Successful treatment of strabismus in a child with Moebius syndrome

Moebiusov sindrom (MBS) je rijetka kongenitalna bolest karakterizirana neprogresivnom unilateralnom ili bilateralnom parezom moždanih živaca, primarno facijalisa (VII.) i abducensa (VI.). Pareza facijalisa dovodi do gubitka mimike lica, smanjenog lučenja suza i sline te poremećaja okusa, a oštećenje abducensa rezultira konvergentnim strabizmom uz nemogućnost lateralnih pokreta oka. Osim navedenih, mogu biti zahvaćeni i drugi kranijalni živci (III. –XII.). Klinička slika varira ovisno o zahvaćenosti ostalih kranijalnih živaca, pa se uz simptome pareze facijalisa i abducensa pojavljuju problemi gutanja i artikulacije govora, promuklost i oštećenje sluha. Mogu biti prisutne i malformacije udova (sindaktilija, brahidaktilija, nepostojanje prstiju ruke i stopala), mikrognatija i mikrostomija. Do sad je u literaturi prikazano tristotinjak bolesnika s MBS-om, a tek nekoliko članaka opisuje operacije strabizma u sklopu njihovog liječenja. Prevalencija sindroma je od 1 - 20 slučaja na milijun porođaja (0,001 – 0,02‰). Opisujemo kombinirano liječenje konvergentnog i vertikalnog strabizma u trogodišnjeg dječaka s MBS-om. Konvergentni strabizam ispravljen je konzervativnim putem, nošenjem naočala, a vertikalni operativnim zahvatom, retropozicijom gornjeg ravnog mišića, radi postizanja paralelnih vidnih osovina koje su nužne za pravilan razvoj vidne oštrine.Moebius syndrome is a rare disease characterized by unilateral or bilateral congenital nonprogressive facial nerve palsy and abducens nerve palsy. It is associated with a wide spectrum of systemic and ocular manifestations; congenital esotropia (convergent strabismus) is common in these patients but vertical strabismus is rare. Only few articles have described results of strabismus surgery for esotropia in children, but only one reports strabismus surgery for vertical and horizontal deviation. We report a rare case of a three-year-old male child with large esotropia and limited ocular abductions along with a signifi cant vertical deviation, which is not common in classic Moebius syndrome. We used conservative approach prescribing glasses with full correction, which resolved convergent strabismus, and surgery for treating vertical strabismus by superior rectus retroposition

Causal Connection of Non-Specific Low Back Pain and Disc Degeneration in Children with Transitional Vertebra and/or Spina bifida occulta: Role of Magnetic Resonance – Prospective Study

The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, »Sestre milosrdnice« University Hospital Center, Zagreb Children’s Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56 patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP

Analiza degeneracije diska magnetskom rezonancijom u adolescenata s idiopatskom skoliozom : moguća povezanost s bolnom kralješnicom

Scoliosis is the most common deformity of the spine, and the incidence of back pain in AIS ranges from 32% - 85%. Although it is considered that AIS can cause pain in the spine, this connection with regard to the scientific evidence is not entirely clear. Aim: The aim of this study was to determine the relationship of morphological changes of intervertebral segments analyzed by MRI in patients with AIS and pain, and also its impact on patients functional status and quality of life. Method: The study included 120 patients diagnosed with AIS based on radiographic examination. Patients underwent MRI (1.5-T) of the thoracic and lumbar spine. SN were detected, and the degree of disc degeneration was classified using the Pfirrmann grading system. Patients filled out VAS, the ODI for back pain and questionnaire SRS-22r. Results: The incidence of pain in AIS is 68.3%, and the largest number of participants experienced mild pain. Statistically significant association of DD in lumbar spine with the occurrence of pain was shown, but only at the fourth degree of DD according to Pfirrmann classification. The incidence of SN were 35%. Patients with SN were 4 times more likely to have pain, and 3,5 times higher intensity of pain scaled according to VAS. In addition, a distinct correlation with DD classified according to Pfirrmann that is more pronounced at high-grade DD was found. There is an independent connection of the female sex with poorer functional status, measured by the ODI, and quality of life, measured by the questionnaire SRS-22r. Conclusion: Morphological changes of the intervertebral disc like SN and DD can be one of the factors that cause back pain in AIS. It should be remembered that the presence of DD, especially if it is low-grade, is not enough to confirm the etiology of pain. We also found a distinct correlation of SN and high-grade DD, and a significantly higher intensity of pain in patients with SN. The association between SN and DD may stress the importance of the endplate on the pathogenesis of the degenerative changes in the intervertebral disc

Causal connection of non-specific low back pain and disc degeneration in children with transitional vertebra and/or Spina bifida occulta: role of magnetic resonance--prospective study [Uzročna povezanost nespecifične niske križobolje i digeneracije diska kod djece s prijelaznim kralješkom i/ili spinom bifidom occultom - uloga magnetske rezonancije - prospektivna studija]

The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP