CONSERVATIVE TREATMENT OF CHILDREN WITH VERTEBRAL COMPRESSION FRACTURES OF THORACIC AND LUMBAR SPINE USING ORTHOSIS (REVIEW)

A review of the literature on conservative and restorative treatment of children with vertebral compression fractures of thoracic and lumbar spine is presented. Conventional treatment techniques with prolonged bed rest and application of braces onlyduring the recovery period are described. In addition, the issues of early application of functional braces as the main treatment modality for patients with compression fractures are considered. This work demonstrated that an issue of conservative treatment of compression spine fractures using orthotics as the main treatment requiresfurther study

Variants of Acetabular Deformity in Developmental Dysplasia of the Hip in Young Children

Background. The choice of pelvic reconstruction technique in children with developmental dysplasia of the hip (DDH) has been the subject of discussion for many years and is often determined by personal preferences of a surgeon rather than by X-ray anatomical state of the acetabulum. The variants of its anatomy structure have still not been reflected in the available scientific literature. Aim of the study to identify the most typical variants of acetabular deformation in children with varying severity of DDH, based on the X-ray anatomical analysis of structure of the acetabulum. Methods. The study was based on the results of examination of 200 patients (200 hip joints) aged 2 to 4 years (3.10.45) with Tnnis grade II-IV DDH. All patients underwent conventional clinical and radiological examination. The latter consisted of hip radiography in several views and computed tomography. We took the values of acetabular index, the extent of acetabulum arch and the presence or the absence of bone oriel as criteria for determination of the most typical variants of acetabular deformation. Results. X-ray analysis of anatomical structure of the acetabulum in young children with varying severity of DDH revealed 3 most common variants of acetabular deformity: 1 moderate underdevelopment of the acetabulum arch (AI 35), its shortening and the presence of bone oriel; 2 pronounced underdevelopment of the acetabulum arch (AI 35), its shortening and the presence of bone oriel; 3 pronounced underdevelopment of the acetabulum arch (AI 35), its sufficient length and the absence of bone oriel. Conclusion. Suggested supplements to existing Tnnis DDH classification might become basic for choosing the surgical correction technique of the acetabulum in children with different severity of DDH

THE SURGICAL TREATMENT OF CHILDREN WITH COMPLICATED FRACTURES OF THORACIC AND LUMBAR VERTEBRAE

The analysis of surgical treatment of 31 patients aged 3 to 17 years with complicated fractures of the vertebrae in the thoracic and lumbar localization was carried out. If damage type A3 with neurological manifestations of type Д В, С at one time served a two-stage decompression-stabilization operation. Surgical treatment of fractures of type В and С consisted in remove all types of dislocation of vertebrae, stabilize the physiologically correct position of the injured segment after the decompression and revision spinal canal. Early surgery in acute phase can eliminate the vertebro-medullar conflict, to stabilize the vertebral-motor segment, restore support ability of injured vertebra (or vertebrae), to recreate the normal anatomy of the spinal canal

TACTIC IN SURGICAL TREATMENT OF THORACIC IDIOPATHIC SCOLIOSIS IN CHILDREN

The results of surgical treatment of 263 patients with thoracic scoliosis from 13 to 18 years old with deformity 50-152° (Cobb) are presented. It was used three tactical variants with dorsal instrumentation Cotrel-Dubousset (CDI). Operation correction in idiopathic thoracic scoliosis varies within in limits from 46,2 to 95%. Lost of correction in 10 years follow up period was 5,10-10,15%. Authors concluded that tactic of surgical treatment of idiopathic thoracic scoliosis should be individual and depends on patient's age, growth potential, and degree of deformation and mobility of the curve

Foot Function Disorders in Children with Severe Spondylolisthesis of L5 Vertebra

Background. In children with spondylolisthesis, there are still unexplained aspects in the relationship of the degree of displacement of the L5 vertebra with the severity of the clinical picture and neurological disorders. At the same time, aspects of the mutual aggravating influence of the indicated spinal disorder on the condition of the feet have not been studied. Therefore, the problem of identifying disorder of foot function in children with spinal spondylolisthesis of the L5 vertebra is relevant.Aim of the study — to evaluate the deviations in parameters of the transverse and longitudinal arches of feet in children suffering from severe spondylolisthesis of the L5 vertebra.Materials and Methods. In the period from 2016 to 2018, 12 children aged 14.1 y.o. [12,7; 15,5] were examined with spondylolisthesis of the L5 vertebral body of grade III-IV, accompanied by stenosis of the spinal canal at the same level and by compression of the roots of the spinal cord. Imaging diagnostics included multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI). To estimate the function of the feet, double-bearing and single-bearing plantography was used. The data for the control group included only plantographic examinations of 12 healthy children of the same age.Results. In patients with spondylolisthesis, the mean value of the anterior t and intermediate s plantographic bearing indices were significantly lower than those of healthy children. At the same time, in tests with an increased load on the foot in patients, there was no significant increase in the mean anterior t and medial m indices, which indicates the dynamic rigidity of the transverse and medial longitudinal arches. The value of the lateral plantographic index l showed its significant pathological increase compared with the normal value at double-bearing load, which indicates the static rigidity of the lateral longitudinal arch. Correlation analysis demonstrated that, against the normal state, the bearing ability of the feet in sick children is realized through a pathological strengthening of the functional relationship between the arches of the foot at double-bearing load and a non-physiological reduction of the interaction between arches at single-bearing load.Conclusion. In children with severe forms of vertebra spondylolisthesis, the parameters of plantographic characteristics indicate the rigidity of the arches of the feet and the distortion of their bearing pattern. It is necessary to take into account the aggravating effect of rigid feet on the state of the spine and include the examination of the bearing function of the feet in the algorithm for the comprehensive diagnosis of children with spondylolisthesis

THE COMPLEX TREATMENT OF THE PATIENT WITH MULTIPLE SPINE AND SPINAL CORD MALFORMATIONS

Clinical case of the patient with the congenital deformation of thoracic and lumbar parts of the spine due to multiple congenital anomalies of vertebrae (disturbance of formation, fusion and segmentation), a terminale filum lipoma at the level of L5, tethered cord, rightside lower leg monoparesis. Multistage surgical treatment was performed: removing of intracanal deformity, correction and stabilization of the deformity at the thoracic and lumbar part of the spine. Patient was followed up during 2,5 years after the last step of the surgical operation. No evidence of recurrence or neurological deterioration were observed