The aim of this study was to report the restauration of the normal vertebral morphology and the absence of curve progression after removal the instrumentation in AIS patients that underwent posterior correction of the deformity by common all screws construct whitout fusion. A series of 36 AIS immature patients (Risser 3 or less) were include in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). Curve correction was assessed at pre and postoperative, before instrumentation removal, just post removal, and more than two years after instrumentation removal. Epiphyseal vertebral growth modulation was assessed by a coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7°±7.5 to 5.5º±7.5º (89.7%) at the immediate postop. After implants removal (31.0±5.8 months) the MC was 13.1º. T5–T12 kyphosis showed a significant improvement from 19.0º before curve correction to 27.1º after implants removal (p<0.05). Before surgery, WR was 0.71±0.06, and after removal WR was 0.98±0.08 (p<0.001). At the end of follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2±21.0º. SRS-22 scores improved from 3.31±0.25 preoperatively to 3.68±0.25 at final assessment (p<0.001). In conclusion, fusionless posterior approach using a common all pedicle screws construct correct satisfactory scoliotic main curves and permits removal of the instrumentation once the bone maturity is reached. The final correction was highly satisfactory and an acceptable ROM of the previously lower instrumented segments was observed.

Background

The improvement of the rib cage deformity (RCD) after surgery correction has not been correlated in detail with the correction of vertebral axial rotation (AR). The loss of at the rib cage after correction has been never monitored. The hypothesis of this work was that the aesthetic improvement of RCD in adolescent idiopathic scoliosis (AIS) does not follow completely the reduction of thoracic AR after correction surgery. Moreover, lesser correction of thorax deformity could be expected in mature patients with more rigid curves.

Background

The overall incidence of neurological symptoms attributed to lumbar misplaced screws has been described to occur in 3.48% of patients undergoing surgery. These lumbar radicular neurological lesions are undetected with conventional intraoperative neurophysiological and radiological controls. The hypothesis of this study was that direct stimulation of the pedicle screw after placement in the lumbar spine may not work as well as for screws placed in the thoracic pedicles. A more suitable method for the lumbar spine could be the stimulation of the pedicle track with a ball-tipped probe.

Calcification and ossification have been described in artery wall in pathologic conditions and aging. We previously described the use of cryopreserved arterial allografts as membranes for guiding bone regeneration. We hypothesize that artery is as good as synthetic membranes (e-PTFE, gold-standard in guided bone regeneration) due to the osteogenic potential of cells from its medial layer.

A comparative study was made creating 10 mm mid-diaphyseal radial defects in 15 New Zeland rabbits (30 forearms): 10 defects were covered with an e-PTFE membrane and 10 defects with no membrane (control group). Studies: X-rays, CT, MR, morpho-densitometric analysis, electronic and optical microscopy.

To demonstrate the cellular arterial stock, cryopre-served and fresh rabbit thoracic aorta specimens were studied. Medial layer was isolated and cultured as explants in normal medium. Cells were harvested and added to a 3-D scaffold based on plasmatic albumin in osteogenic medium. Immunocitochemical study was made. Radial defects surrounded by cryopreserved arterial membranes showed total regeneration in nine of 10 defects versus seven of 10 defects in e-PTFE group (no statistically significant differences were detected between them). No tissue layer was found between bone and artery while a connective tissue layer was observed between e-PTFE and bone. Neither radiological nor histological healing were detected in the control group.

Cells cultured had smooth muscle features as they showed immunofluorescence with anti-smooth muscle alpha-actin, anti-calponin and anti-vimentin antibodies. When cells were added to a 3-D matrix, they showed chondro and osteogenic differentiation, as they stained positive for types II and X collagen, alkaline phosphatase and von Kossa.

Although no statistically significant differences between artery and e-PTFE groups were detected, histological and cellular findings suggest a superiority of cryopreserved arterial allografts when compared with synthetic membranes of e-PTFE, with a contribution of the cellular stock of the medial layer in the healing process.

Introduction and Objectives: The goal of this study is to present results from a series of arthroplasties performed in our hospital in the past 3 years in terms of pain and mobility.

Materials and Methods: In this study, a total of 14 arthroplasties were performed on 12 patients (including 2 revisions). Follow-up was lost on 3 patients. Of the 9 remaining patients, 5 were females and 4 were male. Average age was 59 years (42–75) at time of surgery. Two prosthetic models were used: Coonrad-Morrey in 5 cases (including one revision) and GSB-III in 6 cases (including one revision). The following conditions were treated: 5 cases of post-traumatic arthrosis of the elbow, one haemophilic arthropathy of the elbow with the elbow as the target joint, one case of rheumatoid arthritis, one supracondylar fracture with nonunion in an elderly patient, and one humeral fracture with post-traumatic arthrosis of the elbow.

Results: At the functional level, a postoperative articular balance of 118° flexion and −20° extension and free pronosupination was obtained, with the exception of 2 cases. There was complete elimination or a significant decrease in pain except in 2 cases where a certain level of pain persisted. Radiographically, poor positioning was not seen, but there was one case of septic loosening (resulting in resective arthroplasty) and one peri-prosthetic fracture requiring revision, since it led to instability and repeated dislocation. Other complications included neurologic problems (2), extension deficit > 30° (2), and residual pain (2).

Discussion and Conclusions: Although this study is still in the early stages and follow-up time is short (the study was initiated in 2000), we are seeing promising results in terms of mobility and cessation of pain, similar to various other studies. In terms of the percentage of revisions, complications, and patient satisfaction, results are also comparable to other studies, even though our study thus far has the disadvantage of being shorter. Nonetheless, we wish to present this study to demonstrate that even though elbow arthroplasties are in their infancy, results are promising, and there is hope that they will improve further in future with improved selection criteria, as happened in the past with knee and hip arthroplasties.