Travmatologiâ i Ortopediâ Rossii (Dec 2020)

Extirpation of the Thoracic and Lumbar Hemivertebrae from the Dorsal Access Using the Ultrasonic Bone Scalpel in Children: The Result of a Prospective Multicenter Study

  • D. G. Naumov,
  • A. Yu. Mushkin,
  • E. Yu. Filatov,
  • S. O. Ryabykh,
  • O. B. Chelpachenko

DOI
https://doi.org/10.21823/2311-2905-2020-26-4-45-55
Journal volume & issue
Vol. 26, no. 4
pp. 45 – 55

Abstract

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Background. The surgical treatment of congenital spinal deformity caused by hemivertebra is associated with high rate of complications. A research of a new surgery technique for operation time and blood loss decrease could potentially improve outcomes. The purpose — to evaluate the efficacy of ultrasonic bone scalpel in surgical treatment of pediatric congenital spinal deformities caused by monosegmental hemivertebra. Patients and Methods. Level of Evidence III. The study based on the data of 55 consecutively operated pediatric patients who underwent 59 posterior hemivertebra resection provided by ultrasonic bone scalpel from January 2015 to December 2019. The average age was 4 years and 4 months. 36 hemivertebra were located in thoracic spine and 23 were located in lumbar spine. Total duration of surgery, estimated blood loss (ml and % of circulated blood volume, CBV), complications rate and deformity correction were noted. The influence of posterior instrumentation length and patients age at time of surgery on evaluation parameters was analyzed. 5-year (2015–2019) systematic literature review was performed for compare with obtain results. Results. Total operation time was 131 min ± 33 min for thoracic spine and 165 min ± 50 min for lumbar spine (p = 0,005). Estimated blood loss was 105 ml ± 74 ml (Me 80 ml) for thoracic resection and 123 ml ± 59 ml (Me 120 ml) — for lumbar (p = 0,178). The length of posterior instrumentation were not influence on operation time and total blood loss (p = 0,957; p = 0,967), patients age at time of surgery were not influence on operation time (p = 0,458), but correlate with total blood loss (p = 0,023). Intraoperative complications was not observed. Four cases of transpedicular screw malposition without neurological deficit were noted (type C acc. Gertzbein-Robbins). Conclusions. Posterior hemivertebra resection with ultrasonic bone scalpel is safe and effective procedure provides decrease of operation time and estimated blood loss.

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