[Nonsurgical treatment of patients with cervical spine pain--algorithm for proceeding]. / Leczenie nieoperacyjne chorych z bólem kregoslupa szyjnego--algorytm postepowania.

Diagnosis and treatment of neck pain still remains a therapeutic challenge. Basing on available literature and their own experience the authors present an algorithm for the management of neck pain in daily orthopaedic practice. It is crucial to correlate correctly the patient's complaints, the physical examination and the laboratory findings (including conventional imaging modes and neurodiagnostic procedures). The chronologically organised algorithm should help the physician in find the optimal therapeutic solution for his patient. The use of this algorithm should also lead to a decrease in the number of unnecessarily performed surgical procedures.

[Diskectomy of the lumbar spine: indication and contraindications]. / Discektomia w czesci ledzwiowej kregoslupa--wskazania i przeciwwskazania.

The authors present an overview of the principles of surgical treatment of lumbar disc herniation which are currently applied at spinal surgery ward by the Orthopedic Department of the Poznan School of Medical Sciences. Most of these principles are valid in spinal surgery centres in USA and most European countries. The authors reviewed surgical technique, indications, contrindications and complications related to discectomy in the lumbar spine. Although the articles deals mainly with "classical" discectomy, other surgical techniques (microdiscectomy, percutaneous discectomy, chemonucleolysis, and endoscopy-assisted discectomy) are also briefly reviewed. Careful selection of patients, meticulous analysis of radiographic findings and proper surgical technique yield good results which allow most patients to improve their life conditions and lead a pain-free existence.

[Early results of short segment internal fixation of the thoracic and lumbo-sacral spine after trauma]. / Wczesne wyniki leczenia urazów kregoslupa piersiowego i ledzwiowo-krzyzowego krótkoodcinkowa stabilizacja wewnetrzna.

The aim of this paper was to assess the results of short-segment internal fixation of the spine in posttraumatic instability. A group of 53 cases of spinal trauma was analysed using both Magerl's and Frankel's classifications. Spinal instability was assessed according the Sagittal Index (SI). The metaanalysis of the clinical material demonstrated that early decompression of the spinal cord and the spinal roots following trauma allows either total or partial restitution of their physiological functions.

[Classification of the adolescent idiopathic scoliosis and preoperative strategy]. / Klasyfikacja mlodzienczych skolioz idiopatycznych i jej przydatnosc w planowaniu leczenia operacyjnego.

The authors analysed 841 patients (83% girls and 17% boys) with adolescent idiopathic scoliosis. 678 patients (group I) were treated with the Harrington technique and 163 patients (group II) were treated using multisegmental instrumentation. Follow-up time in group I was on average 14.2 years, and 28 months in group II. Preoperative assessment of patients in group was based on clinical and radiological examination. Assessment of the spine was mainly based on coronal radiogram done in an upright position and lateral side-bending radiograms in a supine position. Traction and lateral X rays were rarely taken into account in this study. The fusion area was decided according to the end vertebrae of the structural curves. The caudal end of the fusion area was identified using Harrington's stable zone. The curves were classified in accordance with the SRS suggestions. Taking into account the apex of the curve, the deformations were classified into: cervico-thoracic, thoracic, thoraco-lumbar, lumbar and lumbo-sacral curves. In group II the triplanar (3D) character of the deformity was taken into account. In the coronal plane the upper and lower stable vertebra of the major structural curves were identified using the CSVL (Central Sacral Vertical Line) based on long films (70 cm x 110 cm) with and without traction. Lumbar curve was classified as mild, moderate, severe according to CSVL. In the axial plane vertebral rotation was assessed according to Nash and Moe method. A careful analysis of lateral radiograms in the upright standing position was performed. Lateral radiograms were performed also in maximal flexion and hyperextension of the spine to obtain a dynamic evaluation of the sagittal plane. Conoral radiograms with maximal rotation of the trunk to assess mobility of the caudad segments of the deformity. Classification of the scoliotic deformity based on its triplanar character included: thoracic curves (King III, IV, V types), double major (thoracic and lumbar), "false" double major curve (thoracic and lumbar) King type II, thoracolumbar/lumbar curves--the main curve is thoracolumbar lumbar/thoracolumbar curves--the main curve is lumbar--10 degrees the thoracolumbar component--King type I triple major curve--all curves have similar structural changes. Correct identification of the type of scoliosis, assessment of structural changes in the frontal, sagittal and axial plane (three dimensional 3D) and analysis of the size and correctiveness of the lumbar curve and all parameters which play a key role in rational preoperative planning. Redefining or at least maintaining lumbar lordosis is far more important than correction of thoracic kyphosis.

The epidemiology and clinical manifestations of hamstring muscle and plantar foot flexor shortening.

A population of 920 healthy children was studied with the aim of assessing the incidence of hamstring muscle and plantar foot flexor tightness, and to correlate such symptoms with gait, posture, and low back discomfort or pain. Special attention was paid to the popliteal angle and dorsal foot flexion. The borderline values for the popliteal angle in the following age groups were, boys: 3 to 5 years, 40 degrees; 6 to 15 years, 50 degrees; and 16 to 19 years, 40 degrees; girls: 3 to 5 years, 30 degrees; 6 to 14 years, 45 degrees; 15 to 19 years, 30 degrees. The borderline values for dorsal foot flexion in the following age groups were 3 to 4 years, 7 degrees; 5 to 13 years, 10 degrees; and 14 to 19 years, 5 degrees. The results obtained indicate a natural increase in hamstring tightness, particularly shortly before the pubertal growth spurt. This seems to be linked with the natural evolution of lumbar lordosis and pelvic tilt. When hamstring tightness surpassed borderline values, dorsiflexion and lumbar lordosis decreased leading to postural deformities, bending-forward deficit, discomfort when sitting, and a shambling gait.

[Professor Franciszek Raszeja--a centenary of his birthday]. / Profesor Franciszek Raszeja--w stulecie urodzin.

The authors present a concise biography of professor Franciszek Raszeja on the centenary of his birthday. Special attention is given to his scientific and organizational achievements, particularly in regard to the formation of the Orthopaedic Department at the University of Poznan.