Study Design: Retrospective cohort. Objective: To analyze the outcome of surgical correction of children with caudal regression syndrome. Methods: The study included 12 patients aged 1.5 to 9 years with caudal regression syndrome. In order determine the type of caudal regression, the Renshaw Classification was used. The surgery included correction and stabilization of the kyphotic deformity at the unstable lumbosacral region, with reconstruction of the sagittal balance using a bony block constructed from allograft. Short- and long-term outcomes were evaluated. The study was approved by the local institutional review board. Results: Children with types III and IV caudal regression syndrome underwent spinal-pelvic fusion, with 100% fusion rate, which allows sufficient stabilization of the lumbopelvic segment permitting patient mobilization and standing in type III patients. There were 5 complications needing additional care. Conclusion: Multilevel pedicular screw fixation in combination with spinopelvic fusion with cortical allografts allows reconstruction of the sagittal alignment with solid bony fusion improving the quality of life for these patients.
Objective Demonstrate an outcome of comprehensive treatment of an adolescent with fracture-dislocation of the thoracic spine accompanied by deep lower paraplegia and pelvic floor dysfunction using noninvasive percutaneous spinal cord stimulation and mechanical stimulation of the foot bearing surface. Case study Comprehensive treatment was performed for a 17-year-old patient who sustained a combined injury during roller ski training. The patient presented with back pain, breathing difficulty, being unable to perform active movements of lower extremities. He reported loss of sensitivity in the lower part of the body, perineum and lower limbs. The injury was classified as ASIA grade B with motor impairment scored 50 and overall sensory score of 88. Surgical intervention was produced within the first hours after injury and was followed by rehabilitation program including stimulation of the foot bearing surface with Korvit plantar support load simulator and noninvasive percutaneous spinal cord stimulation. Neurologic status of the patients was graded as ASIA level D at one-year follow-up with motor score of 85 and sensory level improved to 175. Conclusion Surgical treatment produced for the patient with spinal cord injury within the first hours after trauma using noninvasive percutaneous spinal cord stimulation and mechanical stimulation of the foot bearing surface provided regress of neurological disorders facilitating more intense lower-limb motor recovery and other important gait characteristics. The patient could regain voluntary control of muscle activity, stand unassisted and walk with a cane at one year post-injury.
To assess the dynamics of neurological disorders after surgical treatment in pediatric patients with complicated fractures of the thoracic and lumbar spine using ASIA scale. Material and Methods. Outcomes of surgical treatment in 32 children aged from 3 to 17 years with isolated injuries of the thoracic and lumbar spine accompanied by neurological disorders were analyzed. Type A3 fractures occurred in 50.0 %, type B in 6.3 %, and type C in 43.7 % of cases. Patients were divided into 2 groups: Group I included 12 patients with complete spinal cord injury, and Group II-20 patients with incomplete injury. Results. In all patients, a vertebral-medullary conflict was eliminated and a rigid fixation of the damaged spinal motion segments was achieved. Voluntary movements in lower limbs of patients from Group I did not recover. Patients from Group II had significant decrease in paresis degree and sensitivity recovery in lower limbs: the ability of independent walking without aids and assistance was completely restored in 37.5 %, the ability to walk with one/two-sided assistive devices was achieved in 18.8 %, and significant improvement in lower limb support ability-in 6.3 % of cases. Conclusion. Surgical treatment of children with complicated spinal injury should include the elimination of vertebralmedullary conflict, complete reduction, and rigid stabilization with reconstruction of physiological profiles of injured spinal motion segments.
Objective. To analyze results of surgical treatment of chil� dren with congenital deformity of the thoracolumbar junc� tion of the spine caused by isolated vertebral malformations. Material and Methods. Surgical treatment results in 37 pa� tients aged 10 months to 12 years with congenital scoliosis caused by isolated lateral and posterolateral hemivertebrae in the thoracolumbar junction were analyzed. Magnitude of scoliosis before surgery was 18 to 52�� and that of �ypho� �� and that of �ypho� � and that of �ypho� sis-4 to 49�. Extirpation of the abnormal hemivertebra was performed in 33 (89.2 %) patients� and limited resec� tion-in 4 (10.8 %). Results. Correction of scoliotic deformity after surgical treatment was 85.0% (0-26�)� and correction of �yphotic component-78.6 % (15-23�). Compensatory cranial and caudal counter curves leveled out at the bac�ground of the primary curve correction in all patients. Destabilization of instrumentation requiring repeat surgery was observed in two children. The findings showed the efficacy of the sur� gical treatment by main objective measures in 81.0 % of patients. Conclusion. Progression of congenital spinal deformity with lateral and posterolateral hemivertebrae in the thoracolum� bar junction requires an early radical surgical correction with restoration of the spinal canal anatomy and physiologi� cal curves of the spine at the level of deformity.
A clinical case of surgical and multimodal conservative treatment of an 11-year-old female patient with Hajdu – Cheney syndrome with multiple vertebral fractures in the thoracic and lumbar spine is presented. The main and significant manifestations of this syndrome are osteoporosis and acroosteolysis. After the injury, the child underwent correction of posttraumatic spinal deformity and stabilization of spinal motion segments by a placement of multi-anchor instrumentation through a posterior approach. The long-term postoperative period was characterized by the absence of bone block formation, development of distal junctional kyphosis and scoliotic deformity, which required additional surgical intervention in the amount of elongation of instrumentation and correction of the developed curvature. The paper describes in detail the clinical manifestations of the syndrome, the results of surgical treatment, and clinical and radiological characteristics.
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