Objective. To study the gluteal muscles in patients with scoliosis of various etiologies using multislice computed tomography (MSCT).Material and methods. MSCT was first used to study the gluteal muscles of 27 patients with idiopathic scoliosis. The patients were examined to study the vertebral column in order to determine a method and tactics for scoliosis treatment. The muscles were additionally examined using workstations and programs for MSCT data processing. In a control group of 18 patients with no clinical manifestations of spinal and hip joint abnormalities or those detected on CT, their gluteal muscles were examined due to their pelvic organ diseases.Results. Patients younger than 18 years of age who had spinal deformations of not more than 60 degrees had muscle changes as moderate hypotrophy, increased density, especially that of the gluteus medius muscle to 62.01 ± 7.20 HU. In patients over 18 years of age, the muscle density decreased at any magnitude of deformation and was the smaller the older patients were. In patients with spinal deformation greater than 90 degrees, the density of the gluteus maximus muscle on the convex side was significantly different from that on the concave side and was less on the concave side (p <0.05) than in those with a deformation of 60–90 degrees.Conclusion. The results showed that in patients with scoliosis, the gluteal muscles were affected not only by the magnitude of deformation, but also by age. In patients over 18 years of age, muscle changes with equal magnitudes of deformation were more pronounced and were manifested by hypotrophy, atrophy, and fatty degeneration.

Представлен клинический случай лечения пациента 15 лет с прогрессирующей кифотической деформацией, сопровождающейся болью в позвоночнике, ограничением движений, одышкой и тахикардией. Неоднократно лечился в разных клиниках консервативно. При поступлении по данным рентгенографии и КТ определялся выраженный фиксированный кифосколиоз, угол сколиоза -135°, угол кифоза -155° Больному выполнена коррекция и задняя фиксация позвоночника на уровне Th2-L4 (система REED, Франция). Справа, для усиления системы, с целью профилактики перелома стержней использован двойной стержень. Во время операции остеотомий не производили. После имплантации конструкции применена костная пластика. Задняя фиксация, резекция 6 ребер. Сколиотическая деформация после операции -38º, кифотическая -73º. Ключевые слова: кифосколиоз, оперативное лечение, система REED, костная пластика, задняя фиксация.The work deals with the presentation of a clinical case of treating a male patient at the age of 15 years with progressive kyphotic deformity accompanied by pain in the spine, limited movements, dyspnea and tachycardia. The patient underwent conservative treatment in different clinics more than once. On admission, marked fixed kyphoscoliosis revealed by radiography and CT data with 135° angle of scoliosis and 155° -that of kyphosis. The patient underwent correction and posterior fixation of the spine at Th2-L4 level (REED system, France). A double rod used on the right, for the system enhancement, in order to prevent rod breaking. No osteotomies performed during surgery. Osteoplasty used after the construct implantation, as well as posterior fixation and resection of six ribs. After surgery scoliotic deformity amounted to 38º, kyphotic one -to 73º.

Idiopathic scoliosis, as many authors think, being idiopathic in terms of not fully clear etiology of the disease, due to the most complicated long-term studies, has a certain theory of the pathogenesis of scoliosis, which includes the disharmony of the longitudinal growth of the spine and spinal cord and the formation of vertebral torsion. The application of various versions of modern vertebral instrumentation for 20 years made it possible to develop a differentiated approach to the choice of surgical intervention, taking into account the patient’s age and the peculiarities of the deformed spine. Nevertheless, the use of current diagnostic methods indicated that not all the details of the deformed vertebral structure have been studied, in particular the apical ones, that are usually more changed being at the apex of the deformity. The application of multislice computed tomography (MSCT) and current statistical methods made it possible to reveal the structural features of the apical vertebrae in the group of adolescent scoliosis (14–18 years old), that is important for increasing the effectiveness of preoperative planning and improving the results of idiopathic scoliosis treatment being one of the most difficult problems of the spine surgery.