Neurological scoliosis differs from idiopathic type for some peculiar features that negatively affect operative time and blood loss during surgical treatment. To reduce the rate of complications in neurological scoliosis, an hybrid construct based on combined lumbar pedicle screws and Universal Clamps (UC) at thoracic levels can be used. The aim of our study was to assess the validity of the hybrid construct in neurological scoliosis treatment respect to technical success (deformity correction), operative time and blood loss, in a prospective series of patients with preoperative Cobb angle > 100°. Between 2002 and 2008 we treated 15 patients (3 M, 12 F) affected by neurological scoliosis with preoperative Cobb angle > 100° (107±4°) by hybrid construct. The mean age was 14 years (range 10–17). The etiology was cerebral palsy in 12 cases, Friedreich’s ataxia in 2 cases and Aicardi Syndrome in one case. All patients were treated by posterior access to stabilize each affected level, combining screws (Socore TM), UC and hooks in an hybrid construct. In 3 patients a secondary posterior access was achieved in order to strengthen the UC effect, adding a concave costotomy. Skull traction by sling and pelvic countertraction to control obliquity were used in all cases. Pelvic instrumentation provided iliosacral screw fixation according to Dubousset or iliac fixation in accordance with Sponseller. Two concave rods and one convex were used in all assembly. The average percentage of correction was 70% (32±7°). Mean operative time was 4 hours with mean blood loss of 1800 ml. We used a mean of 6 transpedicular screws (range 4–11), 7 UC (5–9) and 5 hooks (4–6) in our assembly. Mean follow-up time was 36 months (range 12–84), with an average loss of correction of 7°. The hybrid construct (lumbar transpedicular screws, thoracic Universal Clamps, pedicle-transverse hooks at the upper end of the curve) appears safe and effective in treatment of neurological scoliosis > 100°. This assembly provides a good correction of the deformity and reduces operative time, radiation exposure and blood loss respect to all-screws constructs. Sublaminar acrylic loops (Universal Clamp) have the same stress resistance in comparison with steel or titanium alloy sublaminar wires. Moreover, the simplicity of implant and tensioning of the strips is associated with the possibility of re-tensioning and progressive correction, providing a better capacity of managing the kyphotic component in case of thoracic lordosis. Among neurological scoliosis treatments, the hybrid construct can be considered a valid option due to the advantages of shortening the operative time and diminishing the risks of vascular and neurological complications.

Objective: Long term efficacy of Aneurismal Bone Cysts (ABC ) treatment with Ethibloc.

Materials and Methods: Eighteen patients with ABC were treated with direct percutaneous Ethibloc injection. No severe complications were observed; three patients had a local leakage of Ethibloc through the injection site, self-resolving without complications. Follow-up lasted from 2 to 98 months.

Results: Seventeen patients showed a remarkable shrinkage of the cystic lesion with cortex thickening. The reduction of the lesion was not satisfactory for only one patient who has been successively operated on. Pain disappeared in 12 patients; it persisted in two and occurred occasionally in four, during follow-up.

Conclusions: In our experience the direct percutaneous Ethibloc injection is effective in the treatment of ABC and can be recommended as the first-choice treatment after a mandatory histological diagnosis; furthermore scleroembolization does not precludes any subsequent surgical approach. MRI must be considered in all the phases, including follow-up.

There can be no doubt that bone morphogenetic proteins play a hierarchic role in the osteogenetic cascade. Pre-clinical and clinical trials have confirmed their decisive role in achieving anterior lumbar fusion, as they direct mesenchymal stem cells toward osteoblastic lineages.The present study is concerned with initial experience in the application of autologous mesen-chymal stem cells and various growth factors (BMP-7,VEGF,TGFbeta) in the treatment of paediatric spinal pathologies.

Eleven patients affected by serious forms of congenital infantile scoliosis, idiopathic scoliosis and grade I spondylolisthesis received surgical treatment. In three patients with congenital infantile scoliosis, ages ranging from 3 to 12 years, the surgical procedure was an anterior and posterior fusion at the level of the hemiver-tebra, extending it to a level above and below it by means of in situ decortication of the vertebral plates and laminae on the convex side and delivery of stem cells taken from the iliac bone and applied in situ by means of bovine collagen sponge (Healos system). No fixation device was added. Plaster and brace were used during the postoperative course for 9 months. In two cases of intertransverse in situ fusion for grade I spondylolisthesis the age of the patients was 13 and 16 years, respectively, and the surgical procedure consisted in the standard technique to which was added delivery of a mixture composed of small bone chips obtained from decortication, 3.5 mg of eptotermin alpha (Op-1, BMP7), and autologous stem cells taken from iliac bone. A special form of informed consent was obtained for these two patients because of their incomplete bone maturity. TLSO was used in the postoperative course for 2 months. In the six patients with idiopathic scoliosis, ages ranged from 13 to 15 years and the treatment consisted in posterior instrumentation and fusion by means of rods, transpedicular screws and hooks; standard fusion techniques were supported by local bone chips obtained from decortication, placed on collagen sponges and combined with autologous stem cells taken from iliac bone with the addition of platelet gel derived from the autologous preoperative blood collection. No bone chips were taken from iliac wing. The results were evaluated by X-rays and CT at intervals of 1, 2, 4, 6 and 12 months.

In the cases of congenital scoliosis a solid fusion area was obtained only for posterior hemiephysiodesis, without a parallel bone signal of fusion at the anterior level. In the cases of intertransverse in situ fusions for spondy-lolisthesis there was a beginning fusion already visible on the first X-ray control 1 month postopoeratively, confirmed at successive check-ups and maintained in the follow-up. The cases of idiopathic scoliosis showed an initial ossification of the grafts and signals of fusion at the 6-month check-up.

The isolated use of stem cells, although promising from a theoretical point of view, did not prove encouraging in the cases of anterior fusion. It is most probable that the absence of instrumentation induced a defect in the stable fixation of the fused segments, the latter being a crucial factor.The cases of in situ fusion for spondylolisthesis confirm the hierarchic role of the bone morphogenetic protein 7 in inducing the mesenchymal stem cells, released in situ from decortication, toward osteoblastic lineage. To our knowledge these represent the first two cases of use of OP-1 in patients younger than 18 years. In the fusion areas which are more extensive in length (idiopathic scoliosis) the added use of autologous stem cells mixed with platelet gel seems to improve the physiological processes of fusion. It will be necessary to monitor the long-term results of these procedures with special regard to loss of correction and weakness of the fusion area causing torsional or flexion-extension stress. These possible costs have to be compared with the verified benefits of a better use of blood in its capacity to save on corresponding haemotransfusion, combined with the absence of comorbidity related to the donor site of iliac bone chips.