Brachial plexus traction injury is common and is an important socioeconomic issue with surgical outcomes being essential for neurosurgery, neurology, trauma, orthopaedic and rehabilitation specialists. The objective was to compare short-term surgical outcomes in patients with closed brachial plexus traction injuries. Material and methods The study involved 61 patients with closed brachial plexus traction injuries who were divided into two homogeneous groups according to sex, age and severity of neurological deficit. Patients of Group I (n = 33) underwent microsurgical neurolysis as a surgical treatment and patients of Group II (n = 28) underwent microsurgical neurolysis in combination with single-level electrical stimulation. Clinical and functional status of the upper limb was assessed in dynamics using scales and electrophysiological monitoring. Results Short-term results of surgical treatment were significantly better in Group II compared to Group I. Discussion A more apparent recovery of the upper limb function was observed in patients of Group II that indicated advantages of microsurgical neurolysis in combination with electrical stimulation to repair closed brachial plexus traction injuries. Conclusion The combination of microsurgical neurolysis and single-level electrical stimulation improves short-term surgical outcomes of patients with closed brachial plexus traction injuries due to a faster pain relief in the postoperative period and positive dynamics in clinical and electrophysiological parameters.

Introduction Fractures of the humeral condyle make up 0.5-5.0 % of all fractures and about 30.0 % of adult elbow fractures. Complications develop in 18.0-85.0 % of cases and 29.9 % of the injured have signs of disability, giving these fractures a reputation of injuries with a poor prognosis for functional recovery. Objective To improve the treatment results of the injured with humeral condyle fractures by developing differential treatment tactics taking into account the biomechanical characteristics of the injured anatomical structures. Material and methods The authors analyzed the results of conservative and surgical treatment of 194 patients with fractures of the humeral condyle. The average age of the patients was 50.2 years (range from 19 to 89 years); there were 75 (38.7 %) males and 119 (61.3 %) females. Based on the method of treatment, the patients were divided into 2 groups, each group included a control subgroup and the results of treatment were analyzed. The main subgroup of the clinical group 1 (surgical treatment) consisted of 99 patients with an average age of 49.1 years (range from 19 to 85 years). There were 49 (49.5 %) men and 50 (50.5 %) women. The control subgroup of the clinical group 1 (surgical treatment) consisted of 41 patients with an average age of 51.4 years (from 21 to 89 years). There were 17 (41.5 %) men and 24 (58.5 %) women. The main subgroup of the clinical group 2 (conservative treatment) consisted of 29 patients with an
average age of 51.2 years (from 21 to 88 years). There were 5 (17.2 %) men and 24 (82.8 %) women. The control subgroup of the clinical group 2 (conservative treatment) consisted of 25 patients with an average age of 52.9 years (from 21 to 87 years). There were 4 (16.0 %) men and 21 (84.5 %) women. The fractures were rated according to the AO classification: type 13A – 15 (7.7 %) individuals, type 13B - 40 (20.7 %) subjects and type 13C – 139 (71.6 %) patients. Results The mean duration of follow-up was 39.0 ± 1.0 months (7 to 48 months from injury). The mean range of motion in the elbow joint was 110.5 ± 1.2º (50º to 140º), the mean score on the Mayo clinic scale was 81.7 ± 0.9 (45 to 100), and on the Score Scale was 62.7 ± 0.7
(38 to 76). Excellent functional results were obtained in 95 (49.0 %) patients (p < 0.001), good – in 41 (21.2 %) (p < 0.001), fair – in 28 (14.4 %) (p < 0.001) and poor – in 30 (15.5 %) patients (p < 0.001). Conclusion Differentiated treatment tactics in humeral condyle fractures permitted to obtain positive results in 92.2 % (p < 0.001) of the patients in comparison with 89.4 % (p < 0.001) of the control group and to decrease the number of complications by 20.2 % (p < 0.001).

Introduction Differences in the reported results lead to the lack of comprehension of whether the size of osteochondral lesion of talar dome is too big for successful usage of arthroscopic microfracturing and osteochondral autologous transplantation would be more preferrable. Aim To elicit the rate and causes of poor results after using two most common methods of operative treatment of patients with osteochondral lesions of the talus (OCLT) for elaboration of indications for surgical method of choice for this category of patients. Materials and methods This was a retrospective study that included analysis of archive data and subsequent examination of 80 patients (80 ankle joints), who underwent treatment for symptomatic OCL of the talus from 2014 to 2020. Mean time from the operation to examination was 20.5 ± 19.8 months. Results A significant increase in the results of FAOS, AOFAS and VAS scales after operative treatment were observed, as well as a significant decrease in lesion sizes (р < 0.05). Overall patient satisfaction and intensity of preoperative pain syndrome showed strong positive correlation with the sizes of lesions on preoperative CT scans, especially with relative sizes. The data analysis revealed the borderline values of relative OCLT sizes, thus allowing us to divide the results of treatment into predictably poor and predictably good. Discussion The elicited borderline values of relative OCLT sizes as well as elicited correlations can be used to specify indications for choosing the method of operative treatment for this group of patients, but further prospective evaluation should be carried out. Conclusion The borderline values of the relative OCLT sizes were found that allow for division into predictably good and poor treatment outcomes.

Introduction Based on the assessment of the problems and effectiveness in the use of the induced membrane and bone transport techniques, a new technological solution was proposed. It combines the methods of Masquelet and Ilizarov for restorative treatment of patients with bone defects and nonunion. Materials and methods The combination of the technologies was successfully applied for filling bone defects in the conditions of active purulent infection and its remission in 24 patients. Patients of the first group (n = 17) had bone defects in the conditions of the osteomyelitic process remission. In the second group of patients (n = 7), the osteomyelitic process was active. The combined technology of bone grafting included segment reconstruction in two stages. At the first stage of treatment, a sanitizing treatment of soft and bone tissues in the area of the defect and nonunion was performed followed by spacer implantation and transosseous fixation of bone fragments with the Ilizarov apparatus. During the second operating session, the spacer was removed, and after osteotomy (corticotomy), the fragment(s) were transported according to Ilizarov. Empirical antibiotic therapy against a wide range of pathogens was started after the verification of the microbial tests of the biomaterial and the determination of sensitivity to antibiotics, the correction of antibiotic therapy was carried out. Results The postoperative wounds in the area of the implanted spacers healed by primary intention in the first group. In two patients of the second group (29 %), purulent fistulas were formed by the time the spacers were removed, and the wounds healed by secondary intention. The duration of distraction in the first group was 45.4 ± 9.8 days. Bone transport in the patients of the second group continued 52.8 ± 5.3 days. The duration of fixation of the segments with the device was 195.1 ± 9.9 days in the first group and 181.8 ± 11.4 days in the second group. Discussion At the initial stage of the combination of the Masquelet technique and non-free Ilizarov bone grafting, the risks of the activity of a purulent process remain if the debridement of the infection nidus is not radical, implanted spacers with a prophylactic dose of antibiotics are massive, and the antibiotic therapy is empirical. The formation of an induced membrane with bactericidal activity at the second stage of surgical treatment, the creation of favorable conditions for bone transport, adequate sanitation of the purulent focus, and targeted antibiotic therapy ensure a stable suppression of the activity of the purulent process. Conclusions Surgical rehabilitation of patients with segmental infected defects results in bone defect filling with distraction regenerates undergoing complete organotypic restructuring, which eliminates the likelihood of deformities or fractures at the level of newly formed bone areas and reduces the risk of recurrence of the osteomyelitis process.

Introduction Repair of a bone defect in primary total knee arthroplasty remains one of the most common tasks that must be addressed intraoperatively. Autologous bone grafting is a good biological option to preserve the bone tissue for conservative revision. The objective of the study was to analyze the results of autologous bone grafting of the medial tibial defect in primary total knee arthroplasty. Material and methods Results of autografting a bone defect with cancellous bone obtained when forming a groove for the intercondylar box of the femoral component of the tibia during primary total knee arthroplasty were retrospectively analyzed (main group, n = 31). The control group (n = 31) was formed by leveling the heterogeneous clinical parameters identified in the initial data using the PSM method. The mean follow-up period was 72 months. The Mann-Whitney and Wilcoxon tests were used for statistical data analysis. Lower limb realignment and bone graft reconstruction were evaluated radiographically, and KSS and WOMAC questionnaires were used for physical evaluation. Results There were no significant differences in the baseline and postoperative clinical conditions of the realigned lower limbs and the number of identified non-progressive radiolucent lines no greater than 2 mm in the groups. There were significant differences in the severity of varus deformity at baseline. Each group had one case of aseptic loosening of the tibial component. One patient of the comparison group had a late periprosthetic joint infection that was arrested with two-stage revision treatment. Discussion There were significant differences in the size of the varus deformity with no significant differences in the scores at the baseline between the groups. There were no differences in the realigned lower limbs and in the scores reported in the groups postoperatively. Conclusion The method developed was shown to be safe, affordable and effective. The result obtained was confirmed by absent differences in clinical and radiological outcomes between groups.

Introduction Adduction or flexion-adduction contracture of the hip joint often causes static and dynamic impairments in children with spastic cerebral palsy that can be corrected with hip abduction orthosis. No reports confirming or rejecting the effectiveness of the method in the gait correction have not found. The objective was to explore the effect of the hip abduction orthosis on gait kinematics in children with spastic cerebral palsy. Material and methods Twelve biomechanical tests were performed for 6 patients of GMFCS level 3 (6 tests with hip abduction orthosis and 6 tests with no hip abduction orthosis). Gait analysis was produced using the Qualisys Miqus M5 motion capture system (Sweden). Clinical gait analysis was performed with PAF 2.0 of QTM software, Visual3D, Statistica 10 and Excel. Results A comparative analysis of the mean values showed differences in the gait parameters depending on test conditions. Improvements in the spatial-temporal parameters ranged between 0.4 % and 23.6 % with use of orthosis. The kinematic analysis of large joints demonstrated a slight positive effect on the hip joint function. There were no significant differences in the function of other joints. The use of orthosis improved the overall gait index score for the left and right lower limbs by 12.5 % and 5.7 %, respectively. A detailed analysis of the gait index for large joints of the lower limbs demonstrated the discrete improvement. Conclusion Hip abduction orthosis showed a positive effect on the gait pattern of children with spastic cerebral palsy.

The pattern of pathological crouch gait in patients with spastic paralysis is characteristic of diplegic forms and in natural development manifests itself usually after the age of 10-12 years. This pathological gait may develop earlier after early surgical interventions that weaken the triceps of the lower leg, especially the soleus muscle. The heterogeneity of the crouch gait pattern is diverse. Qualitative assessment of the difference in the decompensated crouch pattern, especially associated with stiff-knee gait, according to the graphs of kinematics and kinetics of the joints can be difficult, and quantitative criteria for differentiation have not been reflected in the literature. The purpose of the study was to conduct a comparative analysis of the quantitative parameters of the compensated, decompensated and associated stiff-knee gait crouch pattern. Materials and methods The assessment of the locomotor profile by 3D gait analysis (3DGA) was carried out in stationary conditions in 27 children (54 limbs) with spastic diplegia, who had previously undergone percutaneous fibromyotomy according to the Ulzibat method, or open lengthening of the Achilles tendon. The mean age at the time of the survey was 13.0 (8–17) years. Control group: 19 children without orthopedic pathology (38 limbs) of the same age. Three groups of changes within the crouch gait pattern, recorded on separate limbs, were distinguished: I – model of the crouch pattern of the “compensated” type (n = 30); II – model of the crouch pattern of the "decompensated" type (n = 14); III – models of crouch pattern of the "stiff-knee" type (n = 10). Results An analysis of the evaluation of the models of compensated, decompensated, and stiff-knee patterns of crouch gait revealed criteria for their differentiation in terms of quantitative indicators of kinematics and kinetics. GPS: compensated and decompensated crouch gait up to 25.0, stiff-knee gait – more than 25.0. The angle of maximum dorsiflexion of the foot in the stance phase: compensated and decompensated crouch pattern up to 35.0°, stiff-knee crouch pattern – more than 35.0°. Knee joint extension range: compensated crouch over 11.0°, stiff-knee gait up to 6.0°. Flexion knee joint range: compensated crouch more than 11.0°, stiff-knee gait – up to 6.0°. The strength of the leg extensor muscles during the formation of the support push: compensated and decompensated crouch less than 1.0 H*m/kg, stiff-knee – more than 1.0 N*m/kg. The strength of the leg flexor muscles in the midstance period: compensated crouch less than 0.25 H*m/kg, stiff-knee – more than 0.75 N*m/kg. Absorption power (negative) of the knee joint: compensated and decompensated crouch more than 0.9 W/kg, stiff-knee less than -0.9 W/kg. Useful peak power of the joints: compensated and decompensated crouch patterns – more than 0.40 W/kg, stiff‑knee gait – less than 0.40 W/kg. Conclusions The development of the crouch gait pattern in the absence of a tertiary compensatory deviation (torso tilt) can be formed with or without a decrease in the power of the joints. The decompensated and compensated types of the crouch pattern have a significant difference in the kinematics of the knee joint and in the duration of the internal moment of extension, while the power parameters of the joints do not have significant differences. Stiff-knee associated crouch pattern is the most severe type in which all the power parameters of the joints are decreased. The manifestation of the severity of this pathological pattern may vary between the right and left limbs of the individual.

Introduction A cascade of degenerative spine changes affects the structures including vertebral endplates and bodies of adjacent vertebrae that can be visualized on MRI imaging as Modic changes. The aim of the study was to assess the role of changes in the endplates and adjacent vertebral bodies in radiological results of monosegmental posterior lumbar interbody fusion (PLIF) in patients with degenerative lesions of the spine. Material and methods The design of the study was a monocenter retrospective comparative cohort study. The radiological results of PLIF performed in combination with transpedicular screw fixation for 122 patients with Modic changes in adjacent endplates and adjacent vertebral bodies were evaluated for interbody fusion, subsidence of interbody implants, segmental angle, interbody space height. The followup period was 1-2 years. Results Complete interbody fusion was seen in 94.4 % of Modic type 0 and in 77.3 % of Modic type II changes. Interbody cage subsidence occurred in 38.9 % Modic type I, 22.7 % in Modic type II, 9.1 % in Modic type III and in 11.3 % Modic type 0 changes. A significant decrease in the segmental angle was found in all types of Modic changes (p < 0.05) at 1-2 years with the greatest decrease noted in Modic type I (p = 0.000438). A significant decrease in the interbody space height was noted in all groups (p < 0.05) with the greatest decrease seen in Modic type I changes (p = 0.000438) and the minimum decrease noted in Modic type III changes (p = 0.000438). Discussion The role of the endplates and adjacent vertebral bodies in the results of surgical treatment was evident, and more research is needed to explore the sort of this relationship. Conclusions Modic changes in the endplates and adjacent red bone marrow showed a significant relationship with the radiological outcomes of monosegmental PLIF. The interbody fusion Tan grade I and Tan grade II was more common for Modic type 0 and less common for Modic type II changes. Subsidence of interbody implants was more common for Modic type I and less common for Modic type III changes (9.1%). Postoperative loss of interbody space height and segmental correction was common for Modic type I.

Introduction Bone mineral density (BMD) of the vertebrae is a critical issue before performing stabilizing interventions at the lumbar level. Determination of BMD in Hounsfield units (HU) according to CT data is a more accurate method versus to the "gold" standard – densitometry. Purpose To determine BMD of key anatomical areas of the lumbar vertebrae in HU and correlate with densitometry data. Methods A retrospective cohort of patients was studied prior to decompression and stabilization intervention at the lumbar level. The BMD of each lumbar vertebra in its different anatomical regions in HU was assessed according to CT of the lumbar spine and was compared with densitometry data. Results In the roots of the L2-S1 arch of the vertebrae, BMD was significantly higher than in the bodies of the same vertebrae (p < 0.01); in the L1 and S1 vertebrae, the difference in BMD between the body and the roots of the arch was not significant. An increase in the density of bone tissue in the vertebral bodies to the underlying levels was determined; BMD in the roots of the arch also increases, but only up to the L5 vertebra. BMD in the roots of the arch of the S1 vertebra is significantly lower than in the overlying L5 vertebra (p = 0.032). Discussion The obtained findings supplement the reported data in the current literature. The HU value is a more accurate and significant parameter of BMD, which should be considered in the practice by a spinal surgeon. Conclusions According to CT data of the lumbar spine, the BMD of L2-L5 in the arch roots is significantly higher than in the vertebral bodies. The BMD of the S1 vertebra in the arch roots is significantly lower than in the L5 vertebra. It may be the reason of high failure rate of caudal fixation at this level. Particular attention should be paid to the planning and surgical techniques in patients not only with osteoporosis but also with osteopenia. BMD findings obtained by densitometry in these conditions do not have a significant difference.

Introduction An original ASPID classification was developed for primary total hip arthroplasty in the presence of post-traumatic acetabular deformity at the Vreden National Medical Research Centre for Traumatology and Orthopaedics. We aimed to explore how the extent of displacement and localization of acetabular deformity as classified by the original ASPID grading system can affect the coverage area of the acetabular component. The purpose of the study was to determine the congruence of the standard hemispherical acetabular component and the post-traumatic acetabular deformity in the experiment. Material and methods Computer 3D models of 92 post-traumatic acetabulums were formed, followed by simulated implantation of a standard hemisphere of the appropriate size in compliance with permissible values of the spatial orientation of the acetabular cup in total hip replacement. The congruence of the deformed acetabulum and the standard hemisphere of the corresponding size was determined with simulated implantation. Formula for the acetabular deformity was determined for each case using the original classification. With formula identified for each acetabular deformity and the magnitude of congruence, the data were compared to determine the relationship between congruence, bone displacement and the extent of bone displacement. Results The mean congruence value in the group was 59.5 ± 16.83 %. The sum of the scores A+S+P+I+D was compared with the percentage of congruence. The statistical analysis showed that the congruence of the hemispherical acetabular component and the post-traumatic acetabulum was less than 70% with a sum of parameters greater than four. The continuation of the study will allow for a more global analysis and identification of more patterns to improve surgical approaches to primary total hip arthroplasty in specific cases. Conclusion Screws can be recommended for reliable primary mechanical fixation of the pelvic component in target patients, and cavitary bone defects can be repaired with autobone chips to allow greater congruence at the bone-implant interface.

Introduction The article presents a case report and a brief literature review of an adverse event of brachial plexus injury associated with prone positioning in spinal surgery. The purpose was to report a case of bilateral brachial plexus injury after correction of Scheuermann's kyphosis. Material and methods Reported is a case of brachial plexus injury in a patient with Scheuermann's kyphosis after surgical correction. Results The patient could completely regain motor function of the left limb at 6 months with palsy scored 3 proximally retained in the right hand. Discussion The literature describes three pathophysiological conditions that predispose to brachial plexus injury in the postoperative period: sprain, compression, and ischemia. The adverse event is reversible in most cases and recovery depends on the degree of neurological deficit at an early stage. Recommendations are offered for surgeons and anesthesiologists to avoid the occurrence of the complication or take timely measures to alleviate the consequences. Conclusion Upperlimb somatosensory evoked potentials, a part of neurophysiological monitoring can be practical for prevention of the complication. Prevention of brachioplexopathy should be part of perioperative care.

Introduction Treatment of patients with open fractures of long bones with soft tissue defects remains one of the most difficult tasks of current traumatology. Material and methods We repor a clinical case of the treatment of a patient with an extensive purulent wound, a defect in the tibia,chronic damage to the anterior neurovascular bundle, tendons and muscles of the anterior and lateral groups of the lower leg, post-traumatic severe lymphedema of the right foot. The complex of the treatment process included debride-ment of the wound, orthoplastic surgery using Ilizarov transosseous osteosynthesis and elements of plastic surgery. The defect of the right tibia was managed using a non-free vascularized peroneal compound flap from the opposite tibia. Results The treatment of this patient resulted in the arrest of osteomyelitis, a significant reduction in foot lymphedema, restoration of weight-bearing and functional capacity of the right lower limb. This was achieved by replacing a significant defect in the tibia and soft tissues under conditions of long-term wound and scar processes and compromised main blood flow in the affected lower leg. Discussion The main operations for management of complex defects in the tissues of the lower leg are demonstrated. Among them, the main ones are transosseous osteosynthesis according to Ilizarov and microsurgical replacement with a vascularized complex of tissues.

Introduction Nemaline myopathies (NM) are a group of neuromuscular diseases, the distinctive histological feature of which are nemaline rods in myosymplasts. The purpose of this work is to describe the morphology of a rare form of primary nemaline myopathy that progresses in adulthood. Material and methods The surgical material of the paravertebral muscles of a 51-year-old patient with scoliotic deformity at the level of L4-S1, who was repeatedly operated on to correct spinal deformity due to neurological disorders, was studied. Paraffin sections were stained with hematoxylineosin, according to Masson, using the Ptah method, studied using a 3DHISTECH Pannoramic MIDI II BF scanning microscope to digitize preparations using Whole slide imaging technology in two modes: Single layer mode and Extended focus (3DHISTECH, Hungary). Results In the fragments of the altered muscle tissue, filamentous structures of nemaline bodies in myosymplasts were identified, which were located diffusely-dotted throughout the sarcoplasm or formed clusters of various configurations. There was an increased variability in the diameters of muscle fibers, internal nuclei, myosymplasts altered by contraction and with signs of myophagy, patterns of gradual replacement of muscle fibers by adipocytes, massive fatty degeneration of fibers, and fibrosis of the interstitial space. Intramuscular nerve trunks showed signs of complete involution; fibrous perineurium was preserved, and there were single nerve fibers; neuromuscular spindles were distinguished by an enlarged connective tissue capsule. The vessels of the arterial flow had signs of fibrosis and obliteration of the lumen; the vessels of the venous bed were tortuous. Discussion Due to a large number of genes responsible for NM, genetic search can be difficult and is effective only in 50 % of cases. It has been established that nemaline bodies can be distributed diffusely or form clusters of irregular shape, more often subsarcolemmal and characteristic of small fibers. In the presented clinical case, nemaline bodies were observed over the entire area of the fibers and were characteristic of myosymplasts of various sizes. Conclusion The histopathological study of the paravertebral muscles established the neuromuscular nature of the disease, being nemaline myopathy that progressed in adulthood and had not been diagnosed at previous stages of treatment.

Introduction Congenital lordosis is a severe deformity of the spine in the sagittal plane, which develops due to malformation and segmentation of the dorsal part of the vertebrae and normal growth of the ventral part. The most common nosological variant of the defect is lordoscoliotic deformity of the thoracic spine, which often occurs due to syndromic defects (spondylocostal dysostosis) and systemic diseases of the musculoskeletal system (arthrogryposis). Along with the vertebral syndrome, the pathological complex in congenital lordosis of the thoracic or thoracolumbar spine includes thoracic insufficiency syndrome, which in the overwhelming cases leads to the development of respiratory failure caused by bronchial obstruction. The purpose of the study is to summarize information and analyze literature data on a rare pathology of the spine, which is clinically manifested by the formation of thoracic lordosis due to congenital anomaly in the development of the vertebrae. Materials and methods An analysis of the literature on the diagnosis and treatment of congenital lordosis and lordoscoliosis in children was carried out. The depth of the search was more than 100 years. Inclusion criteria: presence of lordotic deformity of the thoracic, cervicothoracic or thoracolumbar spine. Results and discussion Respiratory failure in this group of patients develops due to reduction in the anteroposterior size of the chest (an increase in the chest penetration index), a decrease in the height of the thoracic spine, changes in the mechanics of rib movements, bronchial obstruction, worsening ventilation and perfusion on the convex side of the deformity. The leading component of disability and impairment of the quality of life of patients is respiratory failure syndrome. A decrease in lung function, primarily due to reduction in VC, is directly proportional to the magnitude of the deformation of the spine and chest. Surgical correction of spinal and chest deformity is the main component of treatment for this group of patients. Surgical treatment consists in the mandatory multilevel mobilization of all three columns of the spine (preferably combined access) and bilateral resection of the ribs to reduce chest rigidity. Postoperative respiratory support is critical in respiratory failure. Conclusion Congenital spinal deformities in the form of thoracic lordosis and lordoscoliosis are extremely rare. The key aspects of treatment are the fight against respiratory failure and the selective choice of surgical technologies for deformity correction with a trend towards simultaneity of interventions. The literature review confirmed the insufficient knowledge on the issues of this pathology.

Introduction The resultant cause of pain syndrome in the lumbosacral spine in the contemporary population are dysplasia and anomalies of the development of vertebral segments, among which the sacralization of the L5 vertebra (Bertolotti syndrome) is often diagnosed. In the domestic medical literature, few publications on this pathology have been found. Methods Scientific studies for this literature review were obtained from PubMed, eLIBRARY, CYBERLENINNKA. Eighty scientific articles were used. The search for literature sources was carried out with the following keywords: sacralization of the L5 vertebra, Bertolotti Syndrome. Results and discussion In the course of the analysis, it was established that the rate of diagnosis of sacralization of the L5 vertebra ranges from 4 to 36 % of cases. It is equally detected among males and females. This pathology is frequently found in children and adolescents. Pain in the lumbar spine and sacrum is the leading clinical symptom of the disease. The severity of pain on the visual analogue scale mainly corresponds to 5 points. Scoliosis, spondylolistesis, herniated disks, spina bifida posterior may exacerbate the clinical symptoms of the associated sacralization of the L5 vertebra. During the examination of patients, plain radiography, computed tomography and magnetic resonance imaging are used. Cases of sacralization of the L5 vertebra are divided into 7 types, according to the classification of A.E. Castellvi et al. (1984). Treatment of vertebrogenic pain syndrome is carried out both conservatively (drug therapy, therapeutic blockades) and surgically (resection of the L5 transverse process, decompression of the stenotic intervertebral foramina, transpedicular fusion, radiofrequency ablation).

Introduction Diagnosis of spinal deformities in children and adolescents is important for continuous development of modern traumatology and orthopaedics. Methods of optical diagnosis of scoliosis and postural disorders have been rapidly improving along with optical and digital assessment technologies over the past centuries and required a structural analysis of the accumulated data. The purpose was to explore clinical and technical aspects of optical diagnosis of spinal deformities. Material and methods The original literature search was conducted on key resources including the National Library of Medicine (PubMed) and Scientific Electronic eLibrary. The search depth was 10 years. Results The article presents a review of the methods historically developed in optical diagnosis of spinal deformities. Major methods and systems of optical diagnosis presented included moire topography, the ISIS system, modern methods of computer optical topography (raster stereography) photogrammetric methods used in clinical medicine and in trauma and orthopaedics. Characteristics of the methods and systems are described with advantages and disadvantages discussed. The article reports evaluated accuracy, reliability and reproducibility of optical diagnostic methods. The article presents the latest information about the possibilities of introducing technology for assessing spinal deformity using modern personal telecommunication devices. Conclusion The evolution of modern trends in optical diagnosis of spinal deformity is important for medicine to facilitate safety, greater accuracy, ease of operation, digitalization and development of the Internet of Medical Things.