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Osteoporotic vertebral compression fractures (OVCF) are common fragility fractures of the spine that can lead to the functional failure and neurological deficit in 15-35 % of cases. There is no clear understanding of preferred surgical techniques to be used for treatment of patients with complicated thoracic and lumbar OVCF. The objective was to analyze reasons of failed ventral intervention in a patient with old Th12 injury affected by osteoporosis and demonstrate a short- and long-term outcome of repeated surgery. Material and methods A 63-year-old patient underwent stabilization of the thoracolumbar spine using a combined polysegmental (screws/hooks) dorsal system with screws augmented with bone cement. Results Physical examination and radiography at 12 months showed no loss of correction or signs of structural instability. Bone-metal fusion was observed at the level of the mesh endofixator (Th11-L1). VAS scored 0-1 (standing = lying), the Oswestry Disability Index was 12 %. Discussion The poor outcome of ventral intervention was caused by inadequate instrumentation of the transitional thoracolumbar spine in osteoporotic patient leading to L1 destruction and gradual kyphotization of the stabilized spine. The satisfactory short- and long-term outcomes of the revision dorsal intervention indicated the effective surgical strategy in the case. Conclusion With the results of the case reported, the reliability of anterior fixation is to be considered in osteoporotic patients to determine the feasibility of extended ventral systems in elderly patients. Dorsal stabilization and spinal fusion without preliminary abdominal revision are practical with unstable anterior fixation being not accompanied by significant secondary spinal deformity.

A clinical case of surgical treatment of a female patient with dumbbell schwannoma growing from the T4 nerve root and aggressive hemangioma of the T4 vertebral body and arch is presented. The open kyphoplasty through posterior approach was performed and followed by T4 laminectomy, costotransversectomy at the T4–T5 level on the left, total microsurgical resection of the tumor through right extrapleural approach, and transpedicular fixation of the T3–T5 vertebrae. There were no postoperative complications. The control computer tomography confirmed the complete removal of the tumor and the spine stability at the level of surgery.

Purpose To determine the specificity of sagittal compensatory mechanisms in patients with post-traumatic deformities of the thoracic and lumbar spine, and also to study their correlation with pain and the life quality of patients. Materials and methods Using X-ray analysis of growth profile spondylograms of 103 patients we studied the effect of segmental post-traumatic deformity (SD) and anatomic shape of the spine (Roussouly type) on regional (TK, LL), pelvic (SS, PT) and global (SVA) parameters of sagittal balance. In addition, the analysis of dependence of pain (VAS) and the life quality of patients (ODI, SF-36) on the above parameters was done. Results SD of the thoracic spine (Th1–Th10) increased TK, which led to hyperextension of LL and a decrease in SS. These compensatory mechanisms were reflected in significant correlations SD-TK, TK-LL, TK-SS, and LL‑SS. In the thoracolumbar spine (Th11–L2) SD at the level of Th11 and Th12 increased TK (SD-TK r = 0.553), and at the level of L1 and L2 they caused reactive hypokyphosis (SD-TK r = –0.687). A compensatory increase in LL was typical for injuries of Th11–Th12 (TK-LL r = 0.831) and L1 (TK-LL r = –0.629). Deformities at the L2 level led to hypolordosis (SD-LL r = –0.710), the magnitude of which, in turn, significantly influenced the TK, SS, and PT (LL-TK r = 0.690; LL-SS r = 0.832; SS-PT r = 0.597). The effectiveness of sagittal alignment in thoracic and thoracolumbar SD was confirmed by normal SVA values, as well as their lack of correlation with TK, LL and SS. In the lumbar spine (L3–L5), SD in 75 % of cases led to a critical decrease in LL and sagittal imbalance, which was reflected in significant correlations SD-LL, SD-PT, and SD-SVA. Compensatory correction of regional (TK, LL) and pelvic sagittal parameters (SS, PT) depended on the anatomical features of the spine (PI, Roussouly type) at all levels of the spinal column. However, a significant effect of PI on global sagittal alignment was noted only in lumbar SD (SVA-PI r = –0.617). Correlation of sagittal modifiers with pain intensity and quality of life was also typical only for patients with SD of the lumbar spine (PT-VAS r = 0.777; PT-ODI r = 0.752; PT-SF36 (PH) r = 0.651; SVA-VAS r = 0.775; SVA-ODI r = 0.762; SVA-SF36 (PH) r = 0.703). Conclusion Sagittal balance in fixed thoracic and thoracolumbar kyphosis is satisfactorily supported by changes in the curvature of adjacent parts of the spine, in contrast to lumbar deformities, in which in 75 % of cases, decompensation of the spine profile alignment occurs.

Introduction Aggressive vertebral hemangiomas occur in 10–11.5 % of the working-age population that determines social significance of the disease. Percutaneous vertebroplasty technique is normally used for the treatment of aggressive spinal hemangiomas. Cement leakage is the most common complication during vertebroplasty (40–87. 5 %). Balloon kyphoplasty is associated with a low incidence of cement leakage. Objective We aimed to analyze literature and summarize information on balloon kyphoplasty used to treat aggressive spinal hemangiomas. Material and methods The original literature search was conducted on key resources including PubMed and GoogleScholar. Literature searches included both Russian and English studies based on keywords. Results and discussion The article presents the main results of balloon kyphoplasty used as a standalone procedure and in combination with other methods of surgical treatment of aggressive spinal hemangiomas. The use of balloon kyphoplasty was shown to reduce the risk of extraspinal cement leakage. However, this aspect is represented by a small number of scientific publications in the current medical literature that emphasizes the relevance of the topic raised. Conclusion Despite the variety of available treatment options, the optimal management strategy remains controversial for aggressive forms of vertebral hemangiomas. There are no well-defined criteria and indications reported recently to be included into a well-structured algorithm for of balloon kyphoplasty in the treatment of aggressive spinal hemangiomas, and therefore the debatable questions need further investigation.

Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

Aggressive vertebral hemangiomas represent 4 % of all hemangiomas. Percutaneous vertebroplasty is typically considered as the first-line treatment option for aggressive hemangioma. The lesions that involve the entire vertebral body, extend into the cortical bone constitute 44 % of all vertebral hemangiomas. Extra-vertebral cement migration is reported to occur in 40 to 87.5 % of the cases at percutaneous vertebroplasty being less with the use of balloon kyphoplasty. There is a paucity of literature examining surgical treatment of aggressive hemangiomas with balloon kyphoplasty. We report two cases of aggressive vertebral hemangiomas involving the entire vertebral bodies treated with balloon kyphoplasty. The treatment provided good outcomes with no complications observed postoperatively.

Objective. To analyze the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoraco- lumbar junction, which influenced the study of this problem. Material and Methods. The Web of Science database was searched for keywords to detect articles related to thoracolumbar junction sur- gery. Articles were selected taking into account the title, abstract and the used methods, and then evaluated by the total number of cita- tions to identify the fifty most cited. Characteristics of publications were analyzed. Results. The United States of America, Thomas Jefferson University and A.R. Vaccaro were the most productive country, institution and author, respectively, dealing with the subject. The 2000s was the most active decade in terms of the number of publications. The great- est attention of scientists dealing with the problems of thoracolumbar injury was attracted by the article by McLain et al. analyzing the causes of the failures of short-segment transpedicular systems in the early postoperative period. The article by Laursen et al. presenting the results of using recombinant bone morphogenetic protein-7 in combination with metal fixation is at the top of the list in terms of aver- age citation index. Most articles are well-designed randomized studies with the evidence level II. Conclusion. Citation analysis allowed to identify the most relevant articles, the authors of which have made a significant contribution to the problem of surgery of the thoracolumbar junction. Study of the information field through the prism of the most cited articles allows seeing the mainstream and future development of diagnostics, classification and treatment of the injuries of this localization.

The given report concerns the method of surgical treatment of vertebral body comminuted fractures. The surgery is presented by transpedicular fixation of an injured part and allows reduction of injured vertebra body fragments. Simplicity of its technical operation and the technique efficiency confirms its practical value.