Spinal osteotomy for children with congenital scoliosis with unilateral unsegmented bar: Preliminary results

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Abstract

Introduction. Segmentation disorder of the lateral surfaces of the vertebral bodies leads to the development of progressive deformity of the spine. Surgical interventions in different variants are the only effective way of treatment. This study examines the use of corrective vertebrectomy in patients with congenital scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies.

Objective of the study. To evaluate the results of surgical treatment of children with congenital scoliosis with impaired segmentation of the lateral surfaces of vertebral bodies.

Materials and Methods. A single-center retrospective study on the basis of the Department of Spinal Pathology and Neurosurgery at the Turner Scientific and Research Center for Pediatric Traumatology and Orthopedics. G.I. Turner for the period from 2014 to 2020. Twenty-six patients were included in the study: 14 girls and 12 boys. The age range was 84 to 144 months. All patients underwent surgical intervention in the volume of a one-stage corrective wedge vertebrectomy. Statistical processing was performed by comparing the reliability of differences in distributions using Wilcoxon t-criterion.

Results and discussion. The median Cobb preoperative scoliotic deformity was 31°, interquartile interval (IQR) = 30.5. The median preoperative lordotic deformity was 29° Cobb, IQR = 29.5. The magnitude of correction of the scoliotic component of the deformity was 84%, (median value after intervention: 5° according to Cobb, IQR = 14.5). The magnitude of correction of pathological lordosis of the thoracic spine was 41%, (median value after intervention: 17° according to Cobb, IQR = 14.5). The obtained results were statistically significant (p < 0.05).

Conclusion. Corrective wedge vertebrectomy is an effective method for surgical treatment of children with congenital spinal deformity with impaired segmentation of the lateral surfaces of vertebral bodies. This method of treatment achieves an average of 84% correction of scoliotic deformity and 41% correction of pathological lordosis.

About the authors

Sergey V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930
Scopus Author ID: 6504128319
ResearcherId: P-8596-2015

MD, PhD, D.Sc., Professor, Corresponding Member of RAS

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Marat S. Asadulaev

H.Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery

Email: marat.asadulaev@yandex.ru
ORCID iD: 0000-0002-1768-2402
SPIN-code: 3336-8996

MD, PhD student

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Michael A. Khardikov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: denica1990@bk.ru
ORCID iD: 0000-0002-8269-0900
SPIN-code: 3378-7685
Scopus Author ID: 57203014683

MD, PhD student

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Anton S. Shabunin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Peter the Great Saint Petersburg Polytechnic University

Author for correspondence.
Email: anton-shab@yandex.ru
ORCID iD: 0000-0002-8883-0580
SPIN-code: 1260-5644
Scopus Author ID: 57191623923

laboratory assistant in the Laboratory of Experimental Surgery, PhD student

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603; 29, Polytechnitcheskaya street, St.-Petersburg, 195251

Nikita O. Khusainov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: nikita_husainov@mail.ru
ORCID iD: 0000-0003-3036-3796
SPIN-code: 8953-5229
Scopus Author ID: 57193274791
ResearcherId: AAM-4494-2020

MD, PhD, Research Associate

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Kirill A. Kartavenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: med-kart@yandex.ru
ORCID iD: 0000-0002-6112-3309
SPIN-code: 5341-4492
Scopus Author ID: 57193272063

MD, PhD, Orthopedic and Trauma Surgeon of the Department of Spinal Pathology and Neurosurgery

Russian Federation, 64-68, Parkovaya str., Saint-Petersburg, Pushkin, 196603

References

  1. Li C, Fu Q, Zhou Y, Yu H, Zhao G. Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach. Eur Spine J. 2012;21(3):498−505. doi: 10.1007/s00586-011-1972-6
  2. Stevenson A, McCarthy S, Kalmey J, Kulesza R. Anatomical dissection of a cadaver with congenital scoliosis. Folia Morphol (Warsz). 2014;73(3):389−394. doi: 10.5603/FM.2014.0058
  3. Kolesov SV. Hirurgiya deformacij pozvonochnika. P. Mironova, ed. Moscow: Avtorskaya Akademiya; 2014.
  4. Vissarionov SV, Baindurashvili AG, Khusainov NO, et al. Comparative analysis of the results for surgical treatment of patients with congenital thoracic spine deformities (preliminary results). Modern Problems of Science and Education. 2018;(2). (In Russ.). doi: 10.17513/spno.27440
  5. McMaster MJ, McMaster ME. Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation. J Bone Joint Surg Am. 2013;95(11):972−979. doi: 10.2106/JBJS.L.01096
  6. Winter RB. Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2: 40-year follow-up after revision anterior and posterior surgery at age 8. Spine (Phila Pa 1976). 2012;37(8):E507−510. doi: 10.1097/BRS.0b013e31824ac401
  7. Ryabykh SO, Ul’rikh EV. Thoracal insufficiency syndrome in congenital scoliosis. Vestn Khir Im I I Grek. 2011;170(4):73−78. (In Russ.)
  8. Mikhailovsky MV, Suzdalov VA. Thoracic insufficiency syndromein infantile congenital scoliosis. Hirurgiâ pozvonočnika (Spine Surgery). 2010;(3):20−28. (In Russ.) doi: 10.14531/ss2010.3.20-28
  9. Vissarionov SV, Khusainov NO, Kokushin DN. Analysis of results of treatment without-of-spinebased implants in patients with multiple congenital anomalies of the spine and thorax. Pediatric, Traumatology, Orthopeaedics and Reconstructive Surgery. 2017;5(2):5−12. doi: 10.17816/PTORS525-12
  10. Ha KY, Suh SW, Kim YH, Kim SI. Long-term management of congenital lordoscoliosis of the thoracic spine. Eur Spine J. 2017;26(Suppl 1):47−52. doi: 10.1007/s00586-016-4711-1
  11. Murphy RF, Pacult MA, Barfield WR, et al. Experience with definitive instrumented final fusion after posterior-based distraction lengthening in patients with early-onset spinal deformity: single center results. J Pediatr Orthop B. 2019;28(1):10−16. doi: 10.1097/BPB.0000000000000559
  12. Lattig F, Taurman R, Hell AK. Treatment of early-onset spinal deformity (EOSD) with VEPTR: A challenge for the final correction spondylodesis – a case series. Clin Spine Surg. 2016;29(5):E246−251. doi: 10.1097/BSD.0b013e31826eaf27
  13. Iyer S, Duah HO, Wulff I, et al.; FOCOS Spine Research Group. The use of halo gravity traction in the treatment of severe early onset spinal deformity. Spine (PhilaPa 1976). 2019;44(14):E841−E845. doi: 10.1097/BRS.0000000000002997
  14. Lonstein JE. Long-term outcome of early fusions for congenital scoliosis. Spine deformity. 2018;6(5):552−559.
  15. Hensinger RN. Congenital scoliosis: etiology and associations. Spine (Phila Pa 1976). 2009;34(17):1745−1750. doi: 10.1097/BRS.0b013e3181abf69e
  16. Ryabykh SO, Filatov EYu, Savin DM. Three column vertebrectomy outside the apical zone as a method for correction of cervicotho- racic junction deformities: analysis of clinical series and literature data. Hirurgiâ pozvonočnika (Spine Surgery). 2017;14(3):15−22. doi: 10.14531/ss2017.3.15-22
  17. Dayer R, Ceroni D, Lascombes P. Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique. European Spine Journal. 2014;23(4):424−431. doi: 10.1007/s00586-014-3338-3
  18. Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine. 2010;35(25):2193−2204.
  19. Li C, Zhou Y, Fu Q et al. Treating severe and rigid kyphoscoliosis with posterior thoracic intervertebral space release and wedge osteotomy. Chin J Orthop. 2008;28(6):448–452. doi: 10.3321/j.issn:0253-2352.2008.06.003
  20. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine. 2005;30(14):1682–1687. doi: 10.1097/01.brs.0000170590.21071.c1

Supplementary files

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2. Fig. 1. Schematic representation - violation of the segmentation of the lateral surfaces of the vertebral bodies

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3. Fig. 2. Scheme of performing a single-stage corrective wedge-shaped vertebrotomy at the apex of an unsegmented nail. 1 - area of execution of vertebrotomy

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4. Fig. 3. Histogram of the distribution of patients by age groups

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5. Fig. 4. Surgical intervention site after wedge osteotomy:

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6. Fig. 5. Panoramic X-ray of the spine in frontal and lateral projections before (a, b) and after (c, d) surgery.

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7. Fig. 6. Distribution of deformity values of the thoracic spine (scoliosis and lordosis) before and after the intervention:

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Copyright (c) 2021 Vissarionov S.V., Asadulaev M.S., Khardikov M.A., Shabunin A.S., Khusainov N.O., Kartavenko K.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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