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 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 Analysis of the Effectiveness of Guide Templates for the Placement of Pedicle Screws in the Surgical Treatment of Children with Congenital Scoliosis

2020 ◽  
Vol 3 (53) ◽  
pp. 13-17
Author(s):  
Sergei Vissarionov ◽  
◽  
Alexey Baindurashvili ◽  
Dmitriy Kokushin ◽  
Nikita Khusainov ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Preschool Children ◽  
Lumbar Spine ◽  
Pedicle Screws ◽  
Congenital Scoliosis ◽  
Thoracolumbar Junction ◽  
Congenital Deformities ◽  
Vertebral Bodies

Objective: to conduct a comparative analysis of the correct position of transpedicular screws installed in the vertebral bodies in young and preschool children with congenital kyphoscoliosis of the thoracolumbar junction and lumbar spine against the background of abnormal formation of the vertebrae by the "free hand" method in vivo and in plastic models of vertebrae using templates -Directors in vitro. Methods. A comparative analysis of the correctness of the position of transpedicular screws installed in the vertebral bodies in young and preschool children with congenital kyphoscoliosis of the thoracolumbar junction and lumbar spine against the background of a violation of the formation of the vertebrae by the "free hand" method in vivo and in plastic models of the vertebrae using guide templates in vitro. Results. The number of correctly inserted transpedicular screws in plastic models of the vertebrae of children with congenital deformities of the thoracolumbar and lumbar spine using guide templates was significantly higher than the number of correctly installed screws using the free hand method (96.3% versus 80.8%, p = 0.011). Conclusion. The obtained results of in vitro guide templates application showed high accuracy and correctness of pedicle screw placement, which gives prospects for the use of this type of navigation in clinical practice in young children with congenital scoliosis.

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

2021 ◽  
Vol 9 (4) ◽  
pp. 417-426
Author(s):  
Sergey V. Vissarionov ◽  
Marat S. Asadulaev ◽  
Michael A. Khardikov ◽  
Anton S. Shabunin ◽  
Nikita O. Khusainov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Statistical Processing ◽  
Congenital Scoliosis ◽  
Surgical Interventions ◽  
Scoliotic Deformity ◽  
Pediatric Traumatology ◽  
Vertebral Bodies ◽  
Age Range ◽  
Congenital Spinal Deformity

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.

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 Role of Femoral Ring Allograft in Anterior Interbody Fusion of the Spine

2001 ◽  
Vol 9 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Areesak Chotivichit ◽  
Takuya Fujita ◽  
Tze-Hong Wong ◽  
John P Kostuik ◽  
Ann N Sieber
Keyword(s):  
Interbody Fusion ◽  
Radiolucent Line ◽  
Degenerative Change ◽  
Congenital Scoliosis ◽  
Anterior Fusion ◽  
Anterior Interbody Fusion ◽  
Femoral Ring ◽  
Grade Ii ◽  
Posterior Laminectomy

A review was carried out on 59 patients (10 males and 49 females) who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75). The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1–2 in 12, L2–3 in 17, L3–4 in 22, L4–5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12). The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months) there was no significant change in allograft angles (average = 1.6o). Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated) and 3% were in grade II (partially incorporated). Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly). One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates – graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.

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.

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.

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