14 research outputs found
Anterior Dynamic Versus Posterior Transpedicular Spinal Fusion for Lenke Type 5 Idiopathic Scoliosis: A Comparison of Long-term Results
Background. Despite the active implementation of dynamic correction in case of idiopathic scoliosis, there are no comparative studies of results of posterior and anterior dynamic correction in patients with completed and near-completed growth.
Aim of the study to compare clinical and radiological results of anterior dynamic correction and conventional posterior transpedicular correction of Lenke type 5 scoliotic defonnities in patients with completed or near-completed growth.
Methods. Eighty-six patients with Lenke type 5 scoliotic deformities were enrolled in the study. The first group (54 patients) underwent deformity correction via posterior approach using a rigid transpedicular system; the second group (32 patients) using dynamic correction system. Mean patients age was 22.612.8 and 27.310.9 years, respectively. We studied radiological data before surgery, immediately after surgery, and 2 or more years after surgery. Blood loss volume, duration of hospital stay, and duration of narcotic analgesics intake in the early postoperative period were analyzed. Functional results were assessed using SRS-22 questionnaire.
Results. Preoperative Cobb angle in the first group was 65.5, and 27.5 at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 21.0 and 13.2 at the long-term follow-up. Preoperative Cobb angle of the initial curve in the second group was 52.5 and 24.5 at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 19.5, and 19.0 at the long-term follow-up. Nash and Moe apical vertebral rotation in the first group before surgery was 1.62 and 0.17 at the last follow-up; in the second group, it was 1.80 and 0.81, respectively. Mean number of fixed levels was 6.41.0 in the first group and 5.61.5 in the second group. Mobility of the thoracolumbar/lumbai curve was higher in the second group, 28.29.1, compared with 36.0 7.2 in the first group. Preoperatively, lumbar lordosis in the second group was 42.5, in the long-tenn period 43.5, and in the first group 43.4 and 44.3, respectively.
Conclusion. Both posterior rigid and anterior dynamic correction in case of Lenke type 5 idiopathic scoliosis can provide satisfactory radiological results with initially similar thoracolumbar deformities in patients with completed or nearcompleted growth. However, dynamic approach can reduce blood loss, duration of hospital stay, duration of narcotic analgesics intake after surgery, and improve quality of life in the long-term period.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° Π°ΠΊΡΠΈΠ²Π½ΠΎΠ΅ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠΊΠΎΠ»ΠΈΠΎΠ·Π΅, ΠΎΡΡΡΡΡΡΠ²ΡΡΡ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π΄ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΈ Π²Π΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π·Π°Π²Π΅ΡΡΠ΅Π½Π½ΡΠΌ ΠΈ Π·Π°Π²Π΅ΡΡΠ°ΡΡΠΈΠΌΡΡ ΡΠΎΡΡΠΎΠΌ.
Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ°Π²Π½ΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π²Π΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΉ Π΄ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΡΠ°Π½ΡΠΏΠ΅Π΄ΠΈΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΡΠΊΠΎΠ»ΠΈΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π΄Π΅ΡΠΎΡΠΌΠ°ΡΠΈΠΉ ΡΠΈΠΏΠ° Lenke 5 Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π·Π°Π²Π΅ΡΡΠ΅Π½Π½ΡΠΌ ΠΈΠ»ΠΈ Π·Π°Π²Π΅ΡΡΠ°ΡΡΠΈΠΌΡΡ ΡΠΎΡΡΠΎΠΌ.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΡΠ»ΠΎ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 86 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΠΊΠΎΠ»ΠΈΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π΄Π΅ΡΠΎΡΠΌΠ°ΡΠΈΡΠΌΠΈ ΡΠΈΠΏΠ° Lenke 5. Π ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ (54 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°) Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡ Π΄Π΅ΡΠΎΡΠΌΠ°ΡΠΈΠΈ ΠΈΠ· Π΄ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ° Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠΈΠ³ΠΈΠ΄Π½ΠΎΠΉ ΡΡΠ°Π½ΡΠΏΠ΅Π΄ΠΈΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ, Π²ΠΎ Π²ΡΠΎΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ (32 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°) Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠΈΡΡΠ΅ΠΌΡ Π΄Π»Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡΡΠ°Π²ΠΈΠ» 22,612,8 ΠΈ 27,310,9 Π»Π΅Ρ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΠ·ΡΡΠ°Π»ΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄Π°Π½Π½ΡΠ΅ Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΡΡΠ°Π·Ρ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΈ ΡΠ΅ΡΠ΅Π· 2 ΠΈ Π±ΠΎΠ»Π΅Π΅ Π³ΠΎΠ΄Π° ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. ΠΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΎΠ±ΡΠ΅ΠΌ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ, ΡΡΠΎΠΊΠΈ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅, Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠΈΠ΅ΠΌΠ° Π½Π°ΡΠΊΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π°Π½Π°Π»ΡΠ³Π΅ΡΠΈΠΊΠΎΠ² Π² ΡΠ°Π½Π½Π΅ΠΌ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅. Π€ΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠ° SRS-22.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΡΠ³ΠΎΠ» ΠΠΎΠ±Π±Π° Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 65,5, ΠΏΡΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΌ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΈ 27,5. ΠΠ΅ΡΠ΅Ρ
ΠΎΠ΄Π½ΡΠΉ ΠΊΠΈΡΠΎΠ· Th10-L2 Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 21,0, ΠΏΡΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΌ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΈ 13,2. ΠΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΡΠ³ΠΎΠ» ΠΠΎΠ±Π±Π° ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π΄ΡΠ³ΠΈ Π²ΠΎ Π²ΡΠΎΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ 52,5, Π° Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΡΠΎΠΊΠΈ 24,5. ΠΠ΅ΡΠ΅Ρ
ΠΎΠ΄Π½ΡΠΉ ΠΊΠΈΡΠΎΠ· Th10-L2 Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ 19,5, Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΡΠΎΠΊΠΈ 19,0. Π ΠΎΡΠ°ΡΠΈΡ Π°ΠΏΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ·Π²ΠΎΠ½ΠΊΠ° ΠΏΠΎ Nash ΠΠΎΠ΅ Π² ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 1,62, ΠΏΡΠΈ ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅ΠΌ ΠΎΡΠΌΠΎΡΡΠ΅ 0,17, Π²ΠΎ Π²ΡΠΎΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ 1,80 ΠΈ 0,81 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π‘ΡΠ΅Π΄Π½Π΅Π΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΡΡΠΎΠ²Π½Π΅ΠΉ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ Π² ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ 6,41,0, Π²ΠΎ Π²ΡΠΎΡΠΎΠΉ 5,61,5. ΠΠΎΠ±ΠΈΠ»ΡΠ½ΠΎΡΡΡ Π³ΡΡΠ΄ΠΎ-ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΠΎΠΉ/ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΠΎΠΉ Π΄ΡΠ³ΠΈ Π±ΡΠ»Π° Π²ΡΡΠ΅ Π²ΠΎ Π²ΡΠΎΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ 28,29,1 ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΠΎΠΉ Ρ 36,07,2. ΠΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΡΠΉ Π»ΠΎΡΠ΄ΠΎΠ· Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΡΠΎΡΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²ΠΈΠ» 42,5, Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΡΠΎΠΊΠΈ 43,5, Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠ΅ΡΠ²ΠΎΠΉ Π³ΡΡΠΏΠΏΡ 43,4 ΠΈ 44,3 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ°ΠΊ Π·Π°Π΄Π½ΡΡ ΡΠΈΠ³ΠΈΠ΄Π½Π°Ρ, ΡΠ°ΠΊ ΠΈ Π²Π΅Π½ΡΡΠ°Π»ΡΠ½Π°Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡ ΠΏΡΠΈ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠΊΠΎΠ»ΠΈΠΎΠ·Π΅ Lenke 5 ΠΌΠΎΠ³ΡΡ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΡΡ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ ΠΏΡΠΈ ΠΈΠ·Π½Π°ΡΠ°Π»ΡΠ½ΠΎ ΡΡ
ΠΎΠΆΠ΅ΠΉ Π²Π΅Π»ΠΈΡΠΈΠ½Π΅ Π³ΡΡΠ΄ΠΎΠΏΠΎΡΡΠ½ΠΈΡΠ½ΡΡ
Π΄Π΅ΡΠΎΡΠΌΠ°ΡΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π·Π°Π²Π΅ΡΡΠ΅Π½Π½ΡΠΌ ΠΈΠ»ΠΈ Π·Π°Π²Π΅ΡΡΠ°ΡΡΠΈΠΌΡΡ ΡΠΎΡΡΠΎΠΌ. ΠΠ΄Π½Π°ΠΊΠΎ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠΎΠΊΡΠ°ΡΠΈΡΡ ΠΎΠ±ΡΠ΅ΠΌ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ, ΡΡΠΎΠΊ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅, Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠΈΠ΅ΠΌΠ° Π½Π°ΡΠΊΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π°Π½Π°Π»ΡΠ³Π΅ΡΠΈΠΊΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠ»ΡΡΡΠΈΡΡ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅
Π₯ΠΠ Π£Π ΠΠΠ§ΠΠ‘ΠΠΠ ΠΠΠ§ΠΠΠΠ Π¦ΠΠ ΠΠΠΠΠΠ¬ΠΠΠΠ Π‘Π’ΠΠΠΠΠ Π£ ΠΠΠ¦ΠΠΠΠ’ΠΠ Π‘ ΠΠ£ΠΠΠΠΠΠΠ‘ΠΠ₯ΠΠ ΠΠΠΠΠΠ: Π‘ΠΠ‘Π’ΠΠΠΠ’ΠΠ§ΠΠ‘ΠΠΠ ΠΠΠΠΠ
A multidisciplinary approach to treatment of patients with mucopolysaccharidosis allows to achieve good results.Β However, progressive spinal canal stenosis at the level of the craniovertebral junction, characteristic of this disease,Β leads to neurological signs, as well as a decrease in quality and length of life. The solution to this problem is aΒ difficult challenge for spinal surgeons, as it is associated with a high risk of complications. There is also a wide rangeΒ of opinions and approaches to the surgical treatment of this group of patients.Using the referred Reporting Items for Systematic Review and Meta-AnalysisΒ» (PRISMA) protocol, a PubMed andΒ eLIBRARY search was conducted using keywords to find articles describing patients with mucopolysaccharidosisΒ who underwent surgical treatment for cervical stenosis. In this review, information on demographic parameters,Β surgical technique and the results of cervical stenosis treatment in patients with mucopolysaccharidosis is collectedΒ and analyzed.ΠΡΠ»ΡΡΠΈΠ΄ΠΈΡΡΠΈΠΏΠ»ΠΈΠ½Π°ΡΠ½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΌΡΠΊΠΎΠΏΠΎΠ»ΠΈΡΠ°Ρ
Π°ΡΠΈΠ΄ΠΎΠ·ΠΎΠΌ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π΄ΠΎΠ±ΠΈΡΡΡΡ Ρ
ΠΎΡΠΎΡΠΈΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ². ΠΠ΄Π½Π°ΠΊΠΎ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΠΊΡΠ΅ΡΠ½ΡΠΉ Π΄Π»Ρ Π΄Π°Π½Π½ΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΡΡΡΠΈΠΉ ΡΡΠ΅Π½ΠΎΠ· ΠΏΠΎΠ·Π²ΠΎΠ½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°Π½Π°Π»Π° Π½Π° ΡΡΠΎΠ²Π½Π΅ ΠΊΡΠ°Π½ΠΈΠΎΠ²Π΅ΡΡΠ΅Π±ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄Π° ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡΠΌ, ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡΒ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΆΠΈΠ·Π½ΠΈ. Π Π΅ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ»ΠΎΠΆΠ½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ Π΄Π»Ρ ΡΠΏΠΈΠ½Π°Π»ΡΠ½ΡΡ
Β Ρ
ΠΈΡΡΡΠ³ΠΎΠ², ΡΠΎΠΏΡΡΠΆΠ΅Π½Π½ΠΎΠΉ Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΡΠΈ ΠΏΠΎΠΌΠΎΡΠΈ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Π° Β«ΠΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΠΎΡΡΠ΅ΡΠ½ΠΎΡΡΠΈ Π΄Π»Ρ ΡΠΈΡΡΠ΅ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΠ±Π·ΠΎΡΠΎΠ² ΠΈ ΠΌΠ΅ΡΠ°-Π°Π½Π°Π»ΠΈΠ·Π°Β» (PRISMA) ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ ΠΏΠΎΠΈΡΠΊ Π² ΡΠΈΡΡΠ΅ΠΌΠ°Ρ
PubMedΒ Β ΠΈ eLIBRARY Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΊΠ»ΡΡΠ΅Π²ΡΡ
ΡΠ»ΠΎΠ² Π΄Π»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠ°ΡΠ΅ΠΉ, ΠΎΠΏΠΈΡΡΠ²Π°ΡΡΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΌΡΠΊΠΎΠΏΠΎΠ»ΠΈΡΠ°Ρ
Π°ΡΠΈΠ΄ΠΎΠ·ΠΎΠΌ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ΅ΡΠ²ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π½ΠΎΠ·Π°. Π ΠΎΠ±Π·ΠΎΡΠ΅ ΡΠΎΠ±ΡΠ°Π½Π° ΠΈ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΎ Π΄Π΅ΠΌΠΎΠ³ΡΠ°Π³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΡ
, Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Ρ
Π½ΠΈΠΊΠ΅ ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°Ρ
Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅ΡΠ²ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π½ΠΎΠ·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΌΡΠΊΠΎΠΏΠΎΠ»ΠΈΡΠ°Ρ
Π°ΡΠΈΠ΄ΠΎΠ·ΠΎΠΌ
Indications for surgical treatment of thoracolumbar kyphosis in patients with Mucopolysaccharidosis
Introduction. Circumferential fusion of kyphosis in patients with MPS is currently accepted as the most effective surgical approach. However, long-term results remain debatable. This study assesses the effectiveness
of posterior-only compared to circumferential fusion.
Methods. Eleven patients (7 male, 4 female) with MPS and thoracolumbar kyphosis underwent surgical
treatment. Hurler Syndrome (type I) was diagnosed in 5 patients, Morquio Syndrome (type IV) in 2, and Maroto-Lamy (type VI) in 4 patients.
Indications for surgical treatment included more than 40Β° kyphosis, sagittal spinal imbalance, progressive
neurological symptoms and severe pain. In 3 cases, patients underwent circumferential arthrodesis combining
anterior and posterior approaches. In 8 cases, instrumentation included hooks and/or pedicular screws, placed
two levels above and two levels below the deformity apex. The follow-up period ranged from 2 to 5 years.
Results. In 8 cases solid spinal fusion was achieved. Complications after surgical treatment were observed
in 4 patients (36%). PJK developed in one case 2 years after surgery, pseudarthrosis was observed in one case,
wound suppuration was observed in one case, and a broken metal rod in one case.
Conclusions. Surgical treatment of MPS patients with thoracolumbar kyphosis is accompanied by a high
risk of complications when circumferential stabilization is performed. Most authors and our data show that the
most optimal method of surgical treatment of thoracolumbar deformation is dorsal correction and fixation
in combination with a wide laminectomy at the level of stenosis. The second stage includes the anterior decompression and interbody fusion. However, if the patientβs lung function is dramatically compromised, and a
high risk of respiratory complications exists, surgery may be limited to only posterior correction and fixation in
conjunction with a wide laminectomy, which allows to achieve a comparable level of fixation with a lower risk
of complications
Risk factors and surgical treatment of craniovertebral stenosis in patients with Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI)
Introduction. Atlantoaxial instability with the outcome of myelopathy and spastic tetraparesis are commonly described in patients with MPS VI type. The accumulation of glycosaminoglycans behind the odontoid
process leads to a gradual development of the spinal canal stenosis and compression of the spinal cord in the
cervical spine. These lesions lead to neurological disorders and loss of quality of life.
Methods. Nine patients with MPS type VI. Of them 3 males and 6 females aged 14 to 35 years (mean
age 20.8 years). All patients presented with craniovertebral stenosis of some degree and underwent posterior
spinal canal decompression with cervical fusion. Neurological symptoms were observed in 7 of all cases preoperatively. Functional assessment and evaluation of neurological status was conducted in all cases. CT and MRI
evaluation was performed at the atlantoaxial level before surgery and at follow-up.
Results. The average follow-up period was 2.9 years. Seven of the nine patients demonstrated regression
of neurological symptoms. In two patients the neurological status was unchanged. Solid fusion was achieved
in 6 cases. Complications from surgery we observed in 3 patients. One patient died one year after surgery due
to unrelated causes, there was one case of pseudarthrosis one case of implant instability and one case of early
postoperative wound suppuration.
Conclusion. The majority of patients with type VI MPS present with some degree of spinal stenosis at the
atlantoaxial level. Based on our experience, these patients require close neurological and radiographic monitoring as early as possible. In our view, surgical treatment of patients with type VI MPS should be considered
before the onset and progression of neurological symptoms