Abstract
Objective. To evaluate the results of surgical treatment of children with congenital deformity of the lumbar and lumbosacral spine associated with isolated failures of vertebra formation. Material and Methods. A total of 37 patients aged 1 year 6 months to 8 years 4 months having isolated vertebra formation failures in the lumbar and lumbosacral spine were treated. In three patients with lateral hemivertebrae the angle of scoliosis before surgery varied from 19° to 35° (average 29.2°); in 34 patients with posterolateral hemivertebrae - from 18° to 51° (average 30.1°), and the angle of kyphosis - from 10° to 34° (average 18.4°). Surgical treatment was performed through combined approach in patients with lumbar hemivertebrae, and through posterior approach in patients with lumbosacral hemivertebrae. It included extirpation of the abnormal vertebra with adjacent discs, deformity correction with posterior instrumentation, interbody fusion, and posterior local spinal fusion with bone autograft. Results. The angle of scoliotic deformity in patients with lateral hemivertebrae after surgery varied from 0° to 6°, the degree of correction ranged from 94 % to 100 %. After extirpation of posterolateral hemivertebrae and deformity correction the residual angle of scoliotic deformity varied from 0° to 4° (average 2.5°), the degree of correction ranged from 95 % to 100 %, and the kyphotic angle - from 9° to -6° (average 2.2°). The formation of solid bone block was noted in all patients at 1.5-2 years after surgery. Conclusion. Complete correction of congenital deformity in children contributes to the formation of a proper frontal and sagittal spine alignment, and provides conditions for normal spine development during the child’s growth. Hir. Pozvonoc. 2012;(3):33-37.
Highlights
To evaluate the results of surgical treatment of children with congenital deformity of the lumbar and lumbosacral spine associated with isolated failures of vertebra formation
Surgical treatment was performed through combined approach in patients with lumbar hemivertebrae, and through posterior approach in patients with lumbosacral hemivertebrae
Hemivertebra resection by a posterior approach: innovative operative technique and first results
Summary
Оценка результатов хирургического лечения детей с врожденной деформацией поясничного и пояснично-крестцового отделов позвоночника при изолированных нарушениях формирования позвонков. Выполняли хирургическое вмешательство из комбинированных доступов при поясничной локализации полупозвонка и из дорсального доступа при пояснично-крестцовой патологии в объеме экстирпации аномального позвонка с прилегающими дисками, коррекции деформации дорсальной металлоконструкцией, корпородеза и заднего локального спондилодеза аутокостью. После оперативного лечения у пациентов с боковыми полупозвонками угол сколиотической деформации в среднем составил 0–6°, степень коррекции – 94–100 %. После экстирпации заднебоковых полупозвонков и коррекции деформации угол остаточного сколиотического компонента 0–4°, степень коррекции – 95–100 %, угол кифотического компонента – от 9 до -6°. Формирование выраженного костного блока отмечено у всех пациентов в течение 1,5–2 лет после операции. Полное исправление врожденной деформации у детей способствует формированию правильных фронтального и сагиттального профилей позвоночника, создает условия для нормального развития позвоночника в процессе роста ребенка.
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