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Introduction. The treatment of burst fractures at the thoracolumbar junction remains a contentious issue in vertebrology. Despite a broad array of surgical interventions available, many surgeons favor isolated posterior stabilization, which can be performed using either minimally invasive or open approaches. However, the biomechanical properties of these methods have not been thoroughly investigated. Objective: This study aims to evaluate the biomechanical stability of the thoracolumbar junction following transpedicular stabilization of a burst fracture at the Th12 vertebra, under different system configurations influenced by lateral flexion. Materials and Methods: A mathematical finite element model of the human thoracolumbar spine, featuring a burst fracture at the Th12 vertebra, was developed. The model included a transpedicular stabilization system with eight screws, simulating “long” stabilization. We examined four variants of transpedicular fixation using both mono- and bicortical screws, with and without the inclusion of two cross-links. Results: The study found that the load borne by the damaged Th12 vertebral body varied depending on the fixation system employed. Specifically, stress levels were 24.0 MPa, 27.3 MPa, 18.4 MPa, and 25.8 MPa for models with short screws without cross-links, long screws without cross-links, short screws with cross-links, and long screws with cross-links, respectively. At the screw entry points in the vertebral arch, the highest stress values were recorded at the L2 vertebra, showing 11.8 MPa, 14.0 MPa, 9.4 MPa, and 13.4 MPa for each respective model. Among the metal construct elements, the connecting rods consistently exhibited the highest stress, with values of 226.7 MPa, 313.4 MPa, 212.4 MPa, and 293.98 MPa, respectively. Conclusion: The results underscore that utilizing cross-links in the stabilization of burst fractures at the thoracolumbar junction, which is only feasible through an open installation, somewhat mitigates stress within the stabilized spinal segment. Meanwhile, the modeling of lateral flexion revealed only minimal differences in stress values between open and minimally invasive installations.

Spinal meningiomas are rare, predominantly benign tumors that exhibit slow growth and typically have a non-invasive pattern of development. They originate from arachnoid cells and fibroblasts of the dura mater. Despite their benign nature, some meningiomas can exhibit intra-extradural extension, complicating both diagnosis and treatment. This article presents a clinical case involving a patient with an intra-extradural spinal meningioma. Despite radiological imaging suggesting a neurinoma, the final diagnosis confirmed a meningioma. Case Report: A female patient underwent surgical tumor resection through a posterolateral approach with laminectomy and facetectomy at the C4-C5 vertebral levels. The tumor, extending through the intervertebral foramen, was completely resected along with the affected nerve root. Histological examination verified a Grade II meningioma. Discussion: Despite advancements in neuroimaging and surgical techniques, intraoperative findings can be unpredictable, necessitating an adaptive approach to tumor resection. The article emphasizes the importance of adequate preoperative planning and the use of intraoperative neurophysiological monitoring to reduce the risk of complications and improve treatment outcomes. Conclusions: The primary treatment for spinal meningiomas is surgical. For dorsal and lateral localizations, total resection with the involved dura mater (Simpson Grade I) is optimal. For ventral localizations, tumor resection with coagulation of the dural attachment site (Simpson Grade II) is preferred. Preoperative and intraoperative use of electrophysiological methods is recommended to assess the functional status of neural structures. Intra-extradural localization of meningiomas is rare and presents significant challenges in preoperative diagnosis, requiring specific skills for effective removal.

Vertebral column fractures (VCF), despite their relatively small proportion in the overall structure of human musculoskeletal trauma, represent a significant medical and social problem. Even injuries not accompanied by neurological deficits often lead to persistent impairments in the functional capacity of the affected individuals, significantly affecting their quality of life, employability, and social activity. The epidemiology of spinal trauma is insufficiently understood, largely due to the difficulty in accurately assessing its true frequency. Existing literature on the epidemiology of vertebral column trauma is mostly based on single-center or multicenter studies focused on specific region. Objective: To conduct a preliminary analysis of the epidemiological features of vertebral column trauma in Eastern European countries. Materials and Methods: Statistical data from the Global Burden of Disease database were analyzed to investigate the epidemiology of spinal trauma. The study focused on countries located entirely within the European part of the Eurasian continent. A 30-year period prior to the onset of the COVID-19 pandemic (1990–2019) was selected as the optimal time frame to reflect the current state of the problem. The main analysis parameters included disease incidence and years lived with disability. Results: It was found that the relative frequency of vertebral column trauma is higher in countries with a higher gross domestic product. Over the analyzed period, all Eastern European countries exhibited a declining trend in the relative frequency of vertebral column trauma. In the overall structure of musculoskeletal trauma, vertebral column trauma accounts for 3.5‒4.5% in Eastern European countries, and this figure is progressively increasing. Armed conflicts in the Republic of Moldova in 1992 and in Ukraine starting from 2014 are characterized by an increase in the frequency of vertebral column trauma. The proportion of males among those with vertebral column trauma is relatively stable and specific to each of the examined countries. In contrast to the conflict in Transnistria, the armed conflict in eastern Ukraine did not significantly alter the gender structure of vertebral column trauma patients, indicating a larger proportion of civilians among the affected individuals. Analysis of the causes of vertebral column injuries revealed that, on average, unintentional injuries account for approximately 81%, injuries resulting from road traffic accidents account for 16%, intentional injuries represent about 3%, with the latter two gradually decreasing. Almost half (42‒46%) of vertebral column trauma cases occur in the age group of 20‒44 years. In countries with a high gross domestic product, a significantly higher frequency of injury among elderly and senile population is recorded, possibly due to more efficient diagnostic methods. Conclusions: Gender and age characteristics of vertebral column trauma have a relatively stable pattern specific to each of the examined countries. Numerous socio-economic and behavioral factors influence the frequency of vertebral column trauma, but the significance of these parameters requires further research.

Traction injury of the peripheral nerve (TIPN) is an injury that occurs as a result of stretching the nerve beyond its normal elastic properties. An analysis of the available literature has revealed the following. TIPN is the most common type of severe nerve injury in the setting of road traffic accidents, catatrauma, gunshot wounds, birth injuries, etc. The dynamics of TIPN during fast and slow stretching is the same and includes three phases: elastic, inelastic and tearing. The limits of elastic stretching of the nerve are determined by the degree of tortuosity of myelinated fibers and the elasticity of the connective tissue framework of the nerve. Stretching of the nerve beyond its elastic limits is characterized by rupture of axons and endoneurial sheaths, including at a considerable distance from the epicenter of pathomorphological changes, which determines the severity of the injury and the impossibility of effective nerve autoregeneration. The force of stretching and the direction of its application to the nerve trunk determine the severity of TIPN. The degree of nerve stretching varies along its length and reaches a maximum in the periarticular areas. A fairly moderate stretching of the nerve can lead to a noticeable change in the conductivity of electrical impulses. Unlike other localized types of nerve injury, the pattern of pathomorphological changes in TIPN includes various forms of damage to structural elements. Understanding the pathophysiology of TIPN is a prerequisite for the development of optimal treatment of this type of injury.

More than 60% of traumatic injuries of the spine occur in the zone of the thoracolumbar junction (TLJ), and 60–75% of these fractures are of a compression nature. Type A1 injuries are characterized by the least osteo-destructive changes compared to other injuries. Traditionally, they are treated conservatively. A number of studies conducted in the last 10 years, shows a high rate of failure of conservative treatment, as evidenced by the progression of kyphotic deformity of the compressed vertebral body. Most of these publications are devoted to osteoporotic lesions in aged patients, while this aspect has been little studied in patients of working age with normal bone density. Objective: to evaluate the factors influencing the risk of kyphotic deformity progression in patients of working age with type A1 traumatic injuries of the thoracolumbar junction. Materials and methods. The analysis of clinical cases of patients who visited the outpatient department of Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2019 to 2022 with traumatic damage to the TLJ zone. Forty-seven victims who met the selection criteria were selected. Gender, age, body mass index, level of damage, location of the damaged endplate (caudal or cranial), bone tissue radiodensity, angular kyphotic deformity of the vertebral body, and pain intensity were considered as predictors. Depending on the presence or absence of deformity progression 2 months after the injury, the patients were divided into two clinical groups. The most clinically significant predictors were identified using the LASSO (Least Absolute Shrinkage and Selection Operator) regression method. Results. LASSO screening identified five potential predictors. The final logistic regression model after regularization demonstrated high predictive performance: the area under the ROC curve (AUC) was 0.907, and the predictive accuracy was 85%. When assessing the risk of kyphotic deformity progression in traumatic injuries of type A1 of the TLJ zone, age, bone density, angular kyphotic deformity of the vertebral body, and pain intensity are of the greatest importance, demonstrating a directly proportional relationship. A compressed caudal endplate is also associated with a higher risk of post-traumatic progression of angular kyphosis. The nomogram developed using the mentioned factors makes it possible to quantify the degree of risk when choosing a therapy strategy. Conclusions. The performed analysis made it possible to create a nomogram for predicting the increase in kyphotic deformity of the vertebral body in A1 fractures of TLJ region. The proposed model can be used for a rational assessment of the risk degree when choosing the optimal tactics for treating patients.

One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the speed of surgical arrest of bleeding. This publication describes in detail the main points of management of patients with massive bleeding according to modern international standards and Ukraine regulatory documents.

Chondroblastoma (CB) ‒ a rare benign tumor of the skeleton that is presented by proliferation of chondroblasts with islands of eosinophilic chondroid matrix. CB accounts for less than 1% of all bone neoplasms, while the spine is affected in only 1.4% of all CB cases. Publications devoted to CB of the spine are sporadic and therefore have a considerable scientific interest due to the rarity of the pathology. A clinical case of CB of the cervical-thoracic junction of a 38-year-old patient hospitalized to State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine" in November 2022 is presented. The anamnesis shows that in 2016 a pathological fracture of the Th2 vertebral body was diagnosed. In 2017, a surgical intervention - an open biopsy of the Th2 vertebral arch was performed in a private clinic, but the histopathological analysis, due to the insufficient amount of material and the absence of clinical data, was descriptive, with a certain diagnostic number of possible nosologies. Additional treatment was not performed. When applying in 2022 to the State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine", significant negative dynamics were noted: a fracture of the body of the Th1 vertebra, total destruction of the body of the Th2 vertebra, a change in the signal from the body of the Th3 vertebra, which indicated its focal lesion. The surgery was performed in two stages. The first stage included a ventral corpectomy of the Th1‒Th3 vertebrae with fusion using telescopic body replacement implant and a ventral rigid plate. During the second stage laminectomy of the Th1‒Th3 vertebrae with complete resection of the Th2 costotransverse joints and partial of Th1‒Th3 ones was performed. Stabilization system screws were installed transarticularly in the facet joints C6 and C7, transpedicularly in the bodies of the Th4‒Th6 vertebrae. To increase the fusion rigidity, additional fixation of the Th1 vertebra on the right and the Th3 vertebra on the left was performed through the remaining costotransverse joints. The patient was discharged with positive neurological dynamics. The uniqueness of this case, in addition to the rarity of the histological variant of the pathology, lies in the possibility of tracking the dynamics of the disease on the basis of both neuroimaging methods and pathohistological and immunohistochemical diagnostics. Features of the prevalence of spine CB in the population, the specifiс signs when performing a spiral computer and magnetic resonance imaging, macroscopic, histological and immunohistochemical characteristics of the tumor are considered in detail. The literature data on differential diagnosis, treatment methods and prognosis of disease are organized. The material is of interest to specialists, since the timely selection of an adequate treatment method and its volume determines both the probability of tumor recurrence as well as prognosis concerning the patient’s life expectancy.

Introduction. Morphological and biomechanical features of the thoracolumbar junction determine the large number of cases of traumatic bone injuries. Reconstructive and stabilizing surgeries performed in this area, due to the significant load on both the elements of hardware and bony structures, require high reliability of fixation. Objective. To study the stress-strain state of the model of the thoracolumbar section of the spine after the Th12-L1 vertebrae resection with various options of transpedicular fixation under the influence of flexion load. Materials and methods. The stress-strain state of the mathematical finite-element model of the thoracolumbar section of the human spine under the influence of flexion load was studied. The model simulated the condition after surgery for a significant traumatic lesion of the thoracolumbar junction with laminectomy, facetectomy, and corpectomy of the Th12 and L1 vertebrae. Four variants of transpedicular fixation were studied (using short or long bicortical fixation screws, two crosslinks and without them). Control points of the model characterizing the load distribution both in bony structures and on metal elements of fusion and body replacement systems were studied. Results. Crosslinks have the greatest effect on reducing the level of stress both in the bony elements of the models and in the metal elements. When comparing the length of the screws, the use of monocortical screws was determined to have minor biomechanical advantages. The stress analysis of the area of the screw entry into the pedicle of the arch of the fixed vertebrae (clinically significant zone) revealed that in the model with short screws and without crosslinks, the stress for the vertebrae Th10, Th11, L2 and L3 is 5.0, 1.9, 7.8 and 13.6 MPa, respectively, while the presence of crosslinks reduces the corresponding values to 4.6, 1.9, 7.3 and 12.7 MPa. In models with bicortical screws, the corresponding values are 5.1, 2.3, 10.2, and 12.7 MPa in the absence of crosslinks and 4.7, 1.8, 9.9, and 12.2 MPa with the presence. A similar trend is observed in other control points. When comparing the results with the compression load in the models studied earlier, it was established that flexion causes an increase in the stress of the models with monocortical screws by an average of 33.7%, with bicortical screws by 39.6%. Conclusions. In case of flexion load, the use of crosslinks makes it possible to reduce the level of stress in all control points of the models, regardless of the length of the used transpedicular screws, while the length of the screws does not have a fundamental effect on the stress distribution.

Any surgical intervention is associated with the possible development of complications. Surgical complications are traditionally an unpopular topic for discussion, but in recent decades they have received increased attention, due to both medical and economic factors. This review discusses the general concepts that characterize the negative consequences of surgical interventions in spinal neurosurgery: complications, adverse events, sentinel events, never events, collateral adverse outcomes. Classifications are given that allow systematizing these negative phenomena. Surgical treatment of the lumbar disk herniation is the most frequently performed spinal surgery. The true number of lumbar discectomies is difficult to estimate because this procedure is often not an isolated surgical intervention, but a step in a larger one. Being a routine surgical procedure, discectomy, performed in one or another way depending on the preferences of the surgeon and available equipment, is characterized by a rather low relative frequency of adverse events and complications compared to other types of spinal surgery. However, due to the significant number of interventions, the absolute figures may present a medical and economic problem. Most authors refer to the classic triad of “wrong level, wrong side, wrong patient” and foreign bodies in the area of surgical intervention as obvious medical errors. Damage to the intestine or peritoneum, trauma to the great vessels and trauma to the nerve roots are considered serious complications, but not always medical errors. The other most commonly reported adverse events of lumbar discectomy are durotomy, neurological complications, surgical wound complications, recurrent disc herniation, and reoperation. Until now, no clear classification of the negative consequences of lumbar discectomy, which would allow to verify the relationship between intraoperative adverse events (both surgical and anesthetic) and postoperative complications has been developed. In addition, it is extremely difficult, based on the criteria available in the literature, to identify a medical error in a number of iatrogenic complications, which requires further comprehensive study of the problem, since it has not only medical, but also legal consequences.

Traumatic injuries of the spine constitute a relatively small part of the consequences of the traumatic factor action on the human body but they significantly affect the social and economic component of the injured patients’ life. During the Russian-Ukrainian war, the number of patients with traumatic injuries to the spine and spinal cord increased significantly. The analysis of previous armed conflicts shows that most spinal injuries in both military and civilians are closed. Therefore, the treatment strategy correspond to those in peacetime. One of the least studied issues is the feasibility of surgical decompression of the spinal canal in the late period of spinal cord injury.An anamnestically complex case of traumatic injury of the thoracolumbar junction is presented. A patient with a combined injury underwent laminectomy of the Th12 vertebra and transpedicular fixation of the Th11, Th12, L1 and L2 vertebrae after fracture-dislocation of the Th12-L1, that was accompanied by gross neurological symptoms of ASIA A. Surgery was performed 11 days after the emergency hospitalization. 6 months after trauma it was revealed the screws malposition in the bodies of the Th12 and L1 vertebrae. After 10 months, a surgery was performed: removal of the left transpedicular screw from the body of the Th12 vertebra, laminectomy of the Th12, L1 and L2 vertebrae, an electronic neurostimulator was installed on the spinal cord, and 12 months after the injury, the transpedicular stabilization system was rearranged and the electrodes of neurostimulator were removed. Within 3 years and 7 months, after the appearance of acute pains in the area of the kidneys, an additional examination was performed. Fragmentation of the left rod of fusion system between the L1 and L2 vertebrae was revealed, as well as the presence of ossified fragments of the intervertebral disc at the Th12-L1 level, which caused absolute stenosis of the spinal canal. In Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine, revision surgery was performed: adequate repositioning of the stabilization system and extensive decompression of the spinal canal with facetectomy and complete decompression of the dural sac. During the follow-up examination after 4 months, regression of the neurological deficit from ASIA A to ASIA B was recorded.In the article classic errors during surgery of traumatic injuries of the thoracolumbar junction and the expediency of performing decompressive-revision surgical interventions in the late period of spinal cord injury were analyzed. An anamnestically complex case of traumatic injury of the thoracolumbar junction is presented. A patient with a combined injury underwent laminectomy of the Th12 vertebra and transpedicular fixation of the Th11, Th12, L1 and L2 vertebrae after fracture-dislocation of the Th12-L1, that was accompanied by gross neurological symptoms of ASIA A. Surgery was performed 11 days after the emergency hospitalization. 6 months after trauma it was revealed an unsatisfactory location of the screws in the bodies of the Th12 and L1 vertebrae. After 10 months, a surgery was performed: removal of the left transpedicular screw from the body of the Th12 vertebra, laminectomy of the Th12, L1 and L2 vertebrae, an electronic neurostimulator was installed on the spinal cord, and 12 months after the injury, the transpedicular stabilization system was rearranged and the electrodes of neurostimulator were removed. Within 3 years and 7 months, after the appearance of acute pains in the area of the kidneys, an additional examination was performed. Fragmentation of the left rod of fusion system between the L1 and L2 vertebrae was revealed, as well as the presence of ossified fragments of the intervertebral disc at the Th12-L1 level, which caused absolute stenosis of the spinal canal. In the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine, revision surgery was performed: adequate repositioning of the stabilization system and extensive decompression of the spinal canal with facetectomy and complete decompression of the dural sac. During the follow-up examination after 4 months, regression of the neurological deficit from ASIA A to ASIA B was recorded. In the article we analyze classic errors during surgery of traumatic injuries of the thoracolumbar junction and the expediency of performing decompressive-revision surgical interventions in the late period of spinal cord injury.

According to some authors, traumatic injuries of the thoracolumbar region account for 2/3 to 3/4 of all vertebral fractures. The development, introduction into clinical practice and improvement of methods for treating injuries in this area are associated with attempts to classify injuries into different categories according to the most common, in the author's opinion, signs. The evolution of classifications of traumatic injuries of the spine in general and its thoracolumbar region in particular is largely due to the development of ideas about the biomechanics of injuries. The review attempts to briefly characterize the most well-known classifications. When analyzing the literature, 28 damage ranking systems were selected, reflecting in the historical aspect the change in ideas about the principles of classification, damage biomechanics and treatment tactics. When describing certain types of damage, we tried to reflect the pathomorphological characteristics of the fracture in the author's interpretation as accurately as possible, therefore, in different classifications given in this publication, the same type of damage may have slightly different signs. The information systematized in the review is primarily of historical interest, but in some cases it may be useful to the practicing clinician for a number of reasons. First, taking into account the huge amount of work carried out by the authors of the classifications on the analysis and systematization of the material, a number of publications describe rare types of fractures, and the proposed methods of treatment can still be of practical importance. Secondly, even in modern publications devoted to the study of certain features of the biomechanics or tactics of treating spinal injuries, the authors often use little-known or formally outdated injury ranking systems, since a certain classification principle may be more appropriate for the research task. Thirdly, a general analysis of the evolution of classification systems makes it possible to identify historically established both definitive and tactical errors, the understanding of which allows a more critical attitude towards generally accepted statements.

Spinal cord traumatic injury as resulting persistent movement and sensory disorders is one of the most disabling consequences of traumatic factor impact on the human body. Despite a large number of experimental and clinical studies aimed at developing methods for restoring lost functions, there is no acceptable solution to the problem. One of the promising areas in the treatment and rehabilitation of this category of patients is the use of hyperbaric oxygenation (HBO). Experimental models have shown that HBO has a neuroprotective effect in spinal cord injury, but the results of clinical application of the method are still controversial. Objective: to determine the effectiveness of HBO in the complex therapy of victims with traumatic spinal cord injury and the feasibility of further study of this area. Materials and Methods: Study design is a pilot observational retrospective “case – control”. The database of patients with spinal cord injury who were hospitalized at Romodanov Neurosurgery Institute in the period from 2010 to 2020 were used for the analysis. When selecting a control for each clinical case, the following factors were considered: gender, age, circumstances of injury, type of damage to the osteoligamentous apparatus, level of neurological deficit, degree of damage and compression of the spinal cord, time elapsed from the moment of injury to surgery. 28 "case ‒ control" pairs were analyzed. The main criterion for therapy effectiveness was the change in the functional class according to the ASIA scale. Results. Positive dynamics was registered in 57% of victims, including in the group of patients receiving HBO therapy - in 71%, in the control group - in 43%. HBO therapy in the postoperative period significantly affects the dynamics of regression of neurological disorders (p=0.0295). The odds ratio is 3.333 (95% confidence interval - 1.098‒10.116, p=0.0335). The calculation of the odds ratio, adjusted for additional analyzed factors, showed a more pronounced efficiency - 4.519 (95% confidence interval - 1.279‒15.962, p=0.0192). Conclusions. The obtained results indicate that usage of HBO as a method of complex therapy for traumatic spinal cord injury is promising for further study in order to determine the effectiveness of the method, the optimal timing of treatment initiation in the postoperative period and its duration.

Many soldiers who were wounded during the war in Ukraine with Russia increased the number of cases of spinal injury. As a result of the Russia-Ukraine war, the number of patients with spine and spinal cord injuries increased significantly. According to the literature, gunshot wounds to the spine and spinal cord accounted for 0.26% of all soldier injuries during the American Civil War, with a mortality rate of 55%. According to the U.S. military data, spinal and spinal cord injuries accounted for 1.2% of war-related deaths during the Korean War, 1.0% - during the Vietnam War and the Gulf War, 6.0% - during the US invasion of Panama, 11.1% - during the war in Afghanistan and Iraq. Disability related to spinal cord injuries (14.0%) is currently the leading cause of discharge from military service for U.S. soldiers who have been injured. Patient M., 32 years old, male sustained mine blast injury. Immediately after the injury there was tetraplegia. Surgery was performed to correct vertebrae С7–Тh1, decompression of the spinal cord at the level of vertebrae С7–Тh1. Sixteen days after surgery, the neurological deficit regressed to the Frankel C clinical group. The patient was transferred to rehabilitation treatment. A clear, consistent, rapid algorithm of action in spinal cord injuries allowed to provide highly qualified care, which allowed to achieve significant results in the regression of neurological deficits in the postoperative period.

Introduction. The thoracolumbar junction is one of the most frequently damaged parts of the human spine when exposed to a traumatic factor. Corpectomy in combination with posterior decompression and restoration of the spinal support function is often performed using an interbody implant and posterior transpedicular stabilization to achieve adequate decompression and stabilization in severe traumatic injuries of this level. The surgery of this type is characterized by significant instability of the operated segment and determines increased requirements for the rigidity and reliability of posterior fixation. We have modeled the situation of a two-level corpectomy with subsequent replacement of bodies with a mesh implant and posterior transpedicular stabilization with 8 screws. Objective. To study the stress-strain state of the thoracolumbar spine model after resection of the Th12-L1 vertebrae with different variants of transpedicular fixation under the influence of a compressive load. Materials and methods. A mathematical finite element model of the human thoracolumbar spine has been developed, the components of which are the Th9 ‒ Th11 and L2-L5 vertebrae (vertebrae Th12-L1 are removed), as well as elements of hardware - interbody support and transpedicular system. Four variants of transpedicular fixation were modeled: using short screws and long screws passing through the cortical layer of anterior wall of vertebral body, as well as two cross links and without them. The stress-strain state of the models was studied under the influence of a vertical compressive distributed load, which was applied to the body of the Th9 vertebra and its articular surfaces. The load value was 350 N, corresponding to the weight of the upper body. Results. d It was found that transpedicular fixation of the thoracolumbar vertebrae with the use of long screws reduces the level of tension in the bone elements of the models. In the area of screw entry into the pedicle of the T10, T11, L2 and L3 vertebral arch, the load when using short screws was 3.1, 1.7, 3.9 and 12.1 MPa, respectively, when using bicortically installed screws - 2.9, 1.8, 3.8 and 10.6 MPa. The addition of two cross-links also reduces the maximum load values in critical areas of the model to a certain extent. In case of short screws combination and two cross-links, the load in these areas was 2.8, 1.7, 3.6 and 11.5 MPa, when using bicortical screws and cross-links - 2.8, 1.6, 3.3 and 9.3 MPa. The study of the stress-strain state of other parts of the model revealed a similar trend. Conclusions. The use of long screws with fixation in the cortical bone of anterior part of the vertebral bodies reduces the level of tension in the bone elements of the models. The use of cross links provides greater rigidity to the transpedicular system, that also reduces the tension in the bone tissue.

Traumatic injuries of subaxial cervical spine are characterized by a wide range of possible pathomorphological changes that depend not only on the direction and intensity of the traumatic force impact, but also on the initial position of cervical spine at the moment of exposure. One of the most detailed classifications of cervical spine traumatic injuries, in which the integrated approach to assessing the type of injury considering the mechanism of injury is used, is the system developed by Ben L. Allen and published with co-authors in 1982. It is also known as the Allen-Ferguson classification and despite long history of existence, still has not lost its relevance. In the classification when characterizing the type of traumatic injury, not only visually detected signs, but also inevitably accompanying changes are given. In total, 6 types of damage were classified: compression-flexion, vertical compression, distraction-flexion, compression-extension, distraction-extension and lateral-flexion, which were divided into stages depending on the severity of pathomorphological changes. The authors of the classification note a pronounced correlation between the nature of damage to anatomical structures and neurological disorders in all patterns of damage. When writing this review, a detailed analysis of the original publication was carried out, highlighting the basic biomechanical aspects that underlie the classification and still have not lost their relevance . It is noted that the schematic images of damages found in modern literature often do not correspond to the description proposed by Ben L. Allen et al., Therefore, when preparing the illustrative material, we relied solely on the data of the original article. Along with the description of morphology, for each type and stage of injury, modern data on possible methods of treatment, both conservative and surgical are given. The complex analysis suggests that the classification developed by Ben L. Allen is a convenient tool for assessing pathomorphological changes and allows choosing the optimal method of treating the patients in each specific clinical situation.

Traumatic injury to the cervical spine accompanied by a wide range of possible changes in its osteo-ligamentous apparatus. One of the basic criteria to determine the treatment strategy is the assessment of injury stability which depends on the condition of the spine supporting columns. Most of the modern and widely used classifications of subaxial cervical spine traumatic injuries quite sufficiently characterize the state of the anterior support column. At the same time, much less attention is paid to the assessment of the degree and nature of traumatic changes in lateral masses, facet joints, as well as possible dislocations. Literature analysis reveals the absence of a generally accepted scheme that would allow one to unambiguously and comprehensively characterize the damage to the facets / lateral masses and choose the optimal surgical or conservative treatment method. This review provides well known assessment schemes: classification of traumatic changes of facet joints by Marcel F. Dvorak et al., variants of traumatic displacement of the cervical vertebrae by V.P. Selivanov, variants of lateral mass traumatic injury by Y. Kotani et al. and Posterior Ligament-Bone Injury Classification and Severity Score. The advantages and disadvantages of anterior, posterior or combined approach for the treatment of traumatic injuries of posterior support complex are considered that is of critical importance for obtaining better clinical results. It is noted that the choice of the optimal treatment method is currently a controversial issue. Although good surgical results can be obtained using a variety of methods, there are certain situations in which one technique may be better than others. The accumulated clinical experience and current research on the injured spine biomechanics demonstrate the advantage of surgical treatment in most patients, since such injuries are usually unstable or potentially unstable.

Introduction. The thoracolumbar junction is the most common location of traumatic spinal injuries. It accounts for 50-60% of all thoracic and lumbar spine injuries. Spondyloptosis is rather rare, but one of the most severe types of traumatic injury, that is characterized by a severe damage of spinal axis in one or more planes. Traumatic spondyloptosis is classified as reducible and irreducible, depending on the possibility of intraoperative restoration of the spinal axis without resection of the damaged vertebra. Objective. To determine the optimal surgical technique for traumatic irreducible spondyloptosis of thoracolumbar junction. Materials and methods. A retrospective analysis of the patients’ database treated at the Romodanov Neurosurgery Institute, Ukraine was performed over the past 4 years (2017 to 2020) to identify all cases with traumatic irreducible spondyloptosis of the thoracolumbar junction. Results. Treatment outcomes of five patients aged 18 to 52 years (mean age 31.2 years) were analyzed. The minimum period from the moment of injury to surgery was 14 days, the maximum was 3 months and 2 days (on average 42.2 days). At the time of admission all patients had a neurological deficit that corresponds to the functional class A on the American spine injury associatin ASIA scale of severity of spinal cord injury. The TLICS (Thoracolumbar injury classification and severity) score was 8 points. All the patients had the injury of lateral spondyloptosis: in three cases as an isolated displacement only in the coronal plane, in two – as a combined one - in the coronal and sagittal plane. Surgical intervention in all cases was performed from the posterior approach. As a body replacement system in 2 patients, a vertical cylindrical implant (Mesh) was used, in 3 patients - a telescopic body replacing implant. The method of bicortical implantation of pedicle screws was applied. The transpedicular system was strengthened by two cross links of the rod-to-rod type. In all cases the restoration of spinal axis was achieved in both the coronal and sagittal planes. Follow-up examinations were carried out 2, 6 and 12-18 months of the postoperative period. Regression of neurological disorders was registered in two patients, in one case to ASIA B, in the other to ASIA C. Conclusions. Isolated posterior approach has demonstrated high efficacy in the surgical management of traumatic irreducible spondyloptosis of the thoracolumbar junction both in restoring the axis of the spine and in ensuring the stability of fusion.

Cervical spine injuries are a fairly common consequence of mechanical impact on the human body. The subaxial level of the cervical spine accounts for approximately half to 2/3 of these injuries. Despite the numerous classification systems that exist for describing these injuries, the recommendations for treatment strategy are very limited, and currently none of them is universal and generally accepted. Consequently, treatment decisions are based on the individual experience of the specialist, but not on evidence or algorithms. While the classification system based on the mechanism of trauma originally proposed by B.L. Allen et al. and subsequently modified by J.H. Harris Jr et al., was comprehensive, but lacked evidence, which to some extent limited its clinical applicability. Similarly, the Subaxial Injury Classification System proposed by the Spine Trauma Group, had no distinct and clinically significant patterns of morphological damage. This fact hindered the standardization and unification of tactical approaches. As an attempt to solve this problem, in 2016 Alexander Vaccaro, together with AO Spine, proposed the AO Spine subaxial cervical spine injury classification system, using the principle of already existing AOSpine classification of thoracolumbar injuries. The aim of the project was to develop an effective system that provides clear, clinically relevant morphological descriptions of trauma patterns, which should contribute to the determination of treatment strategy. The proposed classification of cervical spine injuries at the subaxial level follows the same hierarchical approach as previous AO classifications, namely, it characterizes injuries based on 4 parameters: (1) injury morphology, (2) facet damage, (3) neurological status, and (4) specific modifiers. The morphology of injuries is divided into 3 subgroups of injuries: A (compression), B (flexion-distraction), and C (dislocations and displacements). Damage types A and B are divided into 5 (A0-A4) and 3 (B1-B3) subtypes, respectively. When describing damage of the facet joints, 4 subtypes are distinguished: F1 (fracture without displacement), F2 (unstable fracture), F3 (floating lateral mass) and F4 (dislocation). The system also integrates the assessment of neurological status, which is divided into 6 subtype). In addition, the classification includes 4 specific modifiers designed to better detail a number of pathological conditions. The performance evaluation of AOSpine SCICS showed a moderate to significant range of consistency and reproducibility. Currently, a quantitative scale for assessing the severity of classification classes has been proposed, which also, to a certain extent, contributes to decision-making regarding treatment strategy.

Objective. To determine the dynamics and state of neurosurgical care for tumors of the spinal cord and spine (TSCS) in Ukraine. Materials and methods. The work is based on the analysis of hospitalizations and surgical treatment of patients with TSCS in neurosurgical departments of Ukraine in 2000-2019. Results. In 2019, 1,325 patients with TSCS were hospitalized in neurosurgical departments of Ukraine, which is 2,3 times more than in 2000 (567), per 1 million population - almost 3 times (34,7 vs. 11, 6 ). Over 20 years, the number of operated patients increased 2,8 times (from 385 to 1079), per 1 million population - 3,6 times (from 7,9 to 28,3), there was an increase in surgical activity by 20% (from 67,9 to 81,4%), a decrease in the general and postoperative mortality - twice (from 2,6 to 1,2% and from 2,6 to 1,3% respectively). Patients with TSCS account for 1,5% of all patients hospitalized in neurosurgical departments of Ukraine, 12,8% of all CNS neoplasms and 5,2% of all spinal pathology. Vertebral tumors account for 42,64% of all TSCS and extramedullary tumors have an incidence rate similar to vertebral tumors (42,64%), intramedullary tumors account for 14,72%. In 2019, 74.4% more patients with extramedullary tumors were hospitalized than in 2000 (565 and 324 respectively), and 84.5% more were operated on (463 and 251 respectively). The rate of increase is even higher per 1 million population. In 2019, there were 14.8 hospitalizations per 1 million population for extramedullary tumors, which is 2.2 times greater than in 2000 (6,6 hospitalizations), and 12,1 operations, which is 2,4 times greater than in 2000 (5,1 operations). In 2019, patients with intramedullary tumors were hospitalized 2,2 times more than in 2000. (195 and 89 respectively), were operated 2,5 times more (151 and 61 respectively). The rate of increase is even 4higher per 1 million population. In 2019, there were 5,1 hospitalizations for intramedullary tumors per 1 million population, which is 2,8 times greater than in 2000 (1,8 hospitalizations), and 4,0 operations, which is 3,2 times greater than in 2000 (1,2 operations). In 2019, patients with vertebral tumors were hospitalized 3.7 times more than in 2000 (565 and 154 respectively), were operated 6,4 times more (465 and 73 respectively). The rate of increase is even higher per 1 million population. In 2019, there were 14,8 hospitalizations per 1 million population for vertebral tumors, which is 4,7 greater than in 2000 (3,1 hospitalizations), and 12,2 surgeries, which is 8,2 greater than in 2000 (1,5 operations). Сonclusions. The introduction of modern neuroimaging methods and advanced treatment methods into clinical practice has contributed to an increase in the number of hospitalizations and surgical interventions in TSCS.

Cervical spine traumatic lesion occurs in 3 % of injured patients. These lesions are often associated with a neurological deficit, ranging from radiculopathy to incomplete or complete spinal cord damage. High rates of mortality and permanent disability determine not only the medical but the socio-economic component of the problem.Since the advent of the first methods of instrumental diagnosis to the present time, the development and improvement of classification systems for traumatic injuries of the cervical spine have been ongoing. This is caused by the necessity to briefly and concisely describe the nature of the damage within the staged treatment of the injured person, perform gradation depending on the severity of the injury, provide understanding and prediction of the clinical scenario, and assist in the selection of the optimal treatment tactics.The introduction of more advanced and informative diagnostic methods into clinical practice determines the evolution of classification systems. Radiographic results of the cervical spine, despite the indisputable screening value, are no longer leading in the formation of classification categories.Studies of spine biomechanics allowed forming the ideas about the stability of injury, that, along with the severity of neurological disorders, have a leading tactical and prognostic value. Whereas, absolute unified criteria for stable or unstable damage have not yet been developed.This review analyses the Cervical Spine Injury Severity Score, based on computed tomography data, that allows quantifying the severity of damage and determining the optimal treatment tactics. The classification system has an exclusively morphological basis. It is the most detailed scale for assessing the stability of the damaged vertebral-motion segment developed so far. A high level of evidence allows using CSISS both in clinical practice and in the development and evaluation of the effectiveness of new methods of surgical and non-surgical treatment of patients with traumatic damage to the subaxial cervical spine.

Objective: the primary assessment of the prognostic features of tractography in patients with severe subaxial cervical spine and spinal cord injury.Materials and methods. The clinical group consisted of 5 patients admitted to the Department of Spine Surgery of Romodanov Neurosurgery Institute during the period from April to July 2019 with severe traumatic injury of the cervical spine and spinal cord. MRI was performed in the following modes: T1W, T2W, FLAIR, STIR, T2W FFE, CSF flow and DTI in 5–7 days after surgery. The dynamics of neurological disorders regression were evaluated according to the International Standards for Neurological Classification of Spinal Cord Injury. The level of spinal canal traumatic stenosis was determined by SCT both before and after surgical correction. Due to the small clinical group, statistical processing of the obtained digital indicators was not performed. The main task was to identify general patterns in order to determine the direction of further detailed studies.Results. Spinal cord edema at the damage level was observed in 100 % of patients that corresponded to the level of neurological disorders. The presence of hemorrhagic component was detected in 3 patients, while post-traumatic spinal stenosis was: more than 50 % — in one patient, up to 50 % — one patient and less than 25 % — one patient. Spinal cord parenchyma edema was accompanied by varying degrees of compression of the cerebrospinal spaces, from subtotal to total, with the presence or absence of a hemorrhagic component that did not impact the intensity of cerebrospinal fluid flow disorders. Evaluation of DTI results showed a moderate inverse relationship between FA and MD indicators. Two patients presented with a regression of neurological disorders. Restoration of sensory-motor functions did not correlate with the degree of compression of the spinal canal or the nature of changes in the parenchyma of the spinal cord, but was noted in patients with maximum FA values and low MD.Conclusions. Tractography is an informative predictor of the regression of neurological disorders in patients with severe spine and spinal cord injury. Further studies are needed to identify the optimal timing of its implementation and to establish diagnostically significant values of anisotropic diffusion indices.

Cervical spine trauma remains one of the most severe musculoskeletal injuries with high mortality and disability. The majority of injuries of this location occur at the subaxial level — more than 65 % of fractures and 75 % of dislocations. The complex anatomical structure of the cervical spine, its high mobility, the multiplicity of injury variants, as well as the potentially catastrophic consequences of incorrect therapy, determine correct tactics to be a difficult clinical task, even for specialists with extensive practical experience. Despite the impressive amount of scientific research and clinical achievements, the classification and approaches to treating fractures and dislocations of the cervical spine remain quite controversial.This review describes one of the first clinical classifications of traumatic injuries of the cervical spine at the subaxial level. The Subaxial Injury Classification and Severity Scale were developed by spinal injury study group in 2007, and currently, it is one of the most common, simple, clinically-oriented tools for unifying damage and treatment tactics. One of the indisputable advantages of the presented systematization is the point-based assessment of the injury severity, a sufficiently developed therapeutic and tactical algorithm and a significant evidence base.The classification considers three main groups of criteria that are fundamental in making clinical decisions regarding the management of patients with traumatic injury: the morphology of injury; integrity of the disco-ligamentous complex; neurological status.The article provides a detailed analysis of principles of classification cases construction, as well as the main surgical approaches, depending on the nature and extent of damage to various anatomical structures. Even though the described tactical principles are certainly purely recommendatory, nevertheless, therapy based on the specified scale is highly clinically argued.