To study an applicability of active optical 3D-CT navigation system for surgical treatment of children with idiopathic scoliosis. Material and Methods. The study included 12 children aged 14-17 years with thoracic and thoracolumbar idiopathic scoliosis. The magnitude of scoliotic deformity varied from 52° to 80° (average 70°). Correction of deformity was performed using multisegmental pedicle screw instrumentation inserted under the guidance of active optical 3D-CT navigation system. At the stage of navigation an estimation of mean-square registration error, and monitoring of time required for registration and formation of bone canals for pedicle screws were performed. Results. In 96.6 % of cases the pedicle screws were placed in all preplanned pedicles. In other 9 vertebrae (3.4 %) the screw placement was complicated by pedicle fracture and screw trajectory deviation. There were no cases of neurological and infection complications, and instrumentation loosening in the studied patients. Conclusion. Active optical 3D-CT navigation using preoperative CT images and anatomical landmark registration is applicable in correction of idiopathic scoliosis in children. Multisegmental transpedicular fixation allows reducing the length of metal fixation zone, and achieving maximum curve correction and reliable stability.
Treatment results for 24 patients (21 girls and 3 boys), aged 14—17 years, with idiopathic thoracic scoliosis are presented. In all cases right-side type of deformity was observed. The main arch of curvature ranged from 52° to 92° by Cobb. The operation was performed from dorsal approach with application of metallic devices with transpedicular supporting elements using 3D-CT navigation. Depending on anatomical and anthropometric peculiarities of vertebral bone structures within the curvature arch, two variants of surgical correction were applied. Correction of the first type was performed in 18 patients; second type of correction was applied in 6 children. Second type of deformity correction differed from the first one by the sequence of rods implantation relative to the sides of main arch and corrective maneuvers at deformity correction. In the first group postoperative deformity correction in frontal plane made up 92—99%, derotation correction of the apical vertebra from 72 to 94% versus 91—100% and from 11,4 to 29,4% in the second group.
To assess surgical treatment results in children with thoracic idiopathic scoliosis. Material and Methods. Surgical treatment was performed in 263 patients aged from 13 to 18 years and having spinal deformity of 50 to 152° Cobb angle. Three tactical options using dorsal Cotrel-Dubousset instrumentation were applied in surgical correction. Results. The achieved surgical correction of idiopathic thoracic scoliosis varied from 46.2 to 95,0 %. Lost of correction within a follow-up period of 6-month to 10-year was 5.1 to 10.2 %. Conclusion. Surgical approach to the treatment of idiopathic thoracic scoliosis should be individual and depend on patient's age, growth potential, deformity severity, and curve mobility.
The case of surgical treatment of a patient with scoliotic deformity of the spine and abnormality of the spinal cord (diastematomyelia) is presented. The first surgical stage included elimination of anatomical pathology and fixation of the spinal cord, and the second -correction of the spinal deformity.
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