30 March 2023
Unique operation held by traumatologists of the Pirogov Clinic of High Medical Technologies at St Petersburg University
The doctors of the Department of Paediatric Traumatology and Orthopaedics No 3 from the Pirogov Clinic of High Medical Technologies at St Petersburg University performed a shortening osteotomy of the lumbar spine in a child diagnosed with Spina bifida.
The Clinic was addressed by the girl’s guardian from an orphanage in the Ulyanovsk region. The reason for addressing was severe course of the congenital disease - in the process of growing the girl’s spine had practically folded so that the vertebral bodies overlaid each other, forming a pointed kyphotic deformity. On the apex of the kyphosis, a chronic decubitus was formed. The spinal column had ceased to function as a support, and a 13-year girl could not even sit. It was impossible to verticalise the patient using external means of support and a corset due to severe deformity and decubitus. The presence and progressing f such a deformity caused compression of the thoracic and abdominal organs leading to impaired breathing, digestion and functioning of all body systems. The permanent foci of infection and compression of the inner organs presented a serious threat to the life of the child. The only care that could be provided was surgical intervention.
The operation that lasted about 10 hours involved extirpation (removal) of four vertebrae, forming a pointed deformity. At the same time, the spinal column was reassembled using titanium implants consisting of four titanium rods and 19 screws installed in the thoracic, lumbar, sacral vertebrae and pelvic bones. The operation resulted in shortening the spine and forming a straight line. The world practice accounts for just few similar operations. After successful healing, the girl will be able to sit and special devices - verticalisers - will allow her to take a vertical position.
The operation was performed by leading traumatologists-vertebrologists of top medical category Sergei Ryabykh, Doctor of Science (Medicine) and Aleksand Gubin, Professor of the Pirogov Clinic of High Medical Technologies at St Petersburg University. The two are representatives of the famous paediatric spinal surgery school of Professor E. Ulrich in St Petersburg. Their qualification combined with the state-of-the-art equipment for operating theatres makes it possible to perform the most sophisticated operation with highest precision and care.
Reference information
Spina bifida is a defect of the spine and spinal cord development that occurs at an early stage in the embryo development. It commonly occurs in the lumbar region of the spine, however, it can occur at a higher level - in the thoracic and cervical regions. Unfortunately, this pathology cannot be called a rare one. According to statistics, it reaches 0.1 - 0.2 % of the number of all new-borns in Russia.
The causing factors are still not known for certain. The scientific papers commonly distinguish the following factors: a genetic one, the intake of certain drugs by a pregnant woman, folic acid deficiency and infections. The severity of the disease ranges from the latent to the severe manifestation, which greatly depends on the degree of the spinal lesion (the higher, the worse), as well as on the lesion degree of the spinal cord and its roots, as hernia in the spinal cord develops into a defect of the spinal column. Most babies with such pathology immediately undergo surgery - plastic surgery with the closure of the spinal hernia. However, unfortunately, the spinal cord or its roots are often affected, which, in turn, causes neurological problems: paralysis and paresis of the lower extremities and disorder in the pelvic organs.
Children diagnosed with Spina bifida have a range of health problems. The most common lesions are associated with deterioration in the trophism of the lower and upper extremities, dislocation of the hip joint, and deformity of the feet and pathology of the knee joint. There hydrocephalus, cerebellar disturbance and vision problems can be observed. However, when such children from their birth are monitored by a team of highly qualified doctors-orthopaedists, vertebrologists, neurologists, rehabilitation therapists, exercise therapy methodologists, ophthalmologists and urologists, the resulting impairments can be corrected in time, preventing the development of serious complications.
The centre that provides holistic medical care to children with consequences of Spina bifida (spinal hernias) has been created by the recognised specialist in this pathology area Stanislav Ivanov, Candidate of Science (Medicine), a traumatologist-orthopaedist. Our doctors have been performing operations to correct severe deformities in Spina bifida since 2010. They were the first in the world to use external fixation systems to close non-healing deep ulcers at the apex of kephosis in patients with Spina bifida. Since then, the team have accumulated the extensive experience in dealing with Spina bifida deformities, as well as prepared a number of scientific papers that have been published in Russian and international periodicals.
The operating theatre at the Clinic features all necessary equipment and consumables to perform high-risk spin surgery. Moreover, the competence of doctors allows providing medical care in any diseases of the spine to patients without any age restrictions - from several months of age to senility.