Tactics of surgical treatment of congenital spinal deformities in children

Abstract

Progress in spinal surgery during the second half of the twentieth century was made possible by a deeper study of the three-dimensional nature of the normal and pathological architecture of the spine. The problem of complex spinal deformities remains one of the most important in clinical vertebrology. In Ukraine, more than 9,000 children need surgery for scoliosis spinal deformities. Of these, more than 15% of children have congenital scoliosis deformities. Purpose - to conduct a retrospective analysis of the results of surgical treatment of congenital spinal deformities in children. Materials and methods. A retrospective analysis of the results of treatment of 36 patients (from 9 to 12 years) with congenital spinal deformities who received treatment at the Department of Pediatric Surgery of the Bogomolets National Medical University (National Children's Specialized Hospital «OHMATDYT», Kyiv) in the period from 2008 to 2018. Patients were divided into two groups: I (staged treatment) - 18 children who received treatment using halo-gravity traction (HGT), followed by spinal instrumentation; II (one-time treatment) - 18 children who underwent surgical correction with osteotomies (4-6 levels according to Ponte, VCR osteotomy at 1-2 levels). Results. Two groups of patients were studied. According to HGT, the main arc deformation improved to 55±25%. HGT - complications were observed in 12% (transient neurological disorders). In patients who underwent spinal instrumentation without prior traction complications were observed in 37% of patients (neurological transient disorders in the form of spinal cord dysfunction). In children with congenital spinal deformities, simultaneous implantation of the structure in comparison with staged treatment with HGT increases the risk of neurological deficits by 25%, HGT allows greater correction and adapt the spinal cord to further correction. Conclusions. In the surgical treatment of congenital spinal deformities, HGT reduces the risk of neurological complications, reduces the time of surgery and the amount of blood loss, allows us to get better results of correction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: halo-gravitational traction, scoliotic deformation, surgical treatment.