A clinical case study of long-term injury of the thoracic and lumbar spine

Cover Page

Abstract


Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.

Full Text

Restricted Access

About the authors

Vladimir V Zaretskov

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: fake@eco-vector.com

Russian Federation MD, PhD, professor, leading research associate. Saratov Scientific and Research Institute of Traumatology and Orthopedics.

Vladislav B Arsenievich

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Email: fake@eco-vector.com

Russian Federation MD, PhD, chief of the department of traumatology and orthopedics No 3. Saratov Scientific and Research Institute of Traumatology and Orthopedics.

Sergey V Likhachev

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Email: Likha4@mail.ru

Russian Federation MD, PhD, orthopedic and trauma surgeon. Saratov Scientific and Research Institute of Traumatology and Orthopedics

Alexey E Shul’ga

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Email: fake@eco-vector.com

Russian Federation MD, PhD, senior research associate. Saratov Scientific and Research Institute of Traumatology and Orthopedics.

Sergey V Stepukhovich

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Email: fake@eco-vector.com

Russian Federation MD, PhD, orthopedic and trauma surgeon. Saratov Scientific and Research Institute of Traumatology and Orthopedics.

Nina V Bogomolova

Saratov Scientific and Research Institute of Traumatology and Orthopedics

Email: fake@eco-vector.com

Russian Federation MD, PhD, professor, corresponding member of RANS, AMS. Saratov Scientific and Research Institute of Traumatology and Orthopedics.

References

  1. Норкин И.А., Баратов А.В., Федонников А.С., и др. Значимость анализа медико-социальных параметров травм позвоночника в организации специализированной медицинской помощи // Хирургия позвоночника. - 2014. - № 3. - С. 95-100. [Norkin IA, Baratov AV, Fedonnikov AS, et al. The importance of analysis of medical and social parameters of traumatic spine injuries for organization of specialized medical care. Spine Surgery. 2014;3:95-100. (In Russ).]. doi: 10.14531/ss2014.3.95-100.
  2. Виссарионов С.В., Баиндурашвили А.Г., Кокушин Д.Н., и др. Организация помощи детям с нестабильными и осложненными переломами позвоночника в Санкт-Петербурге // Хирургия позвоночника. - 2014. - № 4. - С. 146-150. [Vissarionov SV, Baindurashvili AG, Kokushin DN, et al. Organization of medical care to children with unstable and complicated vertebral fractures in St Petersburg. Spine Surgery. 2014; 4:146-150. (In Russ).].
  3. Зарецков В.В., Норкин И.А., Арсениевич В.Б., и др. Хирургическое лечение повреждений и заболеваний позвоночника: практическое руководство для врачей. - Рыбинск, 2007. - 110 с. [Zareckov VV, Norkin IA, Arsenievich VB, et al. Khirurgicheskoe lechenie povrezhdenij i zabolevanij pozvonochnika. Prakticheskoe rukovodstvo dlya vrachej. Rybinsk; 2007;110 p. (In Russ).].
  4. Sayama C, et al. A review of pediatric lumbar spine trauma. Neurosurgical focus. 2014;37(1):E6. doi: 10.3171/2014.5.focus1490.
  5. Rush JK, Kelly DM, Astur N, et al. Associated injures in children and adolescents with spinal trauma. J Pediatr Orthop. 2013;33:393-397. doi: 10.1097/bpo.0b013e318279c7cb.
  6. Grigoriou E, Dormans JP. Pediatric Spine Trauma. The Growing Spine. Springer Berlin Heidelberg; 2016:359-381. doi: 10.1007/978-3-662-48284-1-21.
  7. Рерих В.В., Борзых К.О., Рахматиллаев Ш.Н. Хирургическое лечение взрывных переломов грудных и поясничных повонков, сопровождающихся сужением повоночного канала // Хирургия позвоночника. - 2007. - № 2. - С 8-15. [Rerikh VV, Borzykh KO, Rakhmatillaev SHN. Surgical treatment of burst fractures of the thoracic and lumbar spine accompanied with spinal canal narrowing. Spine Surgery. 2007;2:8-15. (In Russ).].
  8. Виссарионов С.В., Баиндурашвили А.Г., Мушкин А.Ю., и др. Хирургическое лечение взрывных переломов тел позвонков грудного и поясничного отделов у детей // Травматология и ортопедия России. - 2006. - № 1 (39). - С. 10-15. [Vissarionov SV., Baindurashvili AG, Mushkin AY, et al. The surgical treatment of burst compression fractures of thoracic and lumbar parts of spine in children. Traumatology and orthopedics of Russia. 2006;39(1):10-15. (In Russ).].
  9. Onen MR, Naderi S. Pediatric Spine Trauma. J Spine. 2015;4(2). doi: 10.4172/2165-7939.1000211.
  10. Шульга А.Е., Зарецков В.В., Островский В.В., и др. К вопросу о причинах развития вторичных посттравматических деформаций грудного и поясничного отделов позвоночника // Саратовский научно-медицинский журнал. - 2015. - Т. 11. - № 4. - С. 570-575. [Shulga AE, Zareckov VV, Ostrovskij VV, et al. Towards the causes of secondary post-traumatic deformations of thoracic and lumbar spine. Saratov Journal of Medical Scientific Research. 2015;11(4):570-575. (In Russ).].
  11. Бердюгин К.А., Чертков А.К., Штадлер Д.И., Бердюгина О.В. О неудовлетворительных исходах транспедикулярной фиксации позвоночника // Хирургия позвоночника. - 2010. - № 4. - С. 19-24. [Berdyugin KA, Chertkov AK, Shtadler DI, Berdyugina OV. On Unsatisfactory Outcomes of Transpedicular Fixation. Spine Surgery. 2010;4:19-24. (In Russ).].
  12. Hempfing A, Zenner J, et al. Restoration of sagittal balance in treatment of thoracic and lumbar vertebral fractures. Orthopade. 2011;40(8):690-702.
  13. Пятакова Г.В., Виссарионов С.В., Овечкина А.В. Психологические факторы риска психосоматических нарушений у детей с идиопатическим сколиозом // Хирургия позвоночника. - 2015. - Т. 12. - № 1. - С. 21-26. [Pyatakova GV, Vissarionov SV, Ovechkina AV. Psychological risk factors of psychosomatic disorders in children with idiopathic scoliosis.Spine Surgery. 2015;12(1):21-26. (In Russ).].
  14. Зарецков В.В., Арсениевич В.Б., Рубашкин С.А. Хирургическая коррекция сколиотической деформации в условиях продолжающегося роста больного //Хирургия позвоночника. - 2007. - № 3. - С. 36-38. [Zaretskov VV, Arsenievich VB, Rubashkin SA. Surgical correction of scoliotic deformation in a patient with continuing growth. Spine Surgery. 2007;3:36-38. (In Russ).].
  15. Норкин И.А., Шемятенков В.Н., Зарецков В.В., и др. Особенности психофизиологического статуса детей и подростков со сколиозом на разных этапах лечения // Хирургия повоночника. - 2006. - № 4. - С. 8-12. [Norkin IA, Shemyatenkov VN, Zaretskov VV, et al. Peculiarities of Psychophysiology of Children and Adolescents with Scoliosis at Different Stages of Treatment. Spine Surgery. 2006;(4):8-12. (In Russ).].
  16. Денисов-Никольский Ю.И., Миронов С.П., Омельяненко Н.П., Матвейчук И.В. Морфофункциональные характеристики кости как органа // Актуальные проблемы теоретической и клинической остеоартрологии. - 2005. - С. 15-35 [Denisov-Nikolskij YI, Mironov SP, Omelyanenko NP, Matvejchuk IV. Morfofunkcionalnye kharakteristiki kosti kak organa. In: Aktualnye problemy teoreticheskoj i klinicheskoj osteoartrologii. 2005. P. 15-35. (In Russ).].
  17. Богомолова Н.В., Норкин И.А., Шульга А.Е., и др. Репаративный остеогенез позвонков в разные сроки после травмы // Сб. «Травматология и ортопедия в России: традиции и инновации». - Саратов, 2015. С. 48-50 [Bogomolova NV, Norkin IA, Shulga AE, et al. Reparativnyj osteogenez pozvonkov v raznye sroki posle travmy. In Sb. “Travmatologiya i ortopediya v Rossii: tradicii i innovacii”. Saratov; 2015, P. 48-50 (In Russ).].
  18. Ким В.Д., и др. Влияние сегментарной транспедикулярной фиксации на активно растущий позвоночник: длительное экспериментальное исследование // Хирургия позвоночника. - 2005. - № 1. - С. 105-111. [Kim VD, et al. The Effect of Segmental Pedicle Screw Instrumentation on Actively Growing Spine: A Long-term Experimental Study. Spine Surgery. 2005;1:105-111. (In Russ).].

Statistics

Views

Abstract - 2762

PDF (Russian) - 508

PDF (English) - 290

Cited-By


PlumX

Dimensions


Copyright (c) 2016 Zaretskov V.V., Arsenievich V.B., Likhachev S.V., Shul’ga A.E., Stepukhovich S.V., Bogomolova N.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies