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Objective. To determine incidence rate and risk factors for the development of venous thromboembolism in complicated cervical spine injury. Material and Methods. The study included 34 patients with acute complicated cervical spine injury. Inclusion criteria were newly diagnosed venous thromboembolic complications, and application of low-frequency piezothromboelastography to study the hemostasis system. All patients received standard drug thromboprophylaxis. Patients were divided into two study groups: Group I included 21 patients with venous thromboembolic complications, and Group II – 13 patients without thromboembolic complications. Results. The incidence of venous thromboembolism in the total sample was 61.8 %. Pulmonary artery embolism developed in 4.7 % of cases. In 91,0 % of cases, thrombosis was asymptomatic. The state of the hemostatic system in Group I before the start of thromboprophylaxis was characterized by chronometric hypocoagulation, and structural hypercoagulation with a 2.6-fold increase in the intensity of clot retraction and lysis. In Group II, there was chronometric and structural hypercoagulation with a 14.4-fold increase in the intensity of clot retraction and lysis. The main significant predictors of the development of venous thromboembolism were identified as intestinal paresis (p = 0.004), absence of changes in neurological status (p = 0.012), length of stay in the ICU (p = 0.025), and length of hospital stay (p = 0.039). The building of a multivariate logistic regression model revealed multiplicative significant predictors of the development of thromboembolism. It has been shown that the presence of intestinal paresis is associated with a 25.07-fold increase in the chances of developing DVT of lower extremities. Conclusion. Considering the high incidence of venous thromboembolic complications in patients with complicated cervical spine injury, further research is required to study the effectiveness and safety of correction of drug thromboprophylaxis regimens in the form of increasing doses of anticoagulants or the frequency of their administration.

Objective. To perform a comparative radiological analysis of the methods of hybrid stabilization (posterior fixation in combination with cement vertebroplasty and osteoplasty with deproteinized allobone) and circular stabilization (posterior fixation in combination with anterior fusion) used in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis. Material and Methods. The study is retrospective. Two groups of patients were formed, and inclusion and exclusion criteria were determined. The magnitude of kyphosis correction (according to Cobb), the magnitude of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period, and the sagittal balance (Barrey index) were assessed. The follow-up period was 12 months. Subjective assessments of the patient’s condition were not considered. Results. The magnitude of initial kyphotic deformity (>20°), incomplete achievement of kyphosis correction after surgery (>5°), the value of densitometry T-score, and sagittal imbalance before and after surgical intervention are, with a statistically significant difference, the main predictors of local kyphosis recurrence, incomplete correction of deformity and decompensated sagittal imbalance. Conclusions. When comparing the methods of hybrid and circular stabilization, there was no statistical difference in radiological outcomes.

Objective. To identify the mechanism of deformity compensation in patients with post-traumatic kyphosis of the thoracolumbar junction, based on the analysis of X-ray results of surgical treatment. Material and Methods. The study included data obtained from medical records of 69 patients (47 women, 22 men) operated on for painful post-traumatic kyphosis at the levels of T12, L1 and L2 vertebra. Patients underwent staged surgical interventions in a single surgical session. Demographic data and X-ray results of surgical treatment were evaluated. Results. As a result of surgical interventions, post-traumatic kyphosis (LK) was corrected to an average of 1.9°. After correction of kyphosis, statistically significant changes in the parameters of sagittal spinal curvatures were revealed: an increase in thoracic kyphosis (TK), a decrease in lumbar lordosis (LL), including due to lower lumbar lordosis (LowLL). At the same time, the parameters of the spinopelvic balance (PT, SS) did not change. Statistically significant correlations (p < 0.001) were detected between the magnitude of local kyphosis correction (LK preOP-LKpostOP), which amounted to 33.63° ± 8.77°, and parameters of lumbar lordosis ΔLL, thoracic kyphosis ΔTK and ΔPI-LL. Parameters of global sagittal balance and pelvic balance did not show correlations with the magnitude of kyphosis correction. The X-ray study of patients in Group I (without signs of initial sagittal imbalance) and Group II (with signs of sagittal imbalance) revealed a statistically significant difference in global balance (GT) and spinopelvic balance (PT, SS, LowLL), both before and after cor- rection intervention in the thoracolumbar junction area, despite comparable indicators of sagittal spinal curvatures and the magnitude of post-traumatic kyphosis. Conclusion. The main compensation mechanism includes changes in the spinal departments adjacent to kyphosis: a decrease in thoracic kyphosis and an increase in lumbar lordosis, rather than changes in the global or spinopelvic balance.

Objective. To establish the effect of neurogenic shock (NS) on the course of acute complicated injury of the cervical spine. Material and Methods. The retrospective study included 96 patients with acute complicated injury of the cervical spine. The criteria for the presence of NS were determined as mean arterial pressure (MAP) < 70 mm Hg, and heart rate (HR) < 60 per minute. Two groups were distinguished: Group 1 included 13 patients with NS, and Group 2 – 83 patients without NS. The main characteristics of patients and the course of spinal cord injury were analyzed from the moment of admission to the 30th day of follow-up. Results. There were no statistically significant differences between the groups in terms of gender, age, level of spinal injury, severity of spinal cord injury and comorbidity. Admission BP and HR in patients with NS were below the reference values and had statistically significant differences in comparison with similar indicators in patients of Group 2. On the first day of treatment in the intensive care unit (ICU), hemodynamic support was required for all patients of Group 1, and for 69 patients of Group 2 (83.1 %). The duration of hemodynamic support in Group 1 was 11 days [6; 15], and in Group 2 – 7 days [4; 14]; p = 0.231. Blood lactate and pH levels were consistent with reference values at all stages, with no intergroup differences. Differences in the severity of organ dysfunctions (SOFA scale) were registered only on the seventh day of treatment in the ICU (p = 0.010); there were no significant differences in the severity of the patients’ condition (APACHE II scale). The presence of NS was accompanied by a statistically significant increase in the complication rate. The duration of treatment in the ICU was 28 days [22; 57] in Group 1, 23.5 days [11; 37] in Group 2 (p = 0.055), and that in the hospital – 58 days [44; 70] in Group 1 versus 41.5 [24; 59.5] in Group 2 (p < 0.025). Positive dynamics in the neurological status was noted at discharge in 15.0 % of Group 1 patients and in 19.3 % of Group 2 patients. Conclusion. The prevalence of NS in isolated injury of the cervical spine was 13.5 %. The development of NS significantly increases the complication rate and duration of hospital stay, but does not exclude the possibility of regression of existing neurological disorders.

Objective. To perform comparative analysis of posterior stabilization methods combined with cement vertebroplasty and osteoplasty with deproteinized bone allograft in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis. Material and Methods. The study was a retrospective analysis. Two groups of patients were formed, inclusion and exclusion criteria were determined. The follow-up period was 12 months. The magnitude of kyphosis correction according to the Cobb method, the magnitude of residual postoperative kyphotic deformity, its recurrence in the long term postoperative period, and the length of transpedicular fixation were assessed. Sagittal balance parameters and subjective assessments of the patient’s condition were not evaluated. Results. With a statistically significant difference, it can be said that the main predictors of recurrence of local kyphosis, incomplete correction of deformity and increased pain syndrome are the level of injury (T12 vertebra), the degree of initial kyphotic deformity, incomplete achievement of its correction after surgery (>10°), and the value of T-criterion according to densitometry. The length of fixation does not affect the loss of correction and recurrence of kyphosis, however it may correlate with the severity of osteoporosis. Conclusions. When comparing posterior stabilization methods in combination with cement vertebroplasty or osteoplasty, there was no statistical difference in clinical and radiological outcomes.

Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment. Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to dis- placement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis. Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear dis- placement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N. Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.

Objective. To analyze the dynamics of neurological symptoms and the structure of complications when using methylprednisolone and the meth-od of maintaining target values of mean arterial pressure during surgical treatment of patients in the acute period of spinal cord injury (SCI). Material and Methods. The study included 110 patients in the acute period of SCI with compression of spinal cord segments who were ad-mitted to the clinic from January 2012 to March 2018 and underwent decompression and stabilization surgery within the first 2–3 hours after admission. In order to improve the blood supply to the damaged segments of the spinal cord and to prevent multiple organ failure, the main direction of intensive care in two groups of patients was to maintain the target blood pressure at the level of 85–90 mm Hg dur-ing the first 7–10 days. The MPD group included 43 patients who received methylprednisolone as a neuroprotector at a dose of 30 mg/kg bolus within the first hour after admission, followed by infusion at a dose of 5.4 mg/kg/h for 23 hours; and the MAP group included 67 pa-tients who did not receive methylprednisolone. Non-invasive monitoring of central hemodynamic parameters was carried out on the basis of impedance cardiography data. The objective status of patients and data of X-ray diagnostics at the time of preoperative examination and during instrumental studies, as well as in 3–14 day intervals and in the mid-term (up to 4–6 months) postoperative period were analyzed. Results. In the MPD group, 22 patients had ASIA type A neurological deficit, and an increase in ASIA grade was observed only in 4 (18 %) of them. There were 18 patients with incomplete injury in this group, and 9 of them (50 %) had a positive trend. In the MAP group, 38 patients had ASIA type A, out of them 11 (29 %) improved, and 28 patients had ASIA type B, C or D, out of them 17 (61 %) showed positive dynamics of neurological symptoms. No statistically significant differences were found. In the MPD group, complications such as nosocomial pneumonia and acute endobronchitis were observed three times more often, pulmonary embolism and decubital soft tissue ulcers – four times more often, and sepsis, acute respiratory distress syndrome and surgical site infection – two times more often. There were statistically significant differences in the incidence of nosocomial pneumonia and acute endobronchitis between MPD and MAP groups (p = 0.004 and p = 0.002, respectively.) Conclusion. Maintaining mean arterial pressure at 85–90 mm Hg during the first 7–10 days after admission to the hospital allowed achiev-ing a greater number of cases of improvement in the neurological status of patients, in contrast to the use of methylprednisolone. The use of methylprednisolone in patients with acute SCI increased the risk of nosocomial pneumonia or acute endobronchitis by 2.91 times (p = 0.003).

Objective. To identify factors leading to the loss of correction and redislocation of the vertebrae after isolated anterior reconstruction and stabilization in the surgical treatment of subaxial cervical dislocations. Material and Methods. A retrospective cohort STROBE-type study was carried out using data of 175 patients with dislocations of vertebrae in the subaxial cervical spine who were operated on in 2010–2019. The key parameters of the study were the relevant indices of the cervical sagittal balance and morphological characteristics of the injury: thoracic inlet angle (TIA), T1 vertebra slope, neck tilt, regional cervical C2–C7 lordosis, fracture of the vertebral body, and fracture of the articular process at the level of dislocation. Statistical analysis of the obtained data was carried out in the RStudio program. Results. At preoperative TIA value of 74.5°, the risk of correction loss corresponds to 28 %. In the group with TIA < 74.5° and that with TIA ≥ 74.5°, the risk of correction loss is 17.3 % (95 % CI: 7–37 %) and 85.7 % (95 % CI: 60–96 %), respectively. With an increase in TIA by 10°, the chance of recurrence increases by 23.3 times. The effect of the articular process fracture on the loss of correction is equivalent to an increase in TIA by 10°, namely, it increases the chance of recurrence by 20.7 times. The parameter “duration of injury” has an effect on the loss of correction, but it is statistically insignificant (p > 0.05). Conclusion. The parameter of the cervical sagittal balance, thoracic inlet angle, as well as the fracture of the articular process at the level of injury are statistically significant factors that determine the initial stability in isolated anterior surgical reconstruction and stabilization of the lower cervical spine for Allen type 3 flexion-distraction injuries.

Introduction A good alternative to bone autograft fusion is the utilization of implants produced from non-biological materials. Such implants can reduce the duration of surgery as well as tissue morbidity, while meeting the mechanical strength and osteoconductivity requirements. According to the study results, carbon is a promising material for interbody fusion because of its biocompatibility and osseointegration, as well as an elastic modulus that is close to bone tissue. Methods From 2015 to 2017 a randomized multicenter study was conducted. Three centers took part in the study: the National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov; Novosibirsk Research Institute for Traumatology and Orthopedics named after Ya.L. Tsivyan; Saint-Petersburg National Phtisiopulmonology Research Institute. One hundred thirteen patients with vertebral body fractures were included in the study and underwent surgical treatment using posterior interbody fusion. In 75 patients (66.37 %, group I) carbon-carbon implants were used, and in 38 patients (group II) – titanium cages. Patient examination was conducted using one protocol, preoperative examination methods and at 6, 12, and 24 month follow-ups, and included VAS score, SF-36 questionnaire, and ASIA scale, as well as CT examination and fusion progress assessment according to G. Tan’s classification. Results The 2-year study showed statistically significant differences between index (carbon implants) and control (titanium cages) groups. Although bone fusion progressed very slowly in the study group (in 86 % of cases no bone fusion was observed at first follow-up 6 months after surgery), the VAS and SF-36 scores were comparable in study and control groups. Discussion Carbon implants are characterized not only by high mechanical strength but also by a significant ability to osteoconductivity that allow for effective bone-carbon fusion due to their porous structure and an elastic modulus of 20–30 GPa, that is comparable to that of bone tissue. These characteristics were confirmed by radiological data (absence of implant subsidence in 38 out of 58 patients (65.51 %) at 24 month follow-up. Titanium implants with an elastic modulus of 80 GPa had a subsidence rate of 100 %.

Purpose To assess osteoconductive properties of carbon fibre implants used in surgery of spine injuries and disorders. Materials and methods Two clinical cases from a multicentre prospective study on nanostructured carbon fibrous implants applied for a variety of spinal pathology are presented. Results The usage of highly porous carbon fibre implant resulted in bone and carbon fusion in the clinical instances whereas implants with a residual porosity of 7–12 % showed no fusion between bone and carbon. The patients had satisfactory clinical condition and quality of life. Discussion Carbon fibrous implant characteristics are close to those of bone tissue, being inert and osteoconductive along with high mechanical strength that ensure bone and carbon fibrous fusion with highly porous implant

Objective. To analyze the results of the anterior spinal fusion with an interbody implant made of nanostructured porous alumina ceramic in patients with degenerative diseases of the spine. Material and Methods. Clinical trial included surgical treatment of three patients aged 28—46 years with cervical inter- vertebral disc disease and severe pain in the neck and upper extremity. The developed porous bioceramic implant was installed into the lower cervical spine through classical anterior approach. The follow-up examination was carried out 3, 6 and 12 months after operation. Results. Patients had a regression of pain in the early postoperative period due to adequate decompression and stabilization at the level of affected spinal segment. Sagittal size of the spinal canal at this level increased from 9.2 ± 0.3 mm to 10.1 ± 0.8 mm. Pain in the neck and arm disappeared completely in two patients after three months and in one patient after six months. The final follow-up showed the full motion recovery and the absence of sensitivity disorders. Conclusion. The use of porous ceramic interbody fixator allows maintaining relationships in the spinal segment for the entire period of bone block formation. It is advisable to use fixing devices made of this material, which does not produce MRI artifacts, for adequate assessment of spinal cord structures.