Results of simultaneous and staged surgical techniques for the correction of congenital spine deformities associated with intracanal anomalies in children

Abstract

Objective. To compare the results of simultaneous and staged corrective surgical interventions for congenital spine deformities associated with intracanal anomalies. Material and Methods. Design: retrospective mono-center observational case-control study. The study included the results of 127 surgeries performed in 49 patients aged from 4 months to 17 years at the time of surgery (mean age 9.2 years). The average follow-up period was 49 months. The study group included 33 patients who underwent simultaneous (in one surgical session) removal of the intracanal component and correction of spine deformity. In the control group (16 children), these interventions were performed in stages. The analysis criteria were: the comparability of groups: the structure of anomalies of the spine, spinal canal and spinal cord, concomitant maldevelopment of organs and systems, and the presence of skin markers; and the comparison of groups: the total volume of blood loss, the duration of surgery, the magnitude of the spine deformity and the neurological status of patients assessed before and after corrective surgery, and complications. Results. Spine pathology was predominantly represented by variants of segmentation failure in 41 (59.0 %) patients and multiple vertebral malformations with a leading component of segmentation failure in 22 (33.0 %) patients. Among pathologies of the spinal canal, Arnold-Chiari malformation (17 patients, 25.0 %) and type 1 diastematomyelia (22 patients, 32.0 %) dominated. In the neurological status, Frankel types D and E prevailed at baseline, accounting for 27.3 % and 42.4 % in the study group, and 25.0 % and 37.5 % in the control group, respectively. Skin markers were detected in 34 (69.0 %) patients. The scoliotic component of the deformity prevailed; the kyphotic component was detected in 17 (35.0 %) cases. The mean magnitude of scoliotic deformity before surgery was 28° (min 20°; max 105°), after surgery 10° (min 0°; max 70°). Correction in the study group was 68 %, in the control one – 57 %. The average duration of surgery in the study group was 227 min, in the control group – 198 min for the first operation and 204 min for subsequent ones. The average volume of blood loss in the study group was 286.6 ml, in the control group – 247.5 ml during the first operation and 266.6 ml during the subsequent ones. There were no significant changes in neurological status after surgery in both groups. Transient neurological complications were observed in 2 (4.5 %) patients of the study group and in 1 (4.0 %) in the control group. It was statistically proven that simultaneous intervention provides significantly lower blood loss with a comparable orthopedic result of surgery, which indicates the preferred use of a combined surgical technique. Conclusion. Performing neurosurgical and orthopedic (correction) stages in children with congenital spine deformities and spinal canal malformations in one surgical session is not statistically associated with a greater surgical aggression and complication rate, but is accompanied by a significantly lower total blood loss. Simultaneous intervention provides somewhat better initial correction of the deformity, eliminates the need for staged interventions, and also reduces the likelihood of complications potentially associated with each surgery.