MULTIMODAL SURGICAL TREATMENT OF SEVERE SCOLIOSIS USING CONCAVE THORACOPLASTY
https://doi.org/10.14531/ss2012.2.37-43
Abstract
Objective. To analyze results of multimodal surgical treatment of patients with severe scoliosis involving concave thoracoplasty.
Material and Methods. A total of 40 patients aged from 12 to 31 years with spinal deformities of 70-150° were operated on with posterior CD instrumentation combined with elevating thoracoplasty on the concave side of the thorax deformity. Mean follow-up period was 2 years. Dynamics of the respiratory function was studied. Patients underwent X-ray and CT examinations of the spine, and appearance assessment.
Results. The mean preoperative Cobb angle of the major thoracic curve was 101° (range: 70-150°), and postoperative - 47°; postoperative correction was 54° (53 %). The loss of correction was not practically registered at the immediate and long-term follow-up. The mean preoperative Cobb angle of the compensatory lumbar curve was 50.5°, and postoperative - 20.6°. The mean thoracic kyphosis was 51° before surgery and 28.7° after surgery. The mean lung vital capacity was 56.3 % before surgery, and 66.5% in 12 months after surgery.
Conclusion. Concave thoracoplasty provides increased mobility of the deformity, and improvement of stabilization, cosmetic and functional results of surgical treatment of patients with severe scoliosis. Hir. Pozvonoc. 2012;(2):37-43.
About the Authors
Aleksandr Alekseyevich Kuleshov
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
S. T. Vetrile
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
I. N. Lisyansky
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
Marchel Stepanovich Vetrile
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
R. G. Zakharin
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
V. G. Guseynov
The Priorov Central Institute of Traumatology and Orthopaedics, Moscow
Russian Federation
Russian Federation
References
1. Васюра А.С., Новиков В.В., Михайловский М.В. и др. Некоторые особенности оперативного лечения тяжелых форм идиопатического сколиоза подростков // Хирургия позвоночника. 2006. № 3. С. 29-37.
2. Вишневский А.А., Рудаков С.С., Миланов Н.О. Хирургия грудной стенки. М., 2005.
3. Губина Е.В. Резекция реберного горба в хирургическом лечении идиопатического сколиоза: Дис. … канд. мед. наук. Новосибирск, 2007.
4. Заявка № 2010143967/14(063358) Российская Федерация. Способ хирургического лечения тяжелых сколиозов с коррекцией вогнутой деформации грудной клетки / Кулешов А.А., Ветрилэ С.Т., Швец В.В. и др.; приоритет 28.10.2010.
5. Кулешов А.А. Тяжелые формы сколиоза. Оперативное лечение и функциональные особенности некоторых органов и систем: Дис. … д-ра мед. наук. М., 2007.
6. Михайловский М.В., Лебедева М.Н., Садовая Т.Н. и др. Ближайшие и отдаленные результаты хирургического лечения пациентов со сверхтяжелыми формами идиопатического сколиоза // Хирургия позвоночника. 2009. № 2. С. 38-47.
7. Шевченко С.Д. Хирургическая коррекция позвоночника и грудной клетки при тяжелых формах сколиоза: Дис. … д-ра мед. наук. Харьков, 1983.
8. El Masry MA, Saleh AM, McWilliams AB, et al. Concave rib osteotomy: a modified techique revisited. Eur Spine J. 2007; 16: 1600-1603.
9. Goldstein LA. American Academy of Orthopaedic Surgeons: Symposium on the spine. Concave rib resection and ligament release for correction of idiopathic scoliosis. St Louis, Mosby, 1969.
10. Halsall AP, James DF, Kostuik JP, et al. An experimental evaluation of spinal flexibility with respect to scoliosis surgery. Spine. 1983; 8: 482-488.
11. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees). Spine. 2008; 33: 979-983.
12. Harding IJ, Chopin D, Charosky S, et al. Longterm results of Schollner costoplasty in patients with idiopathic scoliosis. Spine. 2005; 30: 1627-1631.
13. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2006; 31: 291-298.
14. Kuklo TR, Lenke LG, O`Brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine. 2005; 30: 222-226.
15. Mann DC, Nash CLJr, Wilham MR, et al. Evaluation of the role of concave rib osteotomies in the correction of thoracic scoliosis. Spine. 1989; 14: 491-495.
16. Rinella A, Lenke L, Whitaker C, et al. Perioperativ halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine. 2005; 30: 475-482.
17. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine. 2005; 30: 1682-1687.
18. Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine. 2003; 28: 484-491.
19. Zhang HQ, Wang YX, Guo CF, et al. Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more then 100°. Int Orthop. 2011; 35: 1037-1042.
Review
For citations:
Kuleshov A.A., Vetrile S.T., Lisyansky I.N., Vetrile M.S., Zakharin R.G., Guseynov V.G. MULTIMODAL SURGICAL TREATMENT OF SEVERE SCOLIOSIS USING CONCAVE THORACOPLASTY. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2012;(2):37-43. (In Russ.) https://doi.org/10.14531/ss2012.2.37-43
Email this article 