Purpose: In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis. Methods: The correlations between the Cobb’s angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation. Results: The Cobb’s angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° ( p < 0.001) in the open surgical correction group and from 51.2° ± 11.4° to 11.7° ± 5.8° ( p < 0.001) in the minimally invasive surgery group before and after surgery, respectively. The percentage of curvature correction was 88.2% ± 8.0% and 77.7% ± 10.7% ( p < 0.001) in the open surgical correction and minimally invasive surgery groups, respectively. The estimated blood loss was higher in the open surgical correction group than in the minimally invasive surgery group (208.7 ± 113.4 vs 564.3 ± 242.7 mL). Axial rotation was changed from 29.1°± 7.5 to 17.1°± 6.8 ( p < 0.001) in the open surgical correction group and from 28.9°± 7.8 to 19.4°± 6.4 ( p < 0.001) in the minimally invasive surgery group. The duration of surgery was shorter in the open surgical correction group than in the minimally invasive surgery group (266.6 ± 64.3 vs 346.2 ± 70.5 min). A positive correlation between time of operation and Cobb’s angle correction (in °) in open surgical correction ( r = 0.37) and minimally invasive surgery ( r = 0.43) was found. Conclusion: The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb’s angle. Level of evidence: III.

Background. Currently, there are many studies on the evaluation of the results of surgical intervention and the comparative analysis of various surgical techniques for treating children with congenital spinal deformities. However, there is no consensus regarding the choice of surgical access to the abnormal vertebra that considers the duration of surgery, the volume of intraoperative blood loss, the degree of correction achieved during the intervention, the length of metal fixation, and the preservation of the result in the long-term observation period. Aim. The goal is to identify the advantages and disadvantages of the dorsal and combined approaches to the surgical treatment of preschool children with congenital deformities of the thoracic and lumbar spine against the background of an isolated violation of the vertebral formation. Materials and methods. A retrospective analysis of 56 patients under the age of five with congenital spinal deformities and a history of an isolated hemivertebra in the thoracic and lumbar regions who underwent one-stage hemivertebral extrusion from a dorsal approach (1st group: n = 30) or from a combined approach (2nd group: n = 26) was conducted. Results. All patients showed improvement in the sagittal and frontal profiles of the spine. However, during separation in the first group of patients, a progression of the kyphotic component of the deformity in the lumbar spine from 19 to 8 was noted, while the correction value of the curvature of the scoliotic component remained stable. Intraoperative blood loss in the first group of patients was less (234 mL) compared with that in the second group (319 mL), while the duration of surgery was longer (310 min and 185 min, respectively). On average, in the first group, a longer metal structure was used to correct the spinal deformity compared with the second group. Conclusions. The correction of the patients congenital spinal deformities with a single hemivertebra from a combined access approach allows a complete correction of the congenital curvature, the fixation of a smaller number of vertebrae, and the maintenance of a stable result in the long-term observation period compared with the dorsal approach. Isolated dorsal access to the hemivertebral body is characterized by less intraoperative blood loss compared with the combined approach, although the length of surgical intervention is increased.

Introduction. Equino-plano-valgus deformity of the feet (EPvDS) in patients with cerebral palsy is one of the most common and functionally significant pathologies of the lower extremities, which leads to changes in the shape of the feet, decreased support, and disturbance of gait biomechanics. An important task is to determine the effective methods of treating this pathology (and their combinations) to correct or reduce the severity of these disorders. The evaluation of the radiological changes occurring with the foot is also important. Aim. The paper assesses the changes in the main X-ray significant indicators of the foot by using rammed implants in the treatment of mobile EPvDS in children with cerebral palsy. Materials of the study. The assesses of radiological results of treatment of 64 patients from 6 to 17 years with mobile EPvDS and cerebral palsy have been analyzed using subtalar implants. The results of study showed that 94% of cases showed good and satisfactory indicators, whereas 6% of patients showed unsatisfactory results. Conclusion. High efficiency was shown by using subtalar implants combined with tenodesis and transposition of the anterior tibial muscle tendon in the treatment of mobile EPvDS in children with cerebral palsy of early and middle childhood.

Operative treatment has drastically evolved over the last century, from posterior Harrington instrumentation and casting, which was associated with high failed fusion rates, poor deformity correction, and the need for prolonged bed rest. Anterior thoracoscopic and miniopen approaches were later developed, which resulted in significant curve correction

BACKGROUND: Congenital disorders of vertebrae formation are a common pathology in children. Intraoperative neurophysiological monitoring is a mandatory procedure, although it may not be effective enough due to the immature neural structures and the use of inhalation anesthetics in young children. AIM: To study aims to investigate the characteristic features of intraoperative neurophysiological monitoring in children with a congenital deformity of the spine during dorsal resection of the hemivertebrae. MATERIALS AND METHODS: 42 patients aged 117 years with a congenital deformity of the spine underwent 46 resections of the abnormal vertebra from an isolated dorsal approach (egg-shell technique). Intraoperative neurophysiological monitoring at the stages of the operation included a muscle relaxant test (TOF), transcranial electrical stimulation of the motor cortex (TCeMEP), control of the approach to the nerve (N. Proxy), correct placement of the pedicle screw (Screw Integrity), and EMG recording of the electromyogram. The accuracy of the screw placement was assessed by the Gerzbien method, and the presence of neurological disorders was tested by the Frenkel scale. The effect of inhalation anesthetic (sevoran) on motor evoked potentials was monitored by regulating its delivery, and the dependence on the age of patients was evaluated. RESULTS: The average age of patients was 7.7 4.5 years, and the TOF value was 80.5 17%. In 41 patients, the N. Proxy test was unremarkable, while in one patient, the 812 mA value did not require a change in the trajectory of the screws. From the beginning of sevoran and intraoperatively, motor evoked potentials from all tested muscles were recorded in 54.8% of patients; in children over 8 years old, this was observed in 92.8%, in children under 8 years old in 35.7% of cases in their age groups. In other patients, motor evoked potentials were most often not recorded from the muscles of the thigh and lower leg after sevoran administration. In children over 8 years old in 7.2%, under 8 years old in 83.3% of patients; Interestingly, in 7.2% of patients who are under 8 years of age, motor evoked potentials were not initially recorded from any muscle. Withdrawal of sevorane in 30.9% of patients allowed intraoperative motor evoked potentials to be obtained from all tested muscles in 100% of cases. For adequate management of anesthesia, 5 patients (50%) 14 years old and one patient 6 years old (5.6%) did not receive sevoran, and motor evoked potentials were recorded from the abdominal muscles. This allowed to assess the conduction only at the thoracic level and are required increased vigilance of surgeons when carrying out any corrective manipulations. CONCLUSIONS: Intraoperative neurophysiological monitoring with dorsal hemivertebra resection is an effective method that allows controlling the neurological complications during manipulations on the spine.