Extirpation of the Thoracic and Lumbar Hemivertebrae from the Dorsal Access Using the Ultrasonic Bone Scalpel in Children: The Result of a Prospective Multicenter Study

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Abstract

Background. The surgical treatment of congenital spinal deformity caused by hemivertebra is associated with high rate of complications. A research of a new surgery technique for operation time and blood loss decrease could potentially improve outcomes. The purpose — to evaluate the efficacy of ultrasonic bone scalpel in surgical treatment of pediatric congenital spinal deformities caused by monosegmental hemivertebra. Patients and Methods. Level of Evidence III. The study based on the data of 55 consecutively operated pediatric patients who underwent 59 posterior hemivertebra resection provided by ultrasonic bone scalpel from January 2015 to December 2019. The average age was 4 years and 4 months. 36 hemivertebra were located in thoracic spine and 23 were located in lumbar spine. Total duration of surgery, estimated blood loss (ml and % of circulated blood volume, CBV), complications rate and deformity correction were noted. The influence of posterior instrumentation length and patients age at time of surgery on evaluation parameters was analyzed. 5-year (2015–2019) systematic literature review was performed for compare with obtain results. Results. Total operation time was 131 min ± 33 min for thoracic spine and 165 min ± 50 min for lumbar spine (p = 0,005). Estimated blood loss was 105 ml ± 74 ml (Me 80 ml) for thoracic resection and 123 ml ± 59 ml (Me 120 ml) — for lumbar (p = 0,178). The length of posterior instrumentation were not influence on operation time and total blood loss (p = 0,957; p = 0,967), patients age at time of surgery were not influence on operation time (p = 0,458), but correlate with total blood loss (p = 0,023). Intraoperative complications was not observed. Four cases of transpedicular screw malposition without neurological deficit were noted (type C acc. Gertzbein-Robbins). Conclusions. Posterior hemivertebra resection with ultrasonic bone scalpel is safe and effective procedure provides decrease of operation time and estimated blood loss.

About the authors

D. G. Naumov

St. Petersburg Research Institute of Phthisiopulmonology

Author for correspondence.
Email: dgnaumov1@gmail.com
ORCID iD: 0000-0002-9892-6260

Denis G. Naumov — Cand. Sci. (Med.), Researcher, Orthopedic Surgeon

St. Petersburg

Россия

A. Yu. Mushkin

St. Petersburg Research Institute of Phthisiopulmonology

Email: aymushkin@mail.ru
ORCID iD: 0000-0002-1342-3278

Aleksandr Yu. Mushkin — Dr. Sci. (Med.), Professor, Leading Researcher, Head of the Scientific and Clinical Centre for Spinal Pathology, Head of the Pediatric Surgery and Orthopedic Clinic

St. Petersburg

Россия

E. Yu. Filatov

National Ilizarov Medical Research Center of Traumatology and Orthopaedics

Email: filatov@ro.ru
ORCID iD: 0000-0002-3390-807X

Egor Yu. Filatov — Cand. Sci. (Med.), Researcher

Kurgan

Россия

S. O. Ryabykh

National Ilizarov Medical Research Center of Traumatology and Orthopaedics

Email: rso_@mail.ru
ORCID iD: 0000-0002-8293-0521

Sergey O. Ryabykh — Dr. Sci. (Med.), Head of Spine Pathology and Rare Diseases Clinic, Deputy Director

Kurgan

Россия

O. B. Chelpachenko

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-0333-3105

Sergey O. Ryabykh — Dr. Sci. (Med.), Head of Spine Pathology and Rare Diseases Clinic, Deputy Director

Moscow

Россия

References

  1. Winter R.B., Moe J.H., Eilers V.E. Congenital scoliosis: a study of 234 patients treated and untreated, part I: natural history. J Bone Joint Surg Am. 1968;50(1):1-15.
  2. Ruf M., Jensen R., Letko L., Harms J. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976). 2009;34(17):1791-1799. doi: 10.1097/BRS.0b013e3181ab6290.
  3. Feng Y., Hai Y., Zhao S., Zang L. Hemivertebra resection with posterior unilateral intervertebral fusion and transpedicular fixation for congenital scoliosis: results with at least 3 years of followup. Eur Spine J. 2016;25(10):3274-3281. doi: 10.1007/s00586-016-4556-7.
  4. Ruf M., Harms J. Hemivertebra resection by a posterior approach: innovative operative technique and first results. Spine (Phila Pa 1976). 2002;27(10):1116-1123. doi: 10.1097/00007632-200205150-00020.
  5. Kose K.C., Inanmaz M.E., Altinel L., Bal E., Caliskan I., Isik C., Ergan V. Convex short segment instrumentation and hemi-chevron osteotomies for Putti type 1 thoracic hemivertebrae: a simple treatment option for patients under 5 years old. J Spinal Disord Tech. 2013;26(6): E240-247. doi: 10.1097/BSD.0b013e318288716e.
  6. Рябых С.О., Ульрих Э.В. Экстирпация полупозвонков у детей через корень дуги. Хирургия позвоночника. 2013;(4):30-35. doi: 10.14531/ss2013.4.30-35.
  7. Виссарионов С.В., Картавенко К.А., Кокушин Д.Н., Ефремов А.М. Хирургическое лечение детей с врожденной деформацией грудного отдела позвоночника на фоне нарушения формирования позвонков. Хирургия позвоночника. 2013;(2):32-37. doi: 10.14531/ss2013.2.32-37.
  8. Liu D., Shi B., Shi B., Li Y., Xia S., Liu Z. et al. Partial hemivertebra resection (grade 4 osteotomy) for congenital scoliosis: a comparison with radical hemivertebra resection. World Neurosurg. 2019;130:e1028-e1033. doi: 10.1016/j.wneu.2019.07.070.
  9. Wang Y., Liu Z., Du C., Shi B., Sun X., Wang B. et al. The radiological outcomes of one-stage posterioronly hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up. J Orthop Surg Res. 2019;14(1):426. doi: 10.1186/s13018-019-1482-5.
  10. Erturer R.E., Kilinc B.E., Gokcen B., Erdogan S., Kara K., Ozturk C. The results of hemivertebra resection by the posterior approach in children with a mean followup of five years. Adv Orthop. 2017;2017:4213413. doi: 10.1155/2017/4213413.
  11. Рябых С.О., Филатов Е.Ю., Савин Д.М. Результаты экстирпации полупозвонков комбинированным, дорсальным и педикулярным доступами: систематический обзор. Хирургия позвоночника. 2017;14(1):14-23. doi: 10.14531/ss2017.1.14-23.
  12. Elsamadicy A.A., Adogwa O., Vuong V.D., Mehta A.I., Vasquez R.A., Cheng J. et al. Association of Intraoperative Blood Transfusions on postoperative complications, 30-day readmission rates, and 1-year patient-reported outcomes. Spine. 2017;42(8):610-615. doi: 10.1097/BRS.0000000000001803.
  13. Ma L., Zhang J., Shen J., Zhao Y., Li S., Yu X., Huang Y. Predictors for blood loss in pediatric patients younger than 10 years old undergoing primary posterior hemivertebra resection: a retrospective study. BMC Musculoskelet Disord. 2019;20(1):297. doi: 10.1186/s12891-019-2675-0.
  14. Seicean A., Alan N., Seicean S., Neuhauser D., Weil R.J. The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery. J Clin Neurosci. 2014;21(9):1579-1585. doi: 10.1016/j.jocn.2014.03.003.
  15. Bartley C.E., Bastrom T.P., Newton P.O. Blood loss reduction during surgical correction of adolescent idiopathic scoliosis utilizing an ultrasonic bone scalpel. Spine Deform. 2014;2(4):285-290. doi: 10.1016/j.jspd.2014.03.008.
  16. Мушкин А.Ю., Наумов Д.Г., Уменушкина Е.Ю. Экстирпация грудных и поясничных полупозвонков у детей: как техника операции влияет на ее травматичность? (предварительные результаты и обзор литературы). Травматология и ортопедия России. 2018; 24(3):83-90. doi: 10.21823/2311-2905-2018-24-3-83-90.
  17. Wang S., Zhang J., Qiu G., Li S., Zhang Y., Yang Y., Weng X. Posterior-only hemivertebra resection with anterior structural reconstruction with titanium mesh cage and short segmental fusion for the treatment of congenital scoliokyphosis: the indications and preliminary results. Spine (Phila Pa 1976). 2017;42(22):1687-1692. doi: 10.1097/BRS.0000000000002197.
  18. Guo J., Zhang J., Wang S., Zhang Y., Yang Y., Yang X. et al. Surgical outcomes and complications of posterior hemivertebra resection in children younger than 5 years old. J Orthop Surg Res. 2016;11(1):48. doi: 10.1186/s13018-016-0381-2.
  19. Chang D.G., Kim J.H., Ha K.Y., Lee J.S., Jang J.S., Suk S.I. Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up. Spine (Phila Pa 1976). 2015;40(8):E484-491. doi: 10.1097/BRS.0000000000000809.
  20. Feng Y., Hai Y., Zhao S., Zang L. Hemivertebra resection with posterior unilateral intervertebral fusion and transpedicular fixation for congenital scoliosis: results with at least 3 years of followup. Eur Spine J. 2016;25(10):3274-3281. doi: 10.1007/s00586-016-4556-7.
  21. Zhuang Q., Zhang J., Li S., Wang S., Guo J., Qiu G. One stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up. Eur Spine J. 2016;25(5):1567-1574. doi: 10.1007/s00586-015-3995-x.
  22. Zhang Y., Yang J., Zhou L., Pan A., Hai Y. Selective hemivertebrae resection in a congenital scoliosis patient with multiple hemivertebrae deformities. Eur Spine J. 2017;26(6):1577-1583. doi: 10.1007/s00586-017-4960-7.
  23. Huang Y., Feng G., Liu L., Yang X., Song Y., Zhou C. et al. Posterior hemivertebral resection for upper thoracic congenital scoliosis: be aware of high risk of complications. J Pediatr Orthop B. 2019;28(1):1-9. doi: 10.1097/BPB.0000000000000538.
  24. Qureshi M.A., Pasha I.F., Khalique A.B., Talha M., Afzal W., Ahmad N. et al. Outcome of hemivertebra resection in congenital thoracolumbar kyphosis and scoliosis by posterior approach. J Pak Med Assoc. 2015;65(11 Suppl 3):S142-146.
  25. Basu S., Tikoo A. Posterior hemivertebrectomy and short segment fixation long term results. Child Nerv Syst. 2017;33(2):321-328. doi: 10.1007/s00381-016-3317-6.
  26. Zheng F., Cammisa F.P. Jr., Sandhu H.S., Girardi F.P., Khan S.N. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine. 2002;27(8):818-824. doi: 10.1097/00007632-200204150-00008.
  27. Woods B.I., Rosario B.L., Chen A., Waters J.H., Donaldson W. 3rd , Kang J. et al. The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. J Bone Joint Surg Am. 2013;95(23):21052110. doi: 10.2106/JBJS.L.00979.
  28. Dave B.R., Degulmadi D., Dahibhate S., Krishnan A., Patel D. Ultrasonic Bone Scalpel: Utility in Cervical Corpectomy. A Technical Note. Eur Spine J. 2019;28(2):380-385. doi: 10.1007/s00586-018-5536-x.
  29. Nakase H., Matsuda R., Shin Y., Park Y.S., Sakaki T. The use of ultrasonic bone curettes in spinal surgery (Technical note). Acta Neurochir. 2006;148:207-213. doi: 10.1007/s00701-005-0655-7.
  30. Wahlquist S., Nelson S., Glivar P. Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery. Spine Deform. 2019;7(4):582-587. doi: 10.1016/j.jspd.2018.10.002.

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