Influence of destructive changes and surgical correction on the parameters of sagittal balance of the cervical spine in children

Objective. To analyze dynamics of changes in the parameters of the sagittal balance of the cervical spine against the background of surgical treatment of destructive tumor and infectious inflammatory pathology of the cervical vertebrae in children.

Material and Methods. Design: retrospective-prospective monocentric cohort. A total of 81 radiographs of the cervical spine in a standing position before and after surgery in children operated on for vertebral tumors and cervical spondylitis were selected. The 10 most common parameters were measured: angular values of Oc–C2, C2–C7, C7S, T1S, TIA, NT, CeT, CrT, SCA, as well as the cSVA distance measured in mm. The material was statistically processed using nonparametric analysis methods.

Results. In case of suboccipital lesions, the most significant changes were in the Oc–C2 and CrT parameters, in case of subaxial lesions — Oc–C2, C2–C7, and in case of cervicothoracic junction lesions — C2–C7, C7S, T1S, TIA, NT, CeT, and CrT. Significant difference  between the groups was noted only for NT parameter between the norm and the group of cervicothoracic junction pathology after surgery (p = 0.0190). In case of tuberculous spondylitis, the greatest changes were noted in TIA, NT, CeT, SCA and cSVA parameters. Significant differences were also revealed only for NT parameter between the postoperative groups of tuberculous spondylitis and tumors (p = 0.0016), as well as between the group of tuberculous spondylitis after surgery and the norm group (p = 0.0013). In case of extensive (3 or more vertebrae) destruction, the NT parameter differed from the norm both before (p = 0.0174) and after (p = 0.0059) surgical treatment. The cSVA parameter differed from the norm in case of short destructions only before surgical correction (p = 0.0195), while in case of extensive destructions it differed from the norm only after surgical reconstruction (p = 0.0212).

Conclusion. Studying the issues of spine biomechanics in pathological conditions allows for better understanding the changes that occur and propose effective methods for correcting and restoring the normal anatomy of the segment.

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