CONGENITAL THORACOLUMBAR SPINE DEFORMITIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A78-A85 ◽  
Author(s):  
Hamidreza Aliabadi ◽  
Gerald Grant
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Congenital Anomalies ◽  
Thoracolumbar Spine ◽  
Deformity Correction ◽  
Spinal Deformities ◽  
Spine Deformities ◽  
Frequent Reason

ABSTRACT CONGENITAL THORACOLUMBAR SPINAL deformities are a common and frequent reason for referral to spine surgeons. Neurosurgeons also treat many neurological diagnoses which may result in a progressive spinal deformity, such as scoliosis. Here we review a variety of congenital anomalies and address the maldevelopments associated with each, as well as the appropriate evaluation of such patients including nonoperative and operative approaches. Advances in the field of spinal deformity correction now allow us to better treat individuals with these types of deformities. It is important for the practicing neurosurgeon to be knowledgeable of surgical and nonsurgical treatments of patients with congenital thoracolumbar spinal deformities in order to better understand which patients will ultimately progress and necessitate surgical treatment.

scholarly journals Halo-gravity traction in the treatment of complex (>100°) scoliotic deformities of the spine in children: a review of clinical cases

2020 ◽  
pp. 67-71
Author(s):  
A.F. Levytskyi ◽  
◽  
V.A. Rogozinskyi ◽  
M.M. Dolianytskyi ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Neurological Complications ◽  
Spinal Deformities ◽  
Specialized Hospital ◽  
Definition Of ◽  
Type 3

Relevance. The definition of «complex spinal deformity» remains rather vague, but in most publications mark it as a deformation, which on average exceeds 100 degrees. Modern surgical practice of one-stage correction of complex spinal deformities includes performing osteotomies of the spine, which significantly improves the possibility of deformity correction, but also increases the risk of neurological complications and the volume of intraoperative blood loss. The aim. To improve the results of surgical treatment of patients with complex spinal deformities through the preliminary use of halogravitational traction and to establish an effective and safe algorithm for the treatment of complex spinal deformities in children. Materials and methods. During the period from 2008 to 2018, the Orthopedic and Traumatology Department of the National Children’s Specialized Hospital «OKHMATDYT» treated 48 children with complex spinal deformities (>100°) using halo-gravity traction. Of these, 32 are boys and 16 are girls. The average age of the patients was 12.9 years. The average Risser score was 4.2 (P>0.01). 27.1% of patients had type 1 deformity according to Lenke, type 2 – 54.1%, type 3 – 8.3%, type 4 – 6.4%, type 5 – 4.1%. Results and discussion. Using of halo- gravity traction for the preoperative reduction of spinal deformity and prevention of neurological disorders, the average duration of spinal traction application was 46 (P>0.01) days. A weight of 40–50% of the patient’s body weight was used. After the stage of halo-gravity traction, the spine was stabilized with a polysigmentary construction. Conclusion. Halo-gravity traction as a first stage of severe scoliotic spinal deformations treatment allows to increase the mobility of the vertebral column and to adjust spinal cord step by step for the next correction treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: spinal deformity, halo-gravity traction, surgical treatment.

VERTEBRAL COLUMN RESECTION FOR RIGID SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A177-A182 ◽  
Author(s):  
Justin S. Smith ◽  
Vincent Y. Wang ◽  
Christopher P. Ames
Keyword(s):  
Spinal Deformity ◽  
Vertebral Column ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Postoperative Management ◽  
Three Dimensions ◽  
Spinal Deformities ◽  
Vertebral Column Resection ◽  
Case Examples ◽  
Significant Correction

ABSTRACT OBJECTIVE Vertebral column resection (VCR) is a surgical technique that may be applied for correction of moderate to severe spinal deformities, including those with large rigid curves, fixed trunk translation, or asymmetry between the length of the convex and concave column of the deformity. This article reviews the VCR technique as it relates to correction of rigid spinal deformity, including case examples to illustrate its application. METHODS The literature was reviewed in reference to the use of VCR for correction of rigid spinal deformity. RESULTS VCR involves complete resection of one or more vertebral segments using either combined anterior and posterior approaches or a posterior-only approach and enables significant deformity correction in all three dimensions. Herein, we provide description of the indications, preoperative planning, surgical techniques, complication avoidance, postoperative management, and case examples for VCR. CONCLUSION VCR enables significant correction of rigid spinal deformities in cases in which less aggressive approaches are not adequate.

scholarly journals Auto Preservation and Use of Auto Rib at Two-Step Surgical Treatment of Spine Deformities

2016 ◽  
pp. 28-32
Author(s):  
S. V. Kolesov ◽  
M. L. Sazhnev ◽  
A. A. Snetkov ◽  
A. I. Kaz’Min
Keyword(s):  
Spinal Deformity ◽  
Deformity Correction ◽  
Spine Deformity ◽  
Fatty Tissue ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Spine Deformities ◽  
Subcutaneous Fatty Tissue ◽  
Preservation Technique

The possibility of preservation and use of a resected rib for dorsal fusion at final correction of spinal deformity was studied. Treatment results for 80 patients aged 15 to 45 years, with severe spine deformity (scoliosis or kyphoscoliosis) were analyzed. In all patients two step surgical interventions was performed. Either transpedicular or hybrid (screws and sublaminar cerclage) fixation of the vertebral column were performed in 37 and 43 cases, respectively. After ventral release the resected ribs were stitched to subcutaneous fatty tissue and preserved until the time of final dorsal correction. The follow-up period made up 1 - 2 years. Fusion formation and autograft reconstruction was confirmed by radiologic methods. It was shown that rib auto preservation technique was a simple one, did not require special preservation conditions and allowed to preserve sufficient volume of autograft for final spinal deformity correction.

Correction of Spine Pathology in Patients with Meningocele

2013 ◽  
Vol 20 (1) ◽  
pp. 46-52
Author(s):  
S. V Kolesov ◽  
A. N Baklanov ◽  
I. A Shavyrin
Keyword(s):  
Surgical Treatment ◽  
Life Quality ◽  
Deformity Correction ◽  
Vertebral Column Resection ◽  
Scoliotic Deformity ◽  
Average Curvature ◽  
Spine Instrumentation ◽  
Spine Deformities ◽  
Spine Pathology ◽  
Trunk Balance

Treatment results for 8 patients aged 3 to 17 years with neuromuscular spine deformities on the background of meningocele are presented. In all patients spine deformities were accompanied by spinal dysraphias. Average curvature arch was 86°. Surgical treatment was performed either in one (5patients) or in two (3 patients) steps. In 2 patients vertebral column resection (VCR) was performed. Average achieved scoliotic deformity correction made up62% and postoperative value of thoracic/thoracolumbar kyphosis approximated the physiologic one (40°). Surgical treatment of kyphoscoliosis on the background of meningocele that consisted of extensive spine instrumentation with pelvis fixation favoured the normalization of trunk balance, improved cardiopulmonary function, patients’ appearance and life quality. In this group of patients surgical intervention is associated with high intraoperative risk and rate of postoperative complications.

scholarly journals Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

2020 ◽  
pp. 219256822094417
Author(s):  
Cesar D. Lopez ◽  
Venkat Boddapati ◽  
Nathan J. Lee ◽  
Marc D. Dyrszka ◽  
Zeeshan M. Sardar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Screw Placement ◽  
Spinal Deformities ◽  
Three Dimensional Printing ◽  
Significant Difference ◽  
Dimensional Printing

Study Design: Systematic review. Objectives: This current systematic review seeks to identify current applications and surgical outcomes for 3-dimensional printing (3DP) in the treatment of adult spinal deformity. Methods: A comprehensive search of publications was conducted through literature databases using relevant keywords. Inclusion criteria consisted of original studies, studies with patients with adult spinal deformities, and studies focusing on the feasibility and/or utility of 3DP technologies in the planning or treatment of scoliosis and other spinal deformities. Exclusion criteria included studies with patients without adult spinal deformity, animal subjects, pediatric patients, reviews, and editorials. Results: Studies evaluating the effect of 3DP drill guide templates found higher screw placement accuracy in the 3DP cohort (96.9%), compared with non-3DP cohorts (81.5%, P < .001). Operative duration was significant decreased in 3DP cases (378 patients, 258 minutes) relative to non-3DP cases (301 patients,272 minutes, P < .05). The average deformity correction rate was 72.5% in 3DP cases (245 patients). There was no significant difference in perioperative blood loss between 3DP (924.6 mL, 252 patients) and non-3DP cases (935.6 mL, 177 patients, P = .058). Conclusions: Three-dimensional printing is currently used for presurgical planning, patient and trainee communication and education, pre- and intraoperative guides, and screw drill guides in the treatment of scoliosis and other adult spinal deformities. In adult spinal deformity, the usage of 3DP guides is associated with increased screw accuracy and favorable deformity correction outcomes; however, average costs and production lead time are highly variable between studies.

THE HISTORY OF SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A5-A15 ◽  
Author(s):  
Robert F. Heary ◽  
Karthik Madhavan
Keyword(s):  
Spinal Deformity ◽  
Thoracolumbar Spine ◽  
Surgical Techniques ◽  
Pedicle Screws ◽  
First Record ◽  
Surgical Approaches ◽  
Spinal Deformities ◽  
X Rays ◽  
Rod System ◽  
History Of

ABSTRACT SPINAL DEFORMITY IS the oldest disease known to humankind. The first record of correction of spinal deformity was documented in an Indian religious mythological book written between 3500 BC and 1800 BC. Initially, all spinal deformities were treated with the use of braces, traction, or casts. Hippocrates was the first physician to treat spinal deformities by using axial traction combined with direct pressure. Galen specifically described the anatomy of the spine and spinal nerves. The treatment of spinal deformity was greatly improved by the development of radiographic imaging by Roentgen. After x-rays became available, spinal fusions began to be used to treat scoliotic curves. Hibbs described the first spinal fusion to stabilize a deformed tuberculous spine. Soon enough, other investigators began to report on a variety of surgical techniques used to treat spinal deformity. Surgical approaches from both the posterior and anterior directions were developed and modified in an attempt to achieve durable curve corrections. Harrington's distraction rod system was a major innovation in providing a method to improve coronal plane deformity. Luque introduced segmental instrumentation, which opened up the era of modern surgical techniques for spinal deformity. This concept allowed surgeons to begin to achieve three-dimensional corrections by respecting both the sagittal and coronal curves simultaneously. The introduction of pedicle screws, throughout the thoracolumbar spine, has increased the ability of surgeons to achieve greater degrees of curve correction than had previously been possible. The history of spinal deformity is still maturing as newer procedures continue to be performed on a daily basis.

OBSERVATIONS ON SPINE DEFORMITY AND SYRINGOMYELIA

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 370-378 ◽  
Author(s):  
Ulrich Batzdorf ◽  
Larry T. Khoo ◽  
David L. McArthur
Keyword(s):  
High Risk ◽  
Spinal Deformity ◽  
Common Type ◽  
Spine Deformity ◽  
Spinal Deformities ◽  
Imaging Studies ◽  
Previous Surgery ◽  
Bone Removal ◽  
Spine Deformities ◽  
Axial Musculature

Abstract OBJECTIVE Spine deformities, notably scoliosis, are known to occur in conjunction with syringomyelia. This study aims to analyze the effect of laminectomies performed in the course of treatment of syringomyelia. It examines the incidence, severity, and type of spine deformity as it relates to the extent and location of laminectomies performed. METHODS Records of 169 patients were analyzed for evidence of spinal deformity on imaging studies for the extent of the syringomyelic cavities and for previous surgical procedures on the spine. This analysis included patients with syringomyelia related to Chiari malformation, as well as patients with primary spinal pathology. RESULTS Spinal deformities were encountered in 41% of Chiari-syringomyelia patients who had not undergone previous surgery and in 57% of such patients who underwent reoperation. Scoliosis, the most common type of deformity encountered, was likely to be mild in patients who had not undergone previous surgery and severe in reoperated patients. Spine deformity was significantly more common in those patients who had more extensive bone removal. CONCLUSION Complete laminectomy should be avoided whenever possible in patients with syringomyelia because local denervation of the axial musculature, added to loss of medial anterior horn cells from syringomyelia, favors the development of spine deformities. This is particularly true of laminectomies performed at the junctional areas of the spine, i.e., cervical-thoracic and thoracolumbar. Hemilaminectomy usually suffices for shunt placement; instrumented stabilization should be considered in patients undergoing full laminectomy, especially those considered to be at high risk of developing deformity.

scholarly journals Surgical treatment of gross posttraumatic deformations in thoracic spine

2017 ◽  
Vol 5 (3) ◽  
pp. 80-86
Author(s):  
Aleksei E. Shul’ga ◽  
Vladimir V. Zaretskov ◽  
Galina A. Korshunova ◽  
Aleksei A. Smol'kin ◽  
Dmitrii Yu. Sumin
Keyword(s):  
Surgical Treatment ◽  
Thoracic Spine ◽  
Deformity Correction ◽  
High Energy ◽  
Fracture Dislocation ◽  
Spine Deformity ◽  
Surgical Trauma ◽  
Spine Stabilization ◽  
Spine Deformities ◽  
Post Traumatic

Rigid severe post-traumatic thoracic spine deformities result from frequent, recent high-energy trauma in children with an increasing frequency due to a variety of reasons. These types of injuries are commonly followed by spinal cord anatomic injury; therefore, the treatment of these patients warrants special attention from the ethical viewpoint. Generally, the only indication for surgical intervention is spinal dysfunction. Considering this and the patients’ ordinary severe somatic state, surgical trauma should be minimized as much as possible. However, for adequate deformity correction, effective spine stabilization and restoration of liquorodynamics is necessary. Recent studies have reported the successful use of different methods of dorsal interventions (P/VCR) in cases with unstable damages in children. Here, we present the case of a 15-year-old boy who underwent surgical treatment for coarse post-traumatic thoracic spine deformity with chronic fracture-dislocation of Th7 vertebra.

scholarly journals Loss of temperature and pain sensation as risk marker of neurological complications in surgical correction of severe spinal deformity

2017 ◽  
Vol 5 (4) ◽  
pp. 5-15 ◽  
Author(s):  
Elena N. Shchurova ◽  
Marat S. Saifutdinov ◽  
Sergei O. Ryabykh
Keyword(s):  
Spinal Cord ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Neurological Complications ◽  
Surgical Correction ◽  
Type I ◽  
Spinal Deformities ◽  
Response Type ◽  
Type V ◽  
Severe Spinal Deformity

Background. Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication. There is a high risk of neurological deficit following surgical correction of a severe spinal deformity. Aim. To determine the relationship between the extent of disturbed thermal and pain sensations at Th1-S2 dermatomas and the intensity of the spinal cord pathways’ responses to surgical correction of the severe spinal deformity. Material and methods. We reviewed 58 patients with severe spinal deformities of different etiologies (mean age, 15.7±0.8 years). All patients underwent surgical deformity correction followed by thoracic/thoracolumbar spine fixation by using a variety of internal transpedicular fixations. Intraoperative neurophysiological monitoring (IONM) with transcranial motor-evoked potentials (MEPs) was used during operative interventions. Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer. Results. The extent of disturbed preoperative and postoperative thermal and pain sensations in Th1-S2 dermatomas before and after correction of spinal deformities correlated with the response type scale (I–V) of the spinal cord pathways to the surgical correction we offered. Correlation between the response type and characteristics of thermal and pain sensations was mostly revealed by the test results for the thermal pain threshold (thermal analgesia). The incidence of postoperative thermal analgesia increased monotonically from patients with response type I (persistent MEP form and amplitude-time parameters close to the baseline) to patients with response type V (higher risk of neurological complications). The overall rate of thermal analgesia increased after surgical correction of the spinal deformity relative to the baseline and was higher (≤8%) in patients with response type V. Conclusions. Surgeons and neurophysiologists who perform IONM should give careful attention to patients with severe spinal deformity who exhibit marked postoperative thermal analgesia.

scholarly journals SURGICAL TREATMENT OF CONGENITAL DEFORMATION OF THORACOLUMBAR SPINE IN CHILDREN

2013 ◽  
Vol 1 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Sergey Valentinovich Vissarionov ◽  
Dmitriy Nikolaevich Kokushin ◽  
Sergey Mikhailovich Belyanchikov ◽  
Vladislav Valerevich Murashko ◽  
Kirill Alexandrovich Kartavenko
Keyword(s):  
Surgical Treatment ◽  
Thoracolumbar Spine ◽  
Deformity Correction ◽  
Metal Structure ◽  
Posterior Spinal Fusion ◽  
Neurological Complications ◽  
Long Term Results ◽  
Patients Âgés ◽  
Local Bone ◽  
Minimum Number

The analysis of the results of surgical treatment of 32 patients with congenital spinal de formity against lateral and posterolateral hemivertebrae in the area of the thoracolumbar junction was carried out. The patients' ages ranged from 1.2 to 4 years old, 11 boys and 21 girls. Terms of postoperative follow-up were from 2 to 10 years. The angle of scoliosis before surgery was from 26 to 52, kyphosis - from 12 to 56. Surgical intervention was performed with the combined approach in the amount of extirpation of abnormal vertebrae with surrounding disks, deformity correction with dorsal metalwork, corporodesis and posterior fusion with local bone autograft. Metal structure was removed in 1.5-2 years after surgery. Correction of scoliosis was 94-100 %, kyphotic - 82-90 %. The progression of deformation, neurological complications and joining of the dysplastic process were not observed. In assessing of the long-term results, scoliosis curve ranged from 0 to 8 (average - 4.2), kyphotic from 0 to 10 (average - 5.1). The progression of the spinal deformity with hemivertebrae in the area of the thoracolumbar transition requires early surgical elimination of the defect with a full radical correction of congenital deformation, restoration of the anatomy of the spinal canal and the physiological curves of the spine at the level of deformation with fixation of a minimum number of spinal motion segments with metal construction and bone plastic stabilization (front and posterior spinal fusion).

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