Rehabilitation of patients with early scoliosis after stage corrections of spine deformations by growing systems

Abstract

Idiopathic scoliosis is a large etiological group in the structure of early scoliosis which requires the use of modern effective surgical methods for correction of deformity, in particular, using various structures with possible staged distraction (growing structures). Dysplastic changes in the musculoskeletal tissue are very important in the pathogenesis of scoliosis. Active correction of the tone of the muscular-ligamentous system of the spine in the postoperative period is of great importance in the recovery of such patients. Individual rehabilitation programs are aimed at consolidating the result of the operation (correction of the sagittal profile and normalization of the body balance), improving respiratory function, fast recovery of motor activity (in order to prevent hypostatic and thromboembolic complications), increasing self-esteem and patient satisfaction with the results of the operation. The purpose of the study is to assess the effectiveness of an integrated approach to the rehabilitation of patients with early scoliosis after correction of spinal deformities by growing systems. Materials and methods. A retrospective analysis of the results of a comprehensive rehabilitation of patients (n = 15) with idiopathic infantile scoliosis (mean age 8.6 ± 1.0 years) was performed. This group of patients was operated using a growing system with stepwise corrections using the Growing Rods, VEPTER technique. The algorithm of rehabilitation of the studied group of patients using the parameters of activity, participation, degree of dysfunction in accordance with the International classification of functioning (ICF) is presented. Evaluation of the effectiveness of the results carried out taking into account the criteria of the pain scale (VAS), verticalization time, indicators of walking, coordination, support capacity, balance of body and strength (on the CSBS platform), self-perception, psychological comfort, functions, satisfaction with the treatment. Results and discussion. In all patients, a normal sagittal profile was formed, satisfactory correction was achieved, and body balance was normalized. After a comprehensive rehabilitation course, we observed statistically significant improvements in balance, balance and load distribution, and postoperative pain was stopped. Early verticalization was successfully carried out, walking indicators reached values exceeding the conditional "norm". Assessment of coordination, support ability, balance of the body and strength on the CSBS platform showed a uniform improvement in the index of symmetry, the average value of the load on the limbs. Patients' self-perception and the level of psychological comfort before discharge were rated at 3 points, patients evaluated spinal function after surgery at 2.7 points, satisfaction with treatment was 3.5 points. Characteristics of signs of activity and participation, the degree of dysfunction within 6 months after surgery went from a score of 3-4 to a score of 0-2 (dynamic improvement). Conclusions. Correction of scoliotic spinal deformity with the help of growing systems due to improved respiration function, correction of the sagittal profile and body balance, restoration of motor activity and increased self-esteem and satisfaction with the results of the operation improves the quality of life of the patient. Due to the lack of clinical recommendations for rehabilitation in the postoperative period of patients with scoliosis (with early development), taking into account the age characteristics of this group of patients, the algorithm for their rehabilitation used in the Center shows good results in the restoration of functions and satisfaction with the treatment.

Keywords

early scoliosis / spinal deformities / staged corrections / growing systems / rehabilitation of patients with scoliosis

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Physical and rehabilitation medicine, medical rehabilitation