Spinal osteotomy for children with congenital scoliosis with unilateral unsegmented bar: Preliminary results

Introduction. Segmentation disorder of the lateral surfaces of the vertebral bodies leads to the development of progressive deformity of the spine. Surgical interventions in different variants are the only effective way of treatment. This study examines the use of corrective vertebrectomy in patients with congenital scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies. Objective of the study. To evaluate the results of surgical treatment of children with congenital scoliosis with impaired segmentation of the lateral surfaces of vertebral bodies. Materials and Methods. A single-center retrospective study on the basis of the Department of Spinal Pathology and Neurosurgery at the Turner Scientific and Research Center for Pediatric Traumatology and Orthopedics. G.I. Turner for the period from 2014 to 2020. Twenty-six patients were included in the study: 14 girls and 12 boys. The age range was 84 to 144 months. All patients underwent surgical intervention in the volume of a one-stage corrective wedge vertebrectomy. Statistical processing was performed by comparing the reliability of differences in distributions using Wilcoxon t-criterion. Results and discussion. The median Cobb preoperative scoliotic deformity was 31, interquartile interval (IQR) = 30.5. The median preoperative lordotic deformity was 29 Cobb, IQR = 29.5. The magnitude of correction of the scoliotic component of the deformity was 84%, (median value after intervention: 5 according to Cobb, IQR = 14.5). The magnitude of correction of pathological lordosis of the thoracic spine was 41%, (median value after intervention: 17 according to Cobb, IQR = 14.5). The obtained results were statistically significant (p 0.05). Conclusion. Corrective wedge vertebrectomy is an effective method for surgical treatment of children with congenital spinal deformity with impaired segmentation of the lateral surfaces of vertebral bodies. This method of treatment achieves an average of 84% correction of scoliotic deformity and 41% correction of pathological lordosis.

Does the Fixation Span Impact on Results of Surgical Correction of Pediatric Congenital Spine Deformities? Analysis of a Monocentric Cohort

Background: We aimed at reviewing results of surgical correction of congenital spinal deformity with regard to length of instrumentation and type of osteotomy.Methods. Study comprised 117 patients with congenital spinal deformity treated between 2010 and 2018. Patients’ aged 1 to 18 years. Mean follow-up was 3 years (1 to 8). Posterior approach was used in all cases. Patients were subdivided into 4 groups.Result: Monosegmental unilateral fixation (Group I) for 15 children with mean age of 48.3 months. Cobb angle for scoliosis and kyphosis were 31.1° and 29.3° corrected to 74.9% and 84.0% respectively. Blood loss was 213.6 mL. Operating time was 165 minutes.Monosegmental bilateral fixation (Group II) for 24 patients with mean age of 53.1 months. Cobb angle for scoliosis and kyphosis were 32.5° and 30.9° corrected to 83.7% and 100.6% respectively. Blood loss was 215.4 mL. Operating time was 160.5 minutes.Three segmental bilateral fixation (Group III) for 29 patients with mean age of 78.2 months. Cobb angle for scoliosis and kyphosis were 36.6° and 37.6° corrected to 83.1% and 86.7% respectively. Blood loss was 342.7 mL. Operating time was 197.0 minutes. Polysegmental bilateral fixation (Group IV) for 49 children with mean age of 112.7 months. Cobb angle for scoliosis and kyphosis were 40° and 58.2° corrected to 72.5% and 81.6% respectively. Blood loss was 549.3 mL. Operating time was 288.8 minutes.Conclusion: Choice of spinal fixation technique was determined on the basis of patient’s age, magnitude of the deformity and concomitant vertebral abnormalities.

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

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.