Surgical treatment using The Unit Rod in children with neuromuscular scoliosis.

The article represents a retrospective clinical and radiological study. Objective. To assess the safety and the stability in time of the Unit Rod instrumentation in the treatment of severe neuromuscular scoliosis in children and adolescents. Summary. The treatment of patients with neuromuscular scoliosis always represents a challenge. The patients are debilitated and usual interventions are very long with great loss of blood. Serious complications can compromise the result of the surgery. The technique we used (the Unit Rod) is worldwide recognized, is simple, and gives excellent stability with a low rate of complications. Methods. We conducted a clinical and radiological retrospective study with a follow-up of at least 4 years in 58 patients with serious neuromuscular conditions, most of them being non-walkers. They were surgically treated by using mostly the Unit Rod technique, in the department of Paediatric Orthopaedics of the Rouen University Hospital, France, between 2000 and 2008. The back fusion was generally from T2 to pelvis. We used the Galveston technique for the patients who needed a pelvic fixation. Results. The mean Cobb angle correction was of 67% immediately after surgery; the correction of the curve decreased in time only in 4% of the cases. Pelvic obliquity was also very well corrected: 73% immediately and 70% at the last radiological follow-up. The mean operative time was of 175 minutes compared to 269 minutes for screws and hooks instrumentation. The most common complication for our technique was the radiolucent halo that appeared around the pelvic inserts. There was no significant degradation in time of the correction obtained. Conclusions. The use of this technique is safe, gives excellent results, achieving significant improvements in the postoperative functional status of the patients. The intra- and postoperative complications were minor. The advantage of using this method is the low cost of the material and technical simplicity, the corrective results being the same as the ones obtained with other techniques.

Evaluation of the Unit Rod surgical instrumentation in Duchenne scoliosis. A retrospective study.

The article represents a retrospective clinical and radiological study. Objectives. Evaluating the safety and efficiency of the surgical treatment by using the Unit Rod for scoliosis in adolescents and children presenting Duchenne's muscular dystrophy. Summary. Surgical management of myopathic scoliosis still causes controversies regarding the timing of surgery (patient's age), the pelvic inclusion in the arthrodesis or the advantages of surgery over the conservatory treatment. The patients are very fragile and a long surgery with massive blood loss could lead to serious complications. Unit Rod instrumentation is simple, confers excellent stability and has a low rate of complications. Methods. This is a retrospective clinical and radiological study with a medium follow-up of 6.9 years including 13 patients diagnosed with Duchenne myopathy. All investigated patients were non-ambulatory at the time of surgery and have been treated by the Unit Rod technique at the University Hospital of Rouen between 2002 and 2008. Spinal fusion was, in all cases, realized from T2 to pelvis. Galveston technique of pelvic fixation and Luque's sublaminar wire instrumentation of the spine were used. Results. The results obtained with this treatment and post-surgery complications were analyzed and compared with those from literature. The advantages of this technique consist mostly in a good and stable pelvic fixation, a short interventional time, a minimal blood loss and few complications. Cobb angle correction is similar to that obtained by other surgical procedures. Conclusions. Using the Unit Rod instrumentation of scoliosis in Duchenne's muscular dystrophy is safe, has excellent outcomes, brings post-surgery improvements, and has minor intra and post-surgery complications. The low cost of this treatment could make it a first choice for medical health systems with financial problems.

Livin and Bcl-2 expression in high-grade osteosarcoma.

AIMS: The evaluation of prognosis in patients with osteosarcoma is limited to clinical parameters. Although numerous molecular markers have been studied, none are currently in routine clinical use. The aim of this study was to determine if Livin and Bcl-2, acting as antiapoptotic proteins through different mechanisms, are expressed in osteosarcoma, and whether they can be used as prognostic markers in human osteosarcoma. METHODS: Tumor specimens of 29 patients with high-grade central osteosarcoma, with complete clinical follow-up for a minimum of 5 years, were studied. The localization and distribution of Livin and Bcl-2 were investigated using immunohistochemistry. Results were correlated with the histological response to chemotherapy, 5-year disease-free and 5-year overall survival. RESULTS: Bcl-2 was expressed only in the cytoplasm of 16/29 cases and there was no statistically significant correlation between expression and any of the studied parameters. Livin was detected in 17/29 cases, in the cytoplasm of all 17 and in the nucleus of only 3 cases. Nuclear expression was significantly correlated with a decreased overall survival (P < 0.0002) compared with those patients without nuclear expression. CONCLUSIONS: The results of this study indicate that Bc1-2 and Livin are highly expressed in osteosarcoma cells and that possibly, the evaluation of nuclear Livin expression might be a useful prognostic marker in osteosarcoma.

Metastatic bone disease: a 36-year single centre trend-analysis of patients admitted to a tertiary orthopaedic surgical department.

BACKGROUND AND OBJECTIVES: The treatment and outcome of primary malignant bone tumours has changed with the advances in diagnostic and treatment modalities. A trend-analysis on a large cohort of patients with metastatic bone disease was performed. METHODS: A retrospective chart review of all cases with metastatic bone disease admitted to a single tertiary orthopaedic referral centre, registered with the Vienna Bone and Soft Tissue Tumour Registry between 1968 and 2003 was conducted. For trend-analysis of frequency, survival, primary site, treatment methods, and others, the 36-year study duration was divided into four periods. RESULTS: The study identified 601 females and 580 males (mean: 60 years) with metastatic bone disease. The most common metastases were secondary to breast cancer (n = 275; 23%) and renal cell carcinoma (n = 242; 21%) and the majority were located in the femur (n = 332; 28%) and spine (n = 348; 29%). Overall, the proportion of patients who underwent surgery decreased. At follow-up, 887 (75%) patients were verified to have died of their disease. CONCLUSIONS: Over the 36-year period, the frequency of bone metastases has increased at our centre. Although survival increased over time, the difference was not significant; this was most likely attributable to the seriousness of cases referred to our tertiary care centre.