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. We evaluated samples taken from 12 patients with idiopathic scoliotic deformities and a control set of three patients without scoliotic deformity. We examined the samples of autonomic nerves taken from convexity and concavity of the scoliotic deformity during the patients' surgical correction by the transthoracic approach. We used the electronmicroscopic method to analyse samples, and the morphometric method for statistical evaluation.Introduction
Methods
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.
