Objective.To analyze clinical efficiency of initially stable anterior load-bearing interbody fusion in treatment of thoracic and lumbar spine injuries. Material and Methods. Anterior interbody fusion for thoracic and lumbar spine injury was performed in 86 patients. Out of them 48 patients underwent fusion with cylindrical porous NiTi implants (control group), and 38 patients -initially stable anterior load-bearing interbody fusion (study group). Patients of both groups were matched by age, sex, and injury nature and localization. Clinical and neurological examinations were supplemented by spondylography in coronal and lateral projections in all patients. CT and MRI studies of the injured spinal motion segment were performed to specify the nature of injury. Results. Good treatment results were achieved in 32 (100 %) patients from the study group and in 34 (87.2 %) patients from the control group, and satisfactory result -in 5 (12.8 %) patients from the control group. Suggested method of initially stable load-bearing anterior fusion allowed preventing the implant migration in patients with thoracic and lumbar spine injuries of types A2, A3, B1, and B2 (AO/ASIF classification) and avoiding repeat surgical intervention. Conclusion. Clinical application of initially stable load-bearing anterior fusion proved its high efficiency, allowed preventing the implant migration and avoiding external immobilization even in cases of unstable injury, without increasing surgery time duration and blood loss volume.

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

Female patient was treated for wound suppuration after transpedicular fixation of complicated unstable spine injury. Step-by-step treatment technique was used. First step included removal of transpedicular fixative, wound debridement and extrafocal external transpedicular fixation to prevent spine deformity relapse. Second step was performed after wound healing – external fixative was replaced by the internal (ventral) one. Duration of fixation in the apparatus and hospitalization made up 36 and 90 days respectively.

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