Two-stage treatment of idiopathic scoliosis using the LSZ growing system with a 10-year follow-up: a case report.

A clinical case of an 11-year-old patient with idiopathic scoliosis treatment using the LSZ growing system. The main thoracic curve was 88°, with a lumbar curve of 52°. The patient was at Risser stage 3. At the first stage, posterior correction and instrumentation (T1-L5) of the deformity using the LSZ growing system were performed. Residual deformity of the spine was 15°. At a follow-up, the spine grew by 5 cm. As the second stage of surgical treatment, this system was removed and replaced with selective instrumentation at T4-T12. The patient was followed up for 10 years. On the control radiographs of the spine in the standing position in 2021, adequate correction is preserved. That described technique allowed to ultimately perform selective definitive instrumentation, preserving near full range of movement in the lumbar spine. Further studies are needed to determine the effectiveness of the described approach.

[Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch's windows: transpedicular and translaminar sequestrectomy (ridit analysis)]. / Dve taktiki lecheniya poyasnichnykh gryzh mezhpozvonkovykh diskov s migratsiei v zonu vtorogo i tret'ego okna po Makkalloku: transpedikulyarnaya i translaminarnaya sekvestrektomiya (ridit-analiz).

A ridit analysis of results of transpedicular endoscopic and translaminar microsurgical surgeries for sequester migration to the second and third McCulloch's windows was carried out. The authors assessed pain syndrome, quality of life and neurological impairment. OBJECTIVE: To compare the outcomes of transpedicular and translaminar sequestrectomy for lumbar disc herniation and sequester migration to the second and third McCulloch's windows. MATERIAL AND METHODS: We analyzed treatment outcomes in 51 patients with lumbar disc herniation and severe sequester migration. We assessed lumbar and leg pain syndrome using then visual analogue scale, neurological impairment using the adapted Nurik scale and quality of life using the Oswestry questionnaire and the MacNab scale in early postoperative period, as well as in 2 weeks, 6 and 12 months after surgery. Ridit analysis was used for statistical processing of data. RESULTS: Transpedicular sequestrectomy was performed in 24 patients, translaminar sequestrectomy - in 27 cases. Groups were comparable by gender, size and location of sequestration, somatic and neurological status, as well as pain severity. There was a higher probability of back (0.39) and leg (0.364) pain regression, neurological recovery (0.446) and improvement of quality of life according to the Oswestry questionnaire (0.389) after transpedicular surgery. According to the MacNab scoring system, excellent and good results were obtained in 84.21% and 15.79% of patients in 6 months after transpedicular surgery. In the second group, excellent, good and satisfactory results were obtained in 63%, 25.9% and 11.1% of patients, respectively. CONCLUSION: Herniated intervertebral discs with severe sequester migration should be divided in accordance with localization of the main sequestration. Transpedicular endoscopic approach is advisable for sequester in the third and rarely the second McCulloch's windows. Translaminar microsurgical approach is preferred for sequestration in the second and rarely the third McCulloch's windows. Clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries are similar. However, postoperative back and leg pain regression, neurological recovery and improvement of quality of life according to the Oswestry scoring system are more common after transpedicular surgery.