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 Pub Date : 2024-01-16 DOI:10.15674/0030-59872023422-30

O. Barkov, Volodymyr Radchenko, Y. Katsalap, I. Fedotova

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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.

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对巨大和僵硬的脊柱畸形进行两阶段手术治疗（前方脊柱弯曲移动和后方脊柱器械治疗）

如何选择手术方法治疗巨大而僵硬的脊柱畸形仍存在争议。研究目的评估大型僵硬脊柱畸形的两阶段手术治疗（前方弯曲移动和后方脊柱器械植入）的效果。方法。17名患者，平均年龄为17.7岁（从12岁到38岁），平均随访时间为36个月。患者病因分布：13例特发性脊柱侧凸，2例神经纤维瘤病，2例先天性脊柱侧凸。所有患者均接受了两个阶段的手术治疗（前部矫正弯曲和后部矫正畸形），并对矫正结果和并发症进行了回顾性评估。结果手术前脊柱在额面的平均变形量为 103° ± 10°（根据 Kob 值从 90° 到 126°），前方移动后为 85° ± 8°（从 74° 到 104°），即（17.6 ± 3.3）%的矫正率（从 13.7% 到 24.5%），而在畸形后部矫正完成时 - 40° ± 22°（从 2° 到 78°），按百分比计算，矫正率为（62.1 ± 20.61）%（从 19.6% 到 97.8%）。根据 T-标准，统计显著性指标如下：63.4 ± 19.6 (M ± SD); t = 13.344; p = 0.001。结论两阶段手术治疗巨大而僵硬的脊柱畸形是实现脊柱畸形矫正和获得理想美容效果的现代技术。仔细进行前路活动，随后在床上使用拉伸系统，可以增加脊柱的活动度，使组织和脊髓逐渐适应下一步的脊柱后路矫正，从而显著降低神经系统并发症的风险，并获得最满意的矫正效果。

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ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

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