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

Correction manoeuvres in the surgical treatment of spinal deformities.

Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities.The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior.The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distraction-compression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever.Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170002. Originally published online at www.efortopenreviews.org

Correction manoeuvres in the surgical treatment of spinal deformities

Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities. The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior. The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distractioncompression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever. Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Postoperative surgical site problems (PSSPs) following spinal surgery may lead to patient mortality, increased treatment costs and possible recurrent medical interventions. Despite efforts to reduce spinal surgery-related infection rates, complications are common and significantly increased by patient comorbidities. Since PSSPs occur regardless of deterrent measures, it is essential to distinguish the related risk factors. Different treatment conventions for PSSPs, for example, antibiotic treatment, debridement, soft tissue care and removal of implants have been prescribed with blended outcomes. The utilization of the wound vacuum-assisted closure (VAC) system has gained increasing popularity in the management of deep wound infections after deformity surgery

3D printing and spine surgery

Rapid prototyping (RP), also known as three-dimensional printing (3DP), allows the rapid conversion of anatomical images into physical components by the use of special printers. This novel technology has also become a promising innovation for spine surgery. As a result of the developments in 3DP technology, production speeds have increased, and costs have decreased. This technological development can be used extensively in different parts of spine surgery such as preoperative planning, surgical simulations, patient-clinician communication, education, intraoperative guidance, and even implantable devices. However, similar to other emerging technologies, the usage of RP in spine surgery has various drawbacks that are needed to be addressed through further studies

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

Blended Learning Is a Feasible and Effective Tool for Basic Pediatric Spinal Deformity Training

Study Design: Descriptive study. Objective: Assessing the applicability of blended learning to specific domains of spine surgery. Methods: After the needs assessment, a blended pediatric spine deformity course program was designed. A total of 33 participants, including orthopedic and neurosurgeons, registered for the course and all of them completed an online entrance quiz. Thus, they were eligible to have online part of course, which included the theoretical part of the course and also a discussion forum where the discussions about the topics facilitated by faculty. Thirteen of 33 subjects participated second part of the blended pediatric spine deformity course. This face-to-face (F2F) part consisted of case discussions for each topic and discussions facilitated by faculty members. The same quiz was also taken before and after the F2F part. All quiz results were compared statistically. Results: There were 11 lectures within the online part and 6 case discussions in the F2F part. The quiz scores were improved significantly by having a complete blended pediatric deformity course (P < .05). Conclusions: The current study has demonstrated that blended learning format, including online and F2F, is feasible and effective in training for a domain of spine surgery, pediatric deformity in this specific context