General Session: Pediatric Spine
Presented by: S. Beljanchikov - View Audio/Video Presentation (Members Only)
S. Beljanchikov(1), A. Baindurashvili(1), S. Vissarionov(1), D. Kokushin(1), I. Solokhina(1), V. Murashko(1)
(1) The Turner Scientific Research Institute for Children's Orthopedics, Saint-Petersburg, Russian Federation
Purpose: Assessment of the neurological picture in children with complicated fractures of the thoracic and lumbar spine before, after and late after performing a surgical intervention. Materials and methods. Results of surgical treatment of 16 children aged from 3 to 17 yo with isolated spinal cord injuries, accompanied by neurological disorders were analyzed. By localization, spinal injury were as follows: thoracic - 11(68.7%) patients, lumbar spine - 5(31.3%) children. Fractures type A3 were observed in 50% of cases, of type B - in 6.3%, and type C - in 43.7% (according to F. Magerl). To assess the neurological status of patients with spinal cord injury the scale of ASIA was used. Depending on the severity and type of neurological disorders, patients were divided into two groups: I group (complete spinal cord injury) - 6 patients, II group (incomplete spinal cord injury) - 10 patients. Methods of surgery in patients with lesions of type A3, hospitalized in early hours of the injury, was a one-stage two-steps operation: the first stage - posterior instrumental indirect reduction and fixation by a metal construction, the dorsal spinal fusion with autologic bone; the second stage - anterior decompression of the spinal cord at the level of the damaged vertebra, reconstruction of anterior and middle columns of the spine and restoration of normal anatomy of the spinal canal. In case of damage of type B, posterolateral decompression was performed at the level of damage, the reduction and fixation of injured spinal motor segment under visual control of the dural sac. The operation is completed by formation of local fusion by autobone back along metal construction. In type C lesions, entire volume of interventions was performed from dorsal access: decompressive laminoplasty, revision of spinal canal, one-step posterior instrumental reposition with elimination of all kinds of dislocation displacements, fixation of damaged vertebral-motor segment, corporodesis and posterior local fusion. Regardless of hospitalization time of the child, all stages of operation were performed.
Results: In all patients during intervention the vertebral-medullary conflict was eliminated, a stable fixation of damaged vertebral-motor segments for the entire period of consolidation with formation of a circular bone block in the area of intervention were obtained. In patients in group I (37.4%) voluntary movements in the lower limbs have not been recovered. In group II there was a significant decrease in the degree of paresis and restoration of sensitivity in the lower limbs: 37.5% of patients have fully recovered the ability of independent walking without aids and assistance, 18.8% - to move supported by auxiliary devices, 6.3% - improved support ability of the lower extremities.
Conclusion: Surgical treatment of children with complicated spinal injury should be carried out by emergency indications in the first 6-9 hours after the injury. The surgical procedure should include restoration of physiological profiles of a segment, restoration of normal anatomy of spinal canal, accompanied by complete reduction and rigid stabilization of damaged vertebral-motor segment. Detailed assessment of children with spinal cord injury by ASIA scale provides a digital report on motor and sensory disorders of spinal cord, allows to determine more accurately the level and extent of damage.