Objective. To analyse the outcomes of surgery for severe idiopathic scoliosis. Material and Methods. Seventy nine patients at the age of 12 to 20 years (male and female ratio is 8:71) with spine deformity more than 90° operated on with CDI with ventral fusion (72 patients) and without it (7 patients) were examined. Average follow-up is 1.3 years. Data of X-ray, COMOT examination, intervertebral disk morphological study and Russian version of SRS-4 questionnairy were analyzed. Results. Average correction was 55.0°. Postoperative progression was 3.4°. CDI correction with previous intervertebral disk excision at the apex of scoliotic arch added 26.5° to preoperative correction in lateral bending, and in combination with skeletal traction – 40.6°. Counter-curvature initially averaged 69.7°, correction was 36.5°, and postoperative progression – 4.0°. Preoperative thoracic kyphosis was 59.6°, postoperative – 33.8°, lumbar lordosis was decreased from 68.1° to 48.7°. Patient’s satisfaction was 100.0 % and did not decline in time. Positive dynamics was noted in all parameters of dorsal trunk shape. Conclusion. Contemporary segmental instrumentation for treatment of severe idiopathic scoliosis allows achieving and reliably retaining substantial correction of deformity. Various types of preoperative traction can be replaced by intraoperative release of the deformed spine including discectomy.
To analyze the expression of candidate genes presumably responsible for the development of idiopathic scoliosis. Material and Methods. The study subjects were vertebral body growth plates of children aged 11-15 years suffering from Grade III-IV idiopathic scoliosis. Real-Time SYBR Green PCR assay was used to investigate the expression of genes responsible for growth regulation, chondrogenic differentiation, matrix formation and synthesis, and sulfation and transmembrane transport of sulfates. Results. Comparative analysis of gene expression did not give a clear answer. On the background of representative morphological and biochemical data including violation of the structural organization of cells and matrix on the concave side of deformity, presence of poorly differentiated chondroblasts, and lack of differentiation in columnar and hypertrophic structures, a sharp decline in synthetic potency of cells contradicted the data on high expression of IHH, TGFBR1, and EGFR genes, matrix proteoglycans genes ACAN, LUM, and VCAN, collagen types I and II, and of sulfation and sulfate transmembrane transport genes DTDST, CHST1, and CHST3. Expression of growth hormone receptor gene, differentiation genes SOX9 and PAX9, and link protein gene was reduced. Factor analysis of the studied genes has shown significant difference between gene expression in chondroblasts of patients with idiopathic scoliosis and that in controls. Conclusion. Complex interaction of genes under the control of the central regulatory mechanisms coordinates the periodization of gene turning on, thereby integrating the process of the spine growth. Violation of any of the factors in the complex system of morphogenesis regulation causes asymmetric growth resulting in scoliosis development.
The paper presents analytical review of literature on surgical correction of scoliotic deformity of the spine using transpedicular fixation. Analysis included Russian and foreign medical publications.
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