Treatment Of 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.

Тактика хірургічного лікування вроджених деформацій хребта в дітей

Progress in spinal surgery during the second half of the twentieth century was made possible by a deeper study of the three-dimensional nature of the normal and pathological architecture of the spine. The problem of complex spinal deformities remains one of the most important in clinical vertebrology. In Ukraine, more than 9,000 children need surgery for scoliosis spinal deformities. Of these, more than 15% of children have congenital scoliosis deformities. Purpose - to conduct a retrospective analysis of the results of surgical treatment of congenital spinal deformities in children. Materials and methods. A retrospective analysis of the results of treatment of 36 patients (from 9 to 12 years) with congenital spinal deformities who received treatment at the Department of Pediatric Surgery of the Bogomolets National Medical University (National Children's Specialized Hospital «OHMATDYT», Kyiv) in the period from 2008 to 2018. Patients were divided into two groups: I (staged treatment) - 18 children who received treatment using halo-gravity traction (HGT), followed by spinal instrumentation; II (one-time treatment) - 18 children who underwent surgical correction with osteotomies (4-6 levels according to Ponte, VCR osteotomy at 1-2 levels). Results. Two groups of patients were studied. According to HGT, the main arc deformation improved to 55±25%. HGT - complications were observed in 12% (transient neurological disorders). In patients who underwent spinal instrumentation without prior traction complications were observed in 37% of patients (neurological transient disorders in the form of spinal cord dysfunction). In children with congenital spinal deformities, simultaneous implantation of the structure in comparison with staged treatment with HGT increases the risk of neurological deficits by 25%, HGT allows greater correction and adapt the spinal cord to further correction. Conclusions. In the surgical treatment of congenital spinal deformities, HGT reduces the risk of neurological complications, reduces the time of surgery and the amount of blood loss, allows us to get better results of correction. 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 interests was declared by the authors. Keywords: halo-gravitational traction, scoliotic deformation, surgical treatment.

Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum).

Case series, literature review, and technical note. To compare two different approaches to treat the spinal deformity with split cord malformation type I (SCM I). To present a new method of one-stage surgical treatment of congenital spinal deformity with wide bony septum (SCM I). Analysis of the literature on the different types of combined surgical treatment of spinal deformities with SCM I was performed. We have provided our own data on 27 patients treated for congenital spinal deformity and SCM I, one of which underwent Schwab IV type osteotomy at the apex of the deformity through the bony septum and pedicles. Inclusion criteria were presence of spinal deformity in combination with SCM 1, performed surgery to correct spinal deformity, and follow-up period of at least 2years. The result of the literature review was controversial and requires additional research. The average age of patients was 8.8 ± 6.6years old. One-stage treatment of SCM I and spinal deformity was performed in 10 patients (group I) and two-stage in 14 patients (group II). Three patients with severe myelodysplasia, SCM I, and congenital kyphoscoliosis underwent correction of spinal deformity without SCM I removing (group III). The group I had the longest surgery duration (mean 289 ± 75min) and largest blood loss (mean 560 ± 386ml), a high percentage of deformity correction (mean 69.6%), and the highest rate of complications (60%). The most optimal was the two-stage treatment with the mean surgery duration 191 ± 137min, mean blood loss 339 ± 436ml, mean correction rate 63%, and frequency of complications 21%. The average follow-up time was 6.0 ± 2.6years. One stage surgery associated with a large surgical invasion and a large number of complications. It can be used in some cases, for example when the wide bony septum (SCM I) is localized at the apex of the congenital scoliosis or kyphosis. In all other cases, it is worth adhering to a two-stage treatment. Many new works demonstrate the relative safety and effectiveness of deformity correction without removing the SCM. In our opinion, indications for treatment of spinal deformity without SCM I removing can be the need to perform a shortening ostetomy outside the SCM zone. The remaining cases require a thorough assessment and a balanced decision.

Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature.
 AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine.
 MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature.
 RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses.
 CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

Comparative analysis of the quality of life of children with congenital scoliosis after surgical treatment: Extirpation of the hemivertebra from dorsal and combined access

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the childs quality of life following surgical technique for congenital scoliosis have not been sufficiently studied.
 AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches.
 MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (minmax, 26196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used.
 RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p 0.05).
 CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.

Stage results of the use of orthoses in children after surgical treatment of congenital spine deformity (Preliminary report)

BACKGROUND: After surgical treatment of congenital spinal deformities, we can see the progression of deformities of the spinal column segments free from metal structures, which leads to the need for reoperation. Without sufficient scientific evidence, several specialists after surgical treatment use various orthoses on the body to prevent scoliotic compensatory changes.
 AIM: This study aims to assess the results of body orthosis after surgical treatment of children with congenital spinal deformity with the impaired formation of the vertebrae, using orthoses, compensatory deformity after one year of treatment.
 MATERIALS AND METHODS: Twenty-five patients aged 2 to 12 years (10 boys and 15 girls) after surgical treatment of congenital deformity of the spine in the thoracic regions (13) and lumbar regions (12), wearing body orthoses. The results were assessed at 3, 6, and 12 months using thermal sensors for the orthosis wearing time by X-ray and statistical methods.
 RESULTS: After three months of wearing the brace, we saw a correction of about 50% of the value of the initial compensatory deformity. After six months, both thoracic and lumbar, the correction was 60%. After one year, when performing an X-ray image without an orthosis, in thoracic deformities without a brace, the correction stabilized and remained at the level of 40%. In lumbar deformities without a brace, the original deformity returned, i.e., the correction occurred but was not fixed without the orthosis. Only one of 25 patients (4%) required a second operation to increase the fixations duration.
 CONCLUSION: The results of observing a group of patients (25 children) for one year after surgical treatment of congenital spine deformity showed a positive effect of a functionally corrective orthosis on the body to correct secondary deformities.

Extirpation of the Thoracic and Lumbar Hemivertebrae from the Dorsal Access Using the Ultrasonic Bone Scalpel in Children: The Result of a Prospective Multicenter Study

Background. The surgical treatment of congenital spinal deformity caused by hemivertebra is associated with high rate of complications. A research of a new surgery technique for operation time and blood loss decrease could potentially improve outcomes. The purpose — to evaluate the efficacy of ultrasonic bone scalpel in surgical treatment of pediatric congenital spinal deformities caused by monosegmental hemivertebra. Patients and Methods. Level of Evidence III. The study based on the data of 55 consecutively operated pediatric patients who underwent 59 posterior hemivertebra resection provided by ultrasonic bone scalpel from January 2015 to December 2019. The average age was 4 years and 4 months. 36 hemivertebra were located in thoracic spine and 23 were located in lumbar spine. Total duration of surgery, estimated blood loss (ml and % of circulated blood volume, CBV), complications rate and deformity correction were noted. The influence of posterior instrumentation length and patients age at time of surgery on evaluation parameters was analyzed. 5-year (2015–2019) systematic literature review was performed for compare with obtain results. Results. Total operation time was 131 min ± 33 min for thoracic spine and 165 min ± 50 min for lumbar spine (p = 0,005). Estimated blood loss was 105 ml ± 74 ml (Me 80 ml) for thoracic resection and 123 ml ± 59 ml (Me 120 ml) — for lumbar (p = 0,178). The length of posterior instrumentation were not influence on operation time and total blood loss (p = 0,957; p = 0,967), patients age at time of surgery were not influence on operation time (p = 0,458), but correlate with total blood loss (p = 0,023). Intraoperative complications was not observed. Four cases of transpedicular screw malposition without neurological deficit were noted (type C acc. Gertzbein-Robbins). Conclusions. Posterior hemivertebra resection with ultrasonic bone scalpel is safe and effective procedure provides decrease of operation time and estimated blood loss.

The use of guide templates in the surgical treatment of preschool children with congenital scoliosis of thoracic and lumbar localization

Background. The use of transpedicular screws as support elements from the standpoint of biomechanics is preferable as compared to that of laminar fixation, albeit the former carries the risk of various complications (such as malposition screws, damage to the Dura mater, spinal cord, and major blood vessels) caused by structural changes in the vertebrae under the background of their defects, with small size of roots arcs vertebrae in young children. Thus, the issue of ensuring safe and correct installation of transpedicular screws in the surgical treatment of children with congenital scoliosis remains relevant.
 Aim. We aimed to evaluate the correctness of the position of the transpedicular screws installed in the vertebral bodies in preschool children with congenital scoliosis of thoracic and lumbar localization using guide templates (SHN).
 Materials and methods. We conducted a prospective analysis of the outcomes of surgical treatment of 30 patients with congenital scoliosis against the background of impaired formation of the vertebrae of the thoracic and lumbar spine. The patients included 12 boys and 18 girls of age: 1 year 8 months to 6 years 5 months (average: 3 years 4 months). Based on the computed tomography of the spine, performed postoperatively, the correctness of the position of the installed elements of the corrective multi-support metal structure was evaluated. The correctness of the position of the installed transpedicular support elements was evaluated based on the scale described by S.D. Gertzbein and co-authors (1990).
 Results. The total number of implanted transpedicular screws sets was 96 (100% of the planned transpedicular screws set), and 48 SHN were used for transpedicular screws installation. The correct position of installed screws by degree of displacement revealed Grade 0 93.7% (90 screws), Grade I 4.2% (4 screws), Grade II 2.1% (2 screws), Grade III 0%. The number of screws with a Grade 0 + Grade I offset was 94 (97.9%).
 Conclusion. The results obtained with the use of SHN among preschool children with congenital scoliosis of thoracic and lumbar localization revealed high accuracy and correctness of transpedicular screws installation (93.7%) with the use of this type of navigation in clinical practice. The use of SHN for installing transpedicular screws in the surgical treatment of congenital spinal deformities in young patients allows for the selection of the optimal size and correct position of the transpedicular support elements in the vertebrae to be instrumented.

Treatment of congenital spinal deformities in children: yesterday, today, tomorrow

The paper presents an unsystematized review of technologies, techniques and options for surgical treatment of congenital spinal deformities in children over the past 40 years. The main trends in the surgery of spinal deformities are highlighted: evolution of methods of visual diagnostic, treatment planning, and surgeon action control, introduction of adapted functional status scales and questionnaires for quality of life, hybridization of surgical techniques, evolution of spinal implants and instruments, and progress of anesthetic management. At the same time, new clinical and scientific problems are also discussed in the paper: questions of unifying terminology, planning the volume of treatment, the difficulty of comparing treatment methods and technologies, education, and integration.

Application of three-level navigation template in surgery for hemivertebrae in adolescents

Objective . To assess efficacy and safety of using a three-level navigation template in the surgical treatment of congenital spinal deformities. Material and Methods . Three-level navigation templates were used in surgical treatment of four consecutively operated 10–17-year-old patients with congenital scoliosis associated with thoracic hemivertebrae. The correctness of screw position was evaluated according to CT data using a 2-mm increment method: class 0 – intraosseous screw position; class 1 – the screw extends beyond the pedicle cortex by less than 2 mm; class 2 – by 2–4 mm; and class 3 – by more than 4 mm. Preoperative DICOM data were processed with free software. The model of target zone and navigation template were 3D printed and used in surgery. Results . Four of 16 (25 %) pedicles were narrower than 4.35 mm and were estimated as difficult for implantation with a planned violation of the integrity of the endplate. Perforation of the outer cortical layer took place in all these cases, and screw position corresponded to class 2 only in pedicle width of 1.9 mm. In pedicles wider than 4.35 mm, 11 of 12 (91.7 %) screws were implanted intraosseously. One screw extended beyond the pedicle cortex by 0.8 mm (class 1). Conclusion . Three-level navigation template can be considered as an effective means of positioning transpedicular screws in secondarily changed segments adjacent to anomalous one and confounding implantation. Free software is sufficient for preparing 3D-model of target zone and navigation template, and such a model is a highly informative reference object that is convenient to use during the operation. A navigation template made using 3D printing does not require the use of expensive equipment, which can make surgery for congenital scoliosis more accessible.

Short fusion with vertebrectomy during growth in congenital spinal deformity: is early surgical intervention recommended?

This was a multi-center retrospective cohort study included consecutive pediatric patients who were admitted to 8 institutions for the treatment of congenital spinal deformity from 1991 to 2012. The purpose of this study was to compare curve corrections and balances, reoperations, and complications at 2-year follow-up between those treated early vs. late. Although early intervention has been recommended, no empirical study has examined the optimal timing of short fusion among patients with congenital spinal deformity. Patients with congenital spinal deformity with formation failure undergoing vertebrectomy with short fusion (≤ 6 fusion segments) were categorized as early (surgery at ≤ 6years) and late (7-18years) fusion. Outcomes included coronal and sagittal curve corrections at immediate and 2-year evaluations; loss of curve correction from immediate to 2-year follow-up; coronal and sagittal balance at 2years; and inter-operative, major and minor short-term postoperative, and long-term postoperative complications and reoperations. Early fusion (N = 79) compared to late fusion (N = 96) was associated with greater percent curve correction at immediate (71% vs. 60%, p = 0.0046) and 2-year (63% vs. 52%, p = 0.0153) evaluations adjusting for surgeon experience and preoperative coronal balance. These associations were significant for males and those with 3-level fusions but not 4 to 6-level fusions. Early fusion compared with late fusion had more intraoperative (6% vs. 1%) and postoperative long-term complications (27% vs. 18%), as well as unplanned reoperations (13% vs. 9%). Early vs. late fusion had fewer short-term complications, both major (6% vs. 15%) and minor (6% vs. 15%). Patients who underwent early treatment achieved larger major curve correction by 10% compared to patients with late treatment when assessed at 2-year postoperative evaluation. However, early fusion should be considered with careful attention to possible increased risk of reoperations. Level III.

P91. The surgical outcome of hemivertebra excision and short segment fusion treatment for under five years-old congenital scoliosis: 10 years follow-up

BACKGROUND CONTEXT Full segmented hemivertebra with large growth potential can lead to the early rapid progress of spinal deformity. Hemivertebral resection and fixation is an effective method for the treatment of congenital spinal deformity. But there were few studies focusing on the long-term follow-up of the surgical outcome and impact on spinal growth of undergoing hemivertebra resection and short-segment fusion for congenital hemivertebrae under 5 years old. PURPOSE To evaluate the effect of hemivertebra excision and short segment fixation and fusion for congenital spinal deformity under 5 years-old and its impact on spinal growth. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A consecutive series of 20 patients under 5 years old with hemivertebra deformity undergo hemivertebra resection and short-segment fusion between 2004 and 2008. OUTCOME MEASURES Surgical characteristics, including fusion levels, estimated blood loss, operation duration, main curvature scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA). METHODS All cases were 1-level full segmented hemivertebra and coronal main curve >35° and received a minimum 10-year follow-up. Clinical and imaging data were collected for statistical analysis and evaluation of surgical outcome and impact on spinal growth. RESULTS They were retrospectively studied with a mean follow-up of 11.8 years. There were 12 cases of thoracic hemivertebra and 8 cases of lumbar hemivertebra, mean aged 3.8 years (range, 2.4-5 years). The mean fused segment were 2.1. The mean operative time was 161 min (range: 120 to 320 min). The mean estimated blood loss was 175mL (range: 100 to 400 mL). The Cobb angle of coronal main curve was 39.7° (35-54°) before surgery, 5.4° (0-13°) after surgery, and 6.3° (2-16°) at final follow-up. At final follow-up, the TK angle of thoracic hemivertebra group and lumbar hemivertebra group were 22.4° (6-35°) and 25.6° (8-38°), respectively; the LL angle of lumbar hemivertebra group with 72.1° (58-80°) was significantly larger than thoracic hemivertebra group with 35.5°(24-46°). The SVA of thoracic hemivertebra group and lumbar hemivertebra group were 1.32 cm and 2.1 cm. The height of fixed segmental vertebral body, transverse and longitudinal diameter of fixed segment spinal canal is 92%, 93%, 87% of adjacent segment, respectively. CONCLUSIONS Hemivertebra excision and short-segment fusion for congenital scoliosis under 5 years old can achieve reliable fixation, satisfactory deformity correction and maintained for a long term. It has no significant impact on vertebra growth in fixed segment, but there is more likely to lead to increased lumbar lordosis in lumbar hemivertebra patient which may be related to tethered effect on spine during spinal growth. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Simultaneous Surgical Treatment of Congenital Spinal Deformity Associated with Intraspinal Anomalies.

Study DesignProspective case series.PurposeTo study the safety, efficacy, and long-term outcomes of single-stage surgical intervention for congenital spinal deformity and intraspinal anomalies.Overview of literatureCongenital spinal deformities associated with intraspinal anomalies are usually treated sequentially, first by treating the intraspinal anomalies followed by deformity correction after a period of 3–6 months. Recently, a single-stage approach has been reported to show better postoperative results and reduced complication rates.MethodsThirty patients (23 females and seven males) were prospectively evaluated for the simultaneous surgical treatment of congenital spinal deformity with concurrent intraspinal anomalies from May 2006 to October 2016. The average age at presentation was 9.8±3.7 years, with the average follow-up duration being 49.06±8.6 months. Clinical records were evaluated for clinical, radiological, perioperative, and postoperative data.ResultsThe average angle of deformity was 56.53°±25.22° preoperatively, 21.13°±14.34° postoperatively, and 23.93°±14.99° at the final follow-up. The average surgical time was 232.58±53.56 minutes (range, 100–330 minutes), with a mean blood loss of 1,587.09±439.09 mL (range, 100–2,300 mL).ConclusionsSingle stage surgical intervention for intraspinal anomalies with congenital spinal deformity correction, including adequate intra-operative wake-up test, is a viable option in appropriately selected patients and has minimum complication rates.

Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5years follow-up.

The aim of this retrospective study was to evaluate the changes in the vertebral body and spinal canal area in a group of patients who had pedicle screw fixation under age 5 for the treatment of congenital spinal deformity at least 5year follow-up. 11 patients who had been operated due to spinal deformity under age 5 with who had a CT examination at least 5years after the initial operation were included in the study. All patients underwent hemivertebrectomy and transpedicular fixation procedures at an average age of 3.18years (range 2-5years). All had preoperative CT to evaluate the congenital deformities. Measurements were done at the instrumented vertebrae as well as the un-instrumented ones above and below them to evaluate; vertebral body parameters, pedicle parameters and spinal canal area of upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), upper adjacent un-instrumented vertebra and lower adjacent un-instrumented vertebra. The average follow-up was 7.2 (range 5-12) years. Six of the patients were over age 10 during the final CT examination while 5 were at age 7. Female-to male ratio was 8-3. Measurement of all the parameters in 22 instrumented and 22 non-instrumented segments showed a proportional increase rather than a decrease at each segment. The percentage of canal area growth at UIV and LIV was 21 and 17.5%, respectively. Pedicle screw instrumentation has no adverse effect on further spinal body, pedicle and canal growth and does not result in iatrogenic spinal canal stenosis.

Safety and Efficacy of 1-Stage Surgical Treatment of Congenital Spinal Deformity Associated With Split Spinal Cord Malformation

Retrospective clinical study. The aim of this study was to evaluate retrospectively the safety and efficacy of 1-stage surgical treatment of 45 consecutive patients, who had progressive congenital spinal deformity associated with split spinal cord malformation (SSCM). For correction of progressive congenital spinal deformity with SSCM, it has been reported that all SSCM should be operated on before any orthopedic intervention, and then surgery for correction and stabilization of the spinal deformity should be performed 3 to 6 months later. Recently, different viewpoints have been approved, and the common treatment of these 2 associated conditions needs to be re-evaluated. Patients had 1-stage surgery. After exposure of the determined levels and placement of instruments, bony spur was resected in the patients of type 1; in patients of type 2, we did nothing to the SSCM. In the corrective stage of surgery, posterior fusion surgery was performed in 38 patients; nonfusion surgery was performed in 7 patients. Thirty-six female patients and 9 male patients formed the basis of the study. The mean age was 14 years, and the mean follow-up period was 31 months. Type 1 SSCM was in 15 patients, and type 2 SSCM was in 30 patients. Seven patients had progressive neurological deteriorations preoperatively. The mean major curves were corrected from an average of 73.7° to 33.5°, with a correction rate of 54.5%. The overall complication was transient, including 2 patients of neurological compromise and 1 patient of cerebrospinal fluid leakage. The average loss of correction at final follow-up was 2.5° for major curves. The 1-stage surgical treatment of congenital spinal deformity associated with SSCM provides a satisfactory option to improve the spinal deformity without significant complications effectively. Neurosurgical interventions are recommended to patients with type 1 SSCM before spinal deformity surgery; however, patients with type 2 SSCM can be treated safely without a need of neurosurgical intervention.

Growing Rods in the Treatment of Congenital Spinal Deformity

By nature, congenital spinal deformity is always early in onset. Left untreated, many patients with progressive deformities of the spine and chest wall experience life-threatening complications. The goal of treatment is to improve the deformities and to allow the maximum potential growth of the spine and chest to occur. Therefore, non-fusion distraction-based procedures, such as growing rod (GR) or vertical expandable prosthetic titanium rib (VEPTR) are appealing. The GR procedure may be beneficial in the absence of multiple rib fusions, when the congenital anomaly involves a vertebral segment too long for resection, or with compensatory curve with structural pattern concomitant to the congenital deformity. There has been increasing interest in the use of GR techniques in congenital spine deformities in young children. Most recently results of GR application in congenital scoliosis patients with minimum 2 years follow-up have been presented by Growing Spine Study Group (GSSG). They reported 27% curve correction and 12 mm/year T1S1 growth at latest follow-up. Complications occurred in 8 of the 19 patients (42%), and complication rate per surgery was reported to be 15%. With proper patient selection, GR instrumentation is a useful technique in the treatment of selected cases of early-onset scoliosis caused by congenital spinal anomalies.

Lumbar Hemivertebrectomy

Hemivertebrae may be progressive and result in significant spinal deformity and truncal imbalance. The development of the deformity is dependent upon the nature of the deformity, the site of the deformity, the age of the patient, and potential for future growth. Addressing the deformity early is essential to prevent serious structural deformity and prevent the development of compensatory curvature. Hemivertebrectomy of the lumbar spine is an accepted technique in the treatment of congenital spinal deformity. It is technically demanding, and the technique affords excellent and immediate correction of the deformity with restoration of proper spinal balance.

Treatment of the congenital scoliosis by Cheneau brace: 2 year follow-up

Background The treatment of congenital spinal deformities is a real challenge. The modern standard of treatment includes surgical interventions intended to correct or fuse the spine. In some cases, such an approach is impossible because of severe comorbidities. We hypothesized that a Cheneau brace might be effective in young patients with congenital spinal deformity. This paper is a continuation of our previous study.

Fusionless Instrumentation Systems for Congenital Scoliosis

Review of relevant literature including personal opinions. To review the current researches investigating the efficacy of growing rod and thoracic expansion techniques in the treatment of congenital spine deformity of young children, and to highlight the contrasting advantages and limitations in the fusionless treatment of progressive congenital scoliosis. Congenital scoliosis has the potential for severe spinal deformity and thoracic insufficiency syndrome (TIS). Conventional fusion treatments in children tend to shorten the spine further exacerbating trunk shortening and TIS. In the surgical treatment of congenital spinal deformities in young children, while reconstructing the spinal deformity, one should simultaneously pursue preserving the growth potential of the vertebrae, improving the volume, symmetry, and functions of the thorax, and protecting this improvement during the growth. Today, employed in the treatment of spinal deformities of young children, there are 2 deformity reconstruction methods serving these targets: Growing rod technique and vertical expandable prosthetic titanium rib (VEPTR) with or without expansion thoracostomy. Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations. The growing rod technique is a safe and reliable method in the treatment of congenital spine deformity of young children who present some flexibility in the anomalous segment, or when the congenital anomaly involves a vertebral segment too long for resection, or with compensating curve with structural pattern concomitant to the congenital deformity. Expansion thoracostomy and VEPTR are the appropriate choice for severe congenital spine deformity when a large amount of growth remains. Although ventilator dependence is significantly decreasing, thoracic volume and space available for the lung are increased after expansion thoracostomy and VEPTR. Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.

Convex Growth Arrest in the Treatment of Congenital Spinal Deformities, Revisited

The authors studied 32 patients to delineate the reliability of well-defined but frequently extended indications to define the ideal patient who will benefit from convex growth arrest. Mean age at the time of convex growth arrest was 29 (range 6-72) months, and average follow-up was 40 (24-120) months. Mean Cobb angle was 55 degrees (31-105 degrees) before surgery and 50 degrees (13-107 degrees) at final follow-up. Thirteen patients (41%) had a true epiphysiodesis effect, while 15 (47%) had fusion and 4 (12%) had progression. The age at surgery, magnitude, length and location of the curve, presence of intraspinal anomaly, and presence of sagittal plane or rib deformity were investigated in terms of the outcome, but none of these parameters was found to have an effect on the outcome. In conclusion, convex growth arrest is a safe and effective method in the management of the young patients with congenital spinal deformities. It can be performed for the balanced and cosmetically acceptable deformities of patients younger than 5 years of age regardless of the type, length, magnitude, and location of the curve, the existence of associated rib fusion, or the presence of sagittal plane abnormality.