Email this article 
SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL LUMBAR SCOLIOSIS: COMPLETE OR PARTIAL RESECTION OF MALFORMED VERTEBRAE?
- Authors: Vissarionov S.V.1,2, Kartavenko K.A.1, Kokushin D.N.1, Baindurashvili A.G.1,2, Belyanchikov S.M.1, Khusainov N.O.1, Ovechkina А.V.1
-
Affiliations:
- Turner Scientific and Research Institute for Children’s Orthopedics
- Mechnikov North-Western State Medical University
- Issue: Vol 23, No 4 (2017)
- Pages: 18-28
- Section: Clinical studies
- Submitted: 26.12.2017
- Accepted: 26.12.2017
- Published: 26.12.2017
- URL: https://journal.rniito.org/jour/article/view/827
- DOI: https://doi.org/10.21823/2311-2905-2017-23-4-18-28
- ID: 827
Cite item
Full Text
Abstract
The purpose of the study – to compare the effectiveness of surgical correction of spine lumbar congenital deformity by complete or partial resection of the abnormal vertebra in children.
Material and methods. 68 children with isolated congenital malformation of the lumbar area of the spine were evaluated both clinically and instrumentally. Age of the patients was 6 months — 16 years 2 months (mean — 4 years 5 months). There were 41 female and 27 male patients. Patients were divided in two groups depending on the volume of the surgery. First group (n = 52) consisted of patients treated with complete hemivertebrae resection. Second group (n = 16) consisted of patients treated with partial resection of the malformed vertebrae.
Results. After the surgery in the 1st group scoliotic curve was 0 to 21° and kyphotic curve was from -33 to 9°. 9 years post-op scoliotic and kyphotic curves were 0 to 22° and -31 to 10° respectively. In the 2nd group scoliotic curve was 3 to 27° and kyphotic curve was from -30 to 12°. 9 years post-op scoliotic and kyphotic curves were 7 to 41° and -26 to 8° respectively. Significant differences in the amount of scoliotic curve correction were revealed between the groups: in the 1st group mean Cobb angle for the scoliotic curve after surgery was 3,3° (correction — 94%), in the 2nd group — 13,6° (correction — 80%) (p<0,05). Mean Cobb angle for the scoliotic curve in the long-term period was 5° (correction — 92%) for the 1st group wich was significantly lower (p<0,05) comparing to the 2nd group (mean Cobb angle 18,3° correction — 62%).
Conclusion. Our data showed higher efficacy of the complete resection of the hemivertebrae comparing to its partial resection in pediatric patients with isolated malformation in the lumbar spine. Complete removal of the vertebrae body, its growth plates and disks allowed to achieve radical correction of the deformity and to perform short fusion of the adjacent segments which was crucial for further normal growth and development of the child’s spine with saving the results in the long-term period. Thus complete resection of the malformed vertebrae with radical correction and short segment fusion is the most appropriate option in surgical treatment of pediatric patient of any age with isolated vertebrae malformation in the lumbar spine.
About the authors
S. V. Vissarionov
Turner Scientific and Research Institute for Children’s Orthopedics; Mechnikov North-Western State Medical University
Email: fake@neicon.ru
Sergei V. Vissarionov — Dr. Sci. (Med.), Professor, Deputy Director for Science, Head of the department of Spinal Pathology and neurosurgery TSRICO; Professor of Traumatology and Orthopaedics Department Mechnikov NWSMU.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603; 41, Kirochnaya ul., St. Petersburg, 191015
РоссияK. A. Kartavenko
Turner Scientific and Research Institute for Children’s Orthopedics
Email: fake@neicon.ru
Kirill A. Kartavenko — Cand. Sci. (Med.), Attending surgeon, department of Spinal Pathology and neurosurgery.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603
РоссияD. N. Kokushin
Turner Scientific and Research Institute for Children’s Orthopedics
Author for correspondence.
Email: turner01@mail.ru
Dmitry N. Kokushin — Cand. Sci. (Med.), Research associate, department of Spinal Pathology and neurosurgery.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603
РоссияA. G. Baindurashvili
Turner Scientific and Research Institute for Children’s Orthopedics; Mechnikov North-Western State Medical University
Email: fake@neicon.ru
AlexeyG. Baindurashvili — Dr. Sci. (Med.), Professor, Member of the Russian Academy of Sciences, Director of the TSRICO; Head of Traumatology and Orthopaedics Department Mechnikov NWSMU.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603; 41, Kirochnaya ul., St. Petersburg, 191015
РоссияS. M. Belyanchikov
Turner Scientific and Research Institute for Children’s Orthopedics
Email: fake@neicon.ru
Sergey M. Belyanchikov — Cand. Sci. (Med.), Chief of the department of Spinal Pathology and neurosurgery.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603
РоссияN. O. Khusainov
Turner Scientific and Research Institute for Children’s Orthopedics
Email: fake@neicon.ru
Nikita O. Khusainov — Research associate of the department Spinal Pathology and neurosurgery.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603
РоссияА. V. Ovechkina
Turner Scientific and Research Institute for Children’s Orthopedics
Email: fake@neicon.ru
Alla V. Ovechkina — Cand. Sci. (Med.), Associate Professor, Academic Secretary.
Parkovaya ul., 6468, Pushkin, St. Petersburg, 196603
РоссияReferences
- Виссарионов С.В., Кокушин Д.Н., Картавенко К.А., Ефремов А.М. Хирургическое лечение детей с врожденной деформацией поясничного и поясничнокрестцового отделов позвоночника. Хирургия позвоночника. 2012;(3):33-37. doi: 10.14531/ss2012.3.33-37. Vissarionov S.V., Kokushin D.N., Kartavenko K.A., Efremov A.M. [Surgical treatment of children with congenital deformity of the lumbar and lumbosacral spine]. Hirurgia pozvonochnika [Journal of Spine Surgery]. 2012;(3):33-37. doi: 10.14531/ss2012.3.33-37.
- Виссарионов С.В., Кокушин Д.Н., Белянчиков С.М., Мурашко В.В., Картавенко К.А. Оперативное лечение врожденной деформации грудопоясничного отдела позвоночника у детей. Ортопедия, травматология и восстановительная хирургия детского возраста. 2013;1(1):10-15. doi: 10.17816/PTORS1110-15. Vissarionov S.V., Kokushin D.N., Belyanchikov S.M., Murashko V.V., Kartavenko K.A. [Surgical treatment of congenital deformation of thoracolumbar spine in children]. Ortopediya, travmatologiya i vosstanovitelnaya hirurgiya detskogo vozrasta [Pediatric Traumatology, Orthopaedics and Reconstructive Surgery]. 2013;1(1): 10-15. doi: 10.17816/PTORS1110-15.
- 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. Vissarionov S.V., Kartavenko K.A., Kokushin D.N., Efremov A.M. [Surgical treatment of children with congenital thoracic spine deformity associated with vertebral malformation]. Hirurgia pozvonochnika [Journal of Spine Surgery]. 2013;(2):32-37. doi: 10.14531/ss2013.2.32-37.
- Михайловский М.В., Фомичев Н.Г. Хирургия деформаций позвоночника. Новосибирск, 2002. 430 c. Mihailovskii M.V., Fomichev N.G. Khirurgiya deformatsii pozvonochnika [Surgery of spinal deformities]. Novosibirsk, 2002. 430 p.
- Benli I., Aydin E., Alanay A., Üzümcügil O., Büyükgüllü O., Kiş M. Results of complete hemivertebra excision followed by circumferential fusion and anterior or posterior instrumentation in patients with type-IA formation defect. Eur Spine J. 2006;15(8):1219-1229. doi: 10.1007/s00586-005-0039-y.
- Bollini G., Docquier P.L., Viehweger E., Launay F., Jouve J.L. Lumbar hemivertebra resection by combined approach. Spine. 2006;31(11):1232-1239. doi: 10.1097/01.brs.0000217616.17692.a0
- 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 under age 10 years: greater than 7-year follow-up. Spine. 2015;40(8):484-491. doi: 10.1097/BRS.0000000000000809.
- Chen Y.T., Wang S.T., Liu C.L., Chen T.H. Treatment of congenital scoliosis with single-level hemivertebrae. Arch Orthop Trauma Surg. 2009;129(4):431-438. doi: 10.1007/s00402-008-0596-8.
- Dubousset J., Zeller R., Miladi L., Wicart P., Mascard E. Orthopedic treatment of spinal deformities in infancy and early childhood. Rev Chir Orthop Reparatrice Appar Mot. 2006;92(1):73-82.
- Ferreyra А.С., Ocampo G.A. Congenital kyphoscoliosis due to hemivertebra treatment options and results. Rec Adv Scoliosis. 2012;19:331-344. doi: 10.5772/38784.
- Imrie M.N. A “simple” option in the surgical treatment of congenital scoliosis. Spine J. 2011;11(2):119-121. doi: 10.1016/j.spinee.2010.12.007.
- Zou Chuanqi, Qiu Hao, Zhang Zhengfeng, Zhou Yue, Chu Tongwei. Evaluation of outcomes of posterior hemivertebra resection in the treatment of congenital kyphoscoliosis with hemivertebra. J Pract Orthop. 2014;20(11):965-968. (in Chinese). DOI: 108-5572(2014)11-0965-05.
- Li X.F., Liu Z.D., Hu G.Y., Chen B., Zhong G.B., Zang W.P., Wang H.T. Posterior unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. Spine J. 2011;11(2):111-118. doi: 10.1016/j.spinee.2010.08.028.
- Peng X., Chen L., Zou X. Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age. J Pediatr Orthop B. 2011;20(6):397-403. doi: 10.1097/BPB.0b013e3283492060.
- Liu Zudeng, Li Xinfeng, Hu Guangyu, Cheng Bin, Zhong Guibin, Zang Weiping, Lao Lifeng, Wang hantao. Posterior transpedicular hemivertebra wedge osteotomy for correction of congenital spinal deformity. Chinese J Bone Joint Surg. 2011;04(4). (in Chinese). doi: 10.3969/j.issn.1674-1439.2011.04.003.
- Рябых С.О., Губин А.В., Савин Д.М., Филатов Е.Ю. Результаты резекции полупозвонков грудного и поясничного отделов дорсальным педикулярным доступом у детей. Гений ортопедии. 2015;(4):42-47. doi: 10.18019/1028-4427-2015-4-42-47. Ryabykh S.O., Gubin A.V., Savin D.M., Filatov E.Yu. [The results of thoracic and lumbar hemivertebrae resection by a dorsal pedicular approach in children]. Genij Ortopedii [Orthopaedic Genius]. 2015;(4):42-47. doi: 10.18019/1028-4427-2015-4-42-47.
- Рябых С.О., Филатов Е.Ю., Савин Д.М. Результаты экстирпации полупозвонков комбинированным, дорсальным и педикулярным доступами: систематический обзор. Хирургия позвоночника. 2017;(1):14-23. doi: 10.14531/ss2017.1.14-23. Ryabykh S.O., Filatov E.Yu., Savin D.M. [Results of hemivertebra excision through combined, posterior and transpedicular approaches: systematic review]. Hirurgia pozvonochnika [Journal of Spine Surgery]. 2017;(1):14-23. doi: 10.14531/ss2017.1.14-23.
- Mladenov K., Kunkel P., Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study. Eur Spine J. 2012;21(3):506-513. doi: 10.1007/s00586-011-2010-4.
- Chu G., Huang J., Zeng K., Guo Q., Zhang H. A modified surgical procedure for congenital kyphoscoliosis: selective partial hemivertebrectomy via posterior-only approach. Childs Nerv Syst. 2015;31(6):923-929. doi: 10.1007/s00381-015-2630-9.
Supplementary files
