Vol 12, No 3 (2024)

BACKGROUND: Congenital anomalies of vertebral development account for 2%–11% of cases in the general structure of nosologies that cause spinal deformity. An unsegmented rod (unilateral violation of vertebral segmentation) is attributed to a prognostically unfavorable malformation. Rib synostosis causes the development of thoracic insufficiency syndrome.

AIM: To analyze the results of treatment of children with congenital scoliosis caused by an unsegmented rod and rib synostosis by vertebrotomy.

MATERIALS AND METHODS: This cohort, retrospective, monocenter study evaluated the treatment results of 55 patients. The patients were divided into two groups: group 1, children aged 2–8 years, the scope of intervention was wedge-shaped osteotomy of a non-segmented rod at the apex of the deformity, and group 2, children aged 8–18 years, the scope of intervention was wedge-shaped osteotomy at the apex of the deformity and two linear osteotomies of a non-segmented rod in the cranial and caudal directions. Clinical, radiological, and statistical research methods were used.

RESULTS: Significant correction of scoliosis was achieved in 65.5% of patients aged 2–7 years (group 1) and 56.3% in children aged 8–18 years (group 2). Hypokyphosis of the thoracic spine was observed in the patients. The percentage of correction of kyphosis was 21.1% in group 1 and 19.1% in group 2. Lung volume increased by 27.9% (p = 0.01776) in group 1, and lung volume on the concave side increased by 23.5% (p = 0.04975) and on the convex side by 29.6% (p = 0.01073). Improvement in the overall respiratory impedance reached 47.3% (p < 0.05). In group 2, a insignificant increase was found in VVC by 12.6% (p = 0.3509) and FEV1 by 8.7% of the initial (p = 0.1534), as well as an increase in total lung volume of 13.3% (p = 0.1527) and the contribution of the lung along the concave side of 18.8% (p = 0.1535), and the lung along the convex side was 8.4% (p = 0.169), indicating no significant impact on lung development and function.

CONCLUSIONS: In children with spinal deformity caused by a non-segmented rod with normal respiratory function, vertebrotomy at the apex of the deformity with subsequent correction and stabilization of the spinal deformity is recommended. Performing simultaneous multilevel osteotomies of a non-segmented rod allows for significant correction of rigid spinal deformity.

BACKGROUND: Epiphysis displacement factors in slipped capital femoral epiphysis are defined as an external mechanical impact on the affected joint of different orientation and intensity, the nature of which may determine the type, direction, and severity of epiphysis displacement. There may be differences in the immediate causes of dislocation and in the nature of the course and timing of detection of the disease in children who were engaged in sports compared to those who were not engaged in sports. Identifying these differences may be beneficial for preventing the occurrence of epiphyseal displacement in slipped capital femoral epiphysis.

AIM: To determine the immediate causes of epiphyseal displacement and the peculiarities of the course of SCFE in children practicing sports.

MATERIALS AND METHODS: The study included 256 patients aged 11–14 years with slipped capital femoral epiphysis who were admitted at our center, from whom 68 patients were subsequently selected. The main group included 34 children who were engaged in sports and whose first symptoms of the disease appeared during training. The control group included 34 children who were not engaged in sports activities and whose first symptoms of the disease appeared for no apparent reason. Clinical, radiologic, and statistical methods of research were used.

RESULTS: In the main group, no severe forms of slipped capital femoral epiphysis such as bilateral displacement, acute displacement with chronic displacement, and early complications of the disease were noted, whereas in the control group, the number of patients with such conditions was 6 (17.6%), 4 (11.8%), and 1 (2.9%), respectively. Additionally, in 2 (5.9%) children of the main group, an extremely rare “valgus” displacement of the epiphysis was detected. Both cases occurred in gymnast girls owing to the use of a special “split” sitting technique.

CONCLUSIONS: Severe forms of slipped capital femoral epiphysis are less frequent in children who practiced sports than in those who were not engaged in sports. This is associated with earlier medical attention. “Valgus” displacement of the epiphysis is more common in children with slipped capital femoral epiphysis who practiced sports than in those who did not do sports. This may be attributed to the use of some of the most traumatic exercises in the training process.

BACKGROUND: Currently, minimally invasive repair of pectus excavatum are being developed. However, studies on the physiological aspects of the patient’s body in response to surgery are limited. Recently, researchers have become interested in the functional diagnosis of the state of the musculoskeletal system in patients with this pathology.

AIM: To assess the dynamics of vertical body balance in patients with severe right-sided pectus excavatum before and after minimally invasive reconstructive operations aimed at eliminating deformity.

MATERIALS AND METHODS: Clinical radiation and stabilometric studies of 22 patients aged 13–16 years with right-sided pectus excavatum were conducted. Group A included patients with a low body mass index of 16.0 (15.3–17.7) kg/m². Group B consisted of ten patients with normal body mass index values of 18.5 (17.7–20.4) kg/m². In patients of both groups, an analysis of the stabilometric parameters of the movement of the general body pressure center and individually the pressure centers of the left and right lower extremities was performed before surgery and 1.5–2 years after. The patients underwent the same type of bone reconstructive surgery that is, minimally invasive repair of pectus excavatum. The stabilometric parameters of the patients were compared with similar parameters of 20 healthy children in the control group.

RESULTS: In both groups of patients, a deterioration in vertical balance was recorded before surgery compared with healthy children. In group A, a relatively stable balance of the total body pressure center was revealed, with a deterioration in the movement parameters of the pressure centers of the left and right lower extremities. In contrast, in group B, the mechanism for ensuring a vertical stance was the opposite: a less stable balance of the general center of body pressure against the background of greater postural stability of the contralateral lower extremities was observed. This indicates heterogeneous locomotor strategies to ensure vertical balance in patients with different body mass indices. In the long term, to correct chest deformity after surgery, the patients of both groups showed opposite changes in the postural control system. In patients with a low body mass index, further deterioration was noted in vertical balance; the quality of balance function decreased from 78% to 69% (p < 0.05). Moreover, patients with normal body mass index showed an improvement in posture stability; the quality of balance function increased from 74% to 83% (p < 0.05).

CONCLUSIONS: In patients with pectus excavatum with reduced body mass index, it is recommended to conduct an individual rehabilitation program after minimally invasive deformation correction to adapt them postoperatively and normalize the vertical balance of the body.

BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine.

AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies.

MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results.

RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment.

CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders.

CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children.

DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear.

CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm.

АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists.

MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions.

RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density.

CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.

BACKGROUND: Pectus excavatum deformity is the most common chest wall malformation. Currently, surgeons and researchers of this problem have no consensus on whether pectus excavatum is a purely aesthetic problem or whether pectus excavatum disturbs the function of the cardiopulmonary system.

AIM: To analyze publications on the effect of pectus excavatum on the cardiorespiratory system and the functional features of the heart and lung after thoracoplasty in patients with pectus excavatum.

MATERIALS AND METHODS: Data were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language limitation. In this article, the method of analysis and synthesis of information was used. Most of the studies included in the analysis were published in the last 20 years.

RESULTS: In patients with pectus excavatum, severity of cardiorespiratory dysfunction depends on the degree of chest deformity. According to obtained data, the pulmonary function test in patients with pectus excavatum in the majority of cases revealed restrictive pattern (formed vital capacity <80% of the norm, with normal ratio of forced expiratory volume in 1 minute to forced lung capacity). In most cases, echocardiography showed compression of the right heart chambers. Comparative analysis of the pre- and postoperative study of cardiorespiratory system in most cases indicated improvement and adaptation of the cardiopulmonary system to stress after surgical intervention.

CONCLUSIONS: Funnel chest is an aesthetic problem wherein a severe degree of deformity leads to impaired respiratory mechanics and dysfunction of the cardiovascular system. Surgical restoration of the volume of the retrosternal space allows improvement of the functional capabilities of the heart and lungs.