Affiliation:
1. Novosibirsk Research Institute of Traumatology and Orthpaedics n.a. Ya.L. Tsivyan, Novosibirsk
Abstract
Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS) can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.Material and methods. Since 2008 year 127 patients (64 girls, 63 boys) aged (4.5 ± 2.1) years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib) instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1) years.Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9), secondary curve (42.8 ± 16.0), thoracic kyphosis (46.3 ± 27.4), lumbar lordosis (54.6 ± 14). Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20) (correction 31.7%), at followup to (56.5 ± 18.5), secondary curve (31.8 ± 12.8) (25.7%), at follow-up to (32.4 ± 18.4), thoracic kyphosis (36.8 ± 20.8) (20,5%), at follow-up to (41.8 ± 21.0), lumbar lordosis (45.4 ± 12.7) (16,9%), at follow-up to (48.2 ± 11.7) (p < 0.05). Space available for lung before surgery was (84.5 ± 8.7) %, after surgery was (94.8 ± 6.7)%, at follow-up increased to (98.6 ± 5.4) % (p < 0.05). Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6), secondary curve (47.8 ± 4.6), thoracic kyphosis (61.4 ± 10.4), lumbar lordosis (61.8 ± 4.9). Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%), at follow-up to (66.1 ± 6.3), secondary curve (24.1 ± 2.9) (49.6%), at follow-up to (37 ± 5.4), thoracic kyphosis (38.8 ± 7.7) (36.8%), at follow-up to (59.4 ± 11.2), lumbar lordosis (47.5 ± 4.1) (23.2%), at follow-up to (64.5 ± 4.5) (p < 0.05). Complications included 23 implant dislocations and 1 infection. No neurological complications.Conclusion. Stage correction fusions using various instrumentation is a method of choice for controlled correction of growing children with IS.
Publisher
Siberian State Medical University
Reference30 articles.
1. Berdan E.A., Larson A.N. Double Crush to the Thorax: Kyphoscoliosis and Pectus Excavatum. AAP National Conference and Exhibition, New Orleans. 20.10.2012. Section on Surgery – poster session with oral presentations.
2. Mikhailovsky M.V., Suzdalov V.A. Sindrom torakal'noy nedostatochnosti pri infantil'nom vrozhdennom skolioze [Thoracic Insufficiency Syndrome in Infantile Congenital Scoliosis]. Khirurgiya pozvonochnika – Spine Surgery, 2010, no. 3, pp. 20–28 (in Russian).
3. Mikhailovsky M.V., Ul'rikh E.V., Suzdalov V.A., Dolotin D.N., Ryabykh S.O., Lebedeva M.N. Instrumentariy VEPTR v hirurgii infantil'nyh i yuvenil'nyh skoliozov: pervyj otechestvennyj opyt [VEPTR Instrumentation in the Surgery for Infantile and Juvenile Scoliosis:First Experience in Russia]. Khirurgiya pozvonochnika – Spine Surgery, 2010, no. 3, pp. 31–41 (in Russian).
4. Campbell R.M., Smith M.D., Mayes T.C. et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J. Bone Joint Surg. Am., 2003, vol. 85, pp. 399–408.
5. Hershman S., Park J., Lonner B. Fusionless surgery for scoliosis. Bulletin of the Hospital for Joint Diseases, 2013, vol. 71, pp. 49–53.