Congenital Spinal Deformity Research Articles

Efficacy of a new customized navigation template for placement of transpedicular screws for unilateral access in children with congenital spinal deformity and thoracic malformation

BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine. AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies. MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results. RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment. CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.

Application of neurophysiological studies for diagnosis and justification of neurosurgical treatment of kyphotic deformity due to the congenital anomaly of the spine

The results of a comprehensive clinical, radiological and neurophysiological study were analyzed in patients with kyphotic deformity of the thoracic and lumbar spine due to a congenital anomaly of vertebral development in the dynamics of surgical treatment. It has been established that congenital kyphotic spinal deformity is accompanied by vertebromedullary conflict with a high risk of the occurrence and/or worsening of spinal neurological disorders. The study of the data obtained made it possible to evaluate deformation lesions of the spine from the standpoint of qualitative and quantitative severity of pathological changes in the conduction function in the system of nervous tracts of the spinal cord, which was an objective argument in justifying the indications for surgical correction and its methodological implementation, as well as an important neurophysiological criterion for subsequent dynamic monitoring of clinical conditions of a patient.It was found that the surgical treatment allowed us to improve and subsequently stabilize the functional state of the spinal cord as a consequence of the achieved significant correction of congenital kyphotic spinal deformity.

Comparative analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study

BACKGROUND CONTEXTLumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups. PURPOSETo evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results. STUDY DESIGNRetrospective analysis. PATIENT SAMPLEWe retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years. OUTCOME MEASUREThe following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters. METHODSFrom 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected. RESULTSCompared to Group L, Group E exhibited a lower intraoperative blood loss (p<.001), higher final main curve correction rate (p=.037), smaller post-op compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate post-op (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006). CONCLUSIONThis study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

Atypical Variants of Spinal Dysraphism: A Case Series

Abstract The aim of this study is to present and discuss atypical instances of spina bifida (SB) within a Nigerian paediatric cohort, highlighting their distinctive clinicoradiological features. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This case series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Amongst these, four cases exhibited segmental spinal dysgenesis (SSD; one thoracolumbar, one lumbar, and two sacral). Each of these cases demonstrated diverse associated musculoskeletal, cutaneous, and perineal anomalies, accompanied by varying degrees of neurological dysfunction. Other cases included lipomyelomeningocele (LMMC), human tail (HT), membranous meningocele, and myeloschisis (MSS). Autonomic dysfunction was a common feature in all of the cases, whilst two of the patients presented with congenital kyphotic spinal deformity. Lower limb anomalies varied, including congenital talipes equinovarus deformity, pes planus, congenital calcaneovagus deformity, rocker bottom feet, clinodactyly, and tetrapolydactyly. Remarkably, none of the patients exhibited clinical features indicative of hydrocephalus. SSD, LMMC, HT, membranous meningocele, and MSS represent atypical forms of SB in the Nigerian paediatric population. Early neuroimaging of patients with suspected spinal dysraphism is crucial, as it may reveal a spectrum of diverse vertebral anomalies associated with this neurological condition within the African population.

Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies

BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.

A Comparative Study between Ultra mini Percutaneous Nephrolithotomy versus Stented Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones in Egypt

Abstract Background Nephrolithiasis is the third most common disease of the urinary tract with a 1-year recurrence rate of 7% and 10-year recurrence rate of 50%. Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL) are different surgeries to treat renal stones. Percutaneous nephrolithotripsy (24- 30F) remains the standard procedure for treating large renal calculi. While achieving high SFR, it also has many drawbacks such as bleeding, postoperative pain, and a long recovery period due to its large access tract, so the Ultra mini percutaneous nephrolithotripsy (12-14F) with a smaller tract size came into existence to reduce renal parenchymal injury associated with standard PCNL. ESWL is a minimally invasive intervention with good patient tolerance; it is regarded as the first line treatment for nephrolithiasis &amp;lt; 20 mm in size. Aim andObjectives Compare results, safety and outcome of Ultra mini PCNL versus stented extracorporeal shock wave lithotripsy (ESWL) for the management of renal calculi from 10 – 20 mm. Materials and Methods This study was conducted at Urology department, Faculty of Medicine, Ain Shams University. Patients were recruited from the outpatient urology clinic between March 2021 till September 2022. Inclusion criteria included patients between 18 and 60 years, having radioopaque renal stones ranging from 10-20 mm with BMI not exceeding 40. Exclusion criteria were patients who had radiolucent stones, smaller than 10 mm or larger than 20 mm, with congenital renal anomalies or spinal deformity or BMI exceeding 40. Patients with uncorrected bleeding diathesis or pregnant females or untreated UTI were also excluded. After meeting our inclusion and exclusion criteria, 90 patients were thoroughly informed about the study, feeling well about participating in it, an informed written consent was taken from them. Patients were randomized to either Ultra-Mini-Percutaneous nephrolithotomy group or stented SWL group via the closed envelope method(each group 45 patients). Results Stone free rate was higher in the Ultra-mini-PCNL group compared to the stented ESWL group with no statistically significant difference with P-value = 0.316. As for the need for retreatment was slightly higher in the stented ESWL group compared to the Ultra-mini-PCNL group yet this difference was statistically insignificant with P-value 0.681. No statistical significant difference between both groups regarding post operative complications fever, hematuria and need for blood transfusion respectively. Operative time and hospital stay were significantly higher in the ultra-Mini-PCNL group compared to the stented ESWL group with P-value &amp;lt;0.001 for both. Conclusion Both stented ESWL and Ultra-Mini-PCNL are good treatment choices for renal stones less than 2 cm with low complication rates. Denying Ultra-Mini-PCNL from patients with medium sized stones for fear of complications is considered unwarranted. Stone size indices were significant predictor for the need of retreatment. Further studies to compare stone free rate based on stone size in both interventions are needed.

Histology and chronological magnetic resonance images of congenital spinal deformity: An experimental study in mice model

BackgroundThe natural history of the congenital spinal deformity and its clinical magnitude vary widely in human species. However, we previously reported that the spinal deformities of congenital scoliosis mice did not progress throughout our observational period according to soft X-ray and MRI data. In this study, congenital vertebral and intervertebral malformations in mice were assessed via magnetic resonance (MR) and histological images.MethodsCongenital spinal anomalies were chronologically assessed via soft X-ray and 7 T MR imaging. MR images were compared to the histological images to validate the findings around the malformations.ResultsSoft X-ray images showed the gross alignment of the spine and the contour of the malformed vertebrae, with the growth plate and cortical bone visible as higher density lines, but could not be used to distinguish the existence of intervertebral structures. In contrast, MR images could be used to distinguish each structure, including the cortical bone, growth plate, cartilaginous end plate, and nucleus pulposus, by combining the signal changes on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). The intervertebral structure adjacent to the malformed vertebrae also exhibited various abnormalities, such as growth plate and cartilaginous end plate irregularities, nucleus pulposus defects, and bone marrow formation. In the chronological observation, the thickness and shape of the malformed structures on T1WI did not change.ConclusionsSpinal malformations in mice were chronologically observed via 7 T MRI and histology. MR images could be used to distinguish the histological structures of normal and malformed mouse spines. Malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. This study suggested the importance of MRI and histological examinations of human congenital scoliosis patients with patterns other than nonsegmenting patterns, which may be used to predict the prognosis of patients with spinal deformities associated with malformed vertebrae.

Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population.

Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was sevenyears (range 0.8 to 19years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.

Surgical treatment for congenital vertebral anomalies with bilateral bifid intrathoracic rib in association: A series of five cases.

Congenital scoliosis is often associated with costal deformities, of which a bilateral bifid intrathoracic rib is very rare. The aim of this study was to retrospectively summarize the clinical manifestations, imaging characteristics, treatment strategies, and postoperative outcomes of five patients with bilateral bifid intrathoracic rib. We retrospectively reviewed the imaging findings and medical records of five pediatric patients (two girls, three boys) with bilateral bifid intrathoracic rib who were surgically treated for congenital kyphoscoliosis (mean age = 8 years). The clinical manifestations, imaging characteristics, treatment strategies, and postoperative outcome were summarized. Four of five patients showed abnormalities from birth. All five patients presented with kyphoscoliosis and a fused vertebral body or lamina. The bilateral bifid intrathoracic rib was located at T2-3 in three patients, T7 in one patient, and T10 in one patient. Various congenital spinal deformities and multiple system malformations were present in all five patients. Three patients had preoperative neurological deficits. For corrective surgery, one patient received a traditional growing rod implantation, one patient underwent resection of a bony septum, and three patients underwent spinal osteotomy. One patient suffered complete paralysis of the lower limbs after surgery. Bilateral bifid intrathoracic rib is a rare anomaly that typically occurs in patients with serious kyphoscoliosis. Bilateral bifid intrathoracic rib patients show similar clinical and radiological characteristics and are likely to exhibit neurological deficits before or following corrective surgery. Spinal surgeons should be aware of the high risk of permanent neurological complications related to surgery in these patients. level IV.

Observational Analysis: A Prospective Study of the Correlation Between the State of the Maternal Spine and the Progress of Labor Under Epidural Analgesia

Background: People have always believed that going through the process of childbirth is a gift, although pain experienced during labor by a woman occupies the second level in the pain score table. But that belief that one has to undergo pain during labor is slowly fading away, as we are entering an era where women are seeking options for painless labor, and delivery. Objective: To evaluate the spine of women in labor opting for epidural analgesia. To correlate the abnormal position of the maternal spine to the progress of labor and outcomes. Methods: The current prospective observational study performed between 2021-2023 had enrolled 200 women who were given epidural analgesia irrespective of stage of labor. Women who had a history of spine surgeries or congenital spinal deformities were excluded. Results: Of the 200 women included in the study, 80 women showed a deviation of spine mostly to the right from the midline or significant lordosis, irrespective of babies’ weight and maternal height. Out of the 80 women, 70 women ended up in an emergency cesarean section. Of the 70 women who were taken up for emergency c-sections, the major indication was nonprogress of the second stage of labor. Ten patients had a vaginal delivery, of which 3 had assisted instrumental delivery due to a prolonged second stage and poor maternal efforts. Conclusion: Irrespective of maternal height, weight of the baby, and stages of labor, if the spine shows lordosis with significant deviation from the midline most commonly towards the right it can have a significant impact on the progress of labor and outcomes.

Significance of Premature Vertebral Mineralization in Zebrafish Models in Mechanistic and Pharmaceutical Research on Hereditary Multisystem Diseases.

Zebrafish are increasingly becoming an important model organism for studying the pathophysiological mechanisms of human diseases and investigating how these mechanisms can be effectively targeted using compounds that may open avenues to novel treatments for patients. The zebrafish skeleton has been particularly instrumental in modeling bone diseases as-contrary to other model organisms-the lower load on the skeleton of an aquatic animal enables mutants to survive to early adulthood. In this respect, the axial skeletons of zebrafish have been a good read-out for congenital spinal deformities such as scoliosis and degenerative disorders such as osteoporosis and osteoarthritis, in which aberrant mineralization in humans is reflected in the respective zebrafish models. Interestingly, there have been several reports of hereditary multisystemic diseases that do not affect the vertebral column in human patients, while the corresponding zebrafish models systematically show anomalies in mineralization and morphology of the spine as their leading or, in some cases, only phenotype. In this review, we describe such examples, highlighting the underlying mechanisms, the already-used or potential power of these models to help us understand and amend the mineralization process, and the outstanding questions on how and why this specific axial type of aberrant mineralization occurs in these disease models.

Total Intravenous Anaesthesia for Introperative Neuromonitoring in a Child With Tethered Cord: A Case Report

Paediatric spine surgeries are quite frequently performed these days on patients with congenital spinal anomalies. Correction of congenital spinal deformities, at this early age of life can cause lifestyle modifying changes in young patients, which will help them to live a comparative healthy and disease free life. Spine surgeries are often performed in prone position with aid of Total Intra-Venous Anaesthesia which are better supplemented with Intra-Operative Neuro-Monitoring as they help in improving the desirable outcome of surgeries in children. Here, we report a case of Total Intra-Venous Anaesthesia for release of tethered cord aided with Intra-Operative Neuro-Monitoring, which was managed meticulously without any detrimental complications.

Ovine model of congenital chest wall and spine deformity: From birth to 3 months follow-up.

The evolution and treatment of lung alterations related to congenital spine and chest wall deformities (CWD) are poorly understood. Most animal models of CWD created postnatally were not evaluated for respiratory function. The goal of our study was to evaluate the effects of a CWD induced in utero on lung growth and function in an ovine model. A CWD was induced in utero at 70-75 days of gestation in 14 ovine fetuses by resection of the 7th and 8th left ribs. Each non-operated twin fetus was taken as control. Respiratory mechanics was studied postnatally in the first week and at 1, 2, and 3 months. Post-mortem respiratory mechanics and lung histomorphometry were also assessed at 3 months. Eight out of 14 CWD lambs (57%) and 14 control lambs survived the postnatal period. One severe and five mild deformities were induced. At birth, inspiratory capacity (25 vs. 32 mL/kg in controls), and dynamic (1.4 vs. 1.8 mL/cmH2O/kg), and static (2.0 vs. 2.5 mL/cmH2O/kg) respiratory system compliances were decreased in CWD lambs. Apart from a slight decrease in inspiratory capacity at 1 month of life, no other differences were observed in respiratory mechanics measured in vivo thereafter. Postmortem measurements found a significant decrease in lung compliance-for each lung and for both lungs taken together-in CWD lambs. No differences in lung histology were detected at 3 months in CWD animals compared to controls. Our study is the first to assess the effects of a prenatally induced CWD on lung development and function from birth to 3 months in an ovine model. Our results show no significant differences in lung histomorphometry at 3 months in CWD lambs compared to controls. Resolution at 1 month of the alterations in respiratory mechanics present at birth may be related to the challenge in inducing severe deformities.

Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand/fluoroscopy methods

BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients.&#x0D; AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy.&#x0D; MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group.&#x0D; RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups.&#x0D; CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.

Cervical hemivertebrae: A literature review on the evolution of surgical management and its results

BACKGROUND:Congenital cervical spinal deformities due to hemivertebrae are rare and serious entities that are difficult to solve because of anatomical obstacles in the cervical region and the lack of treatment experience of such patients.&#x0D; AIM:To analyze current literature dedicated to the surgical treatment of patients with congenital scoliotic deformities.&#x0D; MATERIALS AND METHODS:We searched for studies evaluating the results and surgical management of patients with cervical hemivertebrae. The literature search was performed using keywords and similar articles in PubMed, Science Direct, and Google Scholar. The depth of the search was 50 years.&#x0D; RESULTS:No studies have explored the issue of the surgical management of patients with congenital cervical scoliotic deformities because of the rarity and complexity of treatment. Still, data are sufficient to developanefficient and safe algorithm.&#x0D; CONCLUSIONS:Despite the complexity and lack of treatment experience in such patients, modern technologies for perioperative planning and surgical management allow for remarkable improvement of patients quality of life without serious complications.

Comparison of intraoperative neurophysiological monitoring between patients with arthrogryposis multiplex congenita and adolescent idiopathic scoliosis

Objective: To compare the intraoperative neurophysiological monitoring (IONM) results between patients with arthrogryposis multiplex congenita (AMC) and adolescent idiopathic scoliosis (AIS) and to analyze the influence of congenital spinal deformity on IONM in AMC patients, thus to evaluate the efficiency of IONM in AMC patients. Methods: A cross-sectional study. The clinical data of 19 AMC patients underwent correction surgery from July 2013 to January 2022 in Nanjing Drum Tower Hospital were retrospectively reviewed. There were 13 males and 6 females with a mean age of (15.2±5.6) years, and the average Cobb angle of main curve was 60.8°±27.7°. And 57 female AIS patients of similar age and curve type with the AMC patients during the same period were selected as the control group, with an average age of (14.6±4.4) years and a mean Cobb angle of 55.2°±14.2°. The latency and amplitude of samatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TCeMEPs) were compared between the two groups. The difference in IONM data between AMC patients with and without congenital spinal deformity was also evaluated. Results: The success rates of SSEPs and TCeMEPs were 100% and 14/19 for AMC patients, 100% and 100% for AIS patients. The SSEPs-P40 latency, SSEPs-N50 latency, SSEPs-amplitude, TCeMEPs-latency, TCeMEPs-amplitude showed no significant difference between AMC patients and AIS patients (P>0.05 for all). The side-difference of TCeMEPs-amplitude showed an increasing trend in AMC patients when compared with that in AIS patients, but there was no statistical difference between the two groups [(147.0±185.6) μV vs (68.1±311.4) μV, P=0.198]. The SSEPs-amplitude value was (1.4±1.1) μV on concave side in AMC patients with congenital spinal deformity, and it was (2.6±1.2) μV on concave side in AMC patients without congenital spinal deformity (P=0.041). The SSEPs-amplitude value was (1.4±0.8) μV on convex side in AMC patients with congenital spinal deformity, and it was (2.6±1.3) μV on convex side in AMC patients without congenital spinal deformity (P=0.028). Conclusions: The values of SSEPs-P40 latency, SSEPs-N50 latency, SSEPs-amplitude, TCeMEPs-latency and TCeMEPs-amplitude are similar in AMC and AIS patients. The SSEPs-amplitude of AMC patients with congenital spinal deformity is lower than that of AMC patients without congenital spinal deformity.

Short-term outcomes of an enhanced recovery after surgery pathway for children with congenital scoliosis undergoing posterior spinal fusion: a case-control study of 70 patients.

Increasing evidence demonstrates the advantages of an enhanced recovery after surgery (ERAS) protocol; however, few studies have evaluated ERAS in pediatric patients. This study aimed to evaluate the effect of ERAS in pediatric patients with congenital scoliosis. Seventy pediatric patients with congenital scoliosis underwent posterior hemivertebra resection and fusion with pedicle screws and were prospectively randomly assigned to the ERAS group ( n = 35) and control group ( n = 35). ERAS management comprised 15 elements including a shortened fasting time, optimized anesthesia protocol, and multimodal analgesia. The control group received traditional perioperative management. Clinical outcome was evaluated by hospital stay, surgery-related indicators, diet, pain scores, laboratory tests, and complications. The surgical outcome showed a similar correction rate in the ERAS group (84.0%) and control group (89.0%; P = 0.471). The mean fasting time was significantly shorter in the ERAS group than in the control group. Compared with the control group, the ERAS group had significantly shorter mean times to postoperative hospital stay, first anal exhaust and defecation, significantly lower mean pain scores in the first 2 days postoperatively ( P < 0.05), and a significantly lower mean interleukin-6 concentration on postoperative day 1 ( P < 0.001). The incidence of complications was similar in the ERAS group and control group ( P > 0.05). The ERAS protocol is effective and safe for pediatric patients with congenital spinal deformity and may significantly improve the treatment efficacy compared with traditional perioperative management methods. Levels of Evidence: III.

PMMA Teeth-Pedicle Screw Spacers in Revision Spinal Surgery: A Technical Note

BACKGROUND Pedicle screw instrumentation was first described by Boucher in 1959 and subsequently popularised by Camille et al. in 1963. It has since become the most prevalent spinal fixation technique with indications for pedicle screw and rod constructs including congenital disease, trauma, infection, and spinal deformity including scoliosis. Initially used in lumbar spine surgery, the use of pedicle screws has since been extended to the thoracic spine where, because of the narrow pedicle corridor and proximity of critical structures, there is less margin for error in screw placement.1 Pedicle screw misplacement has been described in up to 40% of lumbar spine cases and up to 55% in thoracic spine cases.2 Complications associated with pedicle screw placement include damage to spinal cord, neural elements, nerve roots, pedicle fractures, wall cut out, and difficulty fitting instrumentation to the pedicle. Pedicle screw placement techniques can be grossly divided into freehand and image-guided techniques, with freehand techniques including drill assisted and pedicle gearshift (probe) methods while image-guided techniques incorporate fluoroscopic assisted, navigation assisted and robotic-assisted means. Pedicle screw placement into previously fused spines can be challenging with vital anatomic landmarks altered or obscured by the fusion mass.3 PMMA (Polymethyl methacrylate) was first introduced by Charnley in 1960 for cemented total hip arthroplasty. In spine surgery, PMMA has been used in numerous forms including kyphoplasty, disk substitution, and pedicle screw augmentation. In 1972 Bucholz and colleagues began combining PMMA with antibiotics to achieve high local antibiotic concentration in the setting of osteomyelitis; as such PMMA antibiotic loaded spacers have been well described in revision arthroplasty. Staged revision spinal surgery has been advocated by some authors in the setting of deep infection.4 Our senior author has noted that identification of pedicle screw tracts during second stage surgery can be challenging. Rationale We describe a novel surgical technique for the use of PMMA Teeth in the setting of staged revision spinal surgery to maintain the patency of pedicle screw tracts, permitting prompt identification on proceeding surgery stages and achieving local antibiotic delivery when necessary. Surgical Technique A standard posterior approach to the spine is performed identifying the in situ instrumentation. After removal of the in situ spinal rods and pedicle screws, the pedicle screw tracts are examined evaluating the medial, lateral, superior, and inferior walls of the tract. Residual fibrous tissue is debrided. A standard mix of Palacos R cement (Heraeus Medical, Newbury, UK) with the addition of 2 g vancomycin is performed. The PMMA teeth are subsequently fashioned from the Palacos R cement (Fig. 1). Similar to the technique described by Tsung et al.5 in revision hip arthroplasty, the principle for fixation is that of macroscopic fit as opposed to microscopic interlock of the cement; therefore, the PMMA teeth are inserted once the cement has cured.FIGURE 1: PMMA Teeth.PMMA indicates Polymethyl methacrylate.Expected Outcomes The PMMA teeth technique can assist the spinal surgeon in identifying the pedicle screw tract promptly and safely in staged revision spinal surgery with the added benefit of local antibiotic delivery. Complications Potential complications include PMMA Teeth fracture in situ, however, given the PMMA Teeth are inserted once the cement has cured, removal should be uncomplicated. DISCUSSION & CONCLUSION The incidence of revision spinal fusion has a reported range of 8 to 45%, with the revision rate increasing with follow-up; 21% of patients undergoing revision spinal surgery will require further spinal surgery.6 The rate of pedicle screw perforation has been reported to be as high as 28%, and 19% with a perforation greater than 2mm. This poses a significant challenge with considerable potential for pedicle screws to be misplaced in the revision spinal surgery setting.

The use of the apparatus of an intelligent system with biofeedback in the evaluation of preoperative preparation of a patient with type I diastematomyelia: clinical case

BACKGROUND: Diastematomyelia is a rare congenital anomaly of the spinal cord, characterized by its cleavage in the spinal canal, which can be combined with spinal deformity. When correcting scoliotic deformity, patients with this anomaly have a high risk of developing neurological disorders due to its fixation. Therefore, its preliminary mobilization surgically is necessary. In the upcoming corrective surgery, an important role is also played by preoperative halo-traction training in combination with therapeutic physical culture.&#x0D; CLINICAL CASE DESCRIPTION: A clinical case of the use of the Tergumed 3D intelligent biofeedback system in assessing the effectiveness of preoperative halo-gravity traction in combination with mobilizing therapeutic physical culture in a patient with complex spinal deformity against the background of congenital malformation (type I diastematomyelia) to prepare for surgical correction is presented.&#x0D; CONCLUSION: The results of this study suggest that the combination of physical therapy and halo-traction can be effectively used for preoperative preparation of patients with rigid scoliotic deformities and spinal anomalies. It help analyze preoperative preparation in patients with congenital spinal deformities.

Врожденный лордоз и лордосколиоз: состояние проблемы (обзор литературы)

the dorsal part of the vertebrae and normal growth of the ventral part. The most common nosological variant of the defect is lordoscoliotic deformity of the thoracic spine, which often occurs due to syndromic defects (spondylocostal dysostosis) and systemic diseases of the musculoskeletal system (arthrogryposis). Along with the vertebral syndrome, the pathological complex in congenital lordosis of the thoracic or thoracolumbar spine includes thoracic insufficiency syndrome, which in the overwhelming cases leads to the development of respiratory failure caused by bronchial obstruction. The purpose of the study is to summarize information and analyze literature data on a rare pathology of the spine, which is clinically manifested by the formation of thoracic lordosis due to congenital anomaly in the development of the vertebrae. Materials and methods An analysis of the literature on the diagnosis and treatment of congenital lordosis and lordoscoliosis in children was carried out. The depth of the search was more than 100 years. Inclusion criteria: presence of lordotic deformity of the thoracic, cervicothoracic or thoracolumbar spine. Results and discussion Respiratory failure in this group of patients develops due to reduction in the anteroposterior size of the chest (an increase in the chest penetration index), a decrease in the height of the thoracic spine, changes in the mechanics of rib movements, bronchial obstruction, worsening ventilation and perfusion on the convex side of the deformity. The leading component of disability and impairment of the quality of life of patients is respiratory failure syndrome. A decrease in lung function, primarily due to reduction in VC, is directly proportional to the magnitude of the deformation of the spine and chest. Surgical correction of spinal and chest deformity is the main component of treatment for this group of patients. Surgical treatment consists in the mandatory multilevel mobilization of all three columns of the spine (preferably combined access) and bilateral resection of the ribs to reduce chest rigidity. Postoperative respiratory support is critical in respiratory failure. Conclusion Congenital spinal deformities in the form of thoracic lordosis and lordoscoliosis are extremely rare. The key aspects of treatment are the fight against respiratory failure and the selective choice of surgical technologies for deformity correction with a trend towards simultaneity of interventions. The literature review confirmed the insufficient knowledge on the issues of this pathology.