SURGICAL TREATMENT OF SCOLIOTIC SPINAL DEFORMITY USING TRANSPEDICULAR FIXATION AND THE PONTE OSTEOTOMY

Abstract

The analysis of the material is based on the study of 25 case histories of patients with various degrees of frontal and sagittal deformation of the thoracolumbar spine treated in the Regional Centre for Orthopaedics, Trauma Care and Vertebrology of the Public Healthcare Institution “Rivne Regional Clinical Hospital” between August 2016 and August 2022. The patients included 5 boys and 20 girls aged 14 to 23 years. The relevant methods of surgical treatment of scoliotic spinal deformity are dorsal correction and transpedicular fixation. All deformities exceeding 40° must be corrected surgically, smaller deformities are treated conservatively. This treatment method is aimed at correcting spinal deformity in three planes, stopping the curve progression, normalizing the appearance, achieving body balance in the frontal and sagittal planes. Fixation of the spine was performed with the help of transpedicular screws and dual-rod constructs. In addition, the Ponte osteotomy was performed at the apex of the deformity. The indicators of the frontal and sagittal axis of the spine were evaluated by С-Arm imaging followed by data transfer to a computer calculation programme (CobbAngleApp). A detailed analysis of radiographic data was performed with the calculation of indicators, thoracic kyphosis and the degree of the main arc of deformation (according to Cobb). A detailed assessment of complications in the early and long-term postoperative period was also performed. The presence or absence of bone healing and the integrity of the metal structure were assessed by radiographs. Practical experience has shown that a surgeon may encounter significant technical difficulties when placing pedicle screws in the upper thoracic region of the spine in the area of facet joint dysplasia. However, in the presence of indications, this technique remains a relevant and effective method of surgical treatment of scoliotic deformations of the thoracic and lumbar spine.

Keywords

• ponte osteotomy,transpedicular fixation,scoliosis.