TWO-STAGE SURGICAL TREATMENT OF LARGE AND RIGID SPINAL DEFORMITIES (ANTERIOR MOBILIZATION OF THE CURVATURE AND POSTERIOR INSTRUMENTATION OF THE SPINE)

Authors

  • Oleksandr Barkov Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2161-416X
  • Volodymyr Radchenko Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0001-5949-0882
  • Yelizaveta Katsalap Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
  • Inga Fedotova Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2069-7020

DOI:

https://doi.org/10.15674/0030-59872023422-30

Keywords:

anterior mobilization of the spine, correction of spinal deformities

Abstract

The choice of method of surgical treatment of large and rigid spinal deformities remains debatable. Objective. To evaluate the results of two-stage surgical treatment of large and rigid spinal deformities (anterior mobilization of the curvature and posterior instrumentation of the spine). Methods. Seventeen patients, the average age of which was 17.7 years (from 12 to 38 years), the average follow-up period was 36 months. Distribution of patients by etiology: 13 — idiopathic scoliosis, 2 — neurofibromatosis, and 2 — congenital kyphoscoliosis. All patients underwent two-stage surgical treatment (anterior mobilization of the curvature and posterior correction of the deformity), evaluation of the results of correction and complications was performed retrospectively. Results. The average deformation of the spine in the frontal plane before the operation was 103° ± 10° according to Kob (from 90° to 126°), after the anterior mobilization — 85° ± 8° (from 74° to 104°), which is (17.6 ± 3.3) % of correction (from 13.7 to 24.5 %), and at the time of completion of the posterior correction of the deformity — 40° ± 22° (from 2° to 78°), in percentage terms it amounted to (62.1 ± 20.61) % correction (from 19.6 to 97.8 %). Statistical significance according to the T- criterion had the following indicators: 63.4 ± 19.6 (M ± SD); t = 13.344; p = 0.001. Conclusions. Two-stage surgical treatment of large and rigid spinal deformities is a modern technique for achieving spinal deformity correction and obtaining the desired cosmetic result. Carefully performed anterior mobilization with the subsequent use of the system of stretching the patient in bed, allows to increase the mobility of the spine and gradually adapt the tissues and spinal cord to the next posterior correction of the spine, which significantly reduces the risks of neurological complications, as well as obtaining the most satisfactory correction results.

Author Biographies

Oleksandr Barkov, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, PhD in Traumatology and Orthopаedics

Volodymyr Radchenko, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, Prof. in Traumatology and Orthopаedics

Yelizaveta Katsalap, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD

Inga Fedotova, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, DMSci

References

  1. Chang, K. (2003). Cantilever bending technique for treatment of large and rigid scoliosis. Spine, 28(21), 2452–2458. https://doi.org/10.1097/01.brs.0000092063.63315.d5
  2. Teixeira da Silva, L. E., De Barros, A. G., & De Azevedo, G. B. (2015). Management of severe and rigid idiopathic scoliosis. European Journal of Orthopaedic Surgery & Traumatology, 25(S1), 7–12. https://doi.org/10.1007/s00590-015-1650-1
  3. Macdonald, D. B., Skinner, S., Shils, J., & Yingling, C. (2013). American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring — a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol., 124 (12), 2291–2316. https://doi.org/10.1016/j.clinph.2013.07.025
  4. Barkov, O. O., & Dupliy, D. R. (2021). Practical aspects of intraoperative neuromonitoring in patients with various spine pathologies. Orthopedics, traumatology and prosthetics, 4, 5–12. https://doi.org/10.15674/0030-5987202145-12. (in Ukrainian)
  5. Ganguly, R., Minnema, A., Singh, V., & Grossbach, A. (2020). Retrospective analysis of pedicle screw accuracy for patients undergoing spinal surgery assisted by intraoperative computed tomography (CT) scanner AIRO® and BrainLab© navigation. Clin Neurol Neurosurg, 198, 106–113. doi: 10.1016/j.clineuro.2020.106113
  6. Bullmann, V., Halm, H. F., Schulte, T., Lerner, T., Weber, T. P., & Liljenqvist, U. R. (2006). Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. European Spine Journal, 15(4), 440–448. https://doi.org/10.1007/s00586-005-1016-1
  7. Kandwal, P., Goswami, A., Vijayaraghavan, G., Subhash, K., Jaryal, A., Upendra, B., & Jayaswal, A. (2016). Staged anterior release and posterior instrumentation in correction of severe rigid scoliosis (Cobb angle >100 degrees). Spine Deformity, 4(4), 296–303. https://doi.org/10.1016/j.jspd.2015.12.005
  8. Wiguna, I. G., Ridia, K. G., Suyasa, I. K., Arimbawa, I. B., Wiguna, I. G., Febyan, & Kuswara, L. W. (2023). Severe-rigid scoliosis treated by two-staged procedures: A case series. European Journal of Medical and Health Sciences, 5(1), 10–15. https://doi.org/10.24018/ejmed.2023.5.1.1615
  9. Hsu, C., Wu, K., Lin, M., Kuo, K. N., Chang, J., & Wang, T. (2020). Pioneering experience of Uniportal video-assisted Thoracoscopic surgery for anterior release of severe thoracic scoliosis. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-57984-x
  10. Levytskyi, A. F., Rogozinskyi, V. O., & Dolyanitskyi, M. M. (2020). Halo-gravitational traction in the treatment of complex (>100°) scoliotic spinal deformities in children: review of clinical cases. Paediatric surgery. Ukraine, 4(69), 67–71. https://doi.org/10.15574/PS.2020.69.67. (in Ukrainian)
  11. Yamin, S., Li, L., Xing, W., Tianjun, G., & Yupeng, Z. (2008). Staged surgical treatment for severe and rigid scoliosis. Journal of Orthopaedic Surgery and Research, 3(1). https://doi.org/10.1186/1749-799x-3-26
  12. Bouchoucha, S., Khelifi, A., Saied, W., Ammar, C., Nessib,M. N., Ghachemet, M. B. (2011). Progressive correction of severe spinal deformities with halo-gravity traction. Acta Orthop Belg, 77, 529–534.
  13. Garabekyan, T., Hosseinzadeh, P., Iwinski, H. J., Muchow,R. D., Talwalkar, V. R., Walker, J., & Milbrandt, T. A. (2014). The results of preoperative halo-gravity traction in children with severe spinal deformity. Journal of Pediatric Orthopaedics B, 23(1), 1–5. https://doi.org/10.1097/bpb.0b013e32836486b6
  14. Yang, C., Wang, H., Zheng, Z., Zhang, Z., Wang, J., Liu, H., Kim, Y. J., & Cho, S. (2016). Halo-gravity traction in the treatment of severe spinal deformity: A systematic review and meta-analysis. European Spine Journal, 26(7), 1810–1816. https://doi.org/10.1007/s00586-016-4848-y
  15. Lenke, L. G., Sides, B. A., Koester, L. A., Hensley, M., & Blanke, K. M. (2010). Vertebral column resection for the treatment of severe spinal deformity. Clinical Orthopaedics & Related Research, 468(3), 687–699. https://doi.org/10.1007/s11999-009-1037-x
  16. Yang, C., Zheng, Z., Liu, H., Wang, J., Kim, Y. J., & Cho, S.(2015). Posterior vertebral column resection in spinal deformity: A systematic review. European Spine Journal, 25(8), 2368–2375. https://doi.org/10.1007/s00586-015-3767-7

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How to Cite

Barkov, O. ., Radchenko, V. ., Katsalap, Y., & Fedotova, I. . (2024). TWO-STAGE SURGICAL TREATMENT OF LARGE AND RIGID SPINAL DEFORMITIES (ANTERIOR MOBILIZATION OF THE CURVATURE AND POSTERIOR INSTRUMENTATION OF THE SPINE). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (4), 22–30. https://doi.org/10.15674/0030-59872023422-30

Issue

No. 4 (2023)

Section

ORIGINAL ARTICLES

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