Surgical treatment of scoliosis

The first detailed clinical description of scoliosis belongs to Ambroise Paré, who also outlined the basic principles of treating scoliosis with an iron device. At the same time, as some authors point out, this disease was also known to Hippocrates, who used wooden tires to correct deformations of the spine.

Analyzing the results of examination and surgical treatment of 377 patients, S.A. Mikhailov (2000) found that the presence of concomitant osteoporosis and osteopenia is one of the factors responsible for the loss of postoperative correction and in 14.2% of patients with scoliosis is the cause of the fracture of the supporting bone structures of the spine. This study shows the need to determine the density of vertebral bodies in the preoperative period and the advisability of drug treatment and the selection of optimal treatment tactics.

When surgical treatment of severe forms of scoliosis, the percentage of complications is quite significant (18.7%). A.I. Kislov, et al. (2000), according to various authors, indicates the specific gravity of complications in this category of patients from 11.8 to 57%. The imperfection of methods and devices for treating patients with severe progressive forms of scoliosis and kyphoscoliosis requires further deep study of the problem and the search for optimal solutions. For the prevention of severe complications, such as the syndrome of massive blood transfusion during deformation correction operations in patients with scoliosis, E.E. Biryukova et al. (2001) recommends normovolemic hemodilution with a fence of 500 ml of blood before the operation and return it at the height of blood loss.

The main distinguishing feature of congenital deformities of the spine is their rigidity. Immobility is particularly pronounced in segmentation disorders, and conservative treatment and preoperative mobilization in such cases are contraindicated.

Surgical correction of scoliosis surgeons are engaged more than 150 years. Of all surgical interventions, the most prominent was the posterior osteoplastic fixation of the spine. However, the outcome of the operation of this operation was not very comforting, since it provides for partial preservation of the correction on average in 11 + 3.6% of the operated patients. As early as 1839, Guerrin reported the successful use of myotomy of paravertebral muscles. However, in subsequent years, other authors, using this method, managed to obtain only a minor correction of deformation.

L.I. Shulutko (1968) considered it compulsory to produce on the concave side of the curvature of tenoligamentacapulotomy, and then supplement it with one or another type of operation on the spine. At present, due to low efficiency, mobilizing operations are used only as an element of surgical intervention. Due to operations on the bodies and intervertebral discs of the vertebrae, large deformations of the spine are eliminated.

Correction of congenital deformations of the spine consists in the operative treatment of deformations on the soil of the semi-vertebra and sphenoid vertebrae. The experience of surgical treatment of this pathology has been accumulated since the beginning of the 20th century. The most effective surgical correction of kyphosis in children is achieved using hook contractors with sublaminar Luque fixation, for teenagers and adults rigid polysegmentary CD systems are used. A number of authors, evaluating the clinical experience of using transosseous osteosynthesis and transpedicular fixation of injuries and diseases of the spine, believes that this method allows intraoperatively to eliminate multi-plane deformation, if necessary, to correct in the postoperative period and early activation of patients without external immobilization. The method of correction with the help of two rods and rigid segmental fixation by sublaminar delays was suggested by Edward Luke. Paul Harrington (1988) created his endocorrector, consisting of two metal rods, working on the principle of distraction and contraction. With the Harrington-Luc method, the operating correction was 65 + 4.4 °, and the Armstrong method 44.5 + 4.8 °. However, the use of the Armstrong method with pronounced rigid curvatures (deformation angle more than 60 °) is not justified due to the technical impossibility of installing the structure along the convex side of the curvature.

Yu.I. Pozdnikin and A.N. Mikiaashvili (2001), using a three-component version of the surgical treatment of kyphoscoliosis, including operative mobilization, skeletal, cranio-tibial traction and subsequent correction and stabilization of deformation by a distractor of the Harington type, achieved correction ranging from 50 to 85.5% of the initial value curvature. Based on the methods of Harrington and Luke, J. Cotrel and J. Dubousset developed an original method for correcting the spine using rods, hooks and segmenting them to the vertebral arches. A. Dwyer (1973) and K. Zielke (1983) for surgical correction of scoliosis suggested rather complicated techniques using anterior approaches. However, the authors themselves note up to 43% of the complications. According to some authors, operations on vertebral bodies allow to achieve better correction of curvature of the spine. For correcting and stabilizing the deformities of the spine, Ya.L. Tsivyan (1993), JE Lonstein (1999) propose to perform operations on vertebral bodies and correction by a metal endocorrector.

A.I. Kazmin (1968) was the first to develop and apply the method of two-stage operative treatment of scoliosis: the first stage - the use of a metal distractor for correction and fixation of lumbar curvature, the second stage - discotomy or wedge resection of the thoracic spine. Development and introduction in clinical practice of endocorrectors of a backbone allowed to create simultaneously a correcting effort and to support it during all term of treatment.

Since 1988, A.I. Kislovsoavt. (2000) uses a controlled distractor of the spine of his own model, which contributes to an additional correction of scoliosis by 5-20 °.

I.A. Norkin (1994) developed and successfully applied a dynamic device that allows correction of kyphoscoliosis in the sagittal and frontal planes during the whole period of the child's growth. The Novosibirsk Research and Development Institute uses Dynesys (Sulzer, Switzerland), which consists of titanium transpedicular screws and elastic-elastic elements that join them. According to the authors, in the early postoperative period, the vertebral segment is restored, while functional mobility is maintained in it, and the method of dynamic fixation has an undeniable prospect. According to the literature, the Cotrell-Dubousset endorsementor is the most common and effective system.

S.T. Vetrile and AA Kuleshov (2000, 2001) studied the results of treatment of 52 patients with scoliosis. For the surgical correction, CD Horizon was used. This method was used according to the classical method and in combination with discectomy, spondylectomy, interlaminectomy. The differentiated approach allowed correction of scoliosis to 60 ° and a significant regression of neurological disorders in patients with neurological symptoms. In order to stabilize the achieved correction of the deformations of the spine of different genesis, many authors have used and recommended various methods of spondylodesis.

A promising direction in the treatment of spinal deformities of various genesis are the development and introduction of external correction and fixation devices. The use of these devices makes it possible to carry out a one-step correction, and with coarse and rigid curvatures of the spine, to continue correcting deformations in various planes.

Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics Ibragimov Yakub Khamzinovich. Surgical treatment of scoliosis // Practical medicine. 8 (64) December 2012 / volume 1

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