The experience in treatment of the spine neurogenic deformities

Рябых С.О., Савин Д.М., Медведева С.Н., Губина Е.Б.

Abstract


Purpose. Study vertebral syndrome course and results for different neurogenic spine deformities.
Material and Methods. Retrospective analysis of results made in 23 patients (1,5-28-year old) with spine neurogenic deformities («high risk» group – severe deformity), and progressive deficit of internal organ function. Patients divided into 3 groups by vertebral syndrome nosology and regularities: Group I – patients with myelocele consequences (6), II – spineand- spinal cord injury consequences at cervical and thoracic levels (2), III – neuromuscular diseases (15). Vertebral syndrome special features, dynamics of neurologic status and functional disorders were the study subject. Clinical, radial, functional and statistical methods used.
Results. Techniques of posterior instrumental bi-cortical fixation (PIBCF) with connector system, correcting vertebrotomy at kyphosis apex with PIBCF used in Group I. Mean correction – 68%. For Groups II-III patients extended PIBCF preferred with segment-by-segment step and sacrum-pelvis support platform combined with posterior osteoplastic spondylodesis. The main treatment method was deformity correction and stabilization with CDI segmental instrumentation, posterior spondylodesis with autobone or combined with “Chronos” osteoinductive material. Mean correction in Group II – 60%, in Group III – 57%.
Conclusion. Neurogenic spine deformities require early surgical treatment with maintaining adequate pulmonary ventilation parameters. Surgical treatment is a stage of general treatment strategy. Plan of treatment including surgery can realize only with possible multidisciplinary examination, status monitoring and consulting panel opinion in view of recommendations by an orthopedist, pediatrist, neurologist, anesthesiologist-resuscitator, radial diagnostician, physiologist, physiotherapist. It’s also necessary to create a unified registry of neuroorthopedical patients.

Keywords


neurogenic kyphoscoliosis, denervation scoliosis, neuromuscular deformities, myelocele

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