- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03863496
Efficacy of Surgical Treatment by Different Pedicle Screw Systems in Pediatric Neuromuscular Spinal Deformity
This study was sponsored by Federal state budgetary institution "Russian scientific center for traumatology and orthopedics" n.a. acad. G.A. Ilizarov" of the Ministry of Health of Russian Federation. The study will take place at this center.
It is expected to enroll 70 patients aged 6-25 years with NMD, all of whom will be subjected to thoracic and lumbar spinal deformity surgery.
Patients will be divided into two groups depending on skeletal maturity. The degree of skeletal maturity will be determined on the basis of an X-ray study of spinal and pelvic bones. The type of surgical correction will depend on the group.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
First group of patients: local dorsal access. Cranial access: at the level of posterior Th2 5 structures and caudally at the level of L4-S2 vertebrae with exposure of posterior upper spines of iliac wings. Skeletization of vertebrae will be done within transverse processes. Pedicle support points are set bilaterally cranially at each segment level for the space of 3 segments. Caudal support base is formed with pedicle screws in lateral masses of the sacral bone or iliac crests at the level of L5-S1 vertebrae. Control fluorography is performed in two standard planes in order to control screw position. Two "dynamic" rods are formed on the basis of the distance between screw heads allowing 2 cm for distraction; these are two rods connected with a longitudinal connector and bent following the normal sagittal spine profile. After that, channels are formed on both sides under m. erector spinae in the cranial/caudal direction. Pre-bent rods with connectors are placed into the prepared channels. The metal construct is stabilized with internal set screws. If necessary, the construct may be stiffened with crosslinks. Control fluorography is performed in two standard planes in order to control implant position and evaluate correction. The intervention completes with local dorsal spinal fusion with an autobone at the level of base screws. The wound is sewn up in layers tightly.
Group two: dorsal access to the posterior column is gained in accordance with the preoperative plan. The access length depends on the instrumentation area. Vertebral skeletization is performed within transverse processes. Subgroup 1 - pedicle support points are set bilaterally at each segment level. Subgroup 2 - pedicle support points are set bilaterally in every second segment. Segmented instrumentation of 3 cranial segments to prevent dislocation of metal construct elements at the level of Th2-4 or Th3-5 vertebrae is a special measure. Similar to group I, caudal support base is formed with pedicle screws in lateral masses of the sacral bone or iliac crests at the level of L5-S1 vertebrae. Control fluorography is performed after that in two standard planes in order to control screw position. Segmented facetectomy is recommended for additional spine mobilization. Pre-bent rods are placed into support points. Deformity correction is performed by means of a translational maneuver, segmented distraction (concave side) and compression (convex side). The metal construct is stabilized with internal set screws. If necessary, the construct may be stiffened with crosslinks. Control fluorography is performed in two standard planes in order to control implant position and evaluate correction. The intervention completes with dorsal spinal fusion with an autobone along the implants. The postoperative bed is subjected to Redon drain. The drainage is exteriorized to the skin via a separate puncture. The wound is sewn up in layers tightly.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Kurgan, Russian Federation, 640014
- Ilizarov
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Signed and dated informed consent for participation in the study (separate informed consents for child and parents/caregivers), obtained before conducting any study procedures
- Verified and documented diagnosis (neuromuscular desease, NMD) with the results of neurologic examination
- Deformity of thoracic and/or lumbar spine associated with NMD, which requires surgical intervention
Exclusion Criteria:
- Patient unwillingness or inability to follow study procedures
- Absence of signed and dated informed consent for participation in the study (as for child and for parents/caregivers)
- Patient participation in another clinical study, which can influence the results of this study
- Life expectancy <12 months
- Concomitant diseases, which preclude patient participation in this study according to doctor's opinion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
OTHER: Neuromuscular scoliosis
Efficacy of Surgical Treatment by Different Pedicle Screw Systems in Pediatric Neuromuscular Spinal Deformity
|
All patients will be implanted Medtronic CD Horizon Legacy 4.5 and 5.5 under X-ray control (C-arm), intraoperative spinal deformity surgery safety control and standard anesthetic support.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
First Scoliotic Curve
Time Frame: before surgery
|
First scoliotic curve before surgery in Cobb degrees
|
before surgery
|
Second Scoliotic Curve
Time Frame: before surgery
|
Second scoliotic curve before surgery in Cobb degrees
|
before surgery
|
Tilt of the Pelvis Relative to the Horizon
Time Frame: before surgery
|
tilt of the pelvis relative to the horizon before surgery in Cobb degrees
|
before surgery
|
Kyphotic Curve Th5-Th12
Time Frame: before surgery
|
Kyphotic curve Th5-Th12 before surgery in Cobb degrees
|
before surgery
|
Lordotic Curve L1-S1
Time Frame: before surgery
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Lordotic curve L1-S1 before surgery in Cobb degrees
|
before surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
First Scoliosis Curve
Time Frame: 10 days after surgery
|
First scoliotic curve after surgery in Cobb degrees
|
10 days after surgery
|
Second Scoliotic Curve
Time Frame: 10 days after surgery
|
Second scoliotic curve after surgery in Cobb degrees
|
10 days after surgery
|
Tilt of the Pelvis Relative to the Horizon
Time Frame: 10 days after surgery
|
tilt of the pelvis relative to the horizon after surgery in Cobb degrees
|
10 days after surgery
|
Kyphotic Curve Th5-Th12
Time Frame: 10 days after surgery
|
Kyphotic curve Th5-Th12 after surgery in Cobb degrees
|
10 days after surgery
|
Lordotic Curve L1-S1
Time Frame: 10 days after surgery
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Lordotic curve L1-S1 after surgery in Cobb degrees
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10 days after surgery
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Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Ilizarov
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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