Treatment Of Scoliosis In Children Research Articles

Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis.

Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children. A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days. Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion. A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.

Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis.

There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents. A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy. The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24-3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06-0.78; p = 0.02). The operation time (mean difference [MD] = -34.37; 95% CI: -67.47 to -1.28; p = 0.04) and mean placement time per screw (MD = -3.11; 95% CI: -6.13 to -0.09; p = 0.04) and mean times for fluoroscopy (MD = -6.60; 95% CI: -8.66 to -4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss. Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.

Estimated cumulative X-ray exposure and additional cancer risk during the evaluation and treatment of scoliosis in children and young people requiring surgery

IntroductionClinicians and patients must weigh the benefits of radiological imaging against the risks of radiation exposure in the diagnosis and treatment of scoliosis. This report aims to estimate the cumulative absorbed and equivalent dose of radiation in patients undergoing surgical treatment for scoliosis, and to present this as an estimated risk of cancer compared to background radiation levels.MethodsRetrospective review of estimated absorbed dose on the Computerised Radiology Information System (CRIS®). Patients undergoing surgical correction of scoliosis (age ≤ 25) from August 2010 to August 2015 investigated. Estimated absorbed dose [milligrays (mGy)] recorded. Pedicle screws inserted using image intensification. Equivalent dose [millisieverts (mSv)] and additional cancer risk calculated from the National Research Council document ‘Health risks from exposure to low levels of ionising radiation’ (2006).Results271 patients identified. Mean age 15 (range 2–25). Mean total absorbed dose 2136 mGy [standard deviation (SD) 1700 mGy]. Mean number of plain spine radiographs was 8 (SD 3) with total 1884 mGy exposure (SD 1609 mGy). Additional dose provided by CT (mean 0.17 episodes), plain chest and abdominal radiographs and image intensification. Mean number of image intensification episodes was 1.1 with mean estimated exposure 180 mGy (SD 238 mGy). Image intensification accounted for 8% of the estimated absorbed dose during treatment. Estimated mean effective dose delivered was 20.952 mSv equating to an additional cancer risk of 0.27–0.45%.ConclusionAdditional cancer risk from cumulative imaging is small and equivalent to approximately 8 years of natural background radiation. Use of image intensification for pedicle screw insertion is a minor contribution (8%) to the total patient dose.

The growth-friendly surgical treatment of scoliosis in children with osteogenesis imperfecta using distraction-based instrumentation.

The study was undertaken to determine the feasibility of growth-friendly distraction-based surgery in children with OI. Two multi-center databases were queried for children with OI who had undergone GR or VEPTR surgery. Inclusion criteria were a minimum 2-year follow-up and three lengthening procedures following the initial implantation. Details of the surgical techniques, surgical complications, and radiographic measurements of deformity correction, T1-T12 and T1-S1 elongation and growth were recorded. Five patients were identified. There was one patient with type I OI and two patients each with type III and type IV. Four patients had GR constructs and one a VEPTR construct. The initial scoliosis deformity averaged 80° (70°-103°), and the subsequent corrections averaged 32% for initial correction, 48% at last follow-up, and 54% for the two patients that had a final fusion. The T1-T12 and T1-S1 growth averaged 31mm and 44mm respectively, and yearly growth averaged 4mm and 6mm, respectively. Growth was notably much less in those with more severe disease. There were 13 complications in 4 patients. Nine of the 10 surgical complications were anchor failures which were corrected in 7 planned and 2 un-planned procedures. Significant migration occurred in one patient with severe OI type III. The results varied in this heterogeneous population. In general, satisfactory deformity corrections were obtained and maintained, modest growth was obtained, and complications were similar to those reported in other series of growth-friendly surgery. Limited growth and significant anchor migration are to be anticipated in this population. IV.

The use of corrective Chenot corset in the treatment of idiopathic scoliosis in children and adolescents

Aim. The aim of the study is to evaluate the effectiveness of using a Chenot corset in the treatment of idiopathic scoliosis in children and adolescents.&#x0D; Materials and methods. Thirty-five patients aged 7 to 17 years, suffering from idiopathic scoliosis degree II-III, under our supervision, were included. The distribution according to gender was 8 boys and 27 girls. The range of the angle of scoliotic deformation before the appointment of the corset was from 21 to 47 degrees according to Cobb on the anterior-posterior x-ray of the spine performed standing. The average angle of deformation was 32 degrees.&#x0D; Results. Evaluation of the effectiveness of corset therapy was carried out after the patient had adapted to the orthosis (3 months after the appointment of the corset) and reached a wearing time of 1821 h per day on an x-ray of the spine performed in a standing corset. The average correction was 37.5%, and the average angle of deformation was reduced from 32 to 20 degrees.

EFFICACY AND SAFETY OF GROWING RODS IN THE TREATMENT OF SCOLIOSIS IN CHILDREN UNDER 10

ABSTRACT Objective: To determine the efficacy and safety of growing rods in the treatment of scoliosis in children aged under 10 years. Methods: A retrospective review of medical records of patients under 10 with scoliosis, treated with growing rods from the period between 1997 and 2012. Results: We identified 35 patients treated with growing rods who met the selection criteria. The average age at the start of treatment was 5.9 ± 2.3 years. Most of the patients (51.4%) showed idiopathic etiology scoliosis. Pre-surgery and post-surgery radiographic change showed a 47.7% reduction in Cobb angle (p&gt;0.001). We identified 8 patients with some complication, the most prevalent being instrumentation failure (22.9%). The only predicting factor for post-operative complications was the total number of lengthenings performed (OR=7.03; CI 95% [1.1-45.4]; p=0.040). Conclusions: Treatment of scoliosis with growing rods in patients aged under 10 achieved a significant reduction in the magnitude of the deformity before final bone fusion. However, the rate of complications is rather high, therefore we recommend reducing the frequency of lengthenings to the minimum needed to maintain correction and longitudinal growth of the spine. Level of Evidence IV; Case series.

Интраоперационный мониторинг при операционном лечении сколиоза у детей

Интраоперационный мониторинг при операционном лечении сколиоза у детей

Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation

BackgroundGrowth guidance sliding treatment devices, such as Shilla (Medtronic, Minneapolis, MN USA) or LSZ-4D (CONMET, Moscow, Russia), used for the treatment of scoliosis in children who have high growth potential have unlocked fixtures that allow rods to slide during growth of the spine, which avoids periodical extensions. However, the probability of clinical complications associated with metallosis after implantation of such devices is poorly understood. The content of metal ions in the blood and tissues of pediatric patients treated for scoliosis using fusionless growth guidance sliding instrumentation has not yet been investigated. PurposeThe aim of the present study was to measure the content of metal ions in the blood and tissues surrounding the implanted growth guidance sliding LSZ-4D devices made of titanium alloy (Ti6Al4V), and to identify the incidence of metallosis-associated clinical complications in some patients with these devices. Study DesignThis is a one-center, case-control retrospective study. Patients SampleThe study group included 25 patients with high growth potential (22 females, 3 males; average age at primary surgery for scoliosis treatment is 11.4±1.2 years old) who had sliding growth guidance instrumentation LSZ-4D (CONMET) implanted on 13 (range: 10–16) spine levels for 6±2 years. The LSZ-4D device was made from titanium alloy Ti6Al4V and consisted of two rectangular section rods and fixture elements. Locked fixtures were used on one spinal level, whereas the others were unlocked (sliding). The control group consisted of 13 patients (12 females and 1 male; 11±1.2 years old) without any implanted devices. Outcome MeasuresThe content of Ti, Al, and V metal ions in the whole blood and tissues around the implanted device was measured. The incidences of metallosis-associated complications in the study group were recorded. MethodsMetal ion content was measured by the inductively coupled mass spectrometry method on quadrupolar NexION 300D (PerkinElmer Inc, Shelton, CT, USA). ResultsFive of 25 patients in the study group developed metallosis-associated complications (two sinuses and three seroma in the lumbar part of the spine). Revisions were carried out in two of these patients. Ninety percent of the patients in the study group had increased content of Ti and V ions in the blood (2.8 and 4 times, respectively). Median content of Ti ions in soft tissues adjacentto implanted sliding device was more than 1,500-fold higher than that of the control group. These levels are much higher than previously reported for spinal instrumentation. ConclusionsIncreased content of Ti and V ions in the blood and especially in tissues around the titanium growth guidance sliding device LSZ-4D accompanied by clinical manifestations (seroma and sinuses) indicates the importance of improving wear resistance of such instrumentation with the coatings and the necessity to exchange sliding instrumentation once the child is fully grown.

Updates on surgical treatments for pediatric scoliosis

Scoliosis in children poses serious problems including respiratory problems, trunk imbalance, and depression, as well as detracting from the child’s appearance. Scoliosis can also contribute to back pain later in life. Advanced surgical techniques allow for good correction and maintenance of progressive curves, and growth-sparing treatments are now available for patients with early-onset scoliosis (EOS). Posterior corrective surgeries using pedicle screw (PS) constructs, which allow curves to be corrected in three dimensions, has become the most popular surgical treatment for scoliosis. Several navigation systems and probes have been developed to aid in accurate PS placement. For thoracolumbar and lumbar curves, anterior surgery remains the method of choice. Growth-sparing techniques for treating EOS include growing rods, the Shilla method, anterior stapling, and vertical expandable prosthetic titanium rib, which was originally designed to treat thoracic insufficiency syndrome. However, these advanced surgical techniques do not always offer a perfect solution for pediatric scoliosis, and they are associated with complications such as infections and problems with instrumentation. Surgeons have developed several techniques in efforts to address these complications. We here review historic and recent advances in the surgical treatment of scoliosis in children, the problems associated with various techniques, and the challenges that remain to be overcome.

English

Introduction Long-term follow-ups of untreated patients with adolescent idiopathic scoliosis (AIS) indicate that the consequences of AIS over a lifetime are minimal, sometimes moderate in more severe cases, however, never life-threatening. In light of these findings, the historical indications for treatment should be investigated according to current evidence. This critical review discusses the treatment methods for scoliosis. Materials and methods Recent reviews have been investigated for their contribution to evidence in the field of scoliosis treatment, especially the impact of t-he results obtained on the historical modes of treatment. Results From these findings, we may conclude that there is promising evidence for the application of physi-otherapy in the treatment of scolio-sis in children or adolescents and for adults with curvatures exceeding 35° Cobb. There is a stronger evidence for the application of (hard) braces during growth. There is no evidence for spinal fusion surgery for AIS. The use of surgery should be limited in patients with scoliosis of other ori-gin. Conclusion

Preliminary clinical application of the new instrumentation growing rods of sliding pedicle screw system for scoliosis in children

Objective To evaluate the primary clinical outcome of the new instrumentation growing rods of sliding pedicle screw system in the treatment of scoliosis in children.Methods From January 2009 to July 2011,10 patients with idiopathic scoliosis were treated using a new instrumentation growing rods of sliding pedicle screw system.There were 3 males and 7 females,aged from 4 to 12 years (average,7.8 years).Risser sign was grade 0 in all patients.There were 3 cases of single thoracic curve,6 cases of single thoracolumbar or lumbar curve,and 1 case of double thoracic curve.Before operation,the average coronal Cobb angle was 66.8°(range,38° to 85°),the average sagittal Cobb angle was 45.5°(range,38° to 66°),and the average sitting height was 48.6 cm (range,36 cm to 64 cm).During the follow-up period,some parameters were observed,such as coronal and sagittal Cobb angles,sitting height,complications and so on.Result Immediately after operation,the average coronal Cobb angle was 28°(range,17°to 39°) with the average correction rate of 56％(range,48％ to 65％),the average sagittal Cobb angle was 31° (range,25°to 39°),and the average sitting height was 56.8 cm (range,40 cm to 70 cm).All patients were followed up for 12 to 44 months (average,26.5 months).At final follow-up,the average sitting height increase by 2 cm,skin infection at the end of the rod occurred in 3 cases,which recovered after local dressing change,and shoulder imbalance occurred in 1 cases.There were no broken screws,broken rods and other internal fixation-related complications.Conclusion The new instrumentation growing rods of sliding pedicle screw system is effective and safe in the treatment of scoliosis in children. Key words: Scoliosis; Child; Spinal fusion; Internal fixators

Growing Rods for the Treatment of Scoliosis in Children With Cerebral Palsy

Retrospective analysis. To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14° ± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43° ± 28°; PO, 2° ± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P < 0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.

Advances in nonfusion techniques for the treatment of scoliosis in children

Scoliotic deformity in young children is a challenge for the spinal surgeon. Though traditional spinal correction and fusion techniques can improve these deformities, they inhibit growth of the spine. Nonfusion technologies are an effective approach to this problem. They not only correct the spinal deformity, but also allow the spine to keep growing and developing. These techniques include the growing rod, stapling, pedicle screw tethering, the vertical expandable prosthetic titanium rib (VEPTR), and multi-vertebrae wedge osteotomy. This is a review of advances in nonfusion techniques for the treatment of scoliosis in children.

Rehabilitation of Childrenwith Dysontogenetic-Dystrophic Syndrome for Combined Pelvicand Spinal Deformities

Objective. To analyze the effectiveness of complex remedial measures including biological feedback to pelvic girdle and spinal muscles in treatment of scoliosis in children with dysontogenetic- dystrophic syndrome. Material and Methods. The study included 49 patients aged 6 to 16 years with combined deformities of the pelvis and the spine (grade I and II measured by Cobb method). All examined patients had S-shaped scoliosis and pelvic asymmetry. The treatment included application of biological feedback after EMG training of patients. Results. The study showed that one of the basic requirements for successful EMG biofeedback application is a functional biocontrol. Patients are trained to control the activity of muscles and muscle groups, which are under disturbed or lost voluntary control. Functional biocontrol assumes using activity of the disturbed motor system itself. Biofeedback looping provides learning and fixation of motor patterns and a new behavior strategy allowing for voluntary correction of the disturbed motor functions. Conclusion. The application of EMG biofeedback to pelvic girdle muscles resulted in reduction or reversal of scoliotic deformity in the thoracic and lumbar spine. Formation of new statodynamic system decreased trunk and spinal muscle imbalance, and changed the direction of spinal curves.

Is there still a place for the conservative treatment of idiopathic scoliosis in children and adolescents?

In the existing literature, studies on this subject are not always consistent; hence the results of the orthopaedic treatment in scoliosis are difficult to interpret. Actually, the main difficulty lies in the insufficiency of available data on the features of the treated cases of scoliosis: few or no clinical data recorded at the beginning of the treatment and over the whole follow-up period, especially with regard to the evaluation of hump deformity, the measurement of frontal and sagittal tilt angle, changes of ventilatory capacity, etc., bone age at the start and at the end of the treatment, and to the known extent of the scoliosis.

Massive blood loss and coagulation hemostasis in the surgical treatment of scoliosis in children and adolescents

In 95 patients, operated on for scoliosis, coagulation status was studied using standard tests (activated partial thromboplastin time, prothrombin decrease by Quick, normalized prothrombin ratio, antithrombin III, ethanol and orthophenothroline tests, ХП-a dependent fibrinolysis) pre-, intra- and postoperatively. It was shown that coagulation disturbances developed already during the hemodilution process. Consumption of coagulation factors took place during operation and at early postoperative period. Blood loss by drainage was marked during 48 hours after operation. Maximum changes of coagulation indices were registered on 25 day after operation. Use of fresh-frozen plasma, e-aminocaproic acid to decrease of blood grainage loss was grounded.

Pathomorphological pattern of paravertebral muscles of rabbits after long-term experimental electrostimulation.

The objective of this study was to identify the histopathological features of paravertebral muscles after long-term Lateral Electrical Surface Stimulation (LESS). LESS has been applied for the treatment of idiopathic scoliosis in children and adolescents. Former studies reported the negative effect on the mental state of treated patients, as well as functional disturbances of organs, endocrine glands, and muscle metabolism. The experiment was performed on rabbits (aged 3.5 months), (n = 5 in treated, n = 5 in non-treated group). Stimulation was performed using electrical stimulator SCOL-2. The rabbits were stimulated with the traditional long-term lateral electrical surface stimulation (LESS) method as in clinical applications for children and adolescents. After microscopic examination, atrophy of fibers and cross striation of paravertebral muscles were seen, as well as degenerative lesions, necrosis, and hyperemia. Furthermore, proliferation of nuclei and infiltration of monocytogenic phagocytes mononuclear cells were observed, as well as a wide differentiation of glycosoaminoglycanes in muscle fibers on the stimulated side. However, within the tissue undergoing regression, this resulted in a clear decrease in glycosoaminoglycane levels. The observed lesions may indicate that the damage to the neuromuscular system is an effect of long-term LESS application. Thus, standard LESS therapy may deepen idiopathic scoliosis.

Efficacy of perioperative halo-gravity traction in the treatment of severe scoliosis in children.

Perioperative halo traction was used in the treatment of severe scoliosis in 19 children. Diagnoses included neuromuscular, idiopathic, and congenital scoliosis. Traction was transferable between the bed and a walker or wheelchair. Thirteen patients had prior spinal surgery, and most required osteotomy. Traction was used for 6 to 21 weeks. All patients underwent spinal fusion surgery after traction, with instrumentation used in 15 patients. Improvement was achieved in all patients. The Cobb angle improved 35% from an average 84 degrees before traction (range 63 degrees -100 degrees ) to 55 degrees preceding fusion. Trunk decompensation improved in all patients. Trunk height increased 5.3 cm in traction. Response to traction did not correlate with diagnosis, patient age, or prior surgery. There were no neurologic complications. Perioperative halo-gravity traction improves trunk balance and frontal and sagittal alignment in children with severe spinal deformity. Surgical fusion was enhanced by the improved alignment, and neurologic injury was avoided.

Experience in the treatment of scoliosis in children and adolescents in a rehabilitation center

The rehabilitation center operates on the basis of the sanatorium boarding school No. 25 at the CITO. The sanatorium boarding school was organized in 1992 and is designed for the education and treatment of 150 children aged 6 to 16-17. A typical school building after a major overhaul was converted into an educational and medical institution. The boarding school works on a five-day week, children spend weekends at home. Unlike other similar institutions that exist in Moscow and some regions of Russia, boarding school No. 25 does not specialize in the rehabilitation treatment of patients with pathology of any one system of the musculoskeletal system (spine, large joints, etc.). The main task of the center is to provide qualified rehabilitation assistance to children suffering from a wide variety of orthopedic pathologies, as well as those who have suffered injuries of the joints, limbs, spine, etc. This report is devoted to the analysis of treatment at the center for children suffering from scoliosis. This contingent of patients here is about 60% of the total number of patients.

Urological Problems After Surgical Treatment of Scoliosis in Children with Myelomeningocele

Urological Problems After Surgical Treatment of Scoliosis in Children with Myelomeningocele