Wound-Related Complication in Growth-Friendly Spinal Surgeries for Early-Onset Scoliosis-Literature Review.

BACKGROUND: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study was to review current literature according to this complication. METHODS: PubMed, Cochrane Library, and Embase were systematically searched for relevant articles by two independent reviewers in January 2022. Every step of the review was done according to PRISMA guidelines. RESULTS: A total of 3579 articles were found. Twenty four articles were included in this systematic review after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of wound-related problems (on average, 15.5%). CONCLUSION: The literature concerning the definitions, collection, and interpretation of data regarding EOS wound-related complications is often difficult to interpret. This causes problems in the comparison and analysis. Additionally, this observation indicates that data on the incidence of SSI may be underestimated. Awareness of the high rate of SSI of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review.

BACKGROUND: The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM: To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS: In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS: A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION: The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery.

Spinal deformity corrections in paediatric patients are long-lasting procedures involving damage to many tissues and long pain exposure; therefore, effective pain management after surgical treatment is an important issue. In this study, the effect of inclusion of local infiltration analgesia, as an integral part of the scheme in postoperative pain control, in children and adolescents, subjected to the spinal deformity correction procedure, was assessed. Thirty patients, aged 8 to 17 years, undergoing spinal deformity correction were divided into a study group, receiving a 0.25% bupivacaine solution before wound closure, and a control group (no local analgesic agent). Morphine, at the doses of 0.10 mg/kg of body weight, was administered to the patients when pain occurred. Pain scores, morphine administration, and bleeding were observed during 48 postoperative hours. The pain scores were slightly lower in a 0-4 h period in patients who received bupivacaine compared with those in the control group. However, no differences were observed in a longer period of time and in the total opioid consumption. Moreover, increasing bleeding was observed in the bupivacaine-treated patients (study group) vs. the control. Bupivacaine only modestly affects analgesia and, due to the increased bleeding observed, it should not to be part of pain control management in young patients after spinal deformity correction.

The titanium-made growth-guidance technique for early-onset scoliosis at minimum 2-year follow-up: A prospective multicenter study.

BACKGROUND: The management of early-onset scoliosis (EOS) remains a serious challenge in pediatric orthopedics. The growth-guidance system (GGS) is a surgical option that allows continuous growth along a rod, averting the need for repeated operative lengthening. OBJECTIVES: The objective of this study was to evaluate the outcomes of the GGS in the treatment of EOS. MATERIAL AND METHODS: A prospective study, including 81 patients from 4 departments treated with this method from 2013 to 2015, was conducted with a minimum follow-up period of 24 months. The follow-up data of 57 patients was available, thus the drop-out rate was 29.63%. There were 44 girls with a mean age of 10.03 years and 13 boys with a mean age of 8.04 years. RESULTS: The mean preoperative Cobb angle was 65.3° (range 36°-139°) was corrected to 23.7° (2°-94°), and at the end of the 2-year follow-up increased to 30.7° (8°-93°). The predominant proximal level of instrumentation was T5 and the distal was L1. The combined length of T1-T12 and T12-S1 increased on average by 33.19 mm in 24 months. The overall rate of serious complications was 43.86%. The most prevalent device-related complications were: the dislodgement of top screws because of the short length of the rod (14 cases), the implant failure (11 cases) and loss of correction (9 cases). CONCLUSIONS: The results show that the GGS used in this study allows for a good and stable correction while preserving the ability of the spine to grow in at least a 2-year follow-up. The complication rate is acceptable and comparable with other growth-friendly techniques. To date, this is the largest successful study on the use of titanium-made GGSs.

Allergic reaction to platelet-rich plasma (PRP): Case report.

RATIONALE: In the recent years, growing interest is focused on the use of platelet-rich plasma (PRP) in wound healing and tissue regeneration. There are a number of papers regarding the usefulness of PRP in the healing of ulcerations, skin injures, bone loss or distraction osteogenesis. Most authors emphasize the safety of PRP usage due to its authogenic nature. PATIENT CONCERNS: We present a case of a 14 -year-old boy admitted to our department due to simple bone cyst of the distal tibia, qualified for injection of PRP into the cyst. PRP was separated with the use of Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems Hopkington, MA) according to the manufacturers' manual. Immediately after separation during short-term IV anaesthesia, 3 mL of PRP was installed to the bone cyst under image intensifier control. DIAGNOSES: Within the first 24 hours after exposure to PRP, the skin rash appeared. Physical examination revealed the small red papular, regionally purpuric eruptions, mainly concentrated on the upper extremities and on more warmed regions of skin, in association with pharyngitis, tonsillar enlargement, mucopurulent discharge in the posterior pharynx and swelling of the eyelids. INTERVENTIONS: As the patient received calcium citrate with the PRP injection additional calcium citrate test were performed. Skin prick testing (negative) was and an intradermal test was positive (10×13 mm). Treatment included Claritine (Loratidinum) and Clemastin (Clemastinum)-both antihistaminic drugs. OUTCOMES: All symptoms withdrew and the patient was released home after 4 days. The patient is in 6 years follow-up without any symptoms of allergic disease. LESSONS: Our case shows that safety of use of PRP is not absolutely sure. The pure autologous tissue is safe, but preparation for its use can substantially decrease this safety. In our patient, only limited skin reaction to calcium citrate was observed, but general reaction leading to anaphylactic shock cannot be excluded. In order to reduce the risk of side effects skin test should be performed but as there were no records of allergic diseases on family and patients medical history this should apply to all patients.

Risk factors of postural defects in children at school age.

INTRODUCTION AND OBJECTIVE: Postural defects increasingly more often concern children and adolescents at school age. The lack of prophylaxis and neglecting adequate procedures may lead to limitations of physical and motor abilities, back pain, or the development of severe spinal deformities. Recognition of the risk factors conducive to the occurrence of the disorder allows the creation of adequate conditions for the psychomotor development of children, as well as the elaboration and implementation of specified educational schemes directed at schools and parents. The study concerned determination of the risk factors for the development of postural defects in school age children. MATERIAL AND METHODS: The study was conducted by means of a diagnostic survey. The study group covered 380 children aged 14 (175 girls (46.1%) and 205 boys (53.9%))--selected at random from schools in eastern Poland and the Czech Republic. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: The BMI in the population examined was 20.2, on average (from 14-39). Respondents living in rural areas and small towns constituted 57.63% of the study group, while inhabitants of medium-size and large cities--42.37%. The majority of children in the study had been previously examined for the occurrence of postural defects (74.2%), whereas nearly every tenth child had never undergone such an examination. As many as 16.3% of adolescents did not know whether they had ever participated in a screening test. A defect was detected in 14.7% of children, in 56.6% no asymmetry was detected, while approximately 30% were not aware if their body posture was normal or not. CONCLUSIONS: 1. There is a relationship between physical activity of the child and the occurrence of postural defects. 2. There is a relationship between the economic standard of the family and awareness of own state of health. 3. There is a need for the creation of a system of education for parents and children concerning postural defects and risks resulting from these defects.

Guided-growth implants in the treatment of early onset scoliosis. A pilot study.

BACKGROUND: The aim of treating children with early onset scoliosis is to guide the growth of the spine until the patients reach skeletal maturity. Regardless of its aetiology, progressive early-onset scoliosis requires multiple-stage surgery, usually at 6 to 12 months' intervals. However, precise coordination of the timing of each consecutive surgical procedure with the child's growth pattern is difficult, and the risk of complications that require additional surgery should be taken into account. The aim of this study is to present a new surgical method of treating early onset scoliosis which consists in a single-stage insertion of special implants that enable three-plane correction of spinal deformities, allows the spine to continue growing, does not require multi-stage surgical distractions, and ends after the growth period with a conventional spinal fusion. The results of this pilot study were obtained in a homogeneous group of patients treated identically by insertion of original implants guiding spinal growth. MATERIAL AND METHODS: The study involved 15 females and 2 males aged between 5 and 13 years (mean age: 9.8 years). All children in the study group had single-curve thoracic scoliosis. The duration of follow-up was between 6 and 40 months (mean duration: 18 months). The efficacy of the guided-growth implant treatment was assessed based on standard radiographs by evaluating the angle of the curvature, T1-S1 length, and apical vertebral rotation (AVR) 1. preoperatively, 2. postoperatively, and 3. in long-term follow-up. RESULTS: After surgery the scoliosis improved significantly in the range of 51% to 80% (mean improvement: 65%). The degree of the correction depended directly on the initial angle of curvature, which ranged from 56 to 95° (mean angle of curvature: 67°). During the entire follow-up period, twelve patients did not show any loss of correction, or the loss was within the bounds of measurement error. Because of a growth spurt, two female patients had to have the rods replaced with longer ones, since there was a risk that they might slide out of the farthest lower screws. In three patients further spontaneous improvement occurred during the follow-up period. Apical vertebral derotation was achieved during the surgery in all patients, and it was maintained throughout the follow-up period. All patients showed an increase in spinal length in the range of 7 to 40 mm (mean increase: 1mm/month). CONCLUSIONS: 1. The surgical method described by us provides for very good correction in the first stage of treatment. 2. The maintenance of the correction does not require the use of corrective braces or any indirect multi-stage surgical procedures. 3. The probability of complications during the insertion of the implants is not higher than that seen with conventional multi-stage treatment.

Socio-economic conditionings of families with children treated due to scoliosis in Eastern Poland.

INTRODUCTION AND OBJECTIVE: Scoliosis is a serious clinical problem which requires a systematic physical therapy and control of body balance--treatment from the moment of achieving skeletal maturity by a child. In the situation of neglect of such a management, the deformation of the spine often requires surgical intervention. The role of parents in the process of treatment of a child is undeniable. The study concerned the determination of socio-economic conditions and the engagement of parents with children treated due to scoliosis in Eastern Poland. MATERIAL AND METHODS: The study was conducted by means of a diagnostic survey. The study group consisted of 193 parents (148 females (76.7%) and 45 males (23.3%))--a randomly selected sample of the parents of children who participated in scoliosis rehabilitation courses in rehabilitation centres in Eastern Poland. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: The study group covered 47.7% of inhabitants of the rural areas and small towns, and 52.3% of inhabitants of medium-size and large cities. Respondents with a higher economic status were more engaged in the treatment of their child with scoliosis. A greater number of parents with university education level reported to a specialist; however the frequency of these visits, similar to incomplete families, was the lowest. CONCLUSIONS: The accessibility to specialists is lower in the rural than urban areas. 1. There is a relationship between the economic standard of the family and engagement in the treatment of a child with scoliosis. 2. There is a need to develop a system of education of parents concerning scoliosis and the consequences of neglecting treatment. 3. The system of public health services is insufficient for satisfying health demands of patients with the diagnosis of scoliosis.

Clinical experience with the use of low molecular weight heparin in orthopaedic treatment of paediatric patients.

BACKGROUND: The objective of the paper is to describe our clinical experience with the use of low molecular weight heparin in children treated due to various orthopaedic conditions. MATERIAL AND METHODS: We have studied the treatment outcomes of 35 patients aged 11 to 18 years who were hospitalized in the Department of Paediatric Orthopaedics and Department of Traumatology and Emergency Medicine of the Medical University of Lublin and were treated with a low molecular weight heparin (LMWH). Short-term prophylaxis was applied in 33 patients during immobilization after such orthopaedic procedures as surgical correction of spine deformity and corrective osteotomy of the femoral and tibial bone. Two children received LMWH therapy after reduction and fixation of femoral bone fractures and long-term immobilization following ankle joint distortion with early-stage venous thromboembolism (VTE). RESULTS: None of the patients who received prophylactic treatment showed the clinical manifestations of thrombosis. The VTE symptoms subsided in children treated with the LMWH. Nadroparin was administered for both short-term prophylaxis and treatment, and was administered in doses proportionate to body weight and without prior determination of anti-factor Xa activity (anti-Xa assay). No side effects were observed. CONCLUSIONS: The use of the LMWH turned out to be effective and safe in thromboprophylaxis in paediatric patients.

Change of situation of a family with a child treated due to scoliosis.

INTRODUCTION AND OBJECTIVE: Scoliosis is a serious clinical problem which requires a systematic physical therapy and control of body balance - treatment from the moment of achieving skeletal maturity by a child. In the situation of neglect of such a management, the deformation of the spine often requires surgical intervention. The role of parents in the process of treatment of a child is undeniable. The study concerns the determination of socio-economic conditions and the engagement of parents with children treated due to scoliosis in Eastern Poland. MATERIAL AND METHODS: The study was conducted by means of a diagnostic survey. The study group consisted of 193 parents (148 females [76.7%] and 45 males [23.3%]) - a randomly selected sample of the parents of children who participated in scoliosis rehabilitation courses in rehabilitation centres in Eastern Poland. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: The study group covered 47.7% of inhabitants of rural areas and small towns, and 52.3% of inhabitants of medium-size and large cities. Respondents possessing university education provided their children a wider profile of health care; however, they neither supervised exercises at home nor paid attention to the maintenance of the normal body posture. The diagnosis of scoliosis in a child rarely affects the relationship between parents. The engagement of parents into rehabilitation treatment of their children is small. CONCLUSIONS: There is a relationship between social variables and engagement in the treatment of a child with scoliosis. There is a need to create a system of education for parents concerning scoliosis and the consequences of its negligence. The enrolment of a psychologist into the treatment team should be considered, which would provide support for the parents of children suffering from scoliosis.

Problems and complications in VEPTR-based treatment.

AIM OF THE STUDY: Early-onset scoliosis with co-existing thoracic deformity is particularly difficult to treat, with early surgery usually being the only rational solution. Operative correction of the deformed spine and rib cage employs techniques enabling further growth of the structures, an example of which is the Vertical Expandable Prosthetic Titanium Rib (VEPTR), designed to provide dynamic stabilization of the spinal column and the thoracic cage. Our study aimed to present difficulties and complications related to VEPTR-based operative reduction of the spinal and thoracic deformities in the youngest child. MATERIAL AND METHODS: Twelve children aged 3 to 9 years (a mean age of 5.25 years) underwent sequential VEPTR-based surgery the Department of Paediatric Orthopaedics of the Medical University of Lublin. The subjects were qualified for the procedure on account of multiple congenital spine deformities (3 children), early-onset progressive neuromuscular scoliosis (4 children) and kyphosis secondary to a myelomeningocele (5 children). The number of procedures per child ranged from 4 to 10 and the follow-up was 10 months to 4 years (with a mean of 2.5 years). Treatment failures and complications comprised rib fractures (4 cases), perforation of the iliac ala by the ala hook (5 cases), pulmonary oedema (2 cases), hip joint destabilization (1 case), tissue reaction to the metal (4 cases), breakage of the implant (2 cases). RESULTS AND CONCLUSIONS: The specific character of the method makes it liable to a variety of difficulties and complications that may sometimes affect the outcome. Both the authors' experience and published data prove the clinical effectiveness of VEPTR. Nevertheless, it is only a temporary means that cannot disturb the strategic anatomical elements of the spine which are to be involved in subsequent conventional operative procedures. An awareness of the limitations and possible difficulties connected with VEPTR allows for some modifications with which the technique continues to be the most effective sequential treatment of thoracic and spinal deformities in the youngest child.

Enhancing bone healing during distraction osteogenesis with platelet-rich plasma.

UNLABELLED: Gradual limb lengthening with external fixators using distraction osteogenesis principles is the gold standard for treatment of limb-length discrepancy. However, long treatment time is a major disadvantage of the current lengthening procedures. Efforts to decrease the treatment include biological and biomechanical factors. Injection of platelet-rich plasma (PRP) is a biological method to enhance bone healing during distraction osteogenesis. We hypothesised that PRP can enhance bone healing during limb lengthening. We report our experience with the use of PRP during distraction osteogenesis. This retrospective study included 19 patients divided into the standard group of 10 patients who did not receive PRP and the PRP group of nine patients who received PRP at the end of the distraction phase. The study variables included external fixator time, external fixation index, and complications during treatment. The PRP group had statistically significantly shorter treatment time (p=0.0412). Injection of PRP into regenerate bone might be an effective method to shorten treatment time during limb lengthening and lead to better functional outcomes and improved patient satisfaction. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Diastematomyelia - a diagnostic and therapeutic problem. Case study.

BACKGROUND: Diastematomyelia is a type of dysraphism with a double or bifid spinal cord divided by an osseous septum. This defect often co-occurs with other developmental disorders of the skull or the atlanto-occipital junction. The course may be benign or aggressive. 2. CASE REPORTS: We describe two female patients treated in the Rehabilitation Clinic and the Orthopaedic Department at the Medical University of Lublin in the years 2004 - 2009. The first patient was diagnosed at the age of 20 years to have diastematomyelia at the L3 level and spina bifida occulta at L1- S5 and at the C1 arch. In the other patient, diastematomyelia at the L3 level and spondylolisthesis at L5-S1 were found at the age of 14 years. Initially both patients were treated for lumbosacral radicular syndromes. Physiotherapy intensified the pain. The patient with diastematomyelia and L5-S1 spondylolisthesis had L5-S1 segment stabilization performed at the age of 16. The pain subsided after the surgery. The other patient was instructed to stop rehabilitation, follow a balanced lifestyle, and refrain from physical work, which eliminated the pain. DISCUSSION: Managing a patient with diastematomyelia demands caution. Diagnosis of this defect requires a thorough cause-and-effect analysis of the presenting signs and symptoms of spinal dysfunction. The treatment should be dependent on local pain intensity (which is often not directly associated with the disorder) and on the degree of neurological dysfunction. 5. CONCLUSIONS: 1. A thorough clinical evaluation with spinal imaging prior to elective surgery for scoliosis and other spine deformities should be a standard procedure undertaken in order to avoid complications. 2. The treatment for diastematomyelia should depend on the intensity of local pain and on the level of neurological dysfunction. 3. Broadly understood rehabilitation is not always effective, often increasing the pain and/or neurological complaints.

The vertical expandable prosthetic titanium rib (VEPTR) in the treatment of scoliosis and thoracic deformities. Preliminary report.

BACKGROUND: Severe deformities of the chest, early-onset progressive scoliosis, congenital defects of the ribs and the vertebral column may all give rise to the thoracic insufficiency syndrome (TIS), when the chest capacity is too low to fully support basic vital functions, leading to gradually progressive cardiopulmonary failure. Aim of study. This paper presents new possibilities for sequential correction of progressive deformities of the thorax and spinal column in skeletally immature children using a vertical expandable prosthetic titanium rib (VEPTR) system. MATERIAL AND METHODS: At the Department of Pediatric Orthopedics of the Medical University in Lublin, three children were treated surgically with VEPTR, a low-profile modular system allowing simultaneous correction of scoliosis and chest deformities. Two children (aged 8 and 9 years) required treatment for multiple congenital spinal deformities, while one (aged 7) had early progressive neuromuscular scoliosis. DISCUSSION: Existing surgical approaches based on the Harrington method do not prevent further progression of chest deformity. The ongoing sequential VEPTR treatment of our patients resulted in significant correction of thoracic and spinal deformities already in the first phase of the treatment, with considerably improved respiratory capacity. CONCLUSION: The vertical expandable prosthetic titanium rib appears to be the best alternative to other approaches to sequential treatment of chest and spine deformities currently in use.

Reasons for diagnostic difficulties in spinal defects and deformations in children and adolescents.

Background. The growing spine is vulnerable to pathological processes in the bony, muscular or nervous tissue of the spine, with symptoms that include disturbances of the spinal axis in both planes. The clinical picture often corresponds to idiopathic scoliosis. Radiographic examinations done routinely mostly do not show any pathology in the initial period of disease growth. The aim of our study was to present diagnostic problems in children and adolescents treated "routinely" with the diagnosis of a posture defect or scoliosis. Material and methods. The material included 25 girls and boys mistakenly diagnosed and treated for scoliosis, while the hidden etiology delayed proper treatment. Results. In 12 cases the reason for deformity was osteoid osteoma of the spine, in 2 cases astrocytoma, in 2 others, meningioma, and in the others, hidden congenital defects of the vertebrae. In most cases, scoliosis were diagnosed due to a misleadingly typical clinical picture. All the examined patients needed surgical treatment. In cancer processes, the clinical diagnosis was confirmed by histopathologic examination. Conclusions. These examples of defects and deformities of spine caused by hidden pathological process indicate the necessity of thorough evaluation of every posture deformity in children and adolescents. Early diagnosis and surgical removal of the cause of deformity in all cases led to inhibition of the tumor or reduction of spinal deformity. Our observations indicate the risk of mass screening examinations, after which selected children are referred for treatment without diagnosis. Such therapeutic mistakes can be dangerous and delay proper treatment.

[Outcome after surgical treatment of idiopathic scoliosis using three- dimensional correction with spondylodesis]. / Wyniki leczenia operacyjnego skolioz idiopatycznych metoda trójplaszczynowej korekcji ze spondylodeza.

BACKGROUND: [corrected] Three-dimensional surgical correction of scoliosis was introduced in the 1980s by Cotrel-Dubousset. Initially only laminar and pedicular hooks, two rods (correcting and stabilizing), and transverse links joining both rods were used to correct and stabilize the spine. When implant systems had been developed and modernized, transpedicular screws in the lumbar segment were used, followed by titanium implants. The aim of our study was to evaluate the outcome after surgical correction of scoliosis using the three-dimensional correction method with spondylodesis. MATERIAL AND METHOD: We studied 171 patients with scoliosis treated surgically by the three-dimensional method of correction in the years 1992-2002. These were patients with idiopatic scoliosis not exceeding 70-80 degrees , depending on the degree of correction in extension tests. In 28 cases, titanium implants were used. In most cases, transpedicular screws were used in the lumbar spine, on the convex side of the scoliosis. Tytanium implants were used to enable diagnosis by CT or MRI after surgery. RESULTS: The mean angle of scoliosis before surgery was 56 degrees (range 40 degrees -90 degrees ). After surgical correction the mean angle was 16 degrees (range 5 degrees -37 degrees ); however, in long-term follow-up, the mean angle had increased slightly to 18 degrees (range 8 degrees -50 degrees ). The observation period was 2 to 16 years. There were complications in 9.3% of these cases, mainly late sterile negative tissue reactions to steel implants. Infectious and neurological adverse reactions were not observed. CONCLUSIONS: The best outcome after surgical treatment was achieved in grade II scoliosis. The scale of correction amounted to an average 70%. Transpedicular screws in the lumbar spine enabled a reduced range of stabilization. Titanium implants enabled radiological diagnosis by MRI and CT after surgery.

Computed tomography in bone density measurement and vertebral rotation assessment before and after surgical treatment of scoliosis.

Background. There are changes on radiograms of bone tissue structure after surgical treatment in scoliosis. The aim of the study. The aim of the current study is the assesment of bone density and vertebral rotation in apical part of spine scoliosis before and afrter surgical treatment. Materials and methods. Computed tomography examination was performed on young girls with right-side thoracic scoliosis, before and after surgical correction and spine stabilisation. Three-dimensional option (3D) was used to examine vertebrae from the peak of spine distortion. Bone density measurement in various parts of vertebral bodies and archs on concave and convex sides was performed, both before and after operation. Analogical examination of vertebral rotation in the superior part of spine was executed as well. Results and Conclusions. Preliminary results and conclusions based on analysis of rotation before and after surgical CD method treatment with a use of titanic grafts were presented. Postoperative examination has shown that rotation in the peak of spine distorsion remained unreduced. The grafts used to scoliosis correction have no influence on peak part of spine distorsoin. Bone density changes in vertebrae consisted in increased values on more loaded side and decreased values on less loaded side in accordance to Delpech-Wolf;s principle. Bone density increased also after spondylodesis with a use of autogenic bone grafts.

Computed tomography diagnostic of the intervertebral disc degeneration and degenerative changes of the lumbo-sacral spine.

Background. The aim of the work is problem of computed tomography diagnostic of the intervertebral disc degeneration and degenerative changes of the lumbo-sacral spine.
Authors present result of computed tomography examinations performed in 60 patients at the age from 18 to 69 years, suffering from chronic low back pain for 6 months at least.
Material and methods. Degenerative changes of the vertebra-disc junction on the levels of L3-L4, L4-L5 and L5-S1 were evaluated. The analysis of intervertebral disc changes and osteophytes presence on all of the investigated levels was chose as the assessment criterion.
Results. The pathological changes of the vertebra-disc junction on L5-S1, L4-L5 and L3-L4 levels were stated in 58 (96.6%), 55 (91.6%) and 47 (78.8%) patients, whereas the degeneration of the intervertebral disc was diagnosed in 50, 45 and 15 cases, respectively. Moreover, the vacuum phenomenon was present in connection with the degeneration of the intervertebral disc on L5-S1, L5-L4, L3-L4 levels in 29, 11 and 1 cases, respectively. The osteophytes' presence, as a single proof of the degenerative changes was diagnosed in 8 patients on L5-S1 level, whereas on L4-L5 level in 10 patients. In 32 cases osteophytes were localised on L3-L4 level.
Conclusions. In conclusion, the differences in morphology of the pathological changes are the result of different loading and various mechanisms generating these changes on particular levels.

The radiological imaging of the vertebral body and intervertebral discs wedging in idiopathic, right-side, thoracic scoliosis as a prognostic factor of the angular progression of spine curve.

Background. On the superior-posterior radiograms in patients with scoliosis there is reduction of vertebral body height and intervertebral discs on concave curve side. The aim of the study. The assesment of vertebral body and intervertebral discs wedging in patients with progresive and non-progresive scoliosis, treated using braces. Material and methods. On the basis of superior-posterior radiograms in healthy patients without spine curve and radiograms of skeletal spine preparations the physiological, standard vertebral body height factor and intervertebral discs height factor were determined. The physiological values of vertebral body factor reached 1 (+/-0,003) and intervertebral discs factor reached 0,99 (+/-0,01). The next step in this investigation was analysis of radiograms obtained from two different experimental groups of patients that suffered from idiopathic, right-side, thoracic scoliosis. The first group consisted of 30 patients non-surgically treaded with kinesytherapy and orthopaedic braces. These patients were classified as a group that required non-operative treatment. To the second group belonged 30 patients that required operative treatment although careful non-surgical treatment performed using orthopaedic braces for spine correction. The analysis of superior-posterior radiograms was performed before, during and after treatment, when young patients reached skeletal maturity. The height of vertebral body on concave and convex spine curve sides was measured to determine vertebral body wedging factor in the apex of spine curve. Results. The vertebral body wedging factors calculated after analysis of radiograms obtained from the first experimental group (patients without angular progression) were not statistically significant different. The differences of vertebral body wedging factors in the apex of spine curve obtained in the second group were statistically significant. The increase in vertebral body wedging factor in the second experimental group was stated together with progression of spine curve, what proves intensifying spine scoliosis.

3D CT imaging of the lumbo-sacral spine after surgical treatment of L5-S1 spondylolisthesis by postero-lateral spondylodesis.

Background. The aim of the study is the evaluation of the spatial imaging computed tomography (3D CT) of lumbo-sacral spine after surgically treated spondylolistesis L5-S1 with the postero-lateral spondylodesis using autogenic bone grafts.
Material and methods. Material comprises 9 patients treated surgically due to I degrees spondylolistesis caused by the L5 vertebra spondylolysis. In all cases postero-lateral spondylodesis was performed using autogenic bone grafts, taken from the iliac crest, placed on the transverse processes of the L5 vertebra and the sacral bone. The CT examination was performed in the period between 6 months up to 2 years after operation due to overloading lumbar pain.
Results. The bone grafts was localized correctly in 8 patients. In 1 person the upper side of the one bone graft was localized incorrectly, on the prominent transverse processus of the S1 vertebra, instead of the L5 one. The spatial reconstruction reveal the presence of osteophytes surrounding the ends of the bone grafts or the localization the fissure of the arch. In 2 cases the bone grafts were bigger on the left side, and the wide lower ends were connected with the dorsal surface of the sacral bone and were connected with the shorten due to surgery iliac crest
Conclusions. The CT examination with the use of the spatial option is very valuable in the lumbo-sacral spine imaging in patients treated with the postero-lateral spondylodesis due to spondylolisthesis L5-S1. The spatial images 3D CT are especially useful in imaging of the localization of the bone grafts, assessment of the wide of spinal canal and intervertebral foramens. The use of spatial imaging 3D is valuable supplement of standard CT examination in diagnosis of the patients complaining of the lumbar pain, treated surgically due to spondylolistesis.