the spine in children for the last 20 years were systematized taking into account different treatment approaches. The results of radiation therapy, local puncture interventions, surgical removal of the tumor, selective embolization, and of their combinations were reviewed based on the data of 19 publications representing 165 pediatric patients.