Congenital spine deformity: "What's the latest and what's the best"?

Transpedicular hemiepiphysiodesis and posterior instrumentation as a treatment for congenital scoliosis

Anterior and posterior hemiepiphysiodesis using a transpedicular approach is an effective alternative treatment when compared with the traditional convex hemiepiphysiodesis or hemivertebrae excision. No study has reported the results of instrumentation with transpedicular hemiepiphysiodesis. Our study was a retrospective radiographic evaluation to assess the efficacy of transpedicular convex hemiepiphysiodesis with short segment instrumented posterior spinal fusion for congenital scoliosis. Ten hemivertebrae in 9 patients were evaluated. The average patient age was 10.5 years (range, 2.9-14.5 years). The average follow-up was 29.7 months. Cobb angles were recorded for the instrumented segment (segmental main curve) and the global or entire curve (total main curve). These values were compared preoperatively, postoperatively, and at 2-year follow-up. The average total main curve improved in 6 of 10 curves, from 35.0 to 29.6 degrees (15.4%). The average segmental main curve improved in 8 of 10 curves, from 30.0 to 21.5 degrees (28.3%). Seven of 10 curves demonstrated either no progression or improvement at the average 2-year follow-up. Two curves in older patients (greater than 9 years, 10 months) progressed until a comprehensive posterior spinal fusion was required. Multiple surgical techniques have been developed to provide treatment for progressive congenital scoliosis. Transpedicular hemiepiphysiodesis with a short segment instrumented posterior spinal fusion is a safe and effective treatment method to halt the progression of congenital scoliosis due to a hemivertebra in patients who are skeletally immature.

R, Bonetti CL, Santos CAD, Barros Filho TEP. Mechanical comparative analysis of three different types of sutures in different dimensions tendons - experimental study

The authors present sixteen patients with congenital kyphosis treated by posterior spinal arthrodesis. A homologous or autogenous iliac bone graft was used. The patients walked with Risser-Cotrel body cast in the 6 months of postoperatory period. The mean time of follow-up was 58,25 months and the mean age of the patients at time of surgery was 9,3 years. The mean angular value of the congenital kyphosis before surgery was 50,44º Cobb and after ther surgery it was 46,94º Cobb. One of the patients who had curve of 69º Cobb, presented pseudoarthrosis. The final results were good in 10, regular in 4 and bad in 2 patients. The need of the diagnostic and precocious treatment is recommended by authors.

Congenital scoliosis

Congenital scoliosis is a deformity of the developing spine that results from defects in vertebral development. The developmental etiologies may be classified as either a failure of formation, a failure of segmentation, or a mixture of these two modes of maldevelopment. Early detection and close surveillance of congenital scoliosis is critical, as a rapidly progressive curve may lead to significant deformity, pulmonary restriction, and neurologic problems if not treated. Early surgical treatment is often necessary for rapidly progressive curves.

Spinal shortening in scoliosis surgery, A case with transitory paraplegia

STUDY DESIGN

A case involving a 16-year-old patient with idiopathic adolescent double-major scoliosis is presented. The curve was so rigid that a shortening surgery was done to reduce neurologic risk.

OBJECTIVE

To advise surgeons who are considering this kind of surgical procedure to reduce the neurologic risk involved in correcting scoliosis, may be more dangerous than other, more traditional modes. SUMMARY OF BACKGROUND DATE: The two-stage procedure for anterior resection of a vertebral body followed by posterior resection and fusion by shortening the spine with instrumentation has been reported to be a safe and effective method of correcting deformities and other spinal pathologies.

METHODS

Surgical treatment consisted of two anterior approaches, thoracic lumbotomy and thoracofrenolumbotomy, in which all the discs between 75 and L4 and the vertebral body of T8 were resected, followed by a posterior resection. In the third surgery (posterior resection) a full T8 vertebrectomy was completed, and the gap between the adjacent vertebrae was closed. Then a traditional CD configuration with rod rotation was used, and a thoracoplasty of the rib hump was done.

RESULTS

During the intraoperative wake-up test, the patient did not move her inferior extremities, and it was necessary to partially reverse the shortening of the gap produced by the vertebrectomy. The preoperative and postoperative curves measured 90 degrees/86 degrees and 25 degrees/27 degrees, respectively.

CONCLUSIONS

This procedure appears to be more dangerous than traditional surgery. Partial vertebrectomy as a closing wedge osteotomy of the convexity may be a less risky procedure. The practice of not using bone graft in the intervertebral spaces does not seem to contribute to spinal shortening and increases the pseudoartosis risk.