Introduction

Postural and motor activities are the results of interactions of smaller inhibitory and larger facilitating structures of the central nervous system (CNS). In the case of dysbalance of inhibitory and facilitating structures during CNS evolution, the asymmetry of postural activities can appear. This asymmetry remains hidden in the early periods of evolution and becomes apparent in the periods of quick growth and increased hormonal and metabolic activities. Genetic and neural factors have proven to be significant in the cause of idiopathic scoliosis (IS), so we propose a neural developmental hypothesis of this disease.

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.

Background: Abnormal sagittal plane configuration should be considered as one of the risk factors contributing to development of ASD.

Study design: Retrospective comparative randomised radiologic and clinical study.

Purpose: To analyse the relationship between sagittal plane configuration of the lumbosacral spine in comparison with rigid versus dynamic instrumentation and TDR and ASD.

Material: Study compared 4 groups of patients, who underwent primary monosegmental surgery for spondy-lolisthesis (Group A and B) or DDD (Group C and B) in lumbar spine between 1990–2005. Group A included 35 patients with ASD after 360° fusion, Group B 69 patients with 360° fusion without ASD, Group C 30 patients with dynamic instrumentation and Group D 35 patients with TDR both without ASD. The mean ages of the patients of the groups were 46.5/43.6/47.4/42.3 years respectively, the mean follow-up were 8.3/6.4/3.8/4.2 years respectively. The mean follow-up period between original surgery and ASD in Group A was 3.6 years.

Radiographic evaluation parameters: lumbar lordosis (L1-S1), distal lordosis (L4-S1), sacral slope (SS), segmental lordosis resp. lumbosacral angle (SA) and slippage (S).

Cinical evaluation criteria: VAS and Oswestry disability index questionnaires.

Methods: All parameters were measured and compared in all spines pre- and post-operatively and at the last follow-up observation. The correlation and regresion analysis were used for statistical evaluation of angular characteristics.

Results: Statistically significant correlations at the level of significance of α = 0.05 were found out between parameters: distal lordosis L4-S1 in Group A was smaller after surgery (−39.53°) than in Group C (−44.17°) and D (−52.21°) respectively, but not in Group B (−40.98°). Slippage S and segmental lordosis SA were decreased after surgery in Group A and B from 23.69% /26.11% and −14.21°/−15.26° to 9.77% /7.89% and −15.71°/−18.91° respectively, and thereafter they were increased at the last follow-up/ASD to 12.73%/11.67% and −12.18°/−15.21° respectively. VAS -reported pain and Oswestry decreased in all groups post-operatively and increased in Group A with the ASD. No correlation was found between parameters L1-S1 and SS in any group.

Discussion and Conclusion: All three instrumentation almost equally after surgery maintained the global profile of the lumbosacral spine with significant clinical improvement. No difference was found out between segmental and global sagittal profile by 360° fusion with/without ASD. Further follow-up at long term is necessary in order to confirm the influence of decreased distal lordosis L4-S1 after 360° fusion to development of ASD in comparison with non-fusion methods.

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.

Introduction. The influence of lumbar and lumbosacral fusion on adjacent moving segments has been the subject of a number of studies, which have shown the origin and progress of degenerative changes and instability brought about by alterations of kinematics and elasticity of the fused segment. Back pains which emerge later in the postoperative period may be the consequence of degeneration and instability in the adjacent segment to the said fusion. The fusion shifts the centre of rotation to the level adjacent to the fusion, which increases the pressure and pull on both the disk and joints. It can be supposed that the pull and attendant pains are in direct proportion to the rigidity of the spondylodesis that is more pronounced after anterior intersomatic fusion and less so after posterior. The development of hyperlordosis or kyphosis in the lumbar region is also a risk factor for adjacent segment failure.

Material and methods. The authors performed a retrospective analysis on a group of 91 patients with spondylolisthesis who had undergone PLIF technique with transpedicular fixation surgery and PLF.

A total of 10 (11%) of 91 patients developed symptomatic next segment desease at a previously asymptomatic level. Date were obtained in patients with next – segment failure based on X-rays studies, neurological assessment and sequential follow-up examinations. The aforementioned patients had a mean age of 42.8 years and the mean follow up period was 8.7 years after surgery. 7 cases were isthmic, 2 degenerative and 1 dysplastic spondylolisthesis.

Fusion in every case entailed the use of autologinous bone grafts, and with the PLIF technique cages, in 3 cases, dowels, in 6 cases, and autofibula in 1 case were used. The mean follow-up period between original surgery and next-segment failure was 3.8 years.

Results. In ten cases from the group there was evidence of instability or degeneration, instability in 3 cases (all above fusion) and degeneration in 7 cases (4 above and 3 below fusion) respectively.

All patients with instability in cranial adjacent segment underwent successfully additional surgery by using 360° fusion with instrumentation (ALIF).

Discussion. In X-rays conducted prior to surgery, signs of hypermobility were present in the cranial adjacent segment in one case. This hypermobility affected the rigidity of the fusion in the caudal segment, which accelerated the progress of instability and caused further surgery to be necessary.

The cause of instability could also be overloading of the spine, damage to the stability of ligament and bone structures sustained during the operation, or a combination of the above.

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.