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Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques

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Abstract

Introduction

There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation.

Purpose

Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents.

Methods

Twenty five patients were reviewed (mean age, 15.1 ± 0.4 years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4 years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment.

Results

Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p < 0.05) immediately after treatment and by 55.6 ± 2.8% (p < 0.05) at long term. ODI reduced by 30.2 ± 1.7% (p < 0.05) immediately after treatment and by 37.2 ± 1.6% (p < 0.05) at long term.

Conclusion

The apparatus for external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.

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Authors and Affiliations

  1. Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulianova Street, Kurgan, Russian Federation, 640014

    Oksana G. Prudnikova & Elena N. Shchurova

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  1. Oksana G. Prudnikova
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  2. Elena N. Shchurova
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Correspondence to Elena N. Shchurova.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of our institution and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Parents and guardians signed informed consents on conduction of diagnostic procedures, medical interventions, and participation of children in the study.

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Prudnikova, O.G., Shchurova, E.N. Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques. International Orthopaedics (SICOT) 42, 331–338 (2018). https://doi.org/10.1007/s00264-017-3738-1

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  • DOI: https://doi.org/10.1007/s00264-017-3738-1

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