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.Актуальность. Несмотря на активное внедрение динамической коррекции при идиопатическом сколиозе, отсутствуют сравнительные исследования результатов дорсальной и вентральной динамической коррекции у пациентов с завершенным и завершающимся ростом. Цель исследования сравнить клинические и рентгенологические результаты вентральной динамической коррекции и традиционной дорсальной транспедикулярной коррекции сколиотических деформаций типа Lenke 5 у пациентов с завершенным или завершающимся ростом. Материал и методы. В исследование было включено 86 пациентов со сколиотическими деформациями типа Lenke 5. В первой группе (54 пациента) выполняли коррекцию деформации из дорсального доступа с использованием ригидной транспедикулярной системы, во второй группе (32 пациента) с применением системы для динамической коррекции. Средний возраст пациентов составил 22,612,8 и 27,310,9 лет соответственно. Изучали рентгенологические данные до операции, сразу после операции и через 2 и более года после операции. Анализировали объем кровопотери, сроки пребывания в стационаре, длительность приема наркотических анальгетиков в раннем послеоперационном периоде. Функциональные результаты оценивали с использованием опросника SRS-22. Результаты. В первой группе угол Кобба до операции составил 65,5, при отдаленном наблюдении 27,5. Переходный кифоз Th10-L2 до операции составил 21,0, при отдаленном наблюдении 13,2. Предоперационный угол Кобба основной дуги во второй группе 52,5, а в отдаленные сроки 24,5. Переходный кифоз Th10-L2 до операции 19,5, в отдаленные сроки 19,0. Ротация апикального позвонка по Nash Мое в первой группе до операции составила 1,62, при последнем осмотре 0,17, во второй группе 1,80 и 0,81 соответственно. Среднее количество фиксированных уровней составило в первой группе 6,41,0, во второй 5,61,5. Мобильность грудо-поясничной/поясничной дуги была выше во второй группе 28,29,1 по сравнению с первой группой с 36,07,2. До операции поясничный лордоз у пациентов второй группы составил 42,5, в отдаленные сроки 43,5, у пациентов первой группы 43,4 и 44,3 соответственно. Заключение. Как задняя ригидная, так и вентральная динамическая коррекция при идиопатическом сколиозе Lenke 5 могут обеспечить удовлетворительный рентгенологический результат при изначально схожей величине грудопоясничных деформаций у пациентов с завершенным или завершающимся ростом. Однако динамический подход позволяет сократить объем кровопотери, срок пребывания в стационаре, длительность приема наркотических анальгетиков после операции, а также улучшить качество жизни в отдаленном периоде

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ЦЕРВИКАЛЬНОГО СТЕНОЗА У ПАЦИЕНТОВ С МУКОПОЛИСАХАРИДОЗОМ: СИСТЕМАТИЧЕСКИЙ ОБЗОР

A multidisciplinary approach to treatment of patients with mucopolysaccharidosis allows to achieve good results. However, progressive spinal canal stenosis at the level of the craniovertebral junction, characteristic of this disease, leads to neurological signs, as well as a decrease in quality and length of life. The solution to this problem is a difficult challenge for spinal surgeons, as it is associated with a high risk of complications. There is also a wide range of opinions and approaches to the surgical treatment of this group of patients.Using the referred Reporting Items for Systematic Review and Meta-Analysis» (PRISMA) protocol, a PubMed and eLIBRARY search was conducted using keywords to find articles describing patients with mucopolysaccharidosis who underwent surgical treatment for cervical stenosis. In this review, information on demographic parameters, surgical technique and the results of cervical stenosis treatment in patients with mucopolysaccharidosis is collected and analyzed.Мультидисциплинарный подход к лечению пациентов с мукополисахаридозом позволяет добиться хороших результатов. Однако характектерный для данного заболевания прогрессирующий стеноз позвоночного канала на уровне краниовертебрального перехода приводит к неврологическим проявлениям, снижению качества и продолжительности жизни. Решение этой проблемы является сложной задачей для спинальных хирургов, сопряженной с высоким риском осложнений. При помощи протокола «Предпочтительные параметры отчетности для систематических обзоров и мета-анализа» (PRISMA) проведен поиск в системах PubMed  и eLIBRARY с использованием ключевых слов для определения статей, описывающих пациентов с мукополисахаридозом, которым выполнено хирургическое лечение по поводу цервикального стеноза. В обзоре собрана и проанализирована информация о демограграфических показателях, хирургической технике и результатах лечения цервикального стеноза у пациентов с мукополисахаридозом

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 40° 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 patient’s 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

On the characterization of self-regularization properties of a fully discrete projection method for Symm's integral equation

The influence of small perturbations in the kernel and the right-hand side of Symm's boundary integral equation, considered in an ill-posed setting, is analyzed. We propose a modification of a fully discrete projection method which is more economical in the sense of complexity and allows to obtain the optimal order of accuracy in the power scale with respect to the level of the noise in the kernel or in the parametric representation of the boundary. (orig.)Available from TIB Hannover: RR 5549(394)+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman