Introduction

Autonomic nerve system (ANS) regulates intercostal vascular nutrition (internal mammary artery), and its pathological status leads to developmental asymmetry of the trunk and rib cage, and consequently producing scoliotic deformity of the spine. The aim of this study is to investigate the possible causation of idiopathic scoliosis in development abnormalities of ANS.

There are many various possibilities of treatment from observation and conservative treatment, over simple bony fusion to exacting hemivertebrectomies and deformity correction.

Retrospective analysis of various conservative and surgical techniques.

Subjects. The total number of 702 patients treated in our department since 1976 had been evaluated. An average follow up is 17 years.

Correction grade, security and efficiency of treatment methods, clinical results and complication rate were the main observed outcome measures.

Group A (conservative treatment) - 356 pts.

Group B (hemiepiphyseodesis) – 112 pts. Final result of correction was 9,8 degrees (22%).

Group C (posterior instrumentated fusion) – 147 pts. Final result of correction was 25,6° (38%).

Group D1 (anterior strut graft with posterior instrumentated fusion) – 27 pts. Final result of correction was 26° (40%).

Group D2 (anterior osteotomy with posterior instrumentated fusion) – 33 pts. Final result of correction was 28° (43%).

Group D3 (combined hemivertebrectomy with posterior instrumentated fusion) – 22 pts. Final result of correction was 31,3° (61%).

Group D4 (posterior only hemivertebrectomy with instrumentated fusion) – 5 pts. Final result of correction was 30,7° (61%).

Early detection, good timing and choosing of adequate surgical type are the main factors of quality treatment results. The best surgical method for formation failure types seems combined or posterior only instrumentated hemivertebrectomy and early hemiepiphyseodesis for segmentation failure types.

Purpose of the study: The comparation of long-term clinical as well as radiological results is the main aim of our study.

Material and Methods: We evaluated security and efficiency of conservative as well various surgical treatment methods in our group of 650 patients treated in our department since 1976. An average follow up is16 years. An average age in time of detection was 6,5 y. in group of conservative treatment and 2,3 y. in group of surgically managed patients. An average age in time of surgery was 9,8 y.

Results:

group A: conservative treatment – 321 pts. (49%) – the magnitude of the curves was at time of detection on average 35,7 degrees according to Cobb angle and 39,8 at time of last control with FU 13,7 year.

Conclusions: Early detection, good timing and choosing of adequate surgical treatment type are the main factors of quality treatment results. All methods of surgical treatment led to the improvment in magnitude of the scoliotic curve. The best method seems combined combined hemivertebrectomy with posterior instrumentated fusion.

Purpose of the study: Solid chondrograft in the treatment of the osteochondral defects seems like rutine method in present time. In our prospective study we focused to the evaluation of the chondrograft quality and its incorporation to the implanting place.

Material and Methods. We have been using the technique of the solid autologous chondrograft implantation since 2000. We have been evaluating the patients regulary by magnetic resonance (3,12 and 24 month postoperatively), by second look arthroscopy and clinically with evaluation of the Lysholm and Weber scores. Also we are using the evaluation of the chondrograft quality by electronmicroscopy and by imunohistochemic methods on the samples taken by second look arthroscopy from the border of implanting places.

Our set contains of 51 patients (28 men and 23 women) with the chondrograft implantation (39 knees and 12 ankles). An average age of patients was 27 years and 3 month with average follow up 3 years and 7 month.

Results: The full incorporation of the chondrograft have been observing in 49 patients (94%) using the second look arthroscopy and magnetic resonance imaging. There were no marks of subchondral edema. We took the samples from implanting places in 11 patients. There were hyalin chondral tissue evaluated by electronmicroscopy imaging in 10 samples and mixed hyalin-fibrous tissue in one sample. There were colagen No.2 in all samples examined by imunohistochemy with coloring by hematoxilineosin.

Lysholm score in knee operations were before surgery 37,5, one year after the surgery 81,4 and after two years 83,1. Weber score in ankle operations were before surgery 17,3, one year postoperatively 4,6 and after two years 4,5.

Conclusion: The examination of our set of patients argumentative very good clinical, imaging, as well as histological results of implanted chondrografts incorporation.

Genetic factors and impairment of central nervous system (CNS) are known factors in aetiology of adolescent idiopathic scoliosis. MRI pathology of CNS (brain asymmetry, syringomyelia) was found. Perinatal pathology could cause damage of CNS.

Material and method: Perinatal risk factors are evaluated in adolescent idiopathic scoliosis – AIS group (39 patients) compared with normal individuals – N (28 persons).

In the AIS group, the mean onset of right thoracic curve was 12,2 years, apex vertebrae were T7 – T11 (T8 in 8 cases, T8–9 in 5, T9 in 12 cases), mean Cobb angle measured 49,0 degrees (SD 14,500), thoracic kyphosis T3-T12 19,9 (SD 12,167), lumbar lordosis T12-S1 –53,1 (SD 8,338).

A questionnaire was created to identify parental age, diseases, mother diseases and remedies during pregnancy, pregnancy duration, child resuscitation, childbirth pathology, incubator, jaundice duration, diseases during the first year of life, beginning of sitting and standing, right or left handing. Results have been processed by software Statistica 7.1. StatSoft, Inc. (2005). For evaluation of potential difference between AIS and N groups two-sample t-test for continuous parameters was used. Two-sample t-test and Fisher test were testing the hypothesis that the values of parameters make no difference between two groups (on the 0,05 significant level).

Results: More children who required an incubator were found in AIS group – 4, N group – 1 (statistically insignificant). We found these statistically significant differences:

- Occurrence of familiar scoliosis in AIS group – nine out of 39, 0 in N group.

Conclusion: These finding confirm the importance of genetic factors and support the influence of CNS dysbalance factors in early childhood. The earlier sitting (in AIS group) could start the dysbalance of postural motor system. Further studies are necessary.

The aetiology of idiopathic scoliosis, despite of long-lasting efforts to disclose it, remains unknown.

The purpose of the study was to evaluate the spine development after pinealectomy or cortical sensory motor area damage in the growing rats.

Method: The authors operated 69 Wistar albino rats (aged three to four weeks) in antraperitoneal anaesthesia. In the first group (22 rats) pinealectomy – PIN was performed, in the second one (25) the sensory motor cortical area 2x1x1 mm bellow the coronal suture was removed – SMCA. The sham operation consisted of craniotomy – CRA (11 rats) and craniotomy with durotomy – CRDU (11 rats). All surgeries were performed from the left side. Radiography was made three months after surgery. Scoliosis, C2-T7 lordosis, T7-S1 kyphosis were measured. Results have been processed by software Statistica 7.1. StatSoft, Inc. (2005). We used ANOVA test for evaluation of potential difference between groups, in the case of approving the difference between groups, we tested difference between each two groups by two-sample t-test. Those tests were realised on 0,05 significant level.

Results: In the PIN group scoliosis 9–14 degrees (mean value 10,8) developed in five animals, in SMCA group scoliosis 10 – 24 degrees (mean value 15,9) was observed in eight animals.

These statistically significant differences were found: higher surgery weight in PIN, longer surgery time in PIN and SMCA, lower lordosis in PIN and higher in CRDU, differences of all groups in kyphosis and in an end weight.

Conclusion: Our results indicate the importance of cortical area damage, together with craniotomy and durotomy in the development of growing rat spine. We cannot exclude the influence of peri-operative bleeding, brain hypoxia or metabolic effect of anaesthetics.

These damages could cause a disorder of balance between smaller inhibitory and greater facilitating area of CNS, controlling the muscular tone and resulting in the development of lordosis and scoliosis due to muscle imbalance.

This contribution presents the analysis of a group of 14 patients with a serious form of meningomyelocele associated with equinovarosity of the foot. The severity of the condition depends on the neurosegmental level of the lesion as well as the seriousness of the essential malady.

The primary treatment of these patients is aimed at early surgical management of meningomyelocele. It is fundamental that the patient should undergo a thorough neurological examination in which the prognosis of the illness and the expected degree of immobility of the patient should be determined. If full immobility is expected, radical correction of the foot deformity should be deferred. If, at any age, a tendency to verticalise occurs, immediate correction of the foot deformity is required in order to prevent decubitus and provide for posture stability.

The treatment of paralytic clubfoot is above all adversely affected by skin hypaesthesia which tends to cause decubitus and aggravate healing of the wound after the surgery.

Our group consists of 14 patients who were operated for a serious form of lumbar meningomyelocele associated with L2-S2 areflexia soon after birth. The current mean age of the group is 14 years (range 6 to 20). Four patients aged from two to six years were operated. Serious complications of wound healing after surgery occurred in one patient. All four patients are able to walk with a stagger and clumsily with the help of crutches. The remaining ten patients have been left immobile without hope of stable standing.

The treatment of paralytic clubfoot demands intensive cooperation of neurologists and neurosurgeons. It is necessary to carefully think about all aspects of a patient’s prognosis before radical surgical treatment of the foot is considered.