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

Рябых, С. О.; Ulrikh, Eduard; Mushkin, Aleksandr; Губин, А.В.

doi:10.14531/ss2020.1.15-24

Hir. pozvonoč.

2020

DOI: 10.14531/ss2020.1.15-24

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

С. О. Рябых

Eduard Ulrikh

Aleksandr Mushkin

et al.

Abstract: 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 p… Show more

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Cited by 3 publications

References 65 publications

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Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study

Makarova,

Alshaowa,

Maslak

et al. 2024

Vopr. sovr. pediatr.

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Background. The effect of spinal deformity surgical correction in children with severe neuromuscular scoliosis (NMS) on lung function remains unexplored.Objective. The aim of the study is to — to survey the dynamics of volume and structure of lungs pneumatization in children after surgical correction of severe neuromuscular deformities of the spine complicated by respiratory disorders.Methods. CT scans of lungs from 5 children with right-sided NMS, grade IV (Cobb angle < 50°) and functional respiratory disorders (lung capacity < 30% of normal value according to spirometry data and/or clinical signs of respiratory failure) were retrospectively studied. Right and left lungs volumes, their ratio (asymmetry index), indicators of distribution of tissue density of each lung (as a percentage of total volume) before (not earlier than 2 months) and after (not later than 3 months) surgical correction of scoliosis were determined via the data processing from CT scans of the thoracic spine.Results. All children had both lung volumes below reference values (healthy peers) before surgery. The right lung volume increased by 11% (6.4–40.6%), the left lung — by 41% (22.5–90%) with the asymmetry index approaching the reference values for the corresponding age after correction of spinal deformity (the value of scoliotic deformity decreased (median) from 94 to 68°). The volume of normal ventilation zones increased from 30 to 50% on the right side, and from 41 to 55% on the left side, primarily due to decrease in the volume of hypoventilation zones, but not atelectasis and emphysema.Conclusion. Surgical correction of spinal deformity in children with NMS, grade IV, complicated with respiratory failure led to normalization of lungs volume and tissue density characteristics already in the early postoperative period.

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Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study

Makarova,

Alshaowa,

Maslak

et al. 2024

Vopr. sovr. pediatr.

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Assessment of the efficacy of treatment for children with congenital scoliosis with unsegmented bar and rib synostosis

Vissarionov

Asadulaev²,

Orlova³

et al. 2022

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical. AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis. MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 114 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data. RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74 (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16 (IQR, 11) and the second correction achieved 6 (IQR, 13). The Me kyphosis was 15 (IQR, 32), the first intervention improved kyphosis by 4 (IQR, 16), and the second by 6 (IQR, 11). Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p 0,01). CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.

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Analysis of vertebrotomy treatment in children with congenital scoliosis with unsegmented rod and rib synostosis

Asadulaev,

Vissarionov,

Shabunin

et al. 2024

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome. AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy. MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used. RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function. CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.

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

Cited by 3 publications

References 65 publications

Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study

Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study

Assessment of the efficacy of treatment for children with congenital scoliosis with unsegmented bar and rib synostosis

Analysis of vertebrotomy treatment in children with congenital scoliosis with unsegmented rod and rib synostosis

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