Surgical correction of severe forms of idiopathic kyphoscolyosis in children

Background. Significant results have been achieved through the use of hybrid and transpedicular metal structures. However, when spinal systems are implanted during surgery in patients with severe forms and idiopathic scoliosis, a number of limitations arise. Not only the performance of corrective maneuvers during the operation but also the creation of mobility on the top of the main arc accompany the strategies of surgical treatment. Traditionally, mobilizing discectomy at the top of the spark is performed in patients with idiopathic scoliosis. Pedicle subtractional vertebrotomy and Ponte and Smith-Petersen osteotomy are most common in neuromuscular scoliosis and spinal deformity, with a predominance of the kyphotic component. Problems with correction of extremely low and “neglected” forms and idiopathic scoliosis in children remain. Aim. The present study aimed to provide a comparative analysis between using transpedicular spinal systems alone and in combination with a wedge osteotomy of the apical vertebra to correct spinal deformity in children with extremely severe right-sided idiopathic thoracic scoliosis. Materials and methods. The surgical treatment results of 20 children 15 to 17 years old with extremely severe forms of right-sided idiopathic thoracic kyphoscoliosis were included in the analysis. All patients underwent standard preoperative examination, including radiology, computed tomography, magnetic resonance imaging, and neurophysiological studies. The patients were divided into two groups according to the method used during the second stage of surgical treatment — correction of deformity with the transpedicular system (1) alone or (2) in combination with a wedge osteotomy of the apical vertebra. Results. Patients from the first group showed an amount of scoliotic and kyphotic component correction ranging from 25% to 62% and from 21% to 56%, respectively. In patients from the second group, who underwent additional wedge osteotomy of the apical vertebrae during the operation, correction of the scoliotic and kyphotic components ranged from 36% to 74% and from 50% to 70%, respectively. Conclusion. In children with idiopathic thoracic kyphoscoliosis, performing a wedge corpectomy of the apical vertebral body is an effective additional mobilizing component, which allows achieving significant correction of both scoliotic and kyphotic curve components, restoring the physiological profile of the spine and body balance during the surgical intervention, and maintaining the achieved result during the long-term observation period.