Barkov O. Adult scoliosis (diagnosis and principles of surgical treatment)

Object: scoliosis spinal deformities in patients older than 18 years. Objective: to develop criterions of differential diagnosis, prognostication of state and principles of surgical treatment for adult scoliosis to improve effectiveness of treatment. Меthods: clinical, neurological, X-ray, including MRI computer tomography for verification of results; mathematical modeling using finite element method; statistical method for final calculation of the results. The first time the criterions of differential diagnosis and prediction of different kinds of adult scoliosis were developed. First importance of clinical and roentgen sings for the diagnostics of different types of adult scoliosis was grounded and mathematical program was developed to differentiate these sings. First threatening, prognostic unfavorable diagnostic sings for all kinds of adult scoliotic spinal deformities were evidenced. There are pain, neurological disorders, neurogenic limping, spinal stenosis, instability of deformation as antelisthesis, retrolisthesis, laterolisthesis or progressing of spinal deformity. Firstly with help of mathematical modeling using finite element method stress-stain state of system "implant - lumbar spine - pelvis" was examined. It was proved that the most stressful bone areas were places where the screws were inserted into the vertebras. At the same time with increasing of distance from these areas the stresses of bone is decreasing. When the pelvis was being fixed with rods the most possible zone of their fracture was area of flexion. Stress-strain state of system is more advantageous in the case of instrumentation length is L I-S I- pelvis, where the level of stress in the vertebra LV reduced to 22.5 MPa, while the wing ilium - to 59.2 MPa as compared to previous versions of fixing. For the first time a new fixing device to stabilize the spine was developed. Its new constructive decisions allow perform reliable stabilization of the spine. The offered diagnostic criteria and mathematical program for the distinction of different types of scoliosis in adults will allow timely diagnosis and treat the patient qualitatively, providing prediction of his future life. The developed diagnostic algorithm and principles of surgical treatment of scoliosis in adults will allow to use an individual approach and correct tactics for the treatment of this category of patients, increase effectiveness of the surgical treatment, decrease percentage of postoperative complications. This in its turn will decrease term of sick-list and number of events of primary disability. The offered finite element model of the lumbar spine and the pelvis can be used for future researches. Application of new developed fixing device will provide more reliable rigid stabilization of the spine in the case of long fixation to pelvis what will exclude instability of the device, pulling out of screws and its fracture on the level L V-S I and will provide forming of reliable bone block and will prevent progress of pseudoarthrosis on this level. The offered fixing device can be applied in the any medical institution or hospital where surgical treatment of the diseases and injuries of the spine are carried out. The results of the research was introduced in the clinical practice of the State institution "Sytenko Institute of Spine and Joint Pathology of National Academy of Medical Sciences of Ukraine", neurosurgery clinic of Scientific Research Institute of traumatology and orthopaedics of Donetsk national medical university named M. Gorkiy and educational course on the departments of traumatology and orthopaedics of Kharkiv Medical Academi of Postgraduate Education of Ministry of Health of Ukraine and Karkiv national medical university of Ministry of Health of Ukraine. Traumatology and orthopaedics.