Surgical treatment and outcomes of scoliosis and cervical spine instability in Children

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Title: Surgical treatment and outcomes of scoliosis and cervical spine instability in Children
Author: Mattila, Mikko
Contributor: University of Helsinki, Faculty of Medicine
Doctoral Program in Clinical Research
Publisher: Helsingin yliopisto
Date: 2020-09-11
Language: en
Thesis level: Doctoral dissertation (article-based)
Abstract: Structural changes in the spine are the most common children's musculoskeletal abnormalities, as they cover 70% of all musculoskeletal disorders in children and adolescent. Idiopathic scoliosis is the most common of these structural changes. The congenital structural problems of the spine form an entity of their own. Changes in the development of the spine during fetal period range from changes in individual vertebral to being part of a wider developmental disorder. Careful follow-up and research are the basis of care. Genetically induced syndromes form a wide heterogeneous group that have vertebral problems often seen in cervical development and growth. There are a number of rare diseases in this group. One of the primary aims of this thesis was to assess whether en bloc vertebral column derotation provides an efficient control or correction of thoracic rib hump as compared with no derotation in adolescents with an idiopathic scoliosis. The outcomes of hybrid and total pedicle screw instrumentation were compared in children undergoing surgery for neuromuscular scoliosis or severe scoliosis. Within the rare bone dysplastia group, we studied the outcomes of upper cervical spine fusion in this heterogeneous group.We showed that en bloc derotation provides an effective initial correction of the rib hump,but the effect diminishes during two year follow-up. Comparing hybrid technique with total pedicle screw method we proved that surgery with pedicle screw technique is more effective in correcting neuromuscular and severe scoliosis. Blood loss was significantly smaller (2000 ml) and patients had better major curve correction (two year follow-up 75% vs 59%) with less need for anteroposterior surgery when comparing these techniques in the neuromuscular group. Pedicle screw instrumentation provided shorter operative time (1 hour 39minutes), diminished blood loss(1600ml), enabled better major curve correction (73% vs 59%) with less need for anteroposterior surgery as compared with hybrid constructs in patients with severe over 90degrees scoliosis. Feasibility of different techniques were investigated in the rare disease group. Cervical spine instability in the patients with rare bone dysplasia surgery was found effective.Although results are encouraging , risks and complications are common.Surgery has become an important part of treatment in many types of spinal disorders.Better techniques evolve from old methods and procedures only if these are studied meticulously. Keywords: scoliosis, pedicle, rib hump, total pedicle screw technique, coronalbalance, sagittal balance, rare bone dysplasia, cervical spine
Subject: lääketiede
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