Burnei's disease: teratological spondylolysis.

Teratological spondylolysis is a pathological entity noted for the first time in the specialty literature by Gh. Burnei in "The Spine Journal", in September 25, 2014. This disease was described in a short presentation of the first case treated by the author. The aim of this paper was to expose in a didactic manner the main characteristic aspects of Burnei's disease: embryological, clinical, imaging and treatment data and also to make known this pathological entity with all its pathognomonic diagnostic elements. This paper was based on data obtained after analyzing 2 cases of teratological spondylolysis: a 18-year-old patient with triple L3-L5 teratological spondylolysis with Pang 1 spinal dysraphism and a 1-year-old child with teratological spondylolysis and retrospondylolisthesis.

Burnei's anterior transthoracic retropleural approach of the thoracic spine: a new operative technique in the treatment of spinal disorders.

BACKGROUND: Up to the middle of the last century, the thoracic spine, especially in its upper part, has been considered an unapproachable site, a no-man's land, but the constant evolution of medicine imposed techniques of the spine at these levels in order to solve a large area of pathology (infectious, tumoral, traumatic, and last but not least, deformative). This way, a series of anterior approaches allowed surgeons to gain access to the anterior part of the spine and the posterior mediastinum. The approaches described by Hodgson, Mirbaha or transthoracic transpleural approach (T4-T11), are enumerated. The idea to allow a more visible and extensive approach, but to avoid respiratory issues due to the lesion of the pleura, led to the description of a new anterior approach by Burnei in 2000. MATERIAL AND METHOD: Burnei's approach represents an anterior approach to the thoracic spine, being a transthoracic and retropleural one. This approach allows a large area of spinal pathology due to infectious, traumatic, tumoral and degenerative (idiopathic or congenital scoliosis) causes. Statistically, this approach has been performed more frequently in cases of spinal instrumentation after diskectomy, in order to perform a partial correction of severe, rigid idiopathic scoliosis with more than 70 degrees Cobb and in cases of congenital scoliosis for hemivertebra resection and somatic synthesis to correct the scoliotic curve. RESULTS: This kind of anterior approach allows the surgeon a large visibility of the anterior thoracic spine, diskectomies of up to 5 levels to tender the curve of the deformity and to ensure somatic or/ and transpedicular synthesis of up to 6 thoracic vertebrae. By performing a thoracotomy involving the resection of the posterior arches of the ribs, a thoracoplasty is also ensured with functional and aesthetic effects, by ameliorating the thoracic hump due to the scoliotic deformity. CONCLUSIONS: Burnei's approach joins all the other anterior approaches of the spine, addressing a large area of pathology of the thoracic spine. Even if difficult to be performed, requiring a thorough and perfect technique in the hands of a skilled surgeon, it will ensure satisfaction due to the detailed and visible exposure of the thoracic spine.

Burnei-Gavriliu classification of congenital scoliosis.

INTRODUCTION: The existent classifications of congenital scoliosis cannot contain all the cases encountered in the medical practice taking into account the complexity of the spine deformity in this pathology. PURPOSE: The paper represents a retrospective study that analyses a new classification of congenital scoliosis in comparison with the existing classification. MATERIALS AND METHOD: This study analyses 56 cases over a period of 14 years (2000-2013), based on the spine dominant deviation: longitudinal or rotational imbalance. RESULTS: This new classification contains not only the formation, segmentation and mixed defects, but also the formation failure with or without fusion failure of the ossification centers (wedged vertebra, hemivertebral body, segmented, hemisegmented, unsegmented hemivertebra, which may be successive, intermittent, alternant compensated or alternant decompensated). It also contains the congenital scoliosis with a rotational imbalance by spinal traction, spinal pushing or by a mixed effect. DISCUSSION: In comparison with the other classifications in literature: Winter, Imagama or Kawakami, this classification systematizes data according not only to the spatial disposition of the hemivertebrae, but also to the balance of the deformity. CONCLUSIONS: In conclusion, this classification of congenital scoliosis has a practical, diagnostic, therapeutical and prognostic use.

Proximal congenital radial-ulnar synostosis and synchondrosis; pathogenic concept and a new therapeutic method.

BACKGROUND CONTEXT: Proximal congenital radial-ulnar synostosis (PCRUS) is defined by the development before birth of a bony bridge between the radius and ulna, usually at the proximal level, which blocks forearm rotation. This anomaly is rarely reported in the medical literature, because of its low prevalence, and treatment usually yields unsatisfactory results. The most commonly used surgical interventions are: forearm repositioning osteotomies with derotation of the radius and ulna, segmental resections of the middle third of the radius with muscular interposition, resection of the synostosis with the interposition of fatty tissue, tendons or fascia lata and resection of the proximal radius along with the transfer of the distal extensor carpi ulnaris tendon on the lateral edge of the radius. PURPOSE: To describe a new treatment method for PCRUS, which we based on a new pathogenic concept, and to present our preliminary results. MATERIALS AND METHOD: Between 2011 and 2013 our team performed two myo-osteo-arthroplastic reconstructions of the elbow and forearm for PCRUS. The intervention involves the extraperiosteal stripping of the origins of the ventral forearm musculature, release of the interosseous membrane, resection of the proximal two thirds of the radius, reshaping of the synostosis, a double osteotomy of the ulna and the transfer and fixation of a proximal fibular graft, including the head with its articular cartilage, in place of the resected segment of the radius. RESULTS: Our preliminary study reveals favorable postoperative results, in comparison with other published methods. At the latest follow-up, one case had -10 degrees of pronation and 68 degrees of supination, and the other had 10 degrees of pronation and 66 degrees of supination. CONCLUSIONS: Compared with other techniques, myo-osteo-arthroplastic reconstruction may seem overly invasive. However, the extent of this intervention is mandated by the pathogenic concepts of helical distortion, muscular retraction and anomalous configuration of the interosseous membrane. Benign cases do not require surgery. When there is no helical distortion, the intervention may be limited to the transfer of the proximal extremity of the fibula for the infant and small child.