Surgical Correction Of Idiopathic Scoliosis Research Articles

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

The evaluation of patients after the surgical correction of idiopathic scoliosis in a long-term follow-up with clinical neurophysiological methods has not been presented in detail. This study aimed to compare the results of neurophysiological studies in 45 girls with scoliosis of Lenke types 1–3 performed pre- (T0) and postoperatively, 1 week after surgery (T1) and 6 months after surgery (T2). The parameter values of the surface electromyography while attempting maximal contraction (mcsEMG) and the transcranial motor-evoked potentials (MEPs) recorded in the anterior tibial muscles, as well as the electroneurography (ENG) of the peripheral transmission in the peroneal nerve motor fibers, were compared. The results indicate that efferent neural conduction function both centrally and peripherally, and TA muscle function slightly improved immediately after the surgical correction of scoliosis, and further normalization appeared after six months in the long-term follow-up (at p = 0.03). The sEMG recordings indicate that half a year after surgical treatment in IS patients, the TA muscle motor unit recruitment function, as well as the muscle strength evaluated with Lovett’s scale, was comparable to the normal condition. The ENG recording results indicated a gradual reduction in the motor fiber injury symptoms, mainly of the axonal type, in the peroneal nerves. The surgeries also improved the lumbar ventral roots’ neural transmission to a normal functional status. The MEP amplitude parameter values recorded after the surgical scoliosis corrections in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in the long-term T2 observation period, they reached values comparable to those recorded in healthy volunteers, bilaterally. Preoperatively (T0), the results of all the neurophysiological study parameters in the IS patients were asymmetrical at p = 0.036–0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm for the neurophysiological assessments performed in the pre-, intra-, and long-term postoperative periods using the mcsEMG, MEP, and ENG neurophysiological examinations, together with the clinical studies, may help in the comprehensive functional evaluation of the spinal cord tracts and ventral root neural conduction, which allows the detection of the subclinical neurological changes related to scoliosis itself and the consequences of the corrective surgery. Such an evaluation can also be significant in making final decisions regarding IS surgeries and their personalization after attempting conservative treatments with bracing and kinesiotherapy. Neurophysiological studies, as a sensitive biomarker, allowed us to predict and ascertain the final result of IS treatment in the long-term follow-up, which showed the health status of patients as being comparable to that of healthy volunteers.

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis.

The relationships between the results of pre- and intraoperative motor evoked potential recordings during neuromonitoring and whether idiopathic scoliosis (IS) surgical correction improves the spinal efferent transmission have not been specified in detail. This study aims to compare the results of surface-recorded electromyography (EMG), electroneurography (ENG, M, and F-waves), and especially motor evoked potential (MEP) recordings from tibialis anterior muscle (TA) bilaterally in 353 girls with right idiopathic scoliosis (types 1-3 according to Lenke classification). It has not yet been documented whether the results of MEP recordings induced by transcranial single magnetic stimulus (TMS, pre- and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0-before surgery, T1-after pedicle screws implantation, and T2-after scoliosis curvature distraction and derotation following two-rod implantation) can be compared for diagnostic verification of the improvement of spinal cord neural transmission. We attempted to determine whether the constant level of optimal anesthesia during certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. The values of amplitudes but not latencies in MEP recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in efferent neural transmission. The results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p = 0.04. The surgeries brought significant improvement (p = 0.04) in the parameters of amplitudes of sEMG recordings; however, the consequences of abnormalities in the activity of TA motor units were still reflected. ENG study results showed the symptoms of the axonal-type injury in peroneal motor fibers improving only on the concave side at p = 0.04, in parallel with F-wave parameters, which suggests that derotation and distraction might result in restoring the proper relations of the lumbar ventral roots in the spinal central canal, resembling their decompression. There were no significant differences detected in the amplitudes or latencies of MEPs induced with TMS or TES when comparing the parameters recorded preoperatively and intraoperatively in T0. The amplitudes of TES-evoked MEPs increased gradually at p = 0.04 in the subsequent periods (T1 and T2) of observation. A reduction in MEP latency at p = 0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEP amplitude changes measured in T0-T2, revealed a lack of relationships. These might not be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Pre- (TMS-evoked) and intraoperative (TES-evoked) recordings are reliable for evaluating the patient's neurological status before and during surgical scoliosis correction procedures. An increase in MEP amplitude parameters recorded on both sides after scoliosis surgery proves the immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings, it can be concluded that surgeries might directly result in additional lumbar ventral root decompression. We can conclude that MEP parameter changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings.

Clinical and radiographic outcomes following correction of idiopathic scoliosis in adolescence vs young adulthood.

The natural history of adolescent idiopathic scoliosis (AIS) has been well documented, but the impact of age at the time of surgical correction is relatively understudied. In this study, we matched patients undergoing surgical correction of adult idiopathic scoliosis (AdIS) with a cohort of AIS patients to compare: (1) coronal and sagittal radiographic correction, (2) operative variables, and (3) postoperative complications. A single-institution scoliosis registry was queried for patients undergoing idiopathic scoliosis surgery from 2000-2017. patients with idiopathic scoliosis, no previous spine surgery, and 2-year follow-up. AdIS patients were matched 1:2 with AIS patients based on Lenke classification and curve characteristics. Independent sample t-test and Chi-square test was used to analyze the data. 31 adults underwent surgical correction of idiopathic scoliosis and were matched with 62 adolescents. Mean age of adults was 26.2 ± 11.05, mean BMI was 25.6 ± 6.0, and 22 (71.0%) were female. Mean age of adolescents was 14.2 ± 1.8, mean BMI was 22.7 ± 5.7, and 41(66.7%) were female. AdIS had significantly less postoperative major Cobb correction (63.9% vs 71.3%, p = 0.006) and final major Cobb correction (60.6% vs 67.9%, p = 0.025). AdIS also had significantly greater postoperative T1PA (11.8 vs 5.8, p = 0.002). AdIS had longer operative times (p = 0.003), higher amounts of pRBCs transfused (p = 0.005), longer LOS (p = 0.016), more ICU requirement (p = 0.013), higher overall complications (p < 0.001), higher rate of pseudarthrosis (p = 0.026), and more neurologic complications (p = 0.013). Adult patients undergoing surgical correction of idiopathic scoliosis had significantly worse postoperative coronal and sagittal alignment when compared with adolescent patients. Adult patients also had higher rates of complications, longer operative times, and longer hospital stays. III.

A Comparative Study of Surgical Correction of Idiopathic Scoliosis With Spinal Transpedicular Metal Structures in Children.

A comparative study of surgical correction of idiopathic thoracic scoliosis using transpedicular spinal systems in children was performed. The study showed that using the transpedicular supporting elements along the entire length of the deformation (concave and convex sides) using the VCM (vertebral column manipulation) system, the correction was significantly better (p ≤ 0.05) than for the patients for whom the screws were not installed over two or more vertebrae from the concave side of the curvature, regardless of the magnitude of the spinal deformity. The kyphosis and lordosis were completely restored to their physiological values in all groups of patients.

The Influence of Surgical Correction of Idiopathic Scoliosis on the Function of Respiratory Muscles.

Background and objective: It is important to introduce respiratory exercises to the therapy of patients after the surgical treatment of adolescent idiopathic scoliosis. Surgical correction is the best way to prevent hypoxia in scoliosis, but whether pulmonary rehabilitation increases the effectiveness of scoliosis surgery has not yet been confirmed. Therefore, the aim of the study was to evaluate the function of respiratory muscles after surgical correction of idiopathic scoliosis. Methods: The study involved 24 patients, aged 13.6 ± 0.6. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using the Mikro RPM. In all patients, before the procedure, 7 days after and 3 months after the procedure, the MIP and MEP were measured. Results: MIP was the lowest 7 days after the procedure; it was 45.28 cmH2O and was statistically significantly lower compared to the measurement before the procedure (p < 0.001) and 3 months after the procedure (p < 0.001). Conclusions: The degree of curvature of the spine before the procedure does not significantly affect initial values of the strength of respiratory muscles. The level of MIP is not dependent on the type of surgery.

Pregnancy and delivery in patients with idiopathic scoliosis

Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with instrumented fixation of the spine.Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried out using the χ 2 criterion.Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use.Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

Intraoperative radiation exposure to patients in idiopathic scoliosis surgery with freehand insertion technique of pedicle screws and comparison to navigation techniques.

In surgical correction of scoliosis with pedicle screw dual-rod systems, frequently used freehand technique of screw positioning is challenging due to 3D deformity. Screw malposition can be associated with serious complications. Image-guided technologies are already available to improve accuracy of screw positioning and decrease radiation to surgeon. This study was conducted to measure intraoperative radiation to patients in freehand technique, evaluate screw-related complications and compare radiation values to published studies using navigation techniques. Retrospective analysis of prospectively collected data of 73 patients with idiopathic scoliosis, who underwent surgical correction with pedicle screw dual-rod system. Evaluated parameters were age, effective radiation dose (ED), fluoroscopy time, number of fused segments, correction and complications. Parameters were compared with regarding single thoracic curve (SC) and double thoracic and lumbar curves (DC), adolescent (10-18years) or adult (> 18years) idiopathic scoliosis, length of instrumentation. ED was compared with values for navigation from online database. Average age was 21.0 ± 9.7years, ED was 0.17 ± 0.1mSv, time of fluoroscopy was 24.1 ± 18.6s, 9.5 ± 1.9 fused segments. Average correction for SC was 75.7%, for DC 69.9% (thoracic) and 76.2% (lumbar). No screw-related complications. ED was significantly lower for SC versus DC (p < 0.01), short versus long fusions (p < 0.01), no significant difference for age (p = 0.1). Published navigation data showed 6.5- to 8.8-times higher radiation exposure for patients compared to our results. Compared to navigation procedures, freehanded positioning of pedicle screws in experienced hands is a safe and effective method for surgical correction of idiopathic scoliosis with a significant decrease in radiation exposure to patients.

Risk factors for the development of persistent shoulder imbalance after surgical correction of idiopathic scoliosis

Objective . To assess risk factors for the imbalance of the shoulder girdle and to identify reproducible X-ray criteria for persistent shoulder imbalance after correction of idiopathic scoliosis. Material and Methods . A total of 94 patients with idiopathic scoliosis were included in the retrospective study. All patients underwent primary posterior correction of the deformity using pedicle screw instrumentation. Radiography of the spine throughout its length was performed before surgery, in the early postoperative and in the long-term (at least 12 months after surgery) periods. The shoulder imbalance was considered clinically significant with radiographic shoulder height difference more than 2 cm. Results . A significant decrease in the magnitude of all curves after surgery and in the long-term period was noted. The magnitude of the proximal curve decreased from 25.38° ± 15.89° to 14.51° ± 8.17° (p < 0.0001) and to 14.29° ± 8.25° (p = 0.24); the main thoracic curve from 59.33° ± 20.76° to 20.096° ± 9.89° (p < 0.0001) and to 20.87° ± 9.48° (p = 0.19); and thoracolumbar curve from 47,20° ± 15,99° to 15.69° ± 8.66° (p < 0.0001) and to 16.98° ± 7.6° (p = 0.01), respectively. The shoulder imbalance was recorded in 27 patients (28.72 %) after surgery and in 13 (13.83 %) – in the long-term period. In these patients, various Lenke types of deformity were presented. A correlation of the distal adding-on phenomenon with self-correction of the shoulder balance is revealed (r = 0.56; p < 0.005). Persistent shoulder imbalance correlated with presence of a structural proximal thoracic curve (p = 0.041642), residual proximal curve magnitude after surgery (r = 0.22; p = 0.03), and presence of a symptom of double rib hump on radiographs after surgery (r = 0.75; p ≤ 0.005). Conclusion . The most characteristic pattern of persistent shoulder imbalance is the presence of asymmetry in the proximal and main regions of the chest. This sign can be detected by intraoperative lateral radiography of the spine, which will allow the surgeon to take measures to eliminate this phenomenon and reduce the probability of persistent shoulder imbalance development.

P20-F Dynamics of MEP during corrective spinal surgery for idiophatic scoliosis

The loss of transcranial motor evoked potentials (TcMEP) during spinal surgery is a great problem, because surgical team is required to adequately interpret the real-time changes in observed neuromonitoring and take a decision about further treatment policy. The purpose of this study is to determine the frequency of IOM events, the consideration of corrective actions, and patient outcomes during the surgical correction of Idiopathic scoliosis (IS). For that a total 150 cases of IOM surgery IS were retrospective analyzed. Patients were aged 5–43 years and underwent surgery between 2013 and 2017. The neurophysiology system for the surgeon “NIM-Eclipse system” (Medtronic) was used. MEP were registered on m.abdominis rectus, m.abdominis obliquus, m.vastus lateralis, m.tibialis anterior. Sixty-four (42.6%) cases were conducted on 200–250 V Tc power, MEP amplitudes were close to baseline and tended to increase to the interventions end. The IOM events were observed in 56 (37,3%) cases, when amplitudes were decreased more than 50% from baseline, but after increasing Tc power to 450–630 V the potentials returned to baseline. In 30 (20%) cases were observed loss MEP – in 24(80%) the potentials returned after washing the wound with a warm solution and rising arterial pressue; in 5 (16.6%) cases – after surgical correction actions; and 1 (3%) irreversible MEP loss case resulted lower paraplegia. The loss of MEP is a consequence of corrective maneuvers on the spine. It can be explained by long-term changes in the functioning of the spinal cord under conditions of its chronic compression, which leads to interruption of corticospinal conduction.

SURGICAL CORRECTION OF ADULT IDIOPATHIC SCOLIOSIS IN PATIENTS OF YOUNG AND MIDDLE AGE

Objective.To evaluate the results of surgical correction of idiopathic scoliosis in patients aged 18-50 years, in terms of different age groups.Material and Methods.A total of 393 patients (348 women, 45 men) with idiopathic scoliosis were operated on during 1996-2015. In all cases, posterior correction of the deformity was performed using segmental third-generation instrumentation. The primary curve and structural countercurve were included in the fusion area. Hook fixation was performed in 298 cases, and hybrid (hooks and pedicle screws) in 95. The period of postoperative follow-up was 4.4 years on average. Analysis of immediate and long-term results was performed using X-ray and computer optical topography in three age groups (age at the time of surgery): 18 to 24 years (274 patients), 25 to 34 years (95 patients), 35 years and older (24 patients).Results.No statistically significant differences between age groups were revealed, both in initial parameters (magnitude of the primary curve, countercurve, and the apical vertebra rotation) and in surgical results (magnitude of correction, loss of correction and mobility). When interviewing patients with the SRS-24 questionnaire, the best results were obtained in the group of age 18-24, worse in the group of age 25-34, and even worse in the group of age over 35. Computer topography also revealed the absence of statistically significant difference between age groups.Conclusion.Surgical treatment of adult idiopathic scoliosis provides quite satisfactory results, especially in terms of improving the quality of life, that do not have significant differences when comparing three age groups within the age range exceeding 30 years.

Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia.

Transcranial electric motor evoked potentials (TCeMEPs) play an important role in reducing the risk of iatrogenic paraplegia. TCeMEPs could be obviously suppressed by neuromuscular blockade (NMB). The aims of this study were to examine the effects of NMB on TCeMEPs and to determine an appropriate level of partial neuromuscular blockade (pNMB) for TCeMEPs during surgical correction of idiopathic scoliosis under total intravenous anesthesia (TIVA). All patients were maintained with TIVA. The pNMB levels were classified into five phases: one or two train-of-four (TOF) counts (TOF1); three TOF counts, or T4/T1 (TOFR, T1,4, first or four twitch height of TOF) ≤ 15% (TOF2); TOFR at 16-25% (TOF3); TOFR at 26-50% (TOF4); and TOFR at 51-75% (TOF5). No neuromuscular blockade (nNMB) was achieved when TOFR was more than 75%. The absolute and relative latency, amplitude and area under curve (AUC), efficacy of TCeMEPs and rate of unexpected movement were compared among these phases. Neither the amplitude and AUC nor the efficacy of TCeMEPs were affected at TOF4-5 of abductor halluces muscles TCeMEPs (AH-TCeMEPs) or at TOF3-5 of tibialis anterior muscles TCeMEPs (TA-TCeMEPs) compared with nNMB. However, the rate of unexpected movement was increased significantly at TOF5 and nNMB compared with TOF1 and TOF4. The application of pNMB with TOFR aimed at 26-50% for AH-TCeMEPs or 16-50% for TA-TCeMEPs seems to be an appropriate regimen for TCeMEPs during surgical correction for idiopathic scoliosis under TIVA.

0043 - Physiotherapy Provision Across the UK for Surgical Correction of Idiopathic Scoliosis

BACKGROUND/ INTRODUCTION: It is widely accepted within the NHS that in-patient physiotherapy is provided for patients having scoliosis correction in order to facilitate discharge. However, the level of variation in service provision for scoliosis correction across the UK is unknown.

PATHOGENETIC FOUNDATIONS FOR PREVENTION OF INCREASED BLOOD LOSS IN SURGERY FOR IDIOPATHIC SCOLIOSIS

Objective. To analyze risk factors for the development of increased blood loss during surgical correction of idiopathic scoliosis. Material and Methods . A total of 395 patients with idiopathic scoliosis were operated on using hybrid instrumentation, in prone position, under inhalation multicomponent anesthesia. Four groups of patients were identified: Group I – blood loss below 15 % of total blood volume (TBV) (n = 201); Group II – blood loss 15–30 % of TBV (n = 133); Group III – blood loss 30–40 % of TBV (n = 42); and Group IV – blood loss more than 40 % of TBV (n = 19). In 92 patients, operations were performed under condition of incomplete decompression of the anterior abdominal wall, in 303 patients – under condition of complete decompression. Analysis included data on increased intra-abdominal pressure, the initial condition of the system regulating the aggregate state of blood, the presence of connective tissue dysplasia, and structural features of the bone tissue. Results . Complete decompression of the anterior abdominal wall during posterior instrumental correction allows reducing the volume of intraoperative blood loss by 60 % and avoiding blood transfusion in 75.9 % of patients. Structural and chronometric hypocoagulation associated with the inhibition of lateral aggregation of fibrin, is a start functional state of the hemostasis system in 80.0 % of patients with idiopathic scoliosis. Conclusion . The main importance in solving the problem of reducing the severity of intraoperative blood loss belongs to the correction of the revealed disorders in the system regulating the aggregate state of blood and the implementation of procedures aimed at preventing an increase in intra-abdominal pressure.

ANTERIOR INSTRUMENTATION IN SURGERY FOR LUMBAR AND THORACOLUMBAR IDIOPATHIC SCOLIOSIS

Objective. To analyze the long-term results of surgical correction of idiopathic scoliosis in the lumbar and thoracolumbar spine with anterior instrumentation. Material and Methods . A total of 24 patients (mean age - 18.2 years, male/female ratio - 3/21) were operated on using anterior two-rod instrumentation system. The mean operating time was 170 minutes, and the mean blood loss - 374 ml. The average postoperative follow-up period was 50 months. Results . The primary curve was reduced from 48.7° to 14.8°o (69.6 %). Postoperative progression was 6.4°. Thoracic counter-curve underwent self-correction from 27.7° to 14.7°, postoperative progression was 3.0°. The thoracic kyphosis and lumbar lordosis remained within the normal ranges. Rotation of the apical vertebra before the operation was 27.8 %, immediately after the intervention - 17.5 %, at the end of the follow-up period - 17.1 %. Coronal imbalance before surgery was 24.7 mm, immediately after the intervention - 27.5 mm, at the end of the follow-up period - 7.1 mm. The patients’ self-evaluation of treatment outcomes was carried out using the Russian version of the SRS-24 questionnaire. At the first follow-up visit, patients reported expectedly lower postoperative function score and gave middle scores for the remaining domains. Later, there was a positive dynamics in all assessed parameters, most pronounced in pain syndrome, function and overall activity after surgery. Conclusion . Correction of idiopathic scoliosis of lumbar and thoracolumbar localization using anterior instrumentation is a highly effective method of treatment, which in most cases gives a stable positive result. However, the development of pronounced trunk imbalance in some patients requires the continuation of studies in order to optimize the technique for determining the optimal extent of the instrumented fusion.

The impact of direct vertebral rotation (DVR) on radiographic outcome in surgical correction of idiopathic scoliosis

IntroductionRecent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment.Materials and methodsThirty-six consecutive patients who underwent posterior spinal fusion with pedicle screws only constructs for idiopathic scoliosis. Fifteen patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and postoperatively—coronal curves, kyphosis (T2–T12, T5–T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn.ResultsWe observed reduction of RAsag in all patients; however, in DVR group, decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p = 0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p = 0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2–T12 kyphosis has increased in 28 (65%) patients whereas in non-DVR group in 31 (69%) cases. Mean value of T2–T12 kyphosis growth was 16.7% in DVR and 22.1% in non-DVR group. These differences however did not occur statistically significant.ConclusionsDirect vertebral rotation (DVR) maneuver reduces significantly apical rotation of the spine, enhances ability of coronal correction, and it does not reduce thoracic kyphosis.

The Impact of Direct Vertebral Rotation (DVR) on Radiographic Outcome in Surgical Correction of Idiopathic Scoliosis

Introduction: Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. Material and methods: 36 consecutive patients who underwent posterior fusion with pedicle screws only constructs for idiopathic scoliosis. 15 patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and post operatively - coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn. Results: We observed reduction of RAsag in all patients, however in DVR group decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p=0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p=0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non DVR group. These differences however did not occur statistically significant. Conclusions: Direct vertebral rotation (DVR) manoeuvre reduces significantly apical rotation of the spine, enhances ability of coronal correction and it does not reduce thoracic kyphosis.

USE OF TRANEXAMIC ACID IN SCOLIOSIS SURGERY

Objective. To assess the effectiveness of tranexamic acid in the surgical correction of idiopathic scoliosis. Material and Methods . The study included a retrospective analysis of intraoperative and postoperative blood loss during surgical correction of idiopathic scoliosis in 198 patients. In 70 patients, the operation was performed without administration of tranexamic acid. In 58 patients, tranexamic acid was administered 15 minutes before the skin incision at a dose of 10 mg/kg, and continued uninterruptedly at a dose of 1 mg/kg/h. In 70 patients, tranexamic acid was administered continuously during the operation at a dose of 10 mg/kg. Patients underwent surgery in a prone position with full decompression of the anterior abdominal wall. Results . The registered intraoperative blood loss in most cases corresponded to Class I (no more than 750 ml or 15 % of blood volume) and Class II (no more than 750-1500 ml or 15-30 % of blood volume) according to the WHO classification of severity. The volume of intraoperative blood loss was not statistically different between groups. Significant differences were detected only in assessing parameters of postoperative blood loss. Conclusion . The use of tranexamic acid in surgical correction of scoliosis does not affect the bleeding index of tissues at the surgical site and the total intraoperative blood loss. Using tranexamic acid in spine surgery is a technological procedure allowing for significant reduction in postoperative blood loss.

EARLY INFECTION IN SURGERY OF IDIOPATHIC SCOLIOSIS

Objective. To analyze the current level of early postoperative septic complications in a large retrospective series of patients with idiopathic scoliosis operated in the same clinic. Material and Methods . The single-center retrospective database of 1973 patients who underwent surgical correction of idiopathic scoliosis with corrective segmental 3rd generation instrumentation during 1996-2013 was studied. In all patients, antibiotic prophylaxis was started 30 minutes before incision and lasted up to 72 hours after surgery. Cefazolin in age-specific dosage variances was used as antibiotic. Drainage of the area of surgical intervention was performed within two days after surgery. Results . Surgical site infection occurred in 12 cases (0.6 %) within 90 days after surgery. Suppuration developed only in the area of posterior approach to the spine. The most common pathogen was S. epidermidis isolated in 68.0 % of cases. Implants and the achieved correction of spinal deformity were saved in 10 (83.0 %) patients. Conclusion . Prevention of postoperative infections in surgery of idiopathic scoliosis is the most important task. It is necessary to carry out an early revision and debridement of the wound and strive to maintain implants if they are stable.

Efficacy of En Bloc Direct Vertebral Body Derotation (Dvbd) in Idiopathic Scoliosis Treatment

Introduction Vertebral axial rotation in horizontal plane is a component of spinal deformity in scoliosis. Greater axial rotation is related with inclination to curve progression, contributes to rib hump development. Therefore the correction of axial deformity appears as an obvious component of scoliosis correction. However clinical efficiency and complication risk of derotation maneuvers is still not established. The object of the study was to assess horizontal correction obtained with en bloc direct vertebral body derotation (DVBD) and the influence of the maneuver on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis correction. Material and Methods 36 patients after surgical correction of idiopathic scoliosis were included into study. Authors analyzed two groups; adolescents and adults. All patients underwent posterior fusion with pedicle screws only instrumentation. 15 (20 curves) patients were corrected by rod derotation only and 21 (26 curves) underwent rod derotation and direct en bloc vertebral derotation (DVBD). Measurements according to Cobb method were performed on X-rays obtained before and post surgery - coronal plane curves, sagittal profile (T2-T12, T5-T12, L1-S1). Spine flexibility was assessed of prone bending X-rays. Axial rotation was determined on CT scans obtained intraoperatively (O-Arm, Medtronic) and postoperative CT scan. Rotation assessment was done according to the method described by Aaro and Dahlborn. Results The comparison of axial rotation prior to correction and post correction revealed decrease of axial apical vertebral rotation in both DVBD and non DVBD groups. However in DVBD group vertebral derotation was greater than in non DVBD group and it was confirmed in statistic analysis. Amount of axial derotation was similar in both adults and adolescents. Analysis of coronal curves showed statistically significant better correction in (DVBD) group and obviously better correction was possible in flexible than stiff curves. DVBD did not improve but also did not decrease kyphosis comparing to pre op measurements and results from non DVBD group. This statement concerned both T2-T12, T5-T12 measurements. Neither flexibility nor stiffness of the curves influenced kyphosis results. Conclusion Direct vertebral body derotation is a relevant maneuver to improve correction in idiopathic scoliosis, either in coronal or sagittal plane. It may be useful technique in adolescent as well as adult patients.

ПРОФИЛАКТИКА ПОВЫШЕНИЯ ВНУТРИБРЮШНОГО ДАВЛЕНИЯ КАК ЗНАЧИМЫЙ ФАКТОР УМЕНЬШЕНИЯ ИНТРАОПЕРАЦИОННОЙ КРОВОПОТЕРИ В ХИРУРГИИ СКОЛИОЗА

Objective. Quantitative estimation of intraoperative blood loss volume in surgical correction of idiopathic scoliosis with patient’s positioning ensuring complete decompression of the anterior abdominal wall. Material and Methods. Results of surgical correction of idiopathic scoliosis in 122 patients who underwent surgery involving skeletal traction and posterior correction with hybrid instrumentation in the prone position were analyzed. Posterior correction in 60 patients from Group I was performed on a standard orthopedic table, and in 62 patients from Group II - on a modular operating table for spinal surgery providing complete decompression of the anterior abdominal wall. Results. The studied parameters in groups were as follows: deformity magnitude - 54.7° ± 16,3° in Group I vs 61.5° ± 19.4° in Group II, the length of the posterior spinal fusion - 12.5 ± 1.1 vs 12.8 ± 0.9 segments, the number of levels in transpedicular fixation - 4.1 ± 1.1 vs 4.2 ± 1.8, and surgery duration - 169.4 ± 30.3 min vs 159.0 ± 31.6 min, respectively. The volume of intraoperative blood loss showed significant difference between groups: 1024.9 ± 409.2 ml (28.6 ± 12.3 % of circulating blood) in Group I, and 595.2 ± 208.6 ml (16.7 ± 6.2 % of circulating blood) in Group II. Conclusion. Complete decompression of the anterior abdominal wall during surgical correction of idiopathic scoliosis allowed reducing intraoperative blood loss by 41.6 % and ensuring the absence of indications for blood transfusion in 48.4 % of operated patients. Hir. Pozvonoc. 2014; (1): 94-99.