scholarly journals Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

2021 ◽  
Vol 9 (2) ◽  
pp. 235-244
Author(s):  
Ignatij А. Redchenko ◽  
Sergei V. Vissarionov ◽  
Maxim G. Gusev ◽  
Grigoriy A. Lein ◽  
Ivan V. Pavlov
Keyword(s):  
Surgical Treatment ◽  
Congenital Malformations ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Congenital Deformity ◽  
Spinal Deformities ◽  
Complex Treatment ◽  
Clear Trend ◽  
Keywords And Phrases ◽  
Significant Correction

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature. AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine. MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature. RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses. CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

scholarly journals Comparative analysis of the quality of life of children with congenital scoliosis after surgical treatment: Extirpation of the hemivertebra from dorsal and combined access

2021 ◽  
Vol 9 (2) ◽  
pp. 153-162
Author(s):  
Dmitry N. Kokushin ◽  
Michael A. Khardikov ◽  
Sergey V. Vissarionov ◽  
Vera V. Sokolova ◽  
Nikita O. Khusainov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Deformity Correction ◽  
Lumbar Vertebra ◽  
Congenital Scoliosis ◽  
Congenital Deformity ◽  
Subsequent Increase ◽  
Level Of Satisfaction

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the childs quality of life following surgical technique for congenital scoliosis have not been sufficiently studied. AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches. MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (minmax, 26196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used. RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p 0.05). CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.

scholarly journals The use of guide templates in the surgical treatment of preschool children with congenital scoliosis of thoracic and lumbar localization

2020 ◽  
Vol 8 (3) ◽  
pp. 305-316
Author(s):  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Alexey G. Baindurashvili ◽  
Alla V. Ovechkina ◽  
Nikita O. Khusainov ◽  
...  
Keyword(s):  
Preschool Children ◽  
Surgical Treatment ◽  
Structural Changes ◽  
Young Patients ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Optimal Size ◽  
Correct Position ◽  
Grade Ii ◽  
Vertebral Bodies

Background. The use of transpedicular screws as support elements from the standpoint of biomechanics is preferable as compared to that of laminar fixation, albeit the former carries the risk of various complications (such as malposition screws, damage to the Dura mater, spinal cord, and major blood vessels) caused by structural changes in the vertebrae under the background of their defects, with small size of roots arcs vertebrae in young children. Thus, the issue of ensuring safe and correct installation of transpedicular screws in the surgical treatment of children with congenital scoliosis remains relevant. Aim. We aimed to evaluate the correctness of the position of the transpedicular screws installed in the vertebral bodies in preschool children with congenital scoliosis of thoracic and lumbar localization using guide templates (SHN). Materials and methods. We conducted a prospective analysis of the outcomes of surgical treatment of 30 patients with congenital scoliosis against the background of impaired formation of the vertebrae of the thoracic and lumbar spine. The patients included 12 boys and 18 girls of age: 1 year 8 months to 6 years 5 months (average: 3 years 4 months). Based on the computed tomography of the spine, performed postoperatively, the correctness of the position of the installed elements of the corrective multi-support metal structure was evaluated. The correctness of the position of the installed transpedicular support elements was evaluated based on the scale described by S.D. Gertzbein and co-authors (1990). Results. The total number of implanted transpedicular screws sets was 96 (100% of the planned transpedicular screws set), and 48 SHN were used for transpedicular screws installation. The correct position of installed screws by degree of displacement revealed Grade 0 93.7% (90 screws), Grade I 4.2% (4 screws), Grade II 2.1% (2 screws), Grade III 0%. The number of screws with a Grade 0 + Grade I offset was 94 (97.9%). Conclusion. The results obtained with the use of SHN among preschool children with congenital scoliosis of thoracic and lumbar localization revealed high accuracy and correctness of transpedicular screws installation (93.7%) with the use of this type of navigation in clinical practice. The use of SHN for installing transpedicular screws in the surgical treatment of congenital spinal deformities in young patients allows for the selection of the optimal size and correct position of the transpedicular support elements in the vertebrae to be instrumented.

scholarly journals Analysis of causes of metal structure destabilization in correction of congenital spinal deformation in children of a younger age group

2020 ◽  
Vol 8 (1) ◽  
pp. 15-24
Author(s):  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Michael A. Khardikov ◽  
Nikita O. Khusainov ◽  
Aleksandra N. Filippova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Trauma Surgery ◽  
Congenital Scoliosis ◽  
Metal Structure ◽  
Average Diameter ◽  
Control Group ◽  
Anthropometric Parameters ◽  
National Medical ◽  
Repeated Surgery

Background. One of the most common vertebral malformations that lead to the occurrence and progression of congenital scoliosis is disorders of vertebral formation. Most specialists adhere to the active tactics of surgical correction of spinal deformity in early childhood. The aim. To evaluate the variants and causes of the transpedicular spinal system destabilization, which is not related to the violation of its integrity, in the surgical treatment of children with congenital spinal deformities. Materials and methods. The case histories of 286 children under the age of 6 years undergoing surgical treatment in H. Turner National Medical Research Center for Сhildrens Orthopedics and Trauma Surgery between 2014 and 2019 were analyzed. Depending on the outcome of the surgical treatment, the patients were divided into groups: the main group (n = 7) included those with spinal system destabilization and the control group (n = 12) consisted of those without spinal system destabilization. During the study, the sizes of the bases of the arcs adjacent to the abnormal vertebra, the magnitude of the scoliotic and kyphotic components of the deformation, and the correct position of the supporting elements of the spinal system on the Gertzbein scale were determined. Results. Patients of the studied groups were identified according to their age and the magnitude of scoliotic and kyphotic components of spinal deformity. The average diameter of the arc base in the studied groups varied (p 0.05). In all patients, the complete correction of the congenital curvature of the spine was achieved after surgery. In the long-term postoperative period in patients of the study group after radiation analysis, the malposition of supporting elements relative to the base of the vertebral arch and a loss of correction of spinal deformity by an average of 25 were revealed, which required the repeated surgery in order to restore the stability of the spinal system and to correct deformation. Conclusions. The reasons for the spinal system destabilization during the correction of the spinal congenital deformations are the peculiarities of vertebral anatomical-anthropometric parameters in the curvature zone, as well as tactical aspects during surgery. The main reason for the spinal system destabilization without violating its integrity is the small size of bases of adjacent vertebral arches relative to the abnormal one. The small size of the bases of the vertebral arches and the significant amount of necessary correction of congenital spinal deformity necessitate the installation of a longer spinal system in order to restore physiological profiles in the curvature zone.

scholarly journals The use of orthotics in a patient with congenital backbone deformation after surgical treatment

2018 ◽  
Vol 6 (4) ◽  
pp. 103-109
Author(s):  
Vladislav V. Murashko ◽  
Dmitry N. Kokushin ◽  
Sergei V. Vissarionov ◽  
Grigoriy A. Lein ◽  
Ivan V. Pavlov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Postoperative Period ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Congenital Scoliosis ◽  
Congenital Deformity ◽  
Congenital Deformities ◽  
Thoracic And Lumbar Spine ◽  
Congenital Spinal Deformity

Introduction. New questions of indications and methods of surgical treatment of children with congenital spinal deformity are covered in detail. However, straightening deformed segment of the spine and fixing with metal construction is not sufficient, and conditions for its retention and prevention of migration must be created. The expediency of the study is relevant because of lack of systematic review of the results of orthotic support as complex treatment of this group of patients, both in Russia and abroad. The problems faced by vertebral surgeons are the following: the tendency of deformation relapse as the child grows, tendency of deformation of unfixed (lower and upper) segments of the vertebral column. Clinical case. For observation, we selected an 11-year-old patient. The diagnosis was congenital scoliosis on posterolateral hemivertebra Th4, dysplastic course of congenital spinal deformity. The surgical treatment performed was extirpation of hemivertebra Th4(S) and the correction of local congenital deformity with multicore corrective system in combination with bone grafting. We achieved complete correction of congenital local curve at the level of the posterior lateral hemivertebra and reduction of compensatory curves in the thoracic and lumbar spine. In the postoperative period, the patient was provided with corrective brace, with the aim of influencing on the compensatory curve. Discussion. This clinical observation aimed to determine the different approaches to treatment of children with congenital deformities of the thoracic spine, which consists of surgical correction of local congenital curvature curve with subsequent correction of compensatory curves by using a correcting brace. Conclusion. As a result of the surgical intervention, correction of congenital spinal deformity was achieved, and the use of a corrective brace in the postoperative period allowed the correction of compensatory curves and maintained the achieved result until the end of the patient’s growth.

scholarly journals Embryology of Spinal Dysraphism and its Relationship to Surgical Treatment

2020 ◽  
Vol 47 (6) ◽  
pp. 736-746
Author(s):  
Matthew E. Eagles ◽  
Nalin Gupta
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Surgical Treatment ◽  
Gestational Age ◽  
Congenital Malformations ◽  
Spinal Dysraphism ◽  
Embryological Development ◽  
Correct Treatment ◽  
Pathological Correlation ◽  
The Central Nervous System

ABSTRACT:Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

2021 ◽  
Vol 19 (3) ◽  
pp. 47-54
Author(s):  
A. F. LAZAREV ◽  
◽  
E. I. SOLOD ◽  
YA. G. GUDUSHAURI ◽  
E. I. KALININ ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Ring ◽  
Metal Structure ◽  
Complex Problem ◽  
Long Term Results ◽  
Fixation Method ◽  
Surgical Interventions ◽  
Anterior Section ◽  
Pelvic Injuries ◽  
Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

Surgical treatment as option in treatment of metastatic hormone-sensitive prostate cancer after prior drug treatment

2022 ◽  
pp. 41-45
Author(s):  
Sh. G. Khakimova ◽  
G. G. Khakimova ◽  
G. A. Khakimov ◽  
J. B. Sadullaev
Keyword(s):  
Prostate Cancer ◽  
Surgical Treatment ◽  
Drug Treatment ◽  
Bone Metastases ◽  
Clinical Result ◽  
Metastatic Prostate Cancer ◽  
Clinical Case ◽  
Complex Treatment ◽  
Good Clinical Result ◽  
Hormone Sensitive

Currently, there is no consensus on the place of prostatectomy in the complex treatment of patients with metastatic prostate cancer. A description of a clinical case of complex treatment and observation of a patient with prostate cancer with an unfavorable baseline prognosis and the presence of bone metastases with a good clinical result is presented.

scholarly journals Broken rods in spinal deformity surgery: an analysis of clinical experience and a literature review

2020 ◽  
Vol 7 (4) ◽  
pp. 15-26
Author(s):  
Mikhail V. Mikhaylovskiy ◽  
Alexander S. Vasujra ◽  
Vitaliy L. Lukinov
Keyword(s):  
Literature Review ◽  
Spinal Deformity ◽  
Congenital Scoliosis ◽  
Study Groups ◽  
Lower Percentage ◽  
Reference List ◽  
Spinal Deformities ◽  
Significant Difference ◽  
Spinal Deformity Surgery ◽  
Rod Fracture

Backgrоund. Rod fractures are one of the specific complications of spinal deformity surgery. The number of publications on this topic is small, and the conclusions are often contradictory. Aim. The aim of this study is to analyze the current situation concerning the problem of fractures of the rods in spinal deformities of various etiologies in terms of frequency and risk factors for this complication. Materials and methods. The study included 3,833 patients who underwent operations between 1996 and 2018. The inclusion criteria of being over 10 years of age with no history of spinal surgery were applied. Results. Fractures of metal implant rods were detected in 85 patients out of a total of 3,833 (2.2%). There was a significant difference between the groups of idiopathic and congenital scoliosis patients. A rod fracture in 62 of the 85 patients was the reason for reintervention to restore integrity with a connector or a full replacement. An increase in BMI by one raised the chance of a fracture by 1.07 times (p = 0.019). Increasing the age by one year increased the possibility of a fracture by 1.03 times (p = 0.039). A statistically significant association of the ventral stage of surgical treatment (discectomy and interbody fusion with autologous bone) where no fracture was detected (p = 0.403) was revealed. Being over 15 years old a statistically significant predictor was in the group under 20 years of age (p = 0.048). For BMI, there was no statistically significant threshold for fracture probability in the group under 20 years of age. It was confirmed that a hybrid fixation system produced a significantly lower percentage of complications than a hook system. A systematic literature review of sources on this topic included international databases (Scopus, Medline, and Google Scholar) as well as investigating the publications contained in the reference list. Conclusions. Rod fractures during surgery for spinal deformities of various etiologies are one of the typical complications. Fracture frequency in large study groups is small. The risk of developing this complication rises with both increasing BMI and patient age, although there is no statistically significant threshold for BMI relative to the chances of fracture in the group up to 20 years of age. Modern reticular systems of attachment of the endocorrector to the vertebral structures can dramatically reduce the risk of rod fracture during the postoperative period.

scholarly journals Therapeutic tactics in the deep forms of rectal abscesses complicated by fournie gangrene

2020 ◽  
Vol 73 (2) ◽  
pp. 293-297
Author(s):  
Oleh E. Kanikovskyi ◽  
Andrii V. Osadchyі ◽  
Sergey I. Androsov ◽  
Anatolii V. Tomashevsky ◽  
Oleh A. Yarmak ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Antibacterial Therapy ◽  
Treatment Duration ◽  
Complex Treatment ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Surgical Clinic ◽  
Modern Technologies ◽  
Clinical Emergency ◽  
Early Surgical Treatment

The aim: To conduct an analysis of the complex treatment of severe forms of rectal abscesses complicated by NF. Materials and methods: The results of treatment in 471 patients with deep forms of RA was performed. In 38(8%) the spread of the process and rotten-necrotic affection of the perineal fascia. Patients were treated at the surgical clinic of the medical faculty №2, VNPMMU, and Vinnytsya Clinical Emergency Hospital in the period from 2010-2018. Results: Total lethality 8(1,7%). Mortality in GF was 8(19,5%). It is worth noting the reduction of the treatment duration against the background of the modern technologies usage in the period from 2016 to 12 days in relation to the total figure of 15 days. Conclusions: Early surgical treatment, adequate necrectomy, fasciotomy and antibacterial therapy stop the necrotic process. The active aspiration reduces the timing of wound cleansing and further ensures the accelerated implementation of reconstructive surgical interventions.

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