Diverse approaches to scoliosis in young children

Management of scoliosis in young children needs a comprehensive approach because of its complexity. There are many debatable points; however, only serial casting, growing rods (including traditional and magnetically con trolled) and anterior vertebral body tethering will be discussed in this article. Serial casting is a time-gaining method for postponing surgical interventions in early onset scoliosis, despite the fact that it has some adverse effects which should be con sidered and discussed with the family beforehand. Use of growing rods is a growth-friendly surgical technique for the treatment of early onset spine deformity which allows chest growth and lung development. Magnetically controlled growing rods are effective in selected cases although they sometimes have a high number of unplanned revisions. Anterior vertebral body tethering seems to be a promising novel technique for the treatment of idiopathic scoliosis in immature cases. It provides substantial correction and continuous curve control while maintaining mobility between spinal segments. However, long-term results, adverse effects and their prevention should be clarified by future studies.Peer reviewe

Simultaneous forequarter amputation and radical mastectomy for metastatic breast carcinoma in a male patient: a case report

Although the majority of forequarter amputations are performed for high-grade bone and soft tissue sarcomas or extensive osteomyelitis of the upper extremity, this radical operation may also be indicated for the curative treatment of recurrent breast cancer and for the palliation of locally advanced breast cancer. We report a male patient with metastatic breast adenocarcinoma who underwent simultaneous mastectomy and forequarter amputation for the management of both his primary and metastatic disease

Long-Term Results of Reconstruction with Pelvic Allografts after Wide Resection of Pelvic Sarcomas

Reconstruction after the resection of a pelvic tumor is a challenging procedure in orthopedic oncology. The main advantage of allograft reconstruction is restoration of the bony architecture of the complex pelvic region. However, high complication rates such as infection and allograft resorption had been reported in the literature. In this study, we aimed to retrospectively review nine patients treated with pelvic resection and structural pelvic allograft reconstruction. Functional results, complications, and survival of the patients and the allografts were evaluated. At a mean follow-up of 79 months, three patients were dead. Major complications were detected in eight of the nine patients. Infection (four of the nine patients) and allograft resorption (three of the nine patients) were the most common causes of failure. The cumulative survival of the patients was 66.7 percent at 70 months. However, allograft survival was only 26.7 percent at 60 months. Mean MSTS score was 69. In conclusion, we suggest that other reconstruction options should be preferred after pelvic resections because of the high complication rates associated with massive allograft reconstruction

Is decreased bone mineral density associated with development of scoliosis? A bipedal osteopenic rat model

<p>Abstract</p> <p>Background</p> <p>An association between adolescent idiopathic scoliosis and osteopenia has been proposed to exist. It is still not clear whether there is such an association and if so, whether osteopenia is a causative factor or a consequence. Our previous pilot studies have suggested the presence of osteopenia in scoliotic animals. The aim of this study was to investigate the development of scoliosis in an unpinealectomized bipedal osteopenic rat model, implementing osteoporosis as a causative factor.</p> <p>Methods</p> <p>Fifty Sprague-Dawley rats were rendered bipedal at the 3^rdpostnatal week and separated into control (25 rats) and heparin (25 rats receiving 1 IU/gr body weight/day) groups. DEXA scans after 4 weeks of heparin administration showed low bone mass in the heparin group. Anteroposterior and lateral x-rays of the surviving 42 animals (19 in heparin and 23 in control groups) were taken under anesthesia at the 40^thweek to evaluate for spinal deformity. Additional histomorphometric analysis was done on spine specimens to confirm the low bone mass in heparin receiving animals. Results of the DEXA scans, histomorphometric analysis and radiological data were compared between the groups.</p> <p>Results</p> <p>Bone mineral densities of rats in the heparin group were significantly lower than the control group as evidenced by both the DEXA scans and histomorphometric analyses. However, the incidence of scoliosis (82% in heparin and 65% in control; p > 0.05) as well as the curve magnitudes (12.1 ± 3.8 in heparin versus 10.1 ± 4.3 degrees in control; p > 0.05) were not significantly different. Osteopenic rats were significantly less kyphotic compared to control specimens (p = 0.001).</p> <p>Conclusions</p> <p>This study has revealed two important findings. One is that bipedality (in the absence of pinealectomy) by itself may be a cause of scoliosis in this animal model. Further studies on animal models need to consider bipedality as an independent factor. Secondly, relative hypokyphosis in osteopenic animals may have important implications. The absence of sagittal plane analyses in previous studies makes comparison impossible, but nonetheless these findings suggest that osteopenia may be important in the development of 3D deformity in adolescent idiopathic scoliosis.</p

The metabolic basis of adolescent idiopathic scoliosis: 2011 report of the “metabolic” workgroup of the Fondation Yves Cotrel

OBJECTIVE: The purpose of this review is to elucidate the metabolic processes involved in the pathogenesis of adolescent idiopathic scoliosis (AIS) in light of research by the present authors as well as current literature. METHODS: Pathogenetic mechanism

Assessment of variability in Turkish spine surgeons' trauma practices

Objectives: The aim of this study was to analyse the variability among Turkish spinal surgeons in the management of thoracolumbar fractures by carrying out a web survey. Methods: An invitation text and web-link of the survey were sent to the members of the Turkish Spine Society mail group. A fictitious spine trauma vignette, a 23 year-old male with a L1 burst fracture, was presented and 25 questions were asked to participants. Variability of answers in a given question was assessed with the Index of Qualitative Variation (IQV). Questions with high IQV values (>\%80) were selected to evaluate the relation between participant factors (speciality, age, degree and experience level of the surgeon, type of the work centre and volume of the trauma patients). Results: Sixty-four (88\%) among the 73 participating surgeons completed the survey. 45 (70\%) of them were orthopaedic surgeons and 19 (30\%) were neurosurgeons. 11 questions had very high variability (IQV >= 0.80), 5 had high variability (0.58-0.75) and 2 had low variability (IQV <= 0.20). The question with the highest variability was related to the use of brace after surgery (IQV = 0.93). Following one was about the selection of fixation levels (IQV = 0.91). Neurosurgeons were more likely to use brace postoperatively and professors were less likely to perform decompression. Conclusion: This survey shows that thoracolumbar spine trauma practice significantly varies among Turkish spine surgeons. Surgeons' characteristics affected some specific answers. Lack of enough knowledge about spine trauma care, fracture classifications and surgical techniques and/or ethical factors may be other reasons for this variability. (c) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V

Percutaneous Iliolumbar Screw Fixation in a Patient with Unstable Pelvic Fracture and Transitional Lumbar Vertebrae and Cadaveric Illustration of the Fixation

Unstable pelvic ring fractures cause high rates of morbidity and mortality. Percutaneous iliosacral screws provide a safe pelvic fixation obviating large surgical exposures. The presence of transitional vertebrae may present difficulties in numbering and fluoroscopic identification of lumbar discs and vertebrae. We performed percutaneous iliolumbar screw fixation for an unstable pelvic fracture due to a traffic accident in a 20-year-old male patient with transitional lumbar vertebrae. No neurologic or vascular complications were seen and the patient returned to his preinjury work and was pain-free in the second postoperative year. In order to determine the anatomic relationship of the iliolumbar screw with the major neurovascular structures, a cadaveric study was performed on the corpse of an adult man. Following dissection, it was observed that the iliolumbar screw inserted from the lateral wall of the iliac wing passed through the iliopsoas muscle and advanced to the L, vertebral corpus posterior to the fourth and fifth lumbar roots and with a reasonably distant course from the common iliac veins and arteries

Reliability and validity of the cross-culturally adapted Turkish version of the Core Outcome Measures Index for low back pain

To produce a cross-culturally adapted and validated Turkish version of The Core Outcome Measure Index (COMI) Back questionnaire

Transverse Sacral Fractures And Concomitant Late-Diagnosed Cauda Equina Syndrome

Transverse sacral fractures in young patients occur with high-energy mechanisms. Because of the drawbacks in radiographic and neurologic evaluations of the sacral area in polytrauma patients, misdiagnosis is quite common. In this study, we aimed to report our clinical results in three patients with displaced transverse sacral fractures compromising the sacral canal and concomitant late-diagnosed (at least 48 hours) cauda equina syndrome. Bilateral lumbopelvic fixation, followed by sacral laminectomy and decompression, was performed in all patients. Despite the late-diagnosed cauda equina syndrome, we observed that surgical decompression and lumbopelvic fixation had positive effects on neurologic recovery, pain relief and early unsupported mobilization.WoSScopu