THE CHOICE OF SURGICAL APPROACH FOR CONGENITAL SPINAL DEFORMITY CAUSED BY MULTIPLE VERTEBRAL MALFORMATIONS
https://doi.org/10.14531/ss2014.2.21-28
Abstract
Objective. To perform retrospective review of the natural history of spinal deformities caused by multiple vertebral malformations and to develop an algorithm for surgical correction with regard to a leading malformation.
Material and Methods. Treatment results in 94 patients aged 5 months to 33 years with congenital spinal deformities and multiple vertebral malformations were reviewed. Surgery was performed in 81 patients who were followed-up for 6 months to 5 years. Vertebral and thoracic syndromes, neurological dynamics, and functional disorders were evaluated. An algorithm for detection of the leading malformation was applied to predict a natural course of spinal deformity associated with multiple malformations and to choose a surgical approach.
Results. Patients were divided into four groups depending on the type of multiple vertebral anomalies: monosegmental (isolated), polysegmental, outspread multiple, and complicated. The approach to choosing of surgical tactics was offered.
Conclusion. Indications for surgical treatment of spinal deformities caused by multiple vertebral malformations appear to be life-saving. Surgical treatment for this cohort of patients may be performed only after comprehensive examination. The identification of leading malformation is necessary to determine the volume of surgical intervention.
About the Author
Sergey Olegovich RyabykhRussian Federation
References
1. Губин А.В., Ульрих Э.В., Рябых С.О. Перспективы оказания помощи детям младшего и ювенильного возраста с хирургической патологией позвоночника // Гений ортопедии. 2011. № 2. С. 123-127.
2. Пат. № 2484783 Российская Федерация. Способ резекции полупозвонков грудной и поясничной локализации доступом через корень дуги / Рябых С.О., Ульрих Э.В.; заявл. 28.12.2011; опубл. 20.06.2013.
3. Пат. № 2495633 Российская Федерация. Способ спондилэктомии доступом через корень дуги. / Рябых С.О., Прудникова О.Г., Кобызев А.Е., Хомченков М.В.; заявл. 02.04.2012; опубл. 20.10.2013.
4. Рябых С.О. Деформации позвоночника и грудной клетки при нарушениях сегментации у детей младшего возраста: Дис. … канд. мед. наук. СПб., 2009.
5. Рябых С.О., Савин Д.М. Возможности оперативного лечения кифозов III типа методом «Pedicle subtraction osteotomy» // Гений ортопедии. 2013. № 1. С. 120-123.
6. Рябых С.О., Ульрих Э.В. Применение инструментария VEPTR при деформации позвоночника у детей младшего возраста, обусловленной нарушением сегментации // Гений ортопедии. 2012. № 3. С. 34-38.
7. Рябых С.О., Ульрих Э.В. Синдром торакальной недостаточности при врожденном сколиозе // Вестн. хирургии им. И.И. Грекова. 2011. № 4. С. 73-78.
8. Соловьева К.С., Битюков К.А., Долженко Н.В. и др. Амбулаторная ортопедическая служба Санкт-Петербурга // Совершенствование травматолого-ортопедической помощи детям: Тез. докл. симпозиума детских травматологов-ортопедов России с междунар. участием. СПб., 2008. С. 45-47.
9. Ульрих Э.В., Мушкин А.Ю. Вертебрология в терминах, цифрах, рисунках. СПб., 2002. C. 186.
10. Ульрих Э.В., Мушкин А.Ю. Хирургическое лечение пороков развития позвоночника у детей. СПб., 2007.
11. Ульрих Э.В., Мушкин А.Ю., Губин А.В. Врожденные деформации позвоночника у детей: прогноз эпидемиологии и тактика ведения // Хирургия позвоночника. 2009. № 2. С. 55-61.
12. Akbarnia BA, Yazici M, Thompson GH, eds. The Growing Spine: Management of Spinal Disorders in Young Children. Springer, 2010.
13. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine. 2006; 31(19 Suppl): S171-S178.
14. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am. 2004; 86(Suppl 1): 44-50.
15. Campbell RM Jr, Smith MD. Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am. 2007; 89(Suppl 1): 108-122.
16. Campbell RM Jr, Smith MD, Maves TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003; 85: 399-408.
17. Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg Am. 2008; 90: 2509-2520. doi: 10.2106/JBJS.H.00081.
18. Lonstein JE. Congenital spine deformities: scoliosis, kyphosis, and lordosis. Orthop Clin North Am. 1999; 30(3): 387-405.
19. McMaster MJ. Congenital scoliosis caused by a unilateral failure of vertebral segmentation with contralateral hemivetebrae. Spine. 1998; 23: 998-1005.
20. McMaster MJ. Congenital scoliosis. In: Weinstein SL, ed. The Pediatric Spine: Principles and Practice. New York, 1994: 2255-2259.
21. Ryabykh SО, Gubin AV, Prudnikova CO, et al. Treatment of combined spinal deformity in patients with Ollier disease and abnormal vertebrae. Global Spine J. 2013; 3: 109-114. doi: 10.1055/s-0032-1329891
22. Tsirikos AI, McMaster MJ. Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Joint Surg Am. 2005; 87: 2523-2536.
23. Winter RB, Lonstein JE, Boachie-Adjei O. Congenital spinal deformity. Instr Course Lect. 1996; 45: 117-127.
Review
For citations:
Ryabykh S.O. THE CHOICE OF SURGICAL APPROACH FOR CONGENITAL SPINAL DEFORMITY CAUSED BY MULTIPLE VERTEBRAL MALFORMATIONS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2014;(2):21-28. (In Russ.) https://doi.org/10.14531/ss2014.2.21-28