Abstract
Introduction
It is conceded that complicated spinal deformity in underdeveloped countries presents specific obstacles, but these are often made into “using cheaper screws” and being cost effective. In fact, this has become the main discourse for addressing scoliosis in the global South. It is not simply an extra problem on the margin but a fundamentally different institutional context which presents unique constraints and requires innovative solutions. We can innovate ways to make the surgery have less operative and postoperative demands, or to make those demands easier to deal with GIVEN the adverse institutional context. This is precisely where hybrid construct comes in as a surgical choice that is used for complicated spinal deformity in developing country with minimal resources for more than 5 years now.
Material and Methods
13 cases presented with severe spinal deformity, all previously surgically treated for scoliosis, 7 congenital, 3 iatrogenic, 2 syndromic, 1 idiopathic. 8 of them with other associated problems, 6 with scoliosis, 6 with kyphoscoliosis and 1 with kyphosis. The surgical management before the hybrid construct were 28 procedures done, 4 posterior fusion with instrumentation, 3 posterior fusion in situ,2 anterior and posterior fusion in situ, 2 growing rods, 1 VEPTER, 1 posterior fusion and instrumentation with removal of the implants in same day.
Results
Mean age at surgery with hybrid construct 10.5 years, with mean followup time 34 months, all were done with rib hooks proximally and pedicular or iliac screws distally. mean preoperative thoracic scoliosis was 83 became 66, thoracic kyphosis 113 became 70, thoracolumbar scoliosis 60 became 40, thoracolumbar kyphosis 63 became 22. Complications, 8 complications were detected 2 infection, 1 proximal hook dislodgment, 1 implant exposure, 2 broken rod, 1spinal stenosis, 1 died from non-surgical related cause.
Conclusion
With this complex and demanding medical condition in developing countries, we think that hybrid construct may be a good and safe surgical option.