Use of neuronavigation technologies for severe forms of scoliosis in children

Background. The method of choice for surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Its use is associated with inherent difficulties and risks, often associated with malposition of supporting elements, as well as the risk of complications. The incidence of neurological complications during surgical correction of scoliosis can reach 7%. High risks, including irreversible complications, of surgical correction of scoliosis dictate the need to introduce modern safety methods, including O-arm navigation and intraoperative neuromonitoring (IONM). Aim. Increasing the effectiveness and safety of surgical correction of scoliosis in children using O-arm navigation and IONM. Materials and methods. 136 patients operated on for scoliosis were observed. The patients were divided into 2 groups: group 1 included patients operated on using the “free-hand” technology (a total of 609 screws were analyzed in 30 patients); group 2 included patients operated on using O-arm navigation and IONM (524 screws in 25 patients). The average Cobb angle of deformation was 66.9±28.1° in group I and 82.4±25.8° in group 2. Malpositions were assessed using the classification of G. Rao et al. (2002), and an analysis of neurological complications was also carried out in 69 patients in group 1, and in 67 patients in group 2. Results. In group 1, the overall incidence of malpositions was 27.3% (166 out of 609 screws). In group 2, it was 10.5% (55 out of 524 screws). In group 1, the frequency of grade 1 malpositions was 3.9% (24 out of 609), grade 2 – 11.8% (72 out of 609), grade 3 – 11.5% (70 out of 609). In 2: grade 1 occurred in 4.2% of cases (22 out of 524), grade 2 – 3.4% (18 out of 524), and grade 3 – 2.9% (15 out of 524). The frequency of medial malpositions in the first group was 7.6% (46 out of 609), in the second group – 2.7% (14 out of 524). Lateral malpositions in the group 1 were 11.7% (71 out of 609), in the group 2 – 4.4% (24 out of 524). Anterior malpositions in group 1 – 8.05% (49 out of 609), in group 2 – 3.2% (17 out of 524). In group 1 there were 3 cases of neurological complications – 4.3%, in group 2 – in 1 case – 1.4%. Conclusion. O-arm navigation and IONM made it possible to reduce the frequency of malpositions, and there was also a tendency to reduce the number of neurological complications in the group of patients where IONM and O-arm navigation were used.