Introduction: With the advent of thoracoscopy, anterior release procedures in adolescent idiopathic scoliosis (AIS) have come into more frequent use, however, the indication criteria for an anterior release in thoracic AIS are still controversial in the literature. The aim is to achieve a better coronal correction but the benefit as compared to a single posterior approach is not yet clarified.

Material and Methods: Two groups of 15 patients each were matched for sex, age and cobb angle. Patients of group 1 were operated with a staged procedure of an anterior release followed by posterior instrumentation (anterior-posterior spinal fusion, APSF) and patients of group 2 were operated by a single posterior spinal fusion (PSF) with performance of concave sided rib osteotomies (concave thoracoplasty, CTP).

Results: Mean age: 16.2 y (APSF), 17.6 y (PSF). Mean preop curve: 81.7° ± 10.1° (APSF), 84.2° ± 14.1° (PSF). Mean postop curve: 34.9° ± 15.5° (APSF), 34.3° ± 12.2° (PSF) (p=0,49).

Conclusion: The single posterior approach gave the same coronal correction rate as compared to patients operated with a two stage procedure with preceding anterior release. A posterior release with CTP is more effective in increasing spinal flexibility than disc excision. According to our clinical experience, an anterior release prior to posterior instrumentation in AIS should only be considered in hyperkyphosis, coronal imbalance or massive curves.

Introduction: There are few long-term studies after Zielke ventral derotation spondylodesis (VDS). We present a minimum 17 year follow-up study to assess factors predicting distal adjacent disc degeneration.

Material/Methods: Twenty-eight patients with thora-columbar AIS operated in 1982 have been retrospectively evaluated. Mean age 16,3 years, minimum follow-up 15 years. Anterior fusion was performed with rib graft.

Results: Mean pre-op Cobb angle was 65 ± 23°, post-op correction rate was 61,2 ± 12,4%. Mean angulation of end vertebra was 32 ± 10°, post-op corrected to a mean of 8° (correction rate 79%). Mean post-op Th10/L2 kyphosis was 10°. Rod breakage was seen in 17 patients.

Conclusion: Thoracolumbar kyphosis was associated both with proximal implant breakage and with segmental lordosis and degeneration of the distal adjacent segment. Disc angulation in the AP plane seems to be good tolerated. Anterior support with iliac bone graft or cages is expected to overcome these complications.

Introduction: In rigid AIS, the main resistance for thoracic derotation are the anteriorly rotated ribs on the concavity. This study presents clinical and radiographic long term results of the CTP, which is a routine surgical procedure at the authors’ institution.

Material and Methods: Between 1996 and 1997 we have operated on 466 cases of scoliosis. 36 patients with thoracic AIS were evaluated. Technique: The ribs on the concave side are osteotomised close to the costo-transverse joint and elevated over the bended rod.

Results: Mean follow up was 6.4 y. Mean preoperative side bending flexibility was 21%. Mean correction rate was 68%, mean rib hump correction was 3cm. Mean loss of correction 4°. There was no neurological complication, and pulmonary morbidity was not increased.

Conclusion: In rigid thoracic scoliosis, a release of the concave ribs by means of the CTP can both significantly increase the extent of correction and contributes to an excellent cosmetic result.

We present three children with primary subacute epiphyseal and metaepiphyseal osteomyelitis. The diagnosis was delayed because of subtle radiological findings and mild general symptoms. Primary epiphyseal osteomyelitis is extremely rare. We believe that this is the first time that the MRI findings have been presented. In the first case they revealed a perforation into the knee and therefore an intra-articular epiphyseal approach was used for debridement. In the second and third cases the metaepiphyseal lesions showed considerable physical involvement and a metaphyseal approach was chosen. We believe that in this condition MRI is essential both for diagnosis and in the planning of surgical treatment.

We used laser Doppler flowmetry (LDF) with a high energy (20 mW) laser to measure perfusion of the femoral head intraoperatively in 32 hips. The surgical procedure was joint debridement requiring dislocation or subluxation of the hip. The laser probe was placed within the anterosuperior quadrant of the femoral head. Blood flow was monitored in specific positions of the hip before and after dislocation or subluxation.

With the femoral head reduced, external rotation, both in extension and flexion, caused a reduction of blood flow. During subluxation or dislocation, it was impaired when the posterosuperior femoral neck was allowed to rest on the posterior acetabular rim. A pulsatile signal returned when the hip was reduced, or was taken out of extreme positions when dislocated. After the final reduction, the signal amplitudes were first slightly lower (12%) compared with the initial value but tended to be restored to the initial levels within 30 minutes.

Most of the changes in the signal can be explained by compromise of the extraosseous branches of the medial femoral circumflex artery and are reversible. Our study shows that LDF provides proof for the clinical observation that perfusion of the femoral head is maintained after dislocation if specific surgical precautions are followed.