Assessment of the efficacy of treatment for children with congenital scoliosis with unsegmented bar and rib synostosis

Abstract

BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical.

AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis.

MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 1–14 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data.

RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74° (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16° (IQR, 11) and the second correction achieved 6° (IQR, 13). The Me kyphosis was 15° (IQR, 32), the first intervention improved kyphosis by 4° (IQR, 16), and the second by 6° (IQR, 11).

Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p < 0,01).

CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.

Keywords

children / congenital malformation / surgical treatment / congenital scoliosis / segmentation disorder / rib synostosis / unsegmented bar / treatment results / pulse oscillometry

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RIGHTS & PERMISSIONS

Vissarionov S.V., Asadulaev M.S., Orlova E.A., Ivanova P.A., Shabunin A.S., Murashko T.V., Khardikov M.A., Toriya V.G., Rybinskikh T.S., Rodionova K.N., Kokushin D.N.