StatusThe thesis was presented on the 24 June, 2009
Approved by NCAA on the 1 October, 2009
Abstract– 2.62 Mb / in romanian
The purpose of this study was to improve the outcome results in the surgical treatment of patients with scoliotic and posttraumatic deformities of the spine and to implement new surgical procedures of correction, reconstruction and stabilization of the vertebral column, all being based on a complex clinic-experimental study; as well as to perfect the known methods of diagnosis and treatment.
The surgical treatment results of 315 patients with scoliotic and posttraumatic spinal deformities treated between 1995 and 2008 have been (examed) reviewed. 204 patient aged between 9 and 78 years (mean age 25,3±1,0) had scoliotic and kyphotic vertebral deformities. Posttraumatic deformities were present in 111 patients operated at different stages of the traumatic disease, mostly in the late period of consequences, their age varying between 12 and 54 year (mean age 32,4±1,1). The number of patients with scoliotic deformities of dysplastic, idiopathic and congenital origin subjected to endocorrection with dorsal systems, was 129(63%).
Posterior endocorrection by Rodneansky method was applied 38(29,5%) cases. 23(12,8%) patients underwent endocorrection in which Harrington equipment, has been used. 68(52,7%) patients underwent the correction and stabilization of scoliotic deformities by means of a metal structure, these representing our modification of Cotrel-Dubousset instrumentation (CDI) and "Synthes" – system. The remaining 75(37%) patients had their scoliotic deformities associated with other orthopaedic vertebral pathologies, lesions, these being closely related to a clinical manifestation and having a specific development.
The patients operated with the adapted CDI had the main angle of the primary scoliotic arch of 61,3±2,7°. The surgical correction constituted 34,5±1,7°. The secondary scoliotic arches in the orthostatic position were 42,9±2,3°. The intraoperative correction of the secondary scoliotic arch was 23,7±1,5°. The mean preoperative vertebral torsion was 65,9±1,9°. Assesed after 4,7±0,4 years, the loss of the intraoperatively obtained correction was 5,02±0,6° for the primary scoliotic arch, and 4,4±0,5° for the secondary scoliotic arch. The incidence of complications after CDI aplyment was 3,5% (inflammatory – 2,6%, and 1,3% of complications included ruptures of the spinal dorsal elements), but neurological impairments have not been reported. The use of the modified transverse traction device (TTD) with quadrant stabilization allows an average additional correction of 6,8±1,3°. In children and teenagers in volume the osseous growth is in progress sliding structures of stabilization have been used, these allowing a spinal growth of 6±0,8 cm. Patients with complete osseous development posterior spondylodesis surgeries with auto-, allografts at the top of scoliotic arch have been performed, these preventing the subsequent loss of the obtained correction and serving as a prophylaxis method of „cranckshaft‖ development.
The adapted CDI system with laminar and pedicular fixation was used in the treatment of 54(48,6%) patients with posttraumatic deformities of the thoracic spine, including the upper portion of the thoraco-lumbar and the lumbo-sacral portions, the method favoring the patient’s early recovery and making him more active on the 3rd -5th day without any need of external fixation devices.
The instrumentation has been used in the treatment of 10 patients with scoliotic and kyphoscoliotic deformities and vertebral instability of inflammatory and destructive-tumoral genesis and has considerably improved the patients quality of life, prevented the development and/or increase of the secondary neurological impairments, making the patient active sooner. The method of decompression of the medullar vasculo-nervous structures throught unilateral approach has been improved in patients with stenosis of the vertebral canal.
The method of medullar decompression and reconstruction of Urban-fragment, and part of suprajacent vertebral lamella and elements of myeloradiculolisis has been changed in the patients with consequences of spine injury in advanced stage and the neurological condition of 67,3% of patients has considerably improved and the algic syndrome alleviated.
The method of intersomatic spondylodesis used in vertical fractures at our clinic ensures the preservation of the vertebral bone stock and the firm stabilization of bone grafts with the anterior bone block formation within 1 year. Three patented inventions has been worked out and employed into medical practice on the basis of the carried out studies.
The clinical implementation of the study results contributed to better quality of life of the operated patients, to lower confinement to bed from 14±1,3 days in case of Harkov plates employement (or any others), to 4,6±0,9 days when CDI has been used in the treatment of patients with vertical vertebral fractures. Key words: scoliosis, kyphosis, primary and secondary scoliotic arch, scoliotic defor