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

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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.

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About the authors

Dmitry N. Kokushin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: partgerm@yandex.ru
ORCID iD: 0000-0002-6112-3309

MD, PhD, Senior Research Associate of the Department of Pathology of the Spine and Neurosurgery

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.ru
ORCID iD: 0000-0003-4235-5048

MD, PhD, D.Sc., Professor, Corresponding Member of RAS, Deputy Director for Research and Academic Affairs, Head of the Department of Spinal Pathology and Neurosurgery

Russian Federation, Saint Petersburg

Alexey G. Baindurashvili

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0001-8123-6944

MD, PhD, D.Sc., Professor, Member Of RAS, Honored Doctor of the Russian Federation, Director

Russian Federation, Saint Petersburg

Alla V. Ovechkina

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0002-3172-0065

MD, PhD, Associate Professor, Academic Secretary

Russian Federation, Saint Petersburg

Nikita O. Khusainov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: nikita_husainov@mail.ru
ORCID iD: 0000-0003-3036-3796

MD, PhD, Research Associate of the Department of Pathology of the Spine and Neurosurgery

Russian Federation, Saint Petersburg

Mahmud S. Poznovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: poznovich@bk.ru
ORCID iD: 0000-0003-2534-9252

MD, Research Associate of the Genetic Laboratory of the Center for Rare and Hereditary Diseases in Children

Russian Federation, Saint Petersburg

Anna V. Zaletina

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0002-9838-2777

канд. мед. наук, руководитель научно-организационного отдела, врач — травматолог-ортопед отделения № 11

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Planning of virtual screws and guide templates in the PME Planner software environment: a — selection of the size of the transpedicular screw; b — creating the boundaries of the guide template

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3. Fig. 2. Stages of intraoperative examination: a — installation of a guide template on the dorsal bone structures of the vertebra and drilling of a channel for the transpedicular screw; b — probe verification of the integrity of the walls of the formed bone canal in the vertebra; c — installation of X-ray tracers in the vertebral bodies to manage X-ray control

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4. Fig. 3. Design options for the guide template: a — monosegmental with a limited contact area (option 1); b — monosegmental with a contact area including the edges of the spinous process, the arch, and the transverse processes of the vertebra (option 2); c — polysegmental, including ≥2 vertebrae in the contact area (option 3)

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5. Fig. 4. Multispiral computed tomogram of the spine of a patient with congenital scoliosis after extirpation of the posterolateral semi-vertebra L2 with installed transpedicular screws using a guide template, with the completely correct positioning of the screws: a — section in the axial plane; b — section in the coronal plane; c — section in the sagittal plane

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Copyright (c) 2020 Kokushin D.N., Vissarionov S.V., Baindurashvili A.G., Ovechkina A.V., Khusainov N.O., Poznovich M.S., Zaletina A.V.

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