Evaluation of the role of ventral interventions in the surgery of idiopathic scoliosis in patients with active bone growth

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Abstract

BACKGROUND: Today, the question of the tactics of surgical treatment of patients with idiopathic scoliosis during active bone growth, namely, the need for ventral interventions due to the emergence of modern dorsal instruments, remains open.

AIM: This study aims to evaluate the role of ventral interventions in the surgical treatment of patients with progressive idiopathic scoliosis Lenke type 1, 2, 3 during the period of active bone growth.

MATERIALS AND METHODS: The long-term results of operational correction 352 patients with thoracic idiopathic scoliosis aged from 10 to 14 years old operated in Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan from 1998 to 2018 using various methods and different instrumentation types.

RESULTS: Among patients (352 people) aged 10 to 14 years with idiopathic thoracic scoliosis (Lenke type 1, 2, 3), statistically significant postoperative progression was observed in patients who underwent surgical deformity correction using laminar (hook) fixation. At the same time, additional ventral stage conduction could not prevent deformity progression in the postoperative period. In those groups where hybrid fixation was used combined with the ventral stage and total transpedicular fixation, no significant progression was observed in the postoperative period.

CONCLUSION: Modern dorsal systems for transpedicular fixation narrow the indications for using additional mobilizing and stabilizing ventral interventions in the surgical treatment of progressive idiopathic scoliosis in patients with active bone growth. Total transpedicular fixation provides excellent main curve and anti-curvature arch correction in the absence of scoliotic deformity progression in the postoperative long-term follow-up.

About the authors

Marija A. Chernyadjeva

Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan

Author for correspondence.
Email: MChernyadjeva@yandex.ru
ORCID iD: 0000-0002-5034-6515
SPIN-code: 6589-2217

MD, PhD student

Russian Federation, 17 Frunze str., Novosibirsk, 630091

Aleksandr S. Vasyura

Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan

Email: niito@niito.ru
ORCID iD: 0000-0002-2473-3140
SPIN-code: 5631-3912

MD, PhD

Russian Federation, 17 Frunze str., Novosibirsk, 630091

Vyacheslav V. Novikov

Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan

Email: VNovikov@niito.ru
ORCID iD: 0000-0002-9130-1081
SPIN-code: 4367-4143

MD, PhD, D.Sc.

Russian Federation, 17 Frunze str., Novosibirsk, 630091

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2. Fig. 1. Radiographs of a 13-year-old patient in two views: a — preoperative image of the right-sided thoracic scoliotic deformity of IV degree (74° according to Cobb) with lumbar anti-curvature (47°), with thoracic kyphosis of 24° and lumbar lordosis of 67°; b — surgical correction of scoliotic deformity of the spine using hybrid fixation without ventral intervention results in main thoracic curve of 30°; lumbar anti-curvature of 10°, thoracic kyphosis of 18°, and lumbar lordosis of 60°; c — X-ray control 3 years after the surgery revealed main thoracic curve of 46°, lumbar anti-curvature of 10°, thoracic kyphosis of 18°, and lumbar lordosis of 76°

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3. Fig. 2. Radiographs of an 11-year-old female patient in two views: a — preoperative image showing degree IV right-sided thoracic scoliotic deformity (64° according to Cobb) with lumbar anti-curvature (33°), thoracic kyphosis of 36°, and lumbar lordosis of 52°; b — surgical correction of scoliotic deformity of the spine using hybrid fixation in combination with mobilizing discectomy at the levels of Th6–Th7, Th7–Th8, Th8–Th9, and Th9–Th10 results in main thoracic curve of 21°, with complete correction of the anti-curvature curve, thoracic kyphosis of 18°, and lumbar lordosis of 33; c — X-ray control 3 years after the surgery revealed main thoracic curve of 23°, thoracic kyphosis of 18°, and lumbar lordosis of 46°

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4. Fig. 3. Radiographs of a 10-year-old female patient in two views: a — preoperative image of degree IV scoliotic deformity (50° according to Cobb) with equivalent right-sided thoracic and left-sided lumbar curves, thoracic kyphosis of 29°, and lumbar lordosis of 57°; b — surgical correction of scoliotic deformity of the spine using total transpedicular fixation without ventral intervention results in main thoracic curve of 11°, lumbar anti-curvature of 8°, thoracic kyphosis of 19°, and lumbar lordosis of 45°; c — X-ray control 6 years after the surgery revealed the main thoracic curve of 11°, lumbar anti-curvature of 8°, thoracic kyphosis of 19°, and lumbar lordosis of 57°

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5. Fig. 4. Radiographs of an 11-year-old female patient in two views: a — preoperative image of degree IV right-sided thoracic scoliotic deformity (42° according to Cobb), with thoracic kyphosis of 25° and lumbar lordosis of 60°; b — surgical correction of scoliotic deformity of the spine using laminar fixation without ventral intervention resulted in the main thoracic curve of 12°, thoracic kyphosis of 13°, and lumbar lordosis of 48°; c — X-ray control 1 year after the surgery revealed the main thoracic curve of 46°, thoracic kyphosis of 21°, and lumbar lordosis of 54°

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6. Fig. 5. Radiographs of a 13-year-old female patient in two views: a — preoperative image of degree IV right-sided thoracic scoliotic deformity (51° according to Cobb) with lumbar anti-curvature (49°), thoracic kyphosis of 62°, and lumbar lordosis of 59°; b — surgical correction of scoliotic deformity of the spine using laminar fixation in combination with mobilizing discectomy at the levels of Th5–Th6, Th6–Th7, Th7–Th8, and Th8–Th9 results in main thoracic curve of 24°, lumbar anti-curvature of 20°, thoracic kyphosis of 40°, and lumbar lordosis of 46°; c — X-ray control 6 years after surgery revealed the main thoracic curve of 35°, lumbar anti-curvature of 34°, thoracic kyphosis of 51°, and lumbar lordosis of 57°

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Copyright (c) 2021 Chernyadjeva M.A., Vasyura A.S., Novikov V.V.

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