PREOPERATIVE PLANNING OF POSTERIOR SPINAL FUSION EXTENT FOR CONGENITAL SCOLIOSIS

Abstract

Objective. To develop algorithm for planning of surgical intervention in patients with progressing congenital scoliosis.

Materials and methods. The results of surgical treatment of 35 patients with various modifications of Cotrel - Dubousset instrumentation (CDI) were studied. Out of them 29 patients were women and 6 - men. The age varied from 5 to 39 years (М = 15,4 years). All patients were divided in two groups. In the first group (n = 25) the algorithm of planning depending on apex localization of a blocking basic arch in the curve, and also on inclusion in the block of its mobile and rigid levels adjacent to basic arch was used. Five subgroups of deformity localization were differentiated: upper thoracic, thoracic, thoracolumbar, lumbar and lumbosacral, according to which 5 algorithmic block diagrams were offered. In the second group (n=10) the offered algorithm was not used. Follow-up terms were from half a year to three years.

Results. Use of the offered algorithm in the patients of the first group allowed achieving good results. The absence of algorithmic planning in the second group resulted in unsatisfactory results (deformity progression, trunk misbalance) in many patients.

Conclusions. Use of an offered method provides precise determination of the spinal fusion extent of the basic and compensating arches, permitting to reduce the number of cases of deformity postoperative progression and trunk decompensation development, and thus the necessity of reoperations.