Introduction and purpose: Neuropathy associated with syringomyelia is a relatively rare entity that predominantly affects the glenohumeral joint. It is characterized by joint destruction, which is in many cases severe and which requires a differential diagnosis from other severe conditions. The therapeutic options are based on maintaining function rather than on immobilization. We present our experience of treating this condition in 4 cases.

Materials and methods: The cases were 4 females with a mean age of 53.25 years. One of the cases had both the glenohumeral and carpal joints affected. Only in one case was there a known history of syrinogomyelia associated with Arnold Chari disease, whereas in the other 3 the diagnosis of syringomyelia was established by studying the neuroarthropathy.

Results: Two of the patients were treated by means of joint replacement (one total and the other partial) with a favorable postoperative evolution in the medium term. Acceptable pain control and joint balance were achieved. At the end of 5 and 2 years respectively, the total and partial prosthesis had to be revised due to aseptic loosening of the components and joint instability, respectively. The conservative treatment applied to the two remaining cases achieved a functional range of movement for activities of daily living and one of the cases was able to continue with their usual work activities.

Conclusions: In spite of numerous sources in the literature that advise against joint replacement, there are very few documented cases and series that substantiate that recommendation. In the long run, in our experience joint replacement is not a satisfactory treatment for glenohumeral neuroarthropathy.

Purpose: To study the development of the hip and the relationship of radiological angles between acetabulum and proximal femur in children 0–3 years and thus the influence of walking and weight bearing on hip development.

Material and Methods: A study mesuring radiological angles in antero-posterior X-rays of pelvis in 334 children between 0 a 3 years of age (1997–2005), including acetabular index (AI) and physeal proximal angle (PPA (Alsberg’ angle) with goniometer (error ± 1°). Patients with pelvis or femur fractures or inflammatory diseases were excluded. Age distribution was of 1 (69.2%), 2 (22.2%) and 3 years (8.7%). 36.8% were males and 63.2% females. Descriptive statistics, T- test, Spearman correlation and ANOVA were used. Level of significance p< 0.05.

Results: The mean AI was 20.2°, 19.9° and 17.3°, in 1, 2 and 3 years. The AI angle diminishes significatively in children older than 2 years of age (p = 0.002). The mean PPA was 79.5°, 74.9° and 74.2°, in 1,2 y 3 years respectively. The Alberg’s angle reduced significatively at 1 year of age (p = 0.0005). AI and PPA was higher in females after 1 year of age (p = 0.02 and p = 0.04). There are not significative correlation between AI and Alsberg’ angle in different groups of children (r = 0.03). The age was important factor in both angles changes (p = 0.0005), but female patients (p = 0.002) and left side (p = 0.02) influenced only in AI.

Conclusions: AI and PPA angles reduced with age specially in 2 and 1 year, respectively, suggesting the effect of weight bearing and walking on hip shape. There was not relation between both angles in different groups of age.

Purpose of the study: Fixing the pedicles can be difficult to achieve during surgical treatment of scoliosis involving the thoracic spine because of the vertebral rotation raising the risk of neurological and vascular disorders. Use of extrapedicular thoracic screws has been proposed for more adapted and safe fixation. No clinical data has been published concerning the safety of these screws.

Material and methods: This multicentric retrospective clinical and radiological study included 467 thoracic screws in 34 patients operated for scoliosis. Neurophysiological monitoring was used for all procedures. Screws were positioned free hand without radioscopic control. Pedicular screws were inserted in T10, T11, T12. Extra-pedicular screws were inserted for thoracic vertebrae above T10 to T4. Correction was achieved with rods bent in situ. The purpose of this study was to evaluate the position of the thoracic screws within the vertebral body and in relation to the great vessels and the cord. The position of the screws in the thoracic spine was studied by two independent observers reading multiple thin-slice CT images. The observers noted malposition as: 1) penetration into the canal more than 2 mm, 2) less than 1 cm hold in the vertebral body, 3) screw protrusion more than 2 mm beyond the vertebral cortical.

Results: Screw malposition was observed for 9 of 161 pedicular screws (5.4%) and for 21 of 306 (6.8%) thoracic screws. None of the screw malpositions had a clinical expression. There was one episode of thoracic effusion associated with thoracoplasty. Two patients required revision (one for poor indication and one for disincarceration). There were no postoperative deep infections. Three cases of intercostals neuralgia subsided within three months.

Conclusion: Insertion of thoracic screws for fixation and correction is a useful technique with few complications. It enables better 3D correction and better control of the deformation. Screw malposition in this series was similar to that observed with classical pedicular techniques. There was no major complication associated with thoracic screws.

Study design: retrospective clinical study .

Objective: To study radiological late results after posterior stabilization of thoracolumbar fractures with internal fixation. To know factors related with loss of correction and hardware failure.

Summary of background data: The posterior approach using an internal fixator is a standard procedure for stabilizing the injured thoracolumbar spine. None of the surgical techniques used was able to maintain the corrected the kyphosis angle.

Methods: Forty-five patients with thoracolumbar fractures were included in the study. The inclusion criterion was the presence of fracture through the T11-L3 vertebrae without neurologic compromise. The Load-sharing classification has been used for all patients to determine the fracture severity. Surgical techniques (short or long instrumentation) , preoperative and postoperative radiographs ( Cobb technique) and follow-up records of all patients were reviewed carefully from the time of surgery until final follow-up assessment.

Results: 13 patients were treated using short-segment instrumentation (two disc spaces) and 32 patients with long-segment instrumentation (more than two disc spaces). The mean follow-up was 3.4 years (range 1 to 11 years). The mean preoperative Cobb angle was 16.1 degrees and after surgery the mean angle was 6.8° representing an average correction of 9.2 ° . At follow-up assessments the mean Cobb angle was 13.2° representing a loss of correction of 6.4°. Implant failure ( 5 loosening and 8 breakage) was seen in 28.8% of patients: 6/14 (42%) of patients receiving short instrumentation and 7/31 (22%) of patients with long instrumentation. Hardware failure was seen in 53.3% of patients with Cobb angle preoperative more than 20° and in 16.6% of patients with Cobb angle less than 20°.

Conclusions: Radiological behaviour of thoracolumbar fractures treated with posterior instrumentation without anterior support was worse than expected. Hardware failure was related with Cobb angle fracture > 20°, postoperative correction superior than 10° and short pedicular instrumentation technique.