Результаты хирургического лечения сколиоза с ранним началом с применением принципа растущих систем: анализ 10-летней моноцентровой когорты

Цель исследования. Оценка ранних и среднесрочных результатов хирургического лечения сколиозов с ранним началом с применением принципа растущих систем.

Материал и методы. Проведен ретроспективный анализ историй болезней 54 пациентов, в лечении которых использовали хирургические дистрагируемые металлоконструкции. Пациентов разделили на 4 этиологические группы: врожденный сколиоз (n = 17), системный (n = 12), идиопатический (n = 16), нейрогенный (n = 9). Соотношение мальчиков и девочек составило 11 : 43. Средний возраст начала лечения пациентов – 9,6 года, окончания – 13,2 года.

Результаты. Проведена оценка рентгенометрических показателей в процессе и после завершения лечения. Угол основной дуги деформации по Cobb перед началом лечения составил в среднем 56,1°, после первичной операции – 31,8°, после завершения лечения — 23,2°. Коррекция основной дуги деформации за весь период многоэтапного оперативного лечения – 57,8 %. Самый высокий показатель исходной величины деформации отмечен в группе нейромышечного сколиоза — 67,6°, самый низкий при врожденной патологии — 50,4°, в группах системного и идиопатического сколиоза показатели оказались очень близки: до операции 57,6°  – при идиопатическом и 53,4° – при системном. По результатам этапного лечения в группе нейромышечного сколиоза величина остаточной кривизны основной дуги была самой низкой, а процент коррекции самым высоким – 18,9° и 73,6 % против 24,5° и 49,7 % в группе врожденного сколиоза. Результативность лечения с оценкой процента коррекции после финальной инструментации в группах идиопатического и системного сколиоза оказалась близка: 23,0° и 62,3 %; 28,5° и 51,5 % соответственно. Отмечены идентичные средние показатели угла основной дуги после финальной инструментации во всех четырех этиологических группах (в среднем 23,2°). Изменения показателей грудного кифоза и поясничного лордоза оказались незначительны. За время лечения проведено 22 внеплановых оперативных вмешательства у 15 пациентов.

Заключение. Данное исследование выявило ряд ключевых моментов, которые в перспективе могут помочь в формировании более четких алгоритмов помощи выбора оптимальной методики: нейрогенные сколиозы наиболее успешно поддаются коррекции растущими системами; врожденные сколиозы показывают менее выраженную коррекцию деформации и большее относительное количество осложнений на одного пациента при изолированном применении растущих систем, что требует настороженности при этапном оперативном лечении.

1. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP Jr, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am. 2014;96:1359–1367. DOI: 10.2106/JBJS.M.00253.

2. Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine 2005;30(17 Suppl):S46–S57. DOI: 10.1097/01.brs.0000175190.08134.73.

3. Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK, Kostial PN, Tambe A, Asher MA. Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine. 2008;33:984–990. DOI: 10.1097/BRS.0b013e31816c8b4e.

4. Akbarnia BA. Management themes in early onset scoliosis. J Bone Joint Surg Am. 2007;89 Suppl 1:42–54. DOI: 10.2106/JBJS.F.01256.

5. Helenius IJ. Treatment strategies for early-onset scoliosis. EFORT Open Rev. 2018;3:287–293. DOI: 10.1302/2058-5241.3.170051.

6. Tyebkhan G. Declaration of Helsinki: the ethical cornerstone of human clinical research. Indian J Dermatol Venereol Leprol. 2003;69:245–247.

7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. DOI: 10.1097/01.sla.0000133083.54934.ae.

8. R Core Team (2023). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. [Electronic resource]. Avaiable at: https://www.R-project.org/

9. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine. 1992;17:1091–1096. DOI: 10.1097/00007632-199209000-00014.

10. Guzek RH, Murphy R, Hardesty CK, Emans JB, Garg S, Smith JT, Roye BD, Glotzbecker MP, Sturm PF, Snyder BD, Poon SC, Poe-Kochert C, Anari JB. Mortality in early-onset scoliosis during the growth-friendly surgery era. J Pediatr Orthop. 2022;42:131–137. DOI: 10.1097/BPO.0000000000001983.

11. Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, Pinero RF, Alder ME, Duong HL, Surber JL. The characteristics of thoracic insufficiency syndrome associated with fused ribs and scoliosis. J Bone Joint Surg Am. 2003;85:399–408. DOI: 10.2106/00004623-200303000-00001.

12. Рябых С.О., Ульрих Э.В. Возможности коррекции односторонней гипоплазии грудной клетки при деформациях позвоночника у детей с большой потенцией роста // Гений ортопедии. 2011. № 4. С. 44–48. [Riabykh SO, Ulrich EV. Possibilities of unilateral chest hypoplasia correction for the spine deformities in children with great growth potency. Genij Ortopedii. 2011;(4):44–48].

13. Михайловский М.В., Суздалов В.А., Долотин Д.Н., Садовая Т.Н. Результаты многоэтапного хирургического лечения сколиозов I декады жизни с применением инструментария VEPTR. // Хирургия позвоночника. 2017. Т. 14. № 3. С. 8–14. [Mikhaylovskiy MV, Suzdalov VA, Dolotin DN, Sadovaya TN. Results of multistage surgical treatment of scoliosis in the first decade of life using VEPTR instrumentation. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2017;14(3): 8–14]. DOI: 10.14531/ss2017.3.8-14.

14. Михайловский М.В., Альшевская А.А. Магнитно-контролируемые стержни в хирургии ранних сколиозов: обзор англоязычной литературы // Хирургия позвоночника. 2020. Т. 17. № 1. С. 25–41. [Mikhaylovskiy MV, Alshevskaya AA. Magnetically controlled growing rods in early onset scoliosis surgery: a review of English-language literature. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(1):25–41]. DOI: 10.14531/ss2020.1.25-41.

15. Gaume M, Hajj R, Khouri N, Johnson MB, Miladi L. One-way self-expanding rod in neuromuscular scoliosis preliminary results of a prospective series of 21 patients. JB JS Open Access. 2021;6:e21.00089. DOI: 10.2106/JBJS.OA.21.00089.

16. Chen ZX, Kaliya-Perumal AK, Niu CC, Wang JL, Lai PL. In vitro biomechanical validation of a self- adaptive ratchet growing rod construct for fusionless scoliosis correction. Spine. 2019;44:E1231–E1240. DOI: 10.1097/BRS.0000000000003119.

17. Floman Y, El-Hawary R, Millgram MA, Lonner BS, Betz RR. Surgical management of moderate adolescent idiopathic scoliosis with a fusionless posterior dynamic deformity correction device: interim results with bridging 5-6 disc levels at 2 or more years of follow-up. J Neurosurg Spine. 2020;32:748–754. DOI: 10.3171/2019.11.SPINE19827.

18. Lemans JVC, Wijdicks SPJ, Castelein RM, Kruyt MC. Spring distraction system for dynamic growth guidance of early onset scoliosis: two-year prospective follow-up of 24 patients Spine J. 2021;21:671–681. DOI: 10.1016/j.spinee.2020.11.007.

19. Молотков Ю.В., Рябых С.О., Филатов Е.Ю., Сергеенко О.М., Хужаназаров И.Э., Эшкулов Д.И. Эффективность применения растущих систем в лечении сколиозов c ранним началом: систематизированный обзор // Хирургия позвоночника. 2023. Т. 20. № 2. С. 6–20. [Molotkov YuV, Ryabykh SO, Filatov EYu, Sergeenko OM, Khuzhanazarov IE, Eshkulov DI. The effectiveness of growth-friendly systems in the treatment of early onset scoliosis: a systematic review. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2023;20(2):6–20].

20. DOI: 10.14531/ss2023.2.6-20.

21. Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014:14:579. DOI: 10.1186/s12913-014-0579-0.

22. Xu L, Qiu Y, Chen Z, Shi B, Chen X, Li S, Du C, Zhu Z, Sun X. A re-evaluation of the effects of dual growing rods on apical vertebral rotation in patients with early-onset scoliosis and a minimum of two lengthening procedures: a CT-based study. J Neurosurg Pediatr. 2018;22:306–312. DOI: 10.3171/2018.3.PEDS1832.

23. Liang J, Li S, Xu D, Zhuang Q, Ren Z, Chen X, Gao N. Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis. Clin Neurol Neurosurg. 2015;136:15–19. DOI: 10.1016/j.clineuro.2015.05.026.

24. Wijdicks SPJ, Tromp IN, Yazici M, Kempen DHR, Castelein RM, Kruyt MC. A comparison of growth among growth-friendly systems for scoliosis: a systematic review. Spine J. 2019;19:789–799. DOI: 10.1016/j.spinee.2018.08.017.

25. Helenius IJ, Saarinen AJ, White KK, McClung A, Yazici M, Garg S, Thompson GH, Johnston CE, Pahys JM, Vitale MG, Akbarnia BA, Sponseller PD. Results of growth-friendly management of early-onset scoliosis in children with and without skeletal dysplasias: a matched comparison. Bone Joint J. 2019;101-B:1563–1569. DOI: 10.1302/0301-620X.101B12.BJJ-2019-0735.R1.

26. Zarei M, Tavakoli M, Ghadimi E, Moharrami A, Nili A, Vafaei A, Zadeh SST, Baghdadi S. Complications of dual growing rod with all- pedicle screw instrumentation in the treatment of early-onset scoliosis. J Orthop Surg Res. 2021;16:112. DOI: 10.1186/s13018-021-02267-y.

27. Jiang H, Hai JJ, Yin P, Su Q, Zhu S, Pan A, Wang Y, Hai Y. Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study. J Orthop Surg Res. 2021;16:483. DOI: 10.1186/s13018-021-02639-4.

28. Wang S, Zhang J, Qiu G, Wang Y, Li S, Zhao Y, Shen J, Weng X. Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary result of a single center. Spine. 2012;37:E1639–1644. DOI: 10.1097/BRS.0b013e318273d6bf.

29. Jain VV, Berry CA, Crawford AH, Emans JB, Sponseller PD. Growing rods are an effective fusionless method of controlling early-onset scoliosis associated with neurofibromatosis type 1 (NF1): a multicenter retrospective case series. J Pediatr Orthop. 2017;37:e612–e618. DOI: 10.1097/BPO.0000000000000963.

30. Chen Z, Qiu Y, Zhu Z, Li S, Chen X, Sun X. How does hyperkyphotic early-onset scoliosis respond to growing rod treatment? J Pediatr Orthop. 2017;37:e593–e598. DOI: 10.1097/BPO.0000000000000905.

31. Arandi NR, Pawelek JB, Kabirian N, Thompson GH, Emans JB, Flynn JM, Dormans JP, Akbarnia BA. Do thoracolumbar/lumbar curves respond differently to growing rod surgery compared with thoracic curves? Spine Deform. 2014;2:475–480. DOI: 10.1016/j.jspd.2014.04.002.

32. Luhmann SJ, Smith JC, McClung A, McCullough FL, McCarthy RE, Thompson GH. Radiographic outcomes of Shilla Growth Guidance System and traditional growing rods through definitive treatment. Spine Deform. 2017;5:277–282. DOI: 10.1016/j.jspd.2017.01.011.

33. Jayaswal A, Kandwal P, Goswami A, Vijayaraghavan G, Jariyal A, Upendra BN, Gupta A. Early onset scoliosis with intraspinal anomalies: management with growing rod. Eur Spine J. 2016;25:3301–3307. DOI: 10.1007/s00586-016-4566-5.

34. Chiba T, Inami S, Moridaira H, Takeuchi D, Sorimachi T, Ueda H, Ohe M, Aoki H, Iimura T, Nohara Y, Taneichi H. Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis. J Neurosurg Spine. 2020;33:607–612. DOI: 10.3171/2020.4.SPINE2036.

35. Bouthors C, Dukan R, Glorion C, Miladi L. Outcomes of growing rods in a series of early-onset scoliosis patients with neurofibromatosis type 1. J Neurosurg Spine. 2020;33:373–380. DOI: 10.3171/2020.2.SPINE191308.

36. Chen Z, Li S, Qiu Y, Zhu Z, Chen X, Xu L, Sun X. Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation? J Neurosurg Pediatr. 2017;20:

37. –566. DOI: 10.3171/2017.7.PEDS17233.

38. Yang B, Xu L, Qiu Y, Wang M, Du C, Wang B, Zhu Z, Sun X. Mismatch between proximal rod contour angle and proximal junctional angle: a risk factor associated with proximal junctional kyphosis after growing rods treatment for early-onset scoliosis. Preprint. 2020. DOI: 10.21203/rs.3.rs-129851/v1.

39. Yehia MA, Soliman HAG, Sayed AM. Dual growing rod technique for the treatment of early-onset scoliosis. Life Sci J. 2020;17:58–64. DOI:10.7537/marslsj170220.09.

40. Helenius IJ, Oksanen HM, McClung A, Pawelek JB, Yazici M, Sponseller PD, Emans JB, Sanchez Perez-Grueso FJ, Thompson GH, Johnston C, Shah SA, Akbarnia BA. Outcomes of growing rod surgery for severe compared with moderate early-onset scoliosis: a matched comparative study. Bone Joint J. 2018;100-B:772–779. DOI: 10.1302/0301-620X.100B6.BJJ-2017-1490.R1.

41. Chang WC, Hsu KH, Feng CK. Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures. J Child Orthop. 2021;15:451–457. DOI: 10.1302/1863- 2548.15.210021.

42. Bachabi M, McClung A, Pawelek JB, El Hawary R, Thompson GH, Smith JT, Vitale MG, Akbarnia BA, Sponseller PD. Idiopathic early-onset scoliosis: growing rods versus vertically expandable prosthetic titanium ribs at 5-year follow-up. J Pediatr Orthop. 2020;40:142–148. DOI: 10.1097/BPO.0000000000001202.

43. Klyce W, Mitchell SL, Pawelek J, Skaggs DL, Sanders JO, Shah SA, McCarthy RE, Luhmann SJ, Sturm PF, Flynn JM, Smith JT, Akbarnia BA, Sponseller PD. Characterizing use of growth-friendly implants for early-onset scoliosis: a 10-year update. J Pediatr Orthop. 2020;40:e740–e746. DOI: 10.1097/BPO.0000000000001594.

44. Cobanoglu M, Yorgova P, Neiss G, Pawelek JB, Thompson GH, Skaggs DL, Jain VV, Akbarnia BA, Shah SA. Prevalence of junctional kyphosis in early onset scoliosis: can it be corrected at final fusion? Eur Spine J. 2021;30:3563–3569.

45. DOI: 10.1007/s00586-021-06968-0.

46. Paloski MD, Sponseller PD, Akbarnia BA, Thompson GH, Skaggs DL, Pawelek JB, Nguyen PT, Odum SM. Is there an optimal time to distract dual growing rods? Spine Deform. 2014;2:467–470. DOI: 10.1016/j.jspd.2014.08.002.

47. Upasani VV, Parvaresh KC, Pawelek JB, Miller PE, Thompson GH, Skaggs DL, Emans JB, Glotzbecker MP. Age at initiation and deformity magnitude influence complication rates of surgical treatment with traditional growing rods in early-onset scoliosis. Spine Deform. 2016;4:344–350. DOI: 10.1016/j.jspd.2016.04.002.

48. Larson AN, Baky FJ, St Hilaire T, Pawelek J, Skaggs DL, Emans JB, Pahys JM. Spine deformity with fused ribs treated with proximal rib- versus spine-based growing constructs. Spine Deform. 2019;7:152–157. DOI: 10.1016/j.jspd.2018.05.011.

49. Matsumoto H, Fields MW, Roye BD, Roye DP, Skaggs D, Akbarnia BA, Vitale MG. Complications in the treatment of EOS: Is there a diference between rib vs. spine based proximal anchors? Spine Deform. 2021;9:247–253. DOI: 10.1007/s43390-020-00200-7.

50. Waldhausen JHT, Redding G, White K, Song K. Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children. J Pediatr Surg. 2016;51:1747–1750. DOI: 10.1016/j.jpedsurg.2016.06.014.

51. Peiro-Garcia A, Bourget-Murray J, Suarez-Lorenzo I, Ferri-De-Barros F, Parsons D. Early complications in vertical expandable prosthetic titanium rib and magnetically controlled growing rods to manage early onset scoliosis. Int J Spine Surg. 2021;15:368–375. DOI: 10.14444/8048.

52. Upasani VV, Miller PE, Emans JB, Smith JT, Betz RR, Flynn JM, Glotzbecker MP. VEPTR implantation after age 3 is associated with similar radiographic outcomes with fewer complications. J Pediatr Orthop. 2016;36:219–225. DOI: 10.1097/BPO.0000000000000431.

53. El-Hawary R, Samdani A, Wade J, Smith M, Heflin JA, Klatt JW, Vitale MG, Smith JT. Rib-based distraction surgery maintains total spine growth. J Pediatr Orthop. 2016;36:841–846. DOI: 10.1097/BPO.0000000000000567.

54. El-Hawary R, Kadhim M, Vitale M, Smith J, Samdani A, Flynn JM. VEPTR implantation to treat children with early-onset scoliosis without rib abnormalities: early results from a prospective multicenter study. J Pediatr Orthop. 2017;37:e599–e605. DOI: 10.1097/BPO.0000000000000943.

55. Studer D, Buchler P, Hasler CC. Radiographic outcome and complication rate of 34 graduates after treatment with vertical expandable prosthetic titanium rib (VEPTR): a single centre report. J Pediatr Orthop. 2019;39:e731–e736. DOI: 10.1097/BPO.000000000000133.

56. Qiu C, Lott C, Agaba P, Cahill PJ, Anari JB. Lengthening less than 7 months leads to greater spinal height gain with rib-based distraction. J Pediatr Orthop.2020;40:e747–e752. DOI: 10.1097/BPO.0000000000001625.

57. Heflin JA, Cleveland A, Ford SD, Morgan JV, Smith JT. Use of rib-based distraction in the treatment of early-onset scoliosis associated with neurofibromatosis type 1 in the young child. Spine Deform. 2015;3:239–245. DOI: 10.1016/j.jspd.2014.10.003.

58. Saarinen AJ. Safety and Quality of Surgical Treatment of Early Onset Scoliosis. Doctoral Dissertation, University of Turku, 2022.

59. Luhmann SJ, McCarthy RE. A comparison of Shilla Growth Guidance System and growing rods in the treatment of spinal deformity in children less than 10 years of age. J Pediatr Orthop . 2017;37:e567–e574. DOI: 10.1097/BPO.0000000000000751.

60. McCarthy RE, McCullough FL. Shilla Growth Guidance for early-onset scoliosis results after a minimum of five years of follow-up. J Bone Joint Surg Am. 2015;97:1578–1584. DOI: 10.2106/JBJS.N.01083.

61. Nazareth A, Skaggs DL, Illingworth KD, Parent S, Shah SA, Sanders JO, Andras LM. Growth guidance constructs with apical fusion and sliding pedicle screws (SHILLA) results in approximately 1/3rd of normal T1–S1 growth. Spine Deform. 2020;8:531–535. DOI: 10.1007/s43390-020-00076-7.

62. Hardesty CK, Huang RP, El-Hawary R, Samdani A, Hermida PB, Bas T, Balioglu MB, Gurd D, Pawelek J, McCarthy R, Zhu F, Luhmann S. Early-onset scoliosis: updated treatment techniques and results. Spine Deform. 2018;6:467–472. DOI: 10.1016/j.jspd.2017.12.012.

63. Wang S, Zhao Y, Yang Y, Lin G, Shen J, Zhao Y, Wu N, Zhuang Q, Du Y, Zhang J. Hybrid technique versus traditional dual growing rod technique to treat congenital early-onset scoliosis: a comparative study with more than 3 years of follow-up. J Neurosurg Spine. 2022;38:199–207. DOI: 10.3171/2022.8.SPINE22618.