The use of guide templates in the surgical treatment of preschool children with congenital scoliosis of thoracic and lumbar localization

Abstract

Background. The use of transpedicular screws as support elements from the standpoint of biomechanics is preferable as compared to that of laminar fixation, albeit the former carries the risk of various complications (such as malposition screws, damage to the Dura mater, spinal cord, and major blood vessels) caused by structural changes in the vertebrae under the background of their defects, with small size of roots arcs vertebrae in young children. Thus, the issue of ensuring safe and correct installation of transpedicular screws in the surgical treatment of children with congenital scoliosis remains relevant.
 Aim. We aimed to evaluate the correctness of the position of the transpedicular screws installed in the vertebral bodies in preschool children with congenital scoliosis of thoracic and lumbar localization using guide templates (SHN).
 Materials and methods. We conducted a prospective analysis of the outcomes of surgical treatment of 30 patients with congenital scoliosis against the background of impaired formation of the vertebrae of the thoracic and lumbar spine. The patients included 12 boys and 18 girls of age: 1 year 8 months to 6 years 5 months (average: 3 years 4 months). Based on the computed tomography of the spine, performed postoperatively, the correctness of the position of the installed elements of the corrective multi-support metal structure was evaluated. The correctness of the position of the installed transpedicular support elements was evaluated based on the scale described by S.D. Gertzbein and co-authors (1990).
 Results. The total number of implanted transpedicular screws sets was 96 (100% of the planned transpedicular screws set), and 48 SHN were used for transpedicular screws installation. The correct position of installed screws by degree of displacement revealed Grade 0 93.7% (90 screws), Grade I 4.2% (4 screws), Grade II 2.1% (2 screws), Grade III 0%. The number of screws with a Grade 0 + Grade I offset was 94 (97.9%).
 Conclusion. The results obtained with the use of SHN among preschool children with congenital scoliosis of thoracic and lumbar localization revealed high accuracy and correctness of transpedicular screws installation (93.7%) with the use of this type of navigation in clinical practice. The use of SHN for installing transpedicular screws in the surgical treatment of congenital spinal deformities in young patients allows for the selection of the optimal size and correct position of the transpedicular support elements in the vertebrae to be instrumented.