Врожденные аномалии вне апикальной зоны: диагноз и принципы лечения

Objective. The choice of optimal surgical approach to congenital spinal deformities involving abnormally developed vertebrae outside the apical region. Material and Methods. Twelve patients with progressive scoliotic deformities and neutral abnormalities located at the least two segments cranial or caudal to the apical vertebra or intervertebral disc. The mean follow-up period was 2.1 years. Results. In the first group (n = 7) of patients with inclusion of all abnormal vertebrae in the fusion area the mean major curve decreased from 73.8° to 17.6° immediately after surgery. In 2 years this magnitude increased by 2.5° and achieved 20.1°. A mean magnitude of a secondary curve decreased from 44.2° to 22.6° immediately after surgery, and in 2 years remains practically unchanged 21.8°. In the second group (n = 5) of patients the abnormal vertebrae were left beyond the fusion area. Immediately after surgery a primary curve decreased from 76.2° to 23.4° and in 2 years increased only by 1.2°. Different dynamics was observed in the secondary curve: initial correction from 45.2° to 26.2°, and significant augmentation of deformity during postoperative period up to 36.2°. Conclusion. Congenital vertebra abnormalities located outside the apical area of progressive scoliotic deformities should not be considered as neutral, since not being included in the fusion they cause severe progression of the secondary curve, i.e. they are active. Scoliotic deformities, similar in appearance to idiopathic ones but including abnormal vertebrae outside the apical region should be considered as congenital.