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Study Design: Retrospective cohort. Objective: To analyze the outcome of surgical correction of children with caudal regression syndrome. Methods: The study included 12 patients aged 1.5 to 9 years with caudal regression syndrome. In order determine the type of caudal regression, the Renshaw Classification was used. The surgery included correction and stabilization of the kyphotic deformity at the unstable lumbosacral region, with reconstruction of the sagittal balance using a bony block constructed from allograft. Short- and long-term outcomes were evaluated. The study was approved by the local institutional review board. Results: Children with types III and IV caudal regression syndrome underwent spinal-pelvic fusion, with 100% fusion rate, which allows sufficient stabilization of the lumbopelvic segment permitting patient mobilization and standing in type III patients. There were 5 complications needing additional care. Conclusion: Multilevel pedicular screw fixation in combination with spinopelvic fusion with cortical allografts allows reconstruction of the sagittal alignment with solid bony fusion improving the quality of life for these patients.

To evaluate the results of surgical treatment of children with congenital deformity of the lumbar and lumbosacral spine associated with isolated failures of vertebra formation. Material and Methods. A total of 37 patients aged 1 year 6 months to 8 years 4 months having isolated vertebra formation failures in the lumbar and lumbosacral spine were treated. In three patients with lateral hemivertebrae the angle of scoliosis before surgery varied from 19° to 35° (average 29.2°); in 34 patients with posterolateral hemivertebrae-from 18° to 51° (average 30.1°), and the angle of kyphosis-from 10° to 34° (average 18.4°). Surgical treatment was performed through combined approach in patients with lumbar hemivertebrae, and through posterior approach in patients with lumbosacral hemivertebrae. It included extirpation of the abnormal vertebra with adjacent discs, deformity correction with posterior instrumentation, interbody fusion, and posterior local spinal fusion with bone autograft. Results. The angle of scoliotic deformity in patients with lateral hemivertebrae after surgery varied from 0° to 6°, the degree of correction ranged from 94 % to 100 %. After extirpation of posterolateral hemivertebrae and deformity correction the residual angle of scoliotic deformity varied from 0° to 4° (average 2.5°), the degree of correction ranged from 95 % to 100 %, and the kyphotic angle-from 9° to-6° (average 2.2°). The formation of solid bone block was noted in all patients at 1.5-2 years after surgery. Conclusion. Complete correction of congenital deformity in children contributes to the formation of a proper frontal and sagittal spine alignment, and provides conditions for normal spine development during the child's growth.

Актуальность. Идеология лечения пациентов с врожденными деформациями позвоночника на фоне изолированных пороков развития тел позвонков заключается в проведении коррекции и стабилизации деформации в максимально раннем возрасте с сохранением возможности дальнейшего роста. Однако для лечения детей с врожденной деформацией при множественных и комбинированных аномалиях развития позвонков и ребер применение данной тактики затруднительно. С этой целью все шире используют внепозвоночные металлоконструкции, однако публикации, отражающие результаты их применения, немногочисленны. Цель -анализ результатов лечения пациентов с множественными аномалиями развития позвоночника и грудной клетки после этапных оперативных вмешательств с использованием внепозвоночных металлоконструкций. Материалы и методы. За период с 2012 по 2016 г. проведено хирургическое лечение 20 пациентов в возрасте от 2 до 12 лет, которым выполнены 44 оперативных вмешательства. Средний возраст пациентов на момент вмешательства составил 6,9 года. В 13 наблюдениях деформация имела грудную локализацию, у 7 детей -грудопоясничную. Бифокальный реберно-реберный захват применили в 18 наблюдениях, реберно-позвоночные металлоконструкции -в 26 случаях. Результаты хирургического вмешательства оценивали по величине коррекции сколиотической дуги деформации непосредственно после оперативного вмешательства, также оценивали количество этапов проведенного оперативного лечения, частоту и характер осложнений. Результаты. Средняя величина сколиотической деформации до хирургического вмешательства составила 68,7° по Cobb. Количество этапных вмешательств варьировало от 3 до 7. Средняя величина коррекции деформации после хирургического вмешательства составила 15,1°. В отдаленном периоде после проведенных этапных операций у всех 20 пациентов величина деформации не превышала исходную. Частота осложнений в послеоперационном периоде составила 15,9 %. Заключение. Использование внепозвоночных металлоконструкций в лечении пациентов с врожденными сколиотическими деформациями на фоне комбинированных аномалий развития позвонков и одностороннего синостоза ребер позволяет уменьшить имеющуюся деформацию, приостановить темпы ее прогрессирования и увеличить объем гемиторакса.Ключевые слова: врожденный сколиоз, хирургическое лечение, синостоз ребер, дети.Aim. Treatment of patients with multiple congenital anomalies of the spine is a complex problem, demanding both correction and stabilization to be performed as early as possible without disturbing the growth of the spinal column.To achieve the latter, different instrumentation, such as rib-based distractors, may be useful. Little is known this treatment of congenital spine deformities. We aimed to investigate the results of treatment in our patients with the use of out-of-spine-based metal implants. Material and methods. During 2012-2016, there were 44 procedures performed in 20 patients at an age of 2 years to 12 years. In 13 cases, the deformity was located in the thoracic spine and in the thoracolumbar regions in 7 cases. We used bifocal rib-rib...

Objective. To analyze results of surgical treatment of chil� dren with congenital deformity of the thoracolumbar junc� tion of the spine caused by isolated vertebral malformations. Material and Methods. Surgical treatment results in 37 pa� tients aged 10 months to 12 years with congenital scoliosis caused by isolated lateral and posterolateral hemivertebrae in the thoracolumbar junction were analyzed. Magnitude of scoliosis before surgery was 18 to 52�� and that of �ypho� �� and that of �ypho� � and that of �ypho� sis-4 to 49�. Extirpation of the abnormal hemivertebra was performed in 33 (89.2 %) patients� and limited resec� tion-in 4 (10.8 %). Results. Correction of scoliotic deformity after surgical treatment was 85.0% (0-26�)� and correction of �yphotic component-78.6 % (15-23�). Compensatory cranial and caudal counter curves leveled out at the bac�ground of the primary curve correction in all patients. Destabilization of instrumentation requiring repeat surgery was observed in two children. The findings showed the efficacy of the sur� gical treatment by main objective measures in 81.0 % of patients. Conclusion. Progression of congenital spinal deformity with lateral and posterolateral hemivertebrae in the thoracolum� bar junction requires an early radical surgical correction with restoration of the spinal canal anatomy and physiologi� cal curves of the spine at the level of deformity.