Analysis of vertebrotomy treatment in children with congenital scoliosis with unsegmented rod and rib synostosis

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Abstract

BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome.

AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy.

MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used.

RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p < 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function.

CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.

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About the authors

Marat S. Asadulaev

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

Email: marat.asadulaev@yandex.ru
ORCID iD: 0000-0002-1768-2402
SPIN-code: 3336-8996

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

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

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

Anton S. Shabunin

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

Email: anton-shab@yandex.ru
ORCID iD: 0000-0002-8883-0580
SPIN-code: 1260-5644
Russian Federation, Saint Petersburg

Kristina N. Rodionova

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

Email: rkn0306@mail.ru
ORCID iD: 0000-0001-6187-2097
SPIN-code: 4627-3979
Russian Federation, Saint Petersburg

Yury A. Novosad

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

Email: yurynovosad@gmail.com
ORCID iD: 0000-0002-6150-374X
SPIN-code: 3001-1467

PhD student

Russian Federation, Saint Petersburg

Vakhtang G. Toriya

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

Email: vakdiss@yandex.ru
ORCID iD: 0000-0002-2056-9726
SPIN-code: 1797-5031

MD

Russian Federation, Saint Petersburg

Dmitry N. Kokushin

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

Email: partgerm@yandex.ru
ORCID iD: 0000-0002-2510-7213
SPIN-code: 9071-4853

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Nikita O. Khusainov

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

Email: nikita_husainov@mail.ru
ORCID iD: 0000-0003-3036-3796
SPIN-code: 8953-5229

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Aleksandra N. Filippova

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

Email: alexandrjonok@mail.ru
ORCID iD: 0000-0001-9586-0668
SPIN-code: 2314-8794

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitry V. Ryzhikov

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

Author for correspondence.
Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN-code: 7983-4270

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Normal distribution of the values for all study patients in the sagittal and frontal planes.

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3. Fig. 2. Wedge osteotomy of the unsegmented bar at the apex of deformity in Group 1: a, before treatment; b, after treatment. 1, unsegmented bar; 2, intervertebral disc; 3, area of wedge osteotomy of the unsegmented bar; 4, post-correction osteotomy area; 5, cranial portion of the superjacent vertebra; 6, caudal portion of the subjacent vertebra.

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4. Fig. 3. View of the dorsal bone structures of the spine after a wedge vertebrotomy with subsequent correction and stabilization using a screw fixation system in a patient from Group 1. 1, area of wedge osteotomy; 2, pedicular screws; 3, bar; 4, soft tissues.

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5. Fig. 4. Three-level, one-stage osteotomy of the unsegmented bar in Group 2: a, before treatment; b, after treatment. 1, vertebral body; 2, unilateral vertebral segmentation failure; 3, area of wedge vertebrotomy; 4, area of cranial osteotomy of the unsegmented bar; 5, area of caudal osteotomy of the unsegmented bar; 6, spinal screw fixation system; 7, correction vector along the concave side (distraction); 8, correction vector along the convex side (contraction).

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6. Fig. 5. Surgical wound: a, before correction; b, after screw implantation, three-level osteotomies of the unsegmented bar, and deformity correction. 1, unilateral vertebral segmentation failure; 2, area of wedge vertebrotomy; 3, area of cranial osteotomy of the unsegmented bar; 4, area of caudal osteotomy of the unsegmented bar; 5, spinal screw fixation system.

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7. Fig. 6. Incidence of thoracic segmentation failure.

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8. Fig. 7. A 12-year-old patient diagnosed with a congenital spinal deformity associated with vertebral segmentation failure and rib synostosis: a and b, preoperative spinal X-ray images; c and d, postoperative spinal X-ray images.

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9. Fig. 8. Changes in scoliosis and kyphosis curvatures in Group 1.

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10. Fig. 9. Changes in scoliosis and kyphosis curvatures in Group 2.

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11. Fig. 10. Changes in lung volume in Group 1 over the treatment period.

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12. Fig. 11. Changes in lung volume in Group 2 over the treatment period.

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