Vol 9, No 3 (2002)

In 1908, Krause described a case of removal of a damaged intervertebral disc. After making a median skin incision, detaching the paravertebral muscles from the spinous processes and arches, and removing half of the arch, he discovered a dural sac protruding posteriorly. After dissecting the dura mater, the surgeon removed a tumor-like formation of the intervertebral disc (which he called the echondroma). This case can be considered the first attempt to remove a prolapsed disc [60]. In 1929, Dandy discovered that the cartilaginous tissues of the intervertebral disc, migrating into the spinal canal, can compress the nerves and cause pain in the leg. The removal of these "cartilaginous nodules" helped to eliminate the pain syndrome.

In accordance with the Plan of the main organizational measures of the Ministry of Health of Russia for 2002 (paragraph 7.46) and the Directive of the Ministry of Health of Russia No. 594-U dated 15.04.02, on May 29-30, 2002 in Svetlogorsk (Kaliningrad Region) a meeting of the main pediatric orthopedists-traumatologists on topic "Actual issues of pediatric traumatology and orthopedics". It was organized by the State Research Institute for Children's Orthopedics. G.I. Turner (Director - Prof. Yu.I. Pozdnikin), GUN Central Research Institute of Traumatology and Orthopedics. N.N. Priorov (Director - Academician of the Russian Academy of Medical Sciences S.P. Mironov) and the Health Department of the Kaliningrad Region (Head - E.M. Krepak). The meeting was held under the patronage of the Governor of the Kaliningrad Region V.G. Egorov, who addressed the participants with a welcome address.

June 12, 2002 was the 60th anniversary of the Honored Inventor of the Russian Federation, Doctor of Medical Sciences, Professor VASILY IOSIFOVICH ZORA.V.I. Zorya was born in Ukraine in the village of Maly Chernyatin, Vinnitsa region, into a peasant family. After graduating from high school, he entered the Vinnitsa railway technical school. After completing his studies, he was drafted into the ranks of the Soviet Army. After demobilization, he worked as a foreman on the railway.

The results of surgical treatment of 133 patients with spondylolisthesis are analysed. In 60 patients I—II degree, in 69 — III—IV degree, in 4 patients V degree (spondyloptosis) was diagnosed. Preoperative management included traditional and functional roentgenography of lumbosacral spine, myelography, CT and MRT. Tactics of surgical treatment depended on the degree of spondylolisthesis and clinical-roentgenologic manifestations of the disease. In 32 patients bone plasty was performed (posterior and anterior spondylodesis) without additional metal fixation, in 101 patients bone plastic operations were combined with the metal fixation of the lumbosacral spine. Various types of fixatives were used: external fixation device by Byzov (6 cases), Wilson plates (23), Kazmin distractors (20) and different types of transpedicular constructions (52). Vertebral canal revision was performed only in case of persistent neurologic symptomatology. In patients with III-IV degree of spondylolisthesis either interlaminectomy or laminectomy (in marked spondylolisthesis) was performed under the visual control of the dural sac and roots at the moment of reduction. In cases of high degree of dislocation the surgical treatment was performed in two steps — posterior metal fixation was supplemented with the anterior spondylodesis. It is concluded that transpedicular fixation in combination with bone plasty is the method of choice for the surgical treatment of spondylolisthesis. In Ш-IV degree of spondylolisthesis transpedicular fixation is to be combined with the anterior spondylodesis.

Ten years experience in microdiskectomy for the treatment of degenerative spine diseases (about 900 patients) is presented. Seven hundred and seventeen patients have been operated on by traditional W.Caspar technique and 21.4%) out of them required not only diskectomy but radiculolysis, resection of the arch margins and posterior longitudinal ligament. In some patients side by side with microdiskectomy, spondylodesis via interarch approach using CAC system combined with transpedicular system USS (AO) was performed. The same technique was used in patients with lumbar vertebra spondylolisthesis. Positive results were achieved in 88.2% of cases.

The experience in thermographic examination of 108 patients (athlets and ballet dancers) with lumbar-sacral spine diseases is presented. All patients have been treated at the CITO Department of Sports and Ballet Injury during the period from 1987 to 2002. Various thermograms typical of osteochondrosis, spondyloarthrosis, spondylolysis and ligamentous pathology of lumbar-sacral spine are given and described. Thermography is shown to be a nonspecific examination method which only defines more precisely the clinical and radiologic data. The main value of thermography is the possibility to detect the activity of the pathologic process and to retrace the dynamics of the disease development during follow up and treatment.

At the Department of Child and Adolescent Vertebrology of Novosibirsk SRI TO a multi-step technique was used for the surgical treatment of 21 patients with progressive juvenile scoliosis. That technique included epiphysiospondylodesis on the convex side of curvature, step by step distraction with endocorrector from the Cotrel-Dubousset instrumentation set and completely posterior spondylodesis at the age of sexual maturation. Six out of 21 patients completed treatment; the deformity was decreased from 74.6 to 41.5° and the achieved correction has been almost completely preserved. That surgical technique did not disturb the growth of patients trunk (mean growth rate was 6 cm per year). Torsion component of the deformity did not increase confirming the efficacy of epiphysiospondylodesis. Mean follow up made up 27 months. In spite of the significant number of complications the obtained results testified the prospectiveness of that direction.

In 37patients with scoliosis, aged 7—29, immunologic status was studied in pre- and postoperative periods. Material for the study was blood, cerebrospinal fluid, intervertebral disk tissue (tissues of nucleus pulposus and fibrous ring removed intraoperatively). Content of blood lymphocytes; percentage of main lymphocyte subpopulations possessing CD3, CD4, CD8 (T-cells including chelpers and cytotoxic effectors), CD 16 (natural killers) and CD20 (В-cells) markers; lymphocyte activation and proliferation capacity stimulated by activator (mitogen). Analysis of data obtained allowed to define 2 groups of patients. In the 1st group including the majority of patients (n=29) preoperative indices were not significantly different as compared to mean normal ones and postoperative ly those indices restored rapidly. Second group of patients showed preoperative change of at least one index of immunologic status. It allowed to consider that group of patients as a risk group. That group was characterized by the following: patients' age was under 13 years, scoliosis of IV degree, tendency to decrease of CD3+, CD4+ cell content and reduce their functional activity, tendency to increase of CD 16+ cell content. Study of cerebrospinal fluid and intervertebral disk tissue on the top of deformity did not reveal intratissue lymphocytes. It testified that the processes causing the development of scoliotic spine deformity proceeded without direct participation of immune system.

Retrospective analysis was performed to evaluate the long-term results associated with the use of various methods for the treatment of pelvic injury. There were 210 patients who were evaluated using 2 methods: subjective assessment according to Majeed score and objective assessment using optic topography (45 patients). Data obtained showed that in the group of patients in which treatment methods were chosen depending on both the severity of pelvic injury and severity of patient’s condition the reliably higher percentage of good and excellent results were achieved by the time of discharge as well as at 1 year follow up. Complex evaluation offunctional treatment results optic topography examination of pelvis allowed to define the degree of adaptive capacity of loco-motor system and possibility of correction of the revealed disturbances.

The method of valgus revascularizating tibia osteotomy using autoplasty of the clinoid defect by a pedicle graft is proposed for the treatment of patients with varus gonarthrosis. Nine patients with varus deforming arthrosis, decompensated form, stages 2 and 3, were operated on. Varus changes in the tibiofemoral angle ranged from 5 to 15°. The mean consolidation term in the region of osteotomy was about 10 weeks. Follow up period was at least 2 years. The patients were clinically observed using screening monitoring system to control the disease severity and treatment efficacy. Draining effect and normalization of microcirculation were estimated by the measure of intraosseous pressure in subchondral zone. Dispersion analysis of the observation results has shown stable reduction of the average number ofpatient's condition severity from 27. 7 to 17 and the reduction of intraosseous pressure from 2.4 kPa to 0.9 kPa.

The experience (126 patients) in the use of the suggested by O.V. Oganesyan modified hingedistraction device for the treatment of old foot dislocations and fractures of the ankle joint articular ends is presented. Perfection of the construction enabled to simplify the application of the device as well as makes it possible to put together the articular ends and their fragments either in one step or gradually, to maintain the width of the articular slit along the articular surface, to perform active and passive motions in the unloaded joint. When the apparatus is used the volume of open surgical interventions is reduced to the required minimum. Due to the device construction it is also possible to eliminate all types of ankle joint and foot deformities (varus, valgus, equinus, adduction, excavation). In 109 patients the follow up period ranged from 1 to 17 years: the overwhelming majority of cases (82%) showed the restoration of the ankle joint function.