ON THE SUBJECT OF TACTICS OF USING POSTERIOR STABILIZING SYSTEMS IN SCOLIOTIC SPINAL DEFORMITIES

Abstract

Aim. To improve the results of correction and stabilization of scoliotic spinal deformity using posterior screw and combined systems. Materials and methods. The results of surgical treatment of 138 patients aged 3-48 were studied; 76% of patients were operated at the age of 11-17 years old. In 95% of patients, idiopathic and dysplastic scoliosis was diagnosed. Four groups of patients were singled out. In group 1, Harrington rods added by Luke’s fixation and posterior spondylodesis were used for 9 patients, in group 2 - 101 patients underwent a single-stage correction using posterior transpedicular screw and combined systems, in group 3 (18 patients) - 16 patients underwent a three-stage correction (1 - thoracotomy resection of the 4-5 th intervertebral disks, deformation mobilization and front corporodesis, 2 - craniotibial extension for 4-5 weeks) and 2 patients a two-stage correction (1 - thoracotomy resection of the 4-5 th intervertebral disks, mobilization and front corporodesis) and in group 4 (10 patients), patients with congenital anomalies of vertebral development predominantly against the background of disturbed formation (active postlateral semivertebras in the lumbar and inferothoracic parts) underwent resection and (or) vertebra osteotomy and posterior spondylodesis with back access using computer navigation. In groups 3 and 4, the same types of fixation devices as in group 2 were placed at the last stage. Clinicoroentgenological data, magnetic resonance and computer tomography parameters were studied. Results. In group 1, correction did not exceed 50% of the initial one. The lowest traumatism of intervention and high efficiency of a single-access and single-stage correction using posterior pedicular screw and combined systems was observed in group 2 (73%). In this group of patients with the initial deformation value up to 50°, correction was 90% of the initial value, in patients with the initial value of 51-100°, correction was 78% of the initial value. When using these fixation devices, in groups 2,3 and 4 a mean value of deformation correction of the basic arc was 69% of the initial one with screw transpedicular systems alone and 61% - with combined systems ( р <0,05). Correction loss during the period of 2-4 years was not more than 5% of the direct result ( р <0,05). Complications made 4,3%, they were eliminated conservatively and did not influence long-term results. Conclusion. Application of transpedicular and combined systems is a high-efficient variant of surgical treatment of scoliotic deformities with correction not less than 60% of the initial value irrespective of variant of surgical treatment. This technique gives minimal loss of correction in the postoperative long-term period.

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Copyright (c) 2014 Belokrylov N.M., Kurdyumov D.A., Yagovkin M.A., Molchanov A.V.

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