Correction Of Scoliotic Deformity Research Articles

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Safety of Traditional Growing Rods in Patients with Early-Onset Congenital Scoliosis Associated with Type-I Split Cord Malformation.

Literature regarding the application of traditional growing rod (TGR) instrumentation in patients with early-onset congenital scoliosis with type-I split cord malformation is scarce. The purpose of the present study was to assess the safety and effectiveness of TGR surgery and repeated lengthening procedures in patients with congenital scoliosis with type-I split cord malformation not treated with prophylactic osseous spur excision. Thirteen patients with early-onset congenital scoliosis associated with type-I split cord malformation and a stable neurologic status between March 2009 and July 2020 were recruited. All patients underwent primary TGR surgery and subsequent repeated lengthening procedures without osseous spur excision by the same surgical team. Clinical information and radiographic data from the preoperative, postoperative, and latest follow-up periods were collected. The mean preoperative Cobb angle of the major coronal curve was 74.62° ± 25.59°, the mean early postoperative angle was 40.23° ± 17.89°, and the mean latest follow-up angle was 40.62° ± 16.60°. The scoliotic deformity correction percentage was 46.81% ± 12.26% after the initial operation and 45.08% ± 15.53% at the latest follow-up. Compared with the preoperative values, significant improvements were observed in the coronal and sagittal balance early postoperatively and at the latest follow-up (p < 0.05 for all). The average annual amounts of spinal height gained were 15.73 ± 5.95 mm at T1-S1, 8.94 ± 3.94 mm at T1-T12, and 12.02 ± 6.70 mm between the instrumented segments. The total height gained at T1-S1 and T1-T12 was 72.18 ± 28.74 mm and 37.62 ± 12.53 mm, respectively. No intraoperative neurophysiological monitoring events were observed, and no case of neurological deficit was observed postoperatively or during follow-up. Patients without neurologic deficit and having a stable neurologic exam who have early-onset congenital scoliosis associated with type-I split cord malformation can safely and effectively undergo TGR surgery, followed by repeated lengthening procedures, without prophylactic osseous spur excision. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Range of international surgical strategies for adolescent idiopathic scoliosis: Evaluation of a multi-center survey.

Surgical treatment of adolescent idiopathic scoliosis (AIS) is very complex and modern instrumentation techniques offer multiple possibilities. Despite numerous publications, there is no clear consensus on the optimal strategy for the correction of scoliotic deformities. The goal of this study was to summarize the current surgical strategies for specific AIS cases within various countries. Thirty-two experienced scoliosis surgeons from 15 countries were asked to plan surgeries on 12 representative AIS cases. All AIS cases had an indication for surgery. A questionnaire was provided to document surgical planning. The surgeons were provided with the patients' age and sex, together with radiographs in the lateral and sagittal planes during upright standing and in lateral bending to the left and right, as well as with clinical images. The angles of the main spinal curvatures were specified in the questionnaire. The surgeons were asked to specify their preferred classification system, their surgical approach, the planned fusion length, the type of implants, the rod type, and the resection steps. The data were analyzed with respect to the inter-rater variability, which was quantified using the Fleiss-Kappa Method. There was a good agreement (k = 0.61) between the surgeons in choosing the Lenke curve type, and a moderate agreement for the lumbar (0.41) and sagittal (0.56) modifiers. The most frequently planned resection procedure was complete facetectomy (67%). The posterior approach was the most commonly (91%) selected strategy to treat AIS. Anterior approaches were chosen most for Lenke 5 type with a rate of 20%. The upper instrumented vertebra (UIV) varied most for Lenke 1, 5, and 6 cases, with a vertebral level discrepancy of up to 10 levels at Lenke 6. The lowest instrumented vertebra varied most for Lenke 1 and 4 by up to five levels. Polyaxial screws were chosen most (56%), followed by monoaxial (20%) and uniplanar (19%) screws and hooks (5%). The results highlight the commonalities and discrepancy in the surgical treatment of AIS in between surgeons. The selected LIV and UIV can vary depending on the curve type and surgeon. Hook constructs appear to be generally replaced by transpedicular screws. The survey indicates open questions in the AIS treatment and in the understanding of scoliosis biomechanics.

Comparative results of treatment of superior mesenteric artery syndrome in children by forming bypass anastomoses

Introduction. Superior mesenteric artery syndrome (SMAS) is a rare cause of chronic duodenal obstruction in children. It is defined as a compression of the inferior horizontal branch of the duodenum (DU) between aorta and the superior mesenteric artery (SMA). Various methods of surgical correction of the disease have been proposed in the literature, but a comparative analysis of their effectiveness has not been carried out. Objective: the comparative analysis of using various options of bypass anastomoses (side-to-side duodenojejunostomy, Roux-en-Y duodenojejunostomy) for SMAS in children was carried out. Materials and methods: thirty-four patients were treated with SMAS at the clinic of the Federal State Budgetary Institution of Children’s City Clinical Hospital named after. N.F. Filatov for the period from 2012 to 2023. Patients were divided into 2 groups: operated on by forming a side-to-side bypass duodenojejunostomy (group 1 - 21 children (61.8%)) and Roux-en-Y (group 2 - 13 children (38.2%). A retro- and prospective analysis of the results of their treatment was carried out. The average age was 15 years 7 months (from 8 years 5 months to 17 years 8 months). Girls were predominant 85.3%. Standard investigations were performed: ultrasound, fluoroscopy, and computer tomography of the organs of the abdominal cavity with contrast, esophagogastroduodenoscopy, laboratory research methods. The WHO AntroPlus program was used to assess the physical condition of the children. Results: the groups were assessed in terms of anthropometric indicators, gender composition and age. The following causes of SMAS were identified in both groups: weight loss caused by neuropsychiatric diseases - 29.4%; growth spurt - 26.5%; weight loss due to other reasons (repeated surgeries, diseases accompanied by weight loss, etc.) - 23.5%; without an obvious reason - 17.6% (6 people), correction of scoliotic deformity - 2.9%. The analysis showed that statistically significant differences were identified in the duration of surgery. The average duration of the operation in group 1 was 78.10±21.53 minutes, in group 2 - 103.46 ±18.19 minutes (p=0.001*). There was no statistically significant difference between groups in the postoperative period and in the complications (bleeding from the surgical site 8.8% (3 people) and reactive pancreatitis 5.9% (2 people)). Conclusion: no statistically significant difference was found in the results of both types of operations. However, the laparoscopic side-to-side duodenojejunostomy bypass is preferable due to the simplicity and quickness of performing.

The effect of surgical correction of Lenke types I and III scoliotic deformities on the spinal balance in patients aged 15–35 years

Objective. To analyze the effect of spinal deformity correction on the parameters of the frontal and sagittal balance in patients aged 15-35 years with Lenke types I and III idiopathic scoliosis.Material and Methods. The dynamics of sagittal and frontal parameters of the spinal balance was assessed in 268 patients aged 15 to 35 years with Lenke type I and III idiopathic scoliosis before and after surgical treatment. The patients’ quality of life and the number of postoperative complications were assessed depending on the imbalance severity.Results. More than half of patients (55.6 %) with Lenke types I and III idiopathic scoliosis have initial balance disorders, and 14.6 % of them have pronounced abnormalities. Significant balance disorders are predicted by severe scoliosis (85.3° ± 30.3°), greater L5 tilt (10.3 ± 7.9 before surgery; 5.3 ± 4.8 after surgery) and initial sagittal imbalance (32.75 ± 27.7), large residual scoliotic curve (43.3° ± 23.1°), large angle of residual thoracic kyphosis (32.3° ± 15.9°), and smaller angle of lumbar lordosis after surgery (52.3° ± 14.1°); p &lt; 0.05. The main compensatory elements, in addition to PT and SS, are the angle of L5 tilt in the frontal plane and the L5–S1 angle in the sagittal plane. In young patients aged 15-35 years, disc mobility at the L5–S1 level is sufficient to achieve a more balanced body position, even with a significant change in the PI-LL ratio.Conclusion. In the long-term postoperative period, a pronounced imbalance of the spine increases the risk of mechanical postoperative complications up to 50 %, while the quality of life of patients does not decrease, and repeated surgical interventions are required in singular cases. Correction of scoliotic deformity allows increasing the number of patients without balance disorders by 6 %, and reducing the number of gross deviations by 2 times.

Corrective Maneuvers Used in Different Scoliosis Deformities With the Experience of 72 Operated Patients.

This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content. Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated. The mean follow-up was 42.5 (24-108) months, and the mean age was 15.8 (12-29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50-139) degrees, and the final follow-up was 15.6 (5-40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12-110) degrees, and the final follow-up was 41.2 (25-62) degrees. The mean surgical time was 293 (160-440) minutes. The mean hospitalization length was 5.8 (2-21) days. The blood delivered to patients during surgery and postoperative was 715 (300-1800)mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle ( P =0.000). Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

Adolescent Idiopathic Scoliotic Deformity Correction Surgery Assisted by Smart Glasses Can Enhance Correction Outcomes and Accuracy and Also Improve Surgeon Fatigue

Augmented reality (AR) is becoming more commonplace and are slowly penetrating the surgical field. With the continuous progression of navigation and visualization techniques, AR has great potential to improve surgical quality and safety. Nevertheless, the impact of AR on surgical outcomes and surgeons' well-being remains poorly studied. This prospective controlled study aims to assess the effect of surgery assisted with AR smart-glasses on adolescent idiopathic scoliosis (AIS) surgical deformity correction outcomes and surgeons' fatigue. AIS patients scheduled for surgical deformity correction were prospectively recruited and assigned to standard or AR-supported surgery, using lightweight AR-smart glasses. Demographic and clinical features were recorded. Pre- and post-surgery spinal features, surgery time, and blood loss were recorded and compared. Finally, participating surgeons were asked to fill in questionnaires (e.g., VAS-fatigue) to compare the impact of AR on their well-being. Our study highlighted enhanced spinal deformity corrections with Cobb angle (-35.7o versus -46.9o), thoracic kyphosis (8.1o versus 11.6o), and vertebral rotation (-9.3o versus -13.8 o) changes favouring AR-supported surgery. Moreover, AR resulted in significantly lower violation rates per patient (7.5% versus 6.6%, p=0.023). Finally, fatigue scores showed consistently a significant reduction in VAS-fatigue (5.7±1.7 versus 3.3±1.2, p<0.001) and other fatigue classifiers for the surgeons following AR-supported surgery. Our controlled study highlighted the enhanced spinal correction rates in AR supported surgeries while also improving surgeons' well-being and fatigue. These results endorse the adaptation of AR techniques to support AIS surgical correction.

Аналіз ефективності використання системи гало-гравітаційної тракції як фактора, що впливає на крововтрату при хірургічній корекції складних сколіотичних деформацій у дітей

Halo-gravity traction (HGT) systems are widely used in leading clinics around the world as a staged method for correcting complex (&gt;100°) scoliotic deformities of the spine in children. Today there is no single approach to the use of this technique, and each doctor makes a decision regarding the treatment regimen empirically, based on his clinical experience. Purpose - to identify the factors that affect the amount of blood loss during surgical correction of scoliotic deformity in children. Materials and methods. 76 patients aged 7 to 17 years were examined, on average 11.0±2.8 years. I (experimental) group - 38 children were treated with HGT using the developed tactics of staged surgical treatment; II (control) group - 38 children who underwent one-step surgical correction. The age of children in the groups in group I was 11.0±2.8 years, in group II - 11.2±2.8 years, the age of children in groups was statistically the same (t=-0.409; p=0.684). There were 28 (36.8%) boys and 48 (63.2%) girls. The distribution of children by age and sex in the groups was the same. Data on operative blood loss were statistically processed. Results. According to the statistical study, it can be argued that the blood loss during surgical correction of scoliotic deformity is most affected by the angle of deformation and age of the patient. At an angle of deformation of &gt;100° blood loss is significantly greater than at an angle of &lt;100°, children over 14 years also observed a significant increase in blood loss, and this is associated not only with greater body weight but also with the fact that these children the greater the angle of deformation of the spine, as well as the use of HGT, the angle of deformation decreases less than in younger children. Conclusions. It was determined that after HGT in children the angle of deformation decreased statistically significantly (p&lt;0.001) by an average of 36.5±14.9°. The change in deformation in boys and girls was the same. With surgical correction of scoliotic deformity &lt;100° blood loss (1025.0±235.9 ml), (statistically significant) (p&lt;0.001) is statistically significantly less than blood loss with correction of deformity greater than 100° (1297.5±327.8 ml). With age, blood loss increases in children, and this difference between age subgroups is statistically significant (α=0.05). The value of the angle of scoliotic deformity after surgical correction has a statistically significant (r=0.576; p=0.001) effect on blood loss, the value of surgical correction of deformity on blood loss (r=0.015; p=0.879) does not affect. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: intraoperative bleeding, spinal deformity, halo-gravity traction.

Harrington instrumentation in combination with Luque method versus Cotrel-Dubousset instrumentation for scoliosis correction

Results of surgical treatment of 60 patients with scoliosis are presented. In 36 patients Harrington instrumentation in combination with Luque method was used for deformity correction, in 24 patients Cotrel-Dubousset instrumentation was applied. In 8 patients with extremely severe rigid scoliosis the deformity correction was preceded by thoracotomy with multilevel diskectomy for spine mobilization. In frontal plane no differences was observed in obtained correction independent on the type of instrumentation. In horizontal and sagittal planes correction obtained i was more marked if Cotrel-Dubousset instrumentation was applied. In Harrington instrumentation follow up period was 1 year, in Cotrel-dubousset instrumentation follow up ranged from 3 months to 1 year. Scoliotic deformity correction by Cotrel-Dubousset instrumentation is showed to be preferable. However taking into account its high cost the use Harrington instrumentation in combination with Luque method may be recommended as alternative method only.

Аналіз напружено-деформованого стану моделі хребта із заднім спондилодезом при лікуванні сколіотичних деформацій у дітей

Актуальність. Математичне моделювання корекції сколіотичних деформацій хребта дозволяє без хірургічного втручання провести аналіз ефективності різних методів лікування в декількох варіантах. При дослідженні тракційних способів лікування застосовувалися переважно експериментальні методи досліджень. Мета: дослідити напружено-деформований стан моделей хребта з різним ступенем сколіотичної деформації при задньому спондилодезі. Матеріали та методи. Моделювали деформації хребта 40°, 70° і 100° при задньому спондилодезі хребців Th1-Th12. Використовували навантаження величиною 300 Н. Результати. При деформації 40° найбільш напруженими є ділянки вигину хребта у фронтальній площині. Для верхніх хребців Th1-Th4 спостерігається більш рівномірний розподіл напруження по тілу хребця. Для блоку хребців Th5-Th10 більш напруженою є увігнута сторона тіл хребців. У грудному відділі хребта найбільш напруженими є хребці Th2 і Th5. Основне навантаження несе фіксуюча конструкція, у якій рівень напруженого стану значно вищий, ніж у кісткових структурах хребців. У задньому опорному комплексі хребців ділянки концентрації напруження розташовані у місцях входу фіксуючих гвинтів у кістку. Збільшення величини сколіотичної деформації хребта до 70° викликає збільшення рівня напруження в усіх елементах моделі, за винятком хребців Th9-Th10. При деформації 100° у задньому опорному комплексі хребців ділянки концентрації напруження розташовані у місцях входу фіксуючих гвинтів у кістку. Рівень напруження 116,0 МПа перевищує межу міцності кортикального шару кісткової тканини хребта, що може призвести до мікроушкоджень кісткової тканини та розхитування гвинтів. Висновки. При всіх величинах сколіотичної деформації хребта найбільш напруженими є хребці Th4 та Th5. Зменшення ступеня деформації значно впливає на напружено-деформований стан хребетного стовпа. У тілі хребця Th4 рівень напруження при деформації 100° більш ніж удвічі вищий, ніж при деформації 70°, та більш ніж у 4 рази, ніж при деформації 40°. У тілі хребця Th5 рівень напруження при деформації 70° в 1,5 раза менше, ніж при деформації 100°, а при деформації 40° — менше в 3 рази. Рівень напруження в тілах хребців Th1-Th5 вищий, ніж у Th6-Th12. У задньому опорному комплексі в місцях входу гвинтів у кістку максимальне значення напруження при деформації 40° дорівнює 34,0 МПа, що не є критичним для кісткової тканини. При деформації 70° значення напруження дорівнює 85,0 МПа, що може перевищувати межу міцності для кортикальної кістки і призводити до мікроруйнування кісткової тканини в ділянці контакту «гвинт — кістка». При деформації 100° напруження дорівнює 116,0 МПа, що перевищує межу міцності для кортикальної кістки і може призвести до мікроруйнування в ділянці контакту «гвинт — кістка».

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.&#x0D; 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.&#x0D; 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.&#x0D; 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).&#x0D; 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.

Application of the ‘Surgical GPS’ to posterior spinal fusion procedures for scoliosis correction

ABSTRACT Scoliotic deformity correction is usually addressed with a posterior spinal fusion (PSF) approach. PSF operations are significantly invasive but can become safer and more efficient by reducing the number of ligament releases performed. However, PSF pre-operative planning to lessen ligament releases is constrained by current diagnostic imaging, which struggles with soft tissue localization, causing ligament release minimisation to be indeterminable. Patient-specific meshes that encompass vertebrae, intervertebral disks, ligaments, and other soft tissue may more accurately guide these pre-operative planning studies as well as intra-operative, computer-assisted surgery (CAS) systems supporting deformity correction. Further, merging physician-designated anatomical landmarks and pre-existing surgical ontologies into a resource description framework (RDF) format permits real-time, CAS guidance accommodating countless surgical workflows. By combining RDF-driven CAS guidance and patient-specific meshes, preoperative and intraoperative support of PSF procedures can be achieved at an individualised level. This study presents an early implementation of this combination, as the ‘Surgical GPS’.

Complications of surgical treatment of idiopathic scoliosis in adolescents

Introduction. In modern literature, there are still debates on causes of the most common complications after surgeries for idiopathic scoliosis in adolescents and their risk factors. Currently, there are growing potentials to reduce the length of patients’ postoperative stay in hospitals, but it arises the need for attending physicians to know better the main types of complications of juvenile idiopathic scoliosis after surgery, their risk factors so as to predict and avoid them, to develop an individual program for patient’s management in the postoperative period, especially for patients from the risk group.Material and methods. Literature search was done in databases Pubmed, Medline, Google Scholar, using key words, on complications of surgical correction of juvenile idiopathic scoliosis.Results. On analyzing the obtained literature data, two large groups of postoperative complications were described in details: somatic and neurological. In addition to most common complications, some rare ones are described too which include superior mesenteric artery syndrome and distant deep infections.Conclusion. Over the past twenty years, the incidence of postoperative complications after surgical correction of scoliotic deformities has significantly decreased. When analyzing findings of various trials, it can be concluded that the overall complication rate decreased in 2004-2007 from 5.7% (2000-2003) to 4.95% and then to 0.98% (2013-2016). Despite the general decrease in the incidence of complications, the latter still remain a problem for clinicians. The basic risk factors for such complications are: concomitant renal pathology, large volume of surgical blood loss, significant increase of exposure to anesthesia and surgical intervention, application of stainless steel constructions, anterior or combined surgical access, refusal of intraoperative neuromonitoring.

A multimodal approach to intraoperative neuromonitoring of the spinal cord during spinal deformity correction

Objective. To analyze the results of a multimodal approach in intraoperative neurophysiological monitoring during surgical correction of spinal deformities.Material and Methods. The paper describes a variant of intraoperative neurophysiological monitoring of the spinal cord and nerve root functions which was used in the correction of scoliotic deformity of the spine in 138 patients. Surgery was performed in 83 patients aged 10 to 17 years and in 55 patients older than 17 years. The average age of patients was 20.23 ± 8.3 years. There were 41 male and 97 female patients. The primary scoliotic curve was localized in the thoracic spine in 90 cases, in the thoracolumbar spine in 27 cases, and in the lumbar spine in 21 cases.Results. In the early postoperative period, two patients developed neurological deficit, the electrophysiological predictors of which were recorded during intraoperative neurophysiological monitoring. In one case, the deficit gradually regressed completely due to the measures taken by the operating team during surgery; in the second case, a persistent neurological deficit in the form of lower paraplegia persisted, despite the measures taken during the surgical treatment. In other cases, intraoperative neurophysiological monitoring did not reveal any changes in the spinal cord and nerve roots, which in the early postoperative period would lead to the appearance or aggravation of motor deficit.Conclusion. A multimodal approach to intraoperative neurophysiological monitoring provides an operating surgeon with an objective assessment of the state of the spinal cord and nerve roots at any stage of surgery, which allows timely identification and elimination of the causes of their damage, thereby reducing the likelihood of neurological deficit development or aggravation in the postoperative period.

Risk factors for the presence of syringomyelia in idiopathic scoliosis: analysis of 3,285 cases and brief literature review

Objective. To analyze possible radiological and clinical risk factors for syringomyelia in patients with scoliotic deformity. Material and Methods. An analysis of data from 3,285 patients with idiopathic scoliosis treated from 1997 to 2020 was performed. Syringomyelia was detected in 38 (1.16 %) cases. In 26 cases, syringomyelia was combined with Chiari malformation. In order to search for information on the topic under discussion, the international databases (Scopus, Medline, and GoogleScholar) were used. Additional search for publications listed in the article references was carried out. According to the literature data, possible risk factors for the presence of syringomyelia have been identified. Results. Among patients with confirmed syringomyelia, a left-sided thoracic scoliotic curve was found in 23.7 % of cases, a double thoracic curve in 18.4 %, an upper thoracic scoliotic curve in 7.9 %, an increase in thoracic kyphosis in 60.5 %, and initial neurological deficit in 47.4 %, which is significantly higher than the same indicators in the entire group of patients. The ratio of male and female patients in the entire group was 1.0 : 6.7, in the group with syringomyelia – 1.00 : 1.71. Conclusion. According to the literature review and statistically significant factors identified in the analysis of the monocentric group, it can be said that the left-sided thoracic scoliotic curve, upper thoracic curve, double thoracic curve, increased thoracic kyphosis, initial pyramidal insufficiency in the lower extremities, male sex, and a decrease in the initial somatosensory evoked potentials are risk factors for syringomyelia. If the above factors are present in a patient, the MRI study may be recommended to determine further treatment tactics. Before surgical correction of scoliotic deformity, MRI is recommended for all patients.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele

BackgroundThe aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy.MethodsBetween 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients’ pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated.ResultsThe mean patient age was 6.9 (4–10) years. Mean preoperative kyphosis was 115° (87–166°), mean early postoperative kyphosis was 3.9° (20–10°), and final follow-up postoperative kyphosis was 5.1° (22–8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115–35°) preoperative, as 12.9° (32–0°) early postoperative, and 15.7° (34–0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1–T12 and T1–S1, respectively.ConclusionKyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients.Level of evidenceLevel 4

Horizontal Correction of Scoliotic Deformity with High-Density Pedicle Screw Constructs: A Retrospective Analysis of 40 Patients

Purpose: To report radiologic outcomes in the horizontal plane after scoliosis correction with high-density pedicle screw constructs through a sterEOS®-3D analysis. Methods: We conducted a retrospective monocentric study on scoliotic patients who underwent a surgical correction with high-density constructs. SterEOS®-3D reconstructions were modelled from pre and postoperative EOS® acquisitions. Amplitude of surgical correction and residual deformity were analysed for rotational parameters (vertebrae vectors coordinates, apical vertebral rotation (AVR), intervertebral rotations, Torsion Index) and transversal offset parameters (Spread of Coronal Offsets (SCO), mean of coronal offsets (CO), T9 and L3 to Gravity Line (GL) CO, T9/L3 Transverse Gravitational Deviation Index (TGDI), T9/L3 TGDI θ categories). Results: 80 sterEOS®3D reconstructions were analysed. Paired t-test comparisons between pre and postoperative values showed a significant reduction for Cobb angles (p&lt;0.0001) and AVR (p = 0.0024) but not for TI (p = 0.69). 51% of the curves with a preoperative AVR &gt; 10° were corrected at a segmental level with an average de-rotation amplitude of 19.3° +/- 8° and 56% at a global level with an average de-torsion index of 54% +/- 30%. Correction of SCO was effective for 95% of patients with a mean amplitude of 30mm +/- 10mm and was associated with a significant reduction in T9 and L3 to GL CO (34mm ± 24mm and 7.6mm +/-10mm respectively). Conclusion: Horizontal corrections achieved with high-density constructs in scoliosis surgery are more significant on translation than rotation at a segmental and global level.

SCOLIOSIS AND SPONDYLOLISTHESIS: A SOLUTION TO THE PROBLEM

Objective. To evaluate the results of surgical correction of scoliotic deformities in patients with spondylolisthesis. Material and Methods. A total of 51 patients with scoliosis and spondylolisthesis were observed in 1998–2016. Spondylolisthesis was asymptomatic in 49 cases. Most patients had grade I spondylolisthesis. Surgical correction of scoliotic deformity of the spine with segmental instrumentation was performed in 31 cases. Results. The average magnitude of the initial scoliotic curve before surgery was 67.2°, after surgery – 33.4°, and correction was 50.3 %. The magnitude of countercurve before surgery was 28.1°, after surgery – 11.1°, and correction was 35.5 %. In all cases, the L 5 vertebra was not included in the spinal fusion zone. Progression of the degree of the L 5 vertebra displacement in the postoperative period was not revealed. Neurological deficit was not observed. The average follow-up period was 5.4 ± 3.3 years. Conclusion. Correction of idiopathic scoliosis in the presence of L 5 spondylolisthesis can be carried out with good and satisfactory results and minimal risk of listhesis progression, and with preservation of the achieved result in the long-term period.

ACHIEVING HARMONY IN 3D CORRECTION OF SPINAL DEFORMITY

Achieving harmonious correction of scoliotic deformity requires a clear understanding of this condition with respect to the spinal column. Achieving harmony is not a pursuit of mandatory reduction of the Cobb angle. The main goal of the treatment is to achieve alignment, balance and stability of the spine. This goal should be taken into account both in the planning of surgical intervention, and at all its stages. It is very important to correctly determine the extent of the spinal fusion zone, to select an adequate type of endocorrector fixation and the nature of corrective maneuvers. Intraoperative achieving of harmony is aimed at correct distribution of body masses and their position relative to the load axis. The harmony of the human spine is hardly described mathematically, but it is achievable when using some benchmarks: alignment, body mass distribution, and 3D static and dynamic balances

SCOLIOSIS AND SPONDYLOLISTHESIS: LITERATURE REVIEW

At present, there are no reliable prognostic factors indicating the progressive nature of spondylolisthesis in children and adolescents. Often the main complaint is a pain syndrome, which is well arrested by conservative therapy, while the quality of life of patients without surgery is not significantly impaired. The presented review of the literature shows that it is better to correct scoliotic deformity at a younger age when indications arise. Isthmic spondylolisthesis and scoliosis should be considered as different pathologies. In the absence of convincing evidence that spondylolisthesis has caused the scoliosis development, indications for surgical treatment should be considered as those for individual pathologies. Isolated correction of scoliotic deformity does not lead to a progression of scoliosis. Papers of Russian and foreign authors from e-Library, Medline and PubMed databases were reviewed. The evidence level in majority of papers is III(C), and in part of papers – II(B).