Investigation of Impact of Walking Speed on Forces Acting on a Foot-Ground Unit.

Static and dynamic methods can be used to assess the way a foot is loaded. The research question is how the pressure on the feet would vary depending on walking/running speed. This study involved 20 healthy volunteers. Dynamic measurement of foot pressure was performed using the Ortopiezometr at normal, slow, and fast paces of walking. Obtained data underwent analysis in a "Steps" program. Based on the median, the power generated by the sensors during the entire stride period is the highest during a fast walk, whereas based on the average; a walk or slow walk prevails. During a fast walk, the difference between the mean and the median of the stride period is the smallest. Regardless of the pace of gait, the energy released per unit time does not depend on the paces of the volunteers' gaits. Conclusions: Ortopiezometr is a feasible tool for the dynamic measurement of foot pressure. For investigations on walking motions, the plantar pressure analysis system, which uses the power generated on sensors installed in the insoles of shoes, is an alternative to force or energy measurements. Regardless of the pace of the walk, the amounts of pressure applied to the foot during step are similar among healthy volunteers.

Inter-observer and intra-observer reliability in the radiographic measurements of paediatric forefoot alignment.

BACKGROUND: Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric forefoot angle measurements. MATERIAL AND METHODS: Six forefoot angles in 34 AP standing paediatric foot radiographs were measured by 5 researchers. A classic statistical analysis with use of IBM SPSS Statistics 25 was performed and a new method with two-way analysis of variance was applied. RESULTS: Results of statistical analysis revealed the properties of a subjective assessment related to specific angles. Kilmartin's angle, calcaneus-fifth metatarsal angle and first ray angle are the most reliable; metatarsus adductus angle should be used with great caution in pediatric population. Engel's angle is the most difficult for measuring and measurement error is the highest. CONCLUSION: The power of paediatric forefoot measurements is various. Several angles are reliable, while Engle's angle is the most doubtful.

Quantitative Analysis of Foot Plantar Pressure During Walking.

BACKGROUND There are many methods of dynamic analysis of foot loading, however, we still need a simple, easily applicable system for foot plantar pressure analysis. In this study we asked the question: "Can a new system for foot evaluation, the ITE System, provide a good quantitative dynamic foot pressure analysis? Can it be used in clinical practice?". MATERIAL AND METHODS Twenty healthy volunteers, 8 females and 12 males, aged 20 to 25 years old took part in this study. Normal static foot loading was tested using a typical pedobarographic platform, followed by a dynamic analysis using the foot-pressure ITE System. A new algorithm for data analysis (from 8 sensors) was proposed. RESULTS The sum of all maximal values from sensors was 11.71 N mean, with relatively low standard deviation (SD) of 1.81. Loading of sensor 1 (heel) was the highest - on average 29.84%. Sensor 2 (medial midfoot) received the lowest loading - normal range for this segment would be 0-4%. The manner of loading heel/toes, dynamics of changes in loading during gait was quite diverse; when analyzing courses of changes on sensors, 4 gait patterns were observed. CONCLUSIONS Use of the ITE System creates a new possibility for dynamic foot evaluation, drawing from pedobarography and methods of gait analysis. The proposed data analysis algorithm is simple and can be applied in all cases. Normally, 30% of the sum of all pressures during stance phase falls on the rearfoot; 39% falls on forefoot.

[Long-term consequences of resection of 1/3 proximal epiphysis of child's right tibia--a case study]. / Odlegle nastepstwa resekcji 1/3 nasady blizszej kosci piszczelowej prawej u dziecka--opis przypadku.

Authors report a case of a patient with varus deformity of right knee, caused by wide resection of proximal metaphysis and epiphysis of right tibia. Afore mentioned procedure led to loss of right knee joint integrity, with its lateral instability, shortening, and axis deviation of right tibia. Surgical treatment of this complications was performed in several stages and took about 5 years, starting from temporal, lateral hemiepiphysiodesis of proximal tibial epiphysis, subacute epiphysiolysis of proximal tibial epiphysis and high valgus tibia osteotomy, at the end finished with medial tibia condyle reconstruction with autogenic graft and osteoconductive substances. The proper mechanical and anatomical axis of the right limb, with full stability and movement of right knee was achieved after those surgeries. The process of treatment of lower extremity axis deviation takes long time, frequently involves several surgeries and needs firm cooperation between doctor and patient.

Cross-cultural adaptation and validation of the Polish version of the core outcome measures index for low back pain.

PURPOSE: The core outcome measures index (COMI) is a short, multidimensional outcome scale validated for the use by patients with spinal disorders. It is a recommended instrument in the Spine Society of Europe Spine Tango Registry. The purpose of this study was to produce a cross-culturally adapted and validated Polish COMI. METHODS: The cross-cultural adaptation was carried out using the established guidelines. One-hundred and sixty-nine patients with chronic low back pain were enrolled, 89 took part in the reproducibility part of the study. Data quality, construct validity and reproducibility were assessed. RESULTS: The quality of data was very good with very few missing answers and modest floor effect. Reliability expressed as intraclass correlation coefficient (ICC) was 0.90 (95 % CI 0.85-0.93) for the overall COMI score and for most of the individual core items. The minimum detectable change (MDC95%) was 1.79. CONCLUSIONS: The Polish version of COMI showed a favorable reproducibility similar to that of previously tested language versions. The COMI scores correlated sufficiently with existing measures. This version of the COMI is a valuable instrument for the use by Polish-speaking patients with spinal disorders.

[Methylprednisolone- acute spinal cord injury, benefits or risks?]. / Metyloprednizolon ­ ostre urazy rdzeniakregowego, korzysci czy zagrozenia ?

Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of methylprednisolone is the result of many cellular changes. Methylprednisolone is used in many diseases, such as rheumatic diseases, autoimmune diseases, allergic, anaphylactic shock, asthma. Methylprednisolone was also used in patients with spinal cord injury, in order to minimize neurological damage. While in the above mentioned fields of medicine is undeniable role of methylprednisolone, whereas its use in the treatment of traumatic spinal cord injury within the last few years raises a lot of controversy, and in most cases, the side effects of its use outweigh the potential benefits. 

How back pain influences daily activities and quality of life: Incidence of back pain related to age.

Low back pain is a prevalent global musculoskeletal issue, with a lifetime prevalence ranging from 49% to 70% in adults. Traditionally associated with adults, recent field surveys indicate comparable prevalence rates in children and adolescents, challenging earlier assumptions. Non-specific low back pain, where the source cannot be identified through diagnostic imaging, accounts for about 80%-90% of cases. Studies have shown that over 80% of adolescents with low back pain exhibit no underlying pathology. The prevalence of low back pain in younger populations varies widely, influenced by study methodology, age, and pain types. Research suggests that back pain prevalence in adolescents increases with age, with a shift in attitudes considering it is not necessarily indicative of specific issues. Level of evidence: level V.

Upper Limb after Forearm Lengthening in Patients' and Physicians' Perspective.

BACKGROUND: The goal of this study was to perform a functional (subjective) and radiological evaluation of patients who had undergone forearm lengthening by distraction osteogenesis years before. MATERIAL AND METHODS: Eleven patients with forearm shortening of various etiology were enrolled. They had undergone a total of 21 lengthening procedures. A retrospective analysis of radiological data was conducted and a subjective evaluation was accomplished by using a modified QuickDASH-9 questionnaire. RESULTS: Average bone lengthening was 3.54cm, and mean lengthening index was 40.53day/cm. Eight pa-tients answered the questionnaire at a mean of 7.8yrs after the treatment. The mean questionnaire score was 9.75pts (of 36). Four patients rated the overall function of the affected limb as improved following distraction, while 3 patients were not able to see any improvement. One patient reported that the lengthening had impaired limb function. With regard to cosmetic aspects, 4 patients reported a worsening after the lengthening procedure while 3 patients reported improvement and 1 patient did not note any changes. CONCLUSIONS: 1. Despite deformities and functional limitations, patients after forearm lengthening only occasionally suffered from moderate intensity pain. 2. The radiological outcomes were positive and the rate of complications was low. 3. The radiological outcomes did not match patient-declared functional and cosmetic results.

Clinical and Radiological Evaluation of Results of Surgical Correction of Forefoot Adduction by Cuneiform and Cuboid Osteotomy Using Radiological Forefoot Measurements.

BACKGROUND: Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge. MATERIAL AND METHODS: This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients'/care-givers' subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin's angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9). RESULTS: The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin's angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients. CONCLUSIONS: 1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first meta-tarsal, calcaneal-fifth metatarsal and Kilmartin's angles appear to be good radiologic indicators of correction.

Spine duplication or split notochord syndrome - case report and literature review.

Context: Spine duplication is a rare condition, with various extents and severe additional anomalies. The goal of this study was to describe a unique case of a boy with split notochord syndrome who was followed up from birth until maturity. Findings: Physical examination at birth showed defects of the abdominal wall and cloacal exstrophy with visible urether outlets. A transposed anus was present in the perineal region. Split bony elements of the spine with nonpalpable sacral bone were noted. A soft, skin-covered lump, with the consistency of a lipoma, was present in the sacral area. There was asymmetry of the lower limbs: the left was hypoplastic, with a deformed foot and hip. Computed tomography revealed a normal shape of the Th12 and L1 vertebrae, whereas the L2 was split. Downward from L3, there were two vertebrae at each level, with two spinal canals. The spinal cord divided into two "semicords" at the level of L1. Neurologic status and the shape of the spine remained unchanged during puberty. The last follow-up was performed at the age of 18 years. He managed to walk independently in prosthesis with visible limping. Conclusion: Spine deformities are always suspected in neonates with lipoma in the sacral region, which may sometimes be serious. Walking ability and quality of life depend on neurologic deficits; even with long duplication and double sacrum, walking can be a feasible option.

New criteria of radiological assessment of treatment outcomes in idiopathic scoliosis.

INTRODUCTION: The aim of surgical treatment in idiopathic scoliosis is correction, solid fusion and restoration of normal sagittal alignment of the spinal curves. The goal of this paper is to formulate a new uniform approach to evaluation of treatment outcomes in idiopathic scoliosis patients, considering not only the degree of correction but also coronal and sagittal balance. MATERIAL AND METHODS: A retrospective analysis was performed of radiographs of 150 patients with idiopathic scoliosis (136 females and 14 males). The mean thoracic curve was 56.1 degree and mean lumbar curve was 51.2 degree. All patients underwent posterior fusion with derotational instrumentation. The follow-up period was 3.7 years. The authors used their own radiological criteria for assessing surgical treatment outcomes separately for the coronal and sagittal planes and in both planes collectively. RESULTS: The degree of correction achieved was 61.8% in the thoracic spine and 66.6% in the lumbar spine. Good coronal plane outcomes were achieved in 97 patients (65%), and poor outcomes were seen in 53 (35%) cases. Good sagittal plane outcomes were achieved in 112 cases (75%), with poor outcomes in 38 (25%) patients. Good composite outcomes were noted in 76 cases (51%), and poor composite outcomes were achieved in 24 patients (16%) with ambiguous outcomes in 50 (33%). Apical vertebral translation in lumbar spine >or=35 mm, L4 angle >10 degree and lower fusion end at the L3 level are risk factors for a poor outcome. CONCLUSIONS: The proposed system for evaluation of radiological outcomes provides unequivocal results, not only accounting for the degree of correction, but also enabling quantitative evaluation of spinal balance in the coronal and sagittal planes.

Treatment of idiopathic scoliosis exceeding 100 degrees - comparison of different surgical techniques.

BACKGROUND: The treatment of scoliosis exceeding 100 degrees remains a challenge. Anterior fusion only may lead to low correction and screw plowing, posterior fusion only may cause the cranckshaft phenomenon in skeletally immature patients. Two-stage surgery is advocated, comprising anterior release and posterior fusion. MATERIAL AND METHODS: The aim of the paper is to compare treatment outcomes in patients with a >100% primary curve treated between 1984 - 2004 with one of the following techniques: halo-femoral traction with posterior fusion (Group I; n=124 patients), anterior release with halo-femoral traction and posterior fusion (Group II; n=32), single stage anterior release and posterior fusion (Group III; n=20), and posterior fusion only (Group IV; n=19). Correction and loss of correction were assessed radiologically. Additional surgical procedures and the presence of complications were also recorded. The fusion techniques were compared. Mean post-operative follow-up duration was 3.9 years, ranging from 2 to 15.3 years. RESULTS: Correction was highest in Group II and Group III (52.7% and 51.7%, respectively); vs. Group I and Group IV (45.8% and 38.7%, respectively). The loss of correction at final follow-up was lowest in Group II and Group III (2% and 3.3%), and highest in Group I and Group IV (6.4% and 15.6%, p<0.05). In all groups, the use of derotational instrumentation increased correction (59.7% C-D vs. 37% Wisconsin vs. 24.5% Harrington-Luque) and decreased loss of correction (4% C-D vs. 5% Harrington-Luque vs. 28% Wisconsin). Rates of neurological complications were similar in all groups; no persistent deficits were noted. CONCLUSIONS: Anterior release with halo traction and posterior fusion is the optimal treatment of severe scoliosis. If halo traction is contraindicated, single stage anterior release and posterior fusion should be performed. Contemporary instrumentation techniques result in higher correction rates and better curve stability.

Retrospective study of two-stage surgery in the treatment of scoliosis exceeding 100 degrees - assessment including spinal balance evaluation.

BACKGROUND: Scoliosis exceeding 100 degrees remains an important problem in spinal orthopaedics. The choice of an optimal surgical technique is crucial, not only because of the degree of correction needed, but also because of the need to minimize the number of complications and avoid imbalance after surgery. The aim of this work is to analyse the outcomes of a two-stage surgical regimen for scoliosis exceeding 100 degrees consisting of anterior release, cranio-femoral traction, and posterior fusion with derotational instrumentation. MATERIAL AND METHODS: Twelve patients with thoracic scoliosis (7 females and 5 males) were assessed retrospectively. The mean curve angle before surgery was 129 degrees. All patients underwent a two-stage procedure consisting of anterior release followed by 10-14 days of cranio-femoral traction and posterior fusion with derotational instrumentation. Mean age at surgery was 19 years. The mean follow-up period was 5 years. Radiological evaluation was based on postero-anterior and lateral radiographs. RESULTS: Mean curve correction was 44% and this result was stable during the follow-up period. Thoracic kyphosis did not change significantly after treatment, remaining at 61 degrees on average. Coronal decompensation was noted in 4 patients before surgery and one of the four after treatment. The Th1-midline distance improved significantly, as did the Th12-L2 angle on lateral radiographs. There were no neurological complications. CONCLUSION: Two-stage treatment of very severe scoliosis enables stable correction with some improvement of spinal balance in both the coronal and sagittal plane.

Does instrumentation removal cause curve progression in patients with adolescent idiopathic scoliosis?

Adolescent idiopathic scoliosis (AIS) is usually instrumented using a posterior approach. Hardware removal may be performed for specific clinical reasons. Little data is available on whether removal influences curve magnitude. The aim of the paper is to evaluate the impact of instrumentation removal on curve progression, and the safety and efficacy of the procedure. We analyzed 59 patients who underwent instrumentation removal. Curve types, reasons for removal, period between procedures, and Cobb angles: at baseline, immediately after correction, after removal and in follow-up were evaluated. Clinical symptoms were also assessed. The mean follow-up period after instrumentation removal was 2.2 years (1-5 years). The mean age at primary surgery was 14.5 years (12-25 years) and the mean Cobb angle after surgery was 24.9 degrees in the thoracic spine, and 17.5 degrees in the lumbar spine. The period between procedures was 46.6 months (11-192 months). The reasons for removal were: fistula (38.9%), pain (35.6%), rib hump removal (13.6%), and hardware failure (11.9%). At the final follow-up, mean thoracic curve was 35.4 degrees and lumbar curve was 26.2 degrees , corresponding to 13.3% and 17.5% curve progression after removal, respectively. Patients with infection had the highest loss of correction (21%). In symptomatic patients, pain subsided in 70% of the cases. In cases of hardware removal > 2 years after fusion, loss of correction was lower than in the < 2 years group. The course of surgery was relatively uneventful.

The titanium-made growth-guidance technique for early-onset scoliosis at minimum 2-year follow-up: A prospective multicenter study.

BACKGROUND: The management of early-onset scoliosis (EOS) remains a serious challenge in pediatric orthopedics. The growth-guidance system (GGS) is a surgical option that allows continuous growth along a rod, averting the need for repeated operative lengthening. OBJECTIVES: The objective of this study was to evaluate the outcomes of the GGS in the treatment of EOS. MATERIAL AND METHODS: A prospective study, including 81 patients from 4 departments treated with this method from 2013 to 2015, was conducted with a minimum follow-up period of 24 months. The follow-up data of 57 patients was available, thus the drop-out rate was 29.63%. There were 44 girls with a mean age of 10.03 years and 13 boys with a mean age of 8.04 years. RESULTS: The mean preoperative Cobb angle was 65.3° (range 36°-139°) was corrected to 23.7° (2°-94°), and at the end of the 2-year follow-up increased to 30.7° (8°-93°). The predominant proximal level of instrumentation was T5 and the distal was L1. The combined length of T1-T12 and T12-S1 increased on average by 33.19 mm in 24 months. The overall rate of serious complications was 43.86%. The most prevalent device-related complications were: the dislodgement of top screws because of the short length of the rod (14 cases), the implant failure (11 cases) and loss of correction (9 cases). CONCLUSIONS: The results show that the GGS used in this study allows for a good and stable correction while preserving the ability of the spine to grow in at least a 2-year follow-up. The complication rate is acceptable and comparable with other growth-friendly techniques. To date, this is the largest successful study on the use of titanium-made GGSs.

Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones.

INTRODUCTION: Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. AIM OF PAPER: Presentation of results of simple excision of symptomatic accessory navicular. MATERIAL AND METHODS: Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. RESULTS: The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. CONCLUSION: Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

[Use of VEPTR (Vertebral Expandable Prosthetic Titanium Rib) device in the treatment of congenital spine and thorax deformities]. / Zastosowanie systemu implantów VEPTR (Vertebral Expandable Prosthetic Titanium Rib) w leczeniu wrodzonych deformacji kregoslupa i klatki piersiowej.

UNLABELLED: Congenital spine and thorax deformities are an interdisciplinary clinical problem. Apart from trunk deformity they may lead to respiratory or cardiovascular insufficiency. Surgical treatment should be implimented as soon as possible in order to improve posture, balance and further development. This treatment should not impair further growth of the young spine. This is possible with the VEPTR device. AIM OF PAPER: Aim of paper is presentation of initial results of surgical treatment of congenital spine deformities with the VEPTR system. MATERIAL, METHODS: We treated 3 patients, aged 5 to 14. All had severe congenital spine and thorax deformities. The VEPTR device was implanted in the following configurations: rib-rib in two patients and spine-rib in one patient. We evaluated: Cobb angle of the main curve, spine balance, respiratory function before and after surgical treatment. Followup was 12 months. RESULTS: Posture and balance of the spine improved in all patients. Curve correction was from 10% to 71%. In one patient with initial respiratory insufficiency symptoms subsided gradually. CONCLUSION: VEPTR device is indicated in treatment of severe congenital deformities of the spine and thoracic cage. It improves patients' posture, changes the shape of thorax wall and consecutively improves respiratory function and further development.

Atypical caudal regression syndrome with agenesis of lumbar spine and presence of sacrum - case report and literature review.

CONTEXT: Caudal regression syndrome is a rare disorder, not well described in the literature. FINDINGS: Authors treated two patients with congenital absence of thoracolumbar vertebrae and lower limbs paraplegia. Patients had hypoplasia of the lower trunk and extremities with motion between upper and lower torso. Imaging showed caudal spine agenesis, but cleft sacrum was present. Due to severe kyphotic deformity and spinal instability, deformity correction and posterior fusion was performed at the age 6 and 8. Finally, fusion was achieved in one case and stable but non-fusion kyphotic posture was observed in second. CONCLUSION: surgery in caudal regression syndrome is challenging and bears high risk of complications.

Effectiveness of Treatment of Idiopathic Scoliosis by SpineCor Dynamic Bracing with Special Physiotherapy Programme in SpineCor System.

BACKGROUND: The SpineCor dynamic brace for the treatment of idiopathic scoliosis is designed to maintain the correct position of the spine and a new movement strategy for 20 hours per day. The SpineCor exercise system intensifies and complements the brace treatment. This study evaluated the effectiveness of a comprehensive treatment of idiopathic scoliosis involving the SpineCor system. MATERIAL AND METHODS: The study assessed a group of 40 patients (38 girls and 2 boys) with idiopathic scoliosis treated with the SpineCor brace. The average age at beginning of treatment was 13.1 yrs (10-15). Minimum treatment time was 18 months. 28 participants met the SRS criteria. Angles of the curve before and after bracing based on imaging studies were measured at the beginning and end of the treatment, analyzed and compared. Rehabilitation focused on teaching active corrective movement throughout the brace treatment. A control group was formed of 33 patients, including 21 meeting the SRS criteria, who used the SpineCor dynamic brace but did not participate in the associated exercise programme. RESULTS: Among patients from the exercise group who met the SRS criteria, 25% demonstrated reduced curve angles, 35.7% demonstrated curve progression and 39.3% showed stabilization (no change). Among patients meeting the SRS criteria from the control group, a decrease in curve angle was observed in 14.3% of the patients, curve progression in 57.1% and stabilization in 28.6%. CONCLUSIONS: 1. The addition of a dedicated physiotherapy programme to SpineCor dynamic bracing improves the chances of obtaining a positive outcome. 2. It is necessary to further analyse the course of the comprehensive treatment, also with regard to other types of braces and kinesiotherapy programmes.

Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up.

Cervical kyphosis in diastrophic dysplasia (DTD) is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results.