Combined extra-/intrathoracic correction of pectus carinatum and other asymmetric chest wall deformities : A novel technique.

OBJECTIVE: Description of a novel technique to surgically correct (asymmetric) pectus carinatum and other chest deformities using a metal bar without fixation to the ribs. INDICATIONS: Severe thoracic deformity, extensive psychological strain, social isolation, pain and respiratory complaints. Pseudarthrosis or insufficient correction of a thoracic deformity after prior surgery. Distinctive deformities. CONTRAINDICATIONS: Acute infections. Postoperative intrathoracic scaring in revision cases can be challenging. SURGICAL TECHNIQUE: One-lung ventilation is used. Through two 3-4 cm long bilateral incisions to the thorax, an introducer is guided into the thorax under thoracoscopic supervision and then guided through an intercostal space out of the thorax again. A 1 cm presternal incision is performed and nylon threads are attached to the introducer bilaterally. Then the preshaped metal bar can be placed following the nylon threads. Once the metal bar is placed, the deformity is instantly corrected. Bilateral stabilizers are fixed with wire cerclage. Fixation on the ribs is not necessary. POSTOPERATIVE MANAGEMENT: Postoperative thorax x­ray. Intensive ventilation exercises. Implant removal after 2-3 years. RESULTS: The technique was used in 10 primary pectus carinatum or combined pectus carinatum and excavatum deformities as well as in 6 revision cases (3 female, 13 male, age 13-32 years). Follow-up ranged from 3-15 months postoperatively. Cosmetic results were excellent. Revision surgery required in 2 patients (one rib fracture and one local implant irritation).

Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating: a randomised clinical pilot study.

AIMS: We compared the clinical and radiological outcomes of using a polyetheretherketone cage with (TiPEEK) and without a titanium coating (PEEK) for instrumented transforaminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: We conducted a randomised clinical pilot trial of 40 patients who were scheduled to undergo a TLIF procedure at one or two levels between L2 and L5. The Oswestry disability index (ODI), EuroQoL-5D, and back and leg pain were determined pre-operatively, and at three, six, and 12 months post-operatively. Fusion rates were assessed by thin slice CT at three months and by functional radiography at 12 months. RESULTS: At final follow-up, one patient in each group had been lost to follow-up. Two patients in each of the PEEK and TiPEEK groups were revised for pseudarthrosis (p = 1.00). The rate of complete or partial fusion at three months was 91.7% in both groups. Overall, there were no significant differences in ODI or in radiological outcomes between the groups. CONCLUSION: Favourable results with identical clinical outcomes and a high rate of fusion was seen in both groups. The titanium coating appears to have no negative effects on outcome or safety in the short term. A future study to determine the effect of titanium coating is warranted. Cite this article: Bone Joint J 2017;99-B:1366-72.

[EOS imaging acquisition system : 2D/3D diagnostics of the skeleton]. / EOS-Imaging : 2-D/3-D-Diagnostik des Skeletts.

The application spectrum of the EOS imaging acquisition system is versatile. It is especially useful in the diagnostics and planning of corrective surgical procedures in complex orthopedic cases. The application is indicated when assessing deformities and malpositions of the spine, pelvis and lower extremities. It can also be used in the assessment and planning of hip and knee arthroplasty. For the first time physicians have the opportunity to conduct examinations of the whole body under weight-bearing conditions in order to anticipate the effects of a planned surgical procedure on the skeletal system as a whole and therefore on the posture of the patient. Compared to conventional radiographic examination techniques, such as x-ray or computed tomography, the patient is exposed to much less radiation. Therefore, the pediatric application of this technique can be described as reasonable.

[History of vertebral body replacement]. / Geschichte des Wirbelkörperersatzes.

BACKGROUND: Vertebral body replacement after corpectomy is nowadays a standard procedure in spinal surgery. OBJECTIVE: Description of the developmental process of vertebral body replacement. METHOD: Historical description of the innovations in vertebral body replacement. RESULTS: The first serious attempts to perform vertebral body replacement were initiated approximately 50 years ago. Over several decades spinal surgeons used bone grafts, polymethyl methacrylate, titanium and glass-ceramics containing apatite and wollastonite. Known vertebral surgeons, including Scoville, Polster, Kaneda and Harms, to name but a few, were involved in the continuous development of vertebral body replacement. CONCLUSION: Many different expandable and non-expandable implants are now available and both types of implant can still be justified. This article describes the historical development of these implants and shows how this innovational process has significantly increased the therapy options for surgeons.

No effect of the IGF-1 gene rs35767 and rs17032362 polymorphisms in the etiology of idiopathic short stature.

Idiopathic short stature (ISS) refers to pathophysiologically wide and heterogeneous range of disorders, which are considered to involve defects in growth hormone (GH) insulin like growth factor-1 (IGF-1) axis. This study was designed to evaluate GH- IGF-1 axis and investigate IGF-1 gene polymorphisms in ISS.108 patients with a mean age of 11.7±3.6 years constituted the study group, while 108 age and gender matched children with normal stature constituted the control group. Serum IGF-1 and insulin-like growth factor binding protein-3 (IGFBP-3) levels and two polymorphisms in IGF-1 gene (rs35767, rs17032362) were investigated.While mean IGF-1 SDS value was lower in study group (p=0.002), no difference was detected between mean IGFBP-3 SDS values. The IGF-1 gene rs35767 polymorphism genotype distribution did not exhibit a statistical difference between study (7.1% wild type, 29.6% heterozygous, 63.3% homozygous) and control groups (3.8% wild type, 39.6% heterozygous, 56.6% homozygous). IGF-1 gene rs17032362 polymorphism genotype distribution was not significantly different either between study (94.8% wild type, 5.2% heterozygous, 0% homozygous) and control groups (97.2% wild type, 2.8% heterozygous, 0% homozygous). Comparing the cases with wild type, homozygous and heterozygous carriers for both polymorphisms with respect to height, weight, BMI, IGF-1 and IGFBP-3 SDS values, no significant difference was detected.IGF-1 SDS levels of patients with ISS were significantly lower compared to control group. There was no difference between IGFBP-3 SDS levels. No effect of IGF-1 gene rs35767 and rs17032362 polymorphisms on stature, IGF-1 and IGFBP-3 levels could be demonstrated.

[Revision strategies for ventral implant failure in the lumbar spine exemplified by stand-alone cages]. / Revisionsstrategien bei ventralem Implantatversagen an der LWS am Beispiel von "stand-alone cages".

This article gives a review of the possible revision strategies after repeated operative treatment of degenerative spinal diseases using stand-alone cages. Own clinical experiences and reports from the literature were taken into consideration. Dorsal stabilization is the main consideration for all access routes even if it can be discussed, albeit controversially, whether ventral removal of an installed cage is justified, because this contains a significantly higher perioperative risk. The increased risk of neurological complications by dorsal revision and for vascular complications by ventral access, especially at the L4/5 level must be particularly considered. Clinical data and own experience have shown that in the majority of cases an additional dorsal stabilization should be favored for revision surgery. Currently large clinical studies which deal with the revision problematic of stand-alone cages with respect to the access route are still lacking.