Reconstructive operations in children and teenagers with spine deformations

Abstract

Introduction. Irrespective of etiology, spine deformations in adolescents represent the cause that influences the main peculiarities of the spinal column: its safety and stability; initially it is manifesting by pains, statics infringements, and internals’ dysfunction, subsequently it leads to severe decrease of quality of life. The choice of surgical and therapeutic options in the management of spine deformations in children is still controversial. Work’s goal: improvement of a life quality of children with spine deformations. Material and methods. 109 patients with spine deformations have been pre- and postoperatively examined. The evaluation included collecting of anamnesis data, clinical examination, labs and imaging (standard radiography/ with functional tests, magnetic resonance) with a follow-up of 1 to 5 years. Children were aged between 3 and 17 years; they were predominantly boys – 61(56 %). Etiology of spine deformations was: traumatic injuries in the acute stage – 29 (26,6 %) patients, posttraumatic cyphosis deformations – 5 (4,6%) patients, scoliosis – 58 (53,2%) children, spondylolisthesis – 17 (15,6%) patients. Results. The main goals of surgical interventions were: elimination of the compression factor, deformation and disbalance. correction and spine stabilization. Surgery allowed obtaining the following results: 1. Reposition (reduction) of the body of displaced vertebras; 2. Reconstruction of forward and average spine columns; 3. Restoration of physiological spine profiles (frontal and sagittal); 4. Restoration of normal anatomy of the vertebral channel; 5. Stabilization of the spine-impellent segment. The comparative analysis of the quality of life of patients with severe spine deformations (according to a questionnaire „EQ-5D”), before and after surgical intervention, has shown that the quality of life of patients in postoperative period essentially improved, in comparison with the preoperative period, from 12,7±0,3 points to 6,7±0,1.The distant results of surgical treatment were good– 85, 1%, satisfactory– 11,2 % and unsatisfactory – 3,7%. Conclusion: 1.) In fresh cases of the complicated spinal - marrow trauma with mild and average degree of a neurologic symptomatology (degree of D on Frenkel) the preference was given to the closed, indirect decompression. At a serious neurologic symptomatology (A, B, C degree) carried out open decompression and revision of dural bag’s contents. 2.) Optimum method of correction of difficult rigid scoliotic spine deformations were: forward spine release; dorsal correction and backbone fixation by a metal construction. 3.) Surgical treatment of difficult juvenile scolioses began at 10-12 years old, and combined forward spine release with the following dorsal correction without posterior spine fusion execution. 4.) In cases of congenital deformations primary operative defect’s correction was carried out at children at the age of 3-7 years - “blocking spondylosyndesis” at curvature top with the following dorsal correction by “a growing construction” without posterior spine fusion execution. 5.) Final correction of deformation, posterior spine spondylosyndesis and thoracoplasty are carried out on the end of spine growth.