nach oben

European Spine Journal

Erschienen in:

07.09.2018 | Original Article

Multilevel spinal reconstruction in pediatric patients under 4 years old with non-congenital pathology (10-year single-center cohort study)

verfasst von: Alexander Yu Mushkin, Denis G. Naumov, Valery A. Evseev

Erschienen in: European Spine Journal | Ausgabe 5/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the influence of anterior fusion option on the short- and long-time outcomes on multilevel spinal reconstructions in young children.

Methods

Forty-five patients aged under 4 years old (2 years 2 months ± 11 months in average) underwent spinal reconstruction due to tuberculosis spondylitis (35), pyogenic spondylitis (9) and spinal tumors (1) complicated by angular kyphosis exceeded 20° (49.2° ± 14.3° in average). All lesions involved two or more spinal motion segments. Clinical and radiographic data were compared in two groups depended on the types of anterior fusion: titanium mesh cage with bone graft (TMC + BG) (19 patients) and cortical BG only (26). The average follow-up was 5 years 10 months ± 2 years 8 months (min = 3 years; max = 12 years).

Results

The deformity correction was similar in groups. The operation time and blood loss were less in TMC + BG group (p = 0.001) as a times for anterior bone block formation (p < 0.001) and posterior instrumentation removal (p = 0.003). Ten late post-op complications registered include disease’s recurrence (1), pseudoarthrosis (6), deformity progression (1) and graft resorption (1). The complication rate was less in TMC + BG than in BG group: two and eight cases consequently, p = 0.024.

Conclusions

Multilevel spinal reconstruction in early aged patients is safe and effective procedure. The anterior fusion by TMC with bone autograft has advantages of reducing blood loss, operation time, time for anterior block formation and complications rate compared with bone autograft only.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Nur mit Berechtigung zugänglich

Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M (2013) Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. Eur Spine J 22(Suppl 4):618–623. https://doi.org/10.1007/s00586-012-2459-9 CrossRefPubMed

Ilaslan H, Sundaram M, Unni KK, Dekutoski MB (2004) Primary Ewing’s sarcoma of the vertebral column. Skelet Radiol 33(9):506–513. https://doi.org/10.1007/s00256-004-0810-x CrossRef

Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthop 48(2):136–144. https://doi.org/10.4103/0019-5413.128747 CrossRefPubMedPubMedCentral

Kelley SP, Ashford RU, Rao AS, Dickson RA (2007) Primary bone tumours of the spine: a 42-year survey from the leeds regional bone tumor registry. Eur Spine J 16(3):405–409. https://doi.org/10.1007/s00586-006-0188-7 CrossRefPubMed

Lewandrowski KU, Hecht AC, DeLaney TF, Chapman PA, Hornicek FJ, Pedlow FX (2004) Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine (Phila PA 1976) 29(10):1150–1158CrossRef

Rajasekaran S (2012) Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 36(2):359–365. https://doi.org/10.1007/s00264-011-1469-2 CrossRefPubMedPubMedCentral

Do Brito JS, Tirado A, Fernandes P (2014) Surgical treatment of spinal tuberculosis complicated with extensive abscess. Iowa Orthop J 34:129–136

Chang DG, Yang JH, Lee JH, Kim JH, Suh SW, Kim YH, Ha KY, Suk SI (2016) Pediatric posterior vertebral column resection (PVCR): before and after ten years of age: greater than 10-year follow-up. Spine (Phila PA 1976) 41(21):E1271–E1278. https://doi.org/10.1097/brs.0000000000001623 CrossRef

Pershin AA, Mushkin AY (2012) Intervertebral disk degeneration in the growing spine in patients with tuberculosis kyphosis exceeding 50 treated by reconstruction with a long-length posterior instrumentation. Glob Spine J 2(Suppl 1):s-0032–s-1319948. https://doi.org/10.1055/s-0032-1319948 CrossRef

10.

Korovessis P, Vardakastanis K, Fennema P, Syrimbeis V (2016) Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade. Eur J Orthop Surg Traumatol 26(7):753–761. https://doi.org/10.1007/s00590-016-1803-x CrossRefPubMed

11.

Sundararaj GD, Amritanand R, Venkatesh K, Arockiaraj J (2011) The use of titanium mesh cages in the reconstruction of anterior column defects in active spinal infections: can we rest the crest? Asian Spine J 5(3):155–161. https://doi.org/10.4184/asj.2011.5.3.155 CrossRefPubMedPubMedCentral

12.

Sung SH, Chang UK (2014) Clinical significance of radiological stability in reconstructed thoracic and lumbar spine following vertebral body resection. J Korean Neurosurg Soc 56(4):323–329. https://doi.org/10.3340/jkns.2014.56.4.323 CrossRefPubMedPubMedCentral

13.

WHO (2010) Treatment of tuberculosis: guidelines, 4th edn. WHO, Geneva

14.

Mushkin AY, Baulin IA, Gavrilov PA, Sovetova NA, Naumov DG (2016) New 5-grade scale for anterior fusion estimation: validation for infectious spondylitis. Glob Spine J 6(Suppl 1):s-0036–s-1582652. https://doi.org/10.1055/s-0036-1582652 CrossRef

15.

Zhang HQ, Li JS, Guo CF, Liu SH, Tang MX, Wang YX, Deng A, Le Gao Q, Lin MZ (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132:1273–1279. https://doi.org/10.1007/s00402-012-1548-x CrossRefPubMed

16.

Zhang HQ, Wang YX, Guo CF, Zhao D, Deng A, Wu JH, Liu JY (2011) One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 27(5):735–742. https://doi.org/10.1007/s00381-010-1319-3 CrossRefPubMed

17.

Wang YX, Zhang HQ, Tang MX, Guo CF, Deng A, Wu JH, Liu JY, Deng Z, Chen J (2016) One-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion in the surgical treatment of thoracolumbar spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 32(8):1495–1502. https://doi.org/10.1007/s00381-016-3152-9 CrossRefPubMed

18.

He QY, Xu JZ, Zhou Q, Luo F, Hou T, Zhang Z (2015) Treatment effect, postoperative complications and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery. J Orthop Surg Res 10:156. https://doi.org/10.1186/s13018-015-0300-y CrossRefPubMedPubMedCentral

19.

Schulitz KP, Kothe R, Leong JC, Wehling P (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis: comparison of four procedures. Spine (Phila PA 1976) 22(10):1150–1155CrossRef

20.

Govender S, Ramnarain A, Danaviah S (2007) Cervical spine tuberculosis in children. Clin Orthop Relat Res 460:78–85. https://doi.org/10.1097/BLO.0b013e31806a915f CrossRefPubMed

21.

Singh SN, Bhatt TC, Kumar S, Chauhan V, Pandey A (2016) A case of cervical spine tuberculosis in an infant. J Clin Diagn Res 10(1):TD03–TD05. https://doi.org/10.7860/jcdr/2016/16824.7019 CrossRefPubMedPubMedCentral

22.

Helenius I, Serlo J, Pajulo O (2012) The incidence and outcomes of vertebral column resection in pediatric patients. J Bone Joint Surg Br 94(7):950–955. https://doi.org/10.1302/0301-620X.94B7.28545 CrossRefPubMed

Titel: Multilevel spinal reconstruction in pediatric patients under 4 years old with non-congenital pathology (10-year single-center cohort study)
verfasst von: Alexander Yu Mushkin
Denis G. Naumov
Valery A. Evseev
Publikationsdatum: 07.09.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 5/2019
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5756-0

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2019

Minimum clinically important difference in outcome scores among patients undergoing cervical laminoplasty

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2019: biomechanical changes in dynamic sagittal balance and lower limb compensatory strategies following realignment surgery in adult spinal deformity patients

Answer to the Letter to the Editor concerning “The association of back muscle strength and sarcopenia-related parameters in the patients with spinal disorders” by Toyoda H, et al. (Eur Spine J; doi.org/10.1007/s00586-018-5858-8)

EUROPEAN SPINE JOURNAL MAX AEBI AWARD FOR CLINICAL SCIENCES 2017/2018

Pure distraction injury of T1–2 with quad fever

Lumbar spine posture and spinopelvic parameters change in various standing and sitting postures