Participation of sex hormones in multifactorial pathogenesis of adolescent idiopathic scoliosis.

PURPOSE: In order to verify the potential association between the aetiopathogenesis of adolescent idiopathic scoliosis (AIS) and the process of sexual maturation, we determined the concentrations of oestrogens in pre- and postmenarcheal girls affected by this condition. AIS, occurring mostly in pubescent girls, is one of the most frequent forms of faulty posture. Therefore, it was assumed that the multifactorial pathomechanism of AIS involves significant deficiency of oestrogens. METHODS: The diagnosis of AIS was established on the basis of physical examination and analyses of radiograms. Concentrations of FSH, LH, oestrogens, progesterone, osteocalcin and RANKL were determined by ELISA. The activity of alkaline phosphatase (AP) was measured by kinetic method. The study included pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls. RESULTS: In premenarcheal scoliotic girls, the levels of FSH, LH and oestradiol were lower; the levels of progesterone, oestrone and oestriol were higher; and the concentrations of oestrone and oestriol were similar compared to premenarcheal controls. Higher levels of RANKL, osteocalcin and AP were observed in premenarcheal adolescents with AIS compared to controls. The concentrations of FSH, LH, oestradiol, and progesterone in postmenarcheal girls with scoliosis were lower, oestrone were slightly lower and oestriol did not differ compared with the control group. Significantly higher levels of RANKL, osteocalcin and AP were observed in postmenarcheal scoliotic adolescents compared with controls. CONCLUSIONS: There is an interdependence between the concentration of oestradiol and development of scoliosis. Determination of estradiol may have diagnostic value in the screening of spinal pathologies associated with AIS.

Current use of methylprednisolone for acute spinal cord injury in Poland: survey study.

PURPOSE: The controversial practice of methylprednisolone (MP) application in acute spinal cord injury (ASCI) is gradually decreasing. This is a survey study designed to assess the current use of MP in ASCI in Poland. METHODS: The questionnaire comprised of five questions was distributed among 251 spinal surgeons, members of the Polish Society of Spinal Surgery. One hundred and ten (43.8 %) responded, and data from 108 were included in the study. RESULTS: Majority of respondents (73.1 %) declared the use of MP in ASCI. Most of them (41.7 %) adhered to the NASCIS II protocol, and 24.1 % rather used the NASCIS III protocol. Predominant rationale for the use of steroids was fear of litigation (36.7 %), 30.4 % declared it is as an institutional standard, nearly one-third believed in the effectiveness of drug in improving neurological outcomes. The subgroup analyses revealed no statistically significant interaction for specialty, age, personal involvement in care and institutional case volume. CONCLUSIONS: As opposed to the literature data from similar studies performed in other countries, the rate of use of MP in ASCI remains high.

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.

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.

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.

Quality of Life Following Prestige LP Cervical Disc Arthroplasty in a Prospective Multicountry Study.

BACKGROUND: To describe routine surgical practice using Prestige LP Cervical Disc (Prestige disc) and patient outcomes for degenerative cervical disc disease in a multicenter 2-year prospective, observational study. METHODS: Patient demographics and intraoperative data were collected; quality of life (QoL) (EQ-5D, EQ-VAS, and neck disability index), average disc height, and adverse events were assessed pre- and postoperatively at 3, 6, 12, and 24 months. RESULTS: One hundred and ninety-four patients were enrolled (190 patients implanted; female: 67%; mean age: 44.0 years; mean body mass index: 25.6). Disc herniation was the most frequent indication for cervical arthroplasty (80.5%). Thirty-seven percent of patients experienced pain for >1 year prior to baseline assessment. Mean procedure duration was 87.1 minutes, and mean blood loss was 43.8 mL. The majority (71.0%) of Prestige discs were implanted at level C5 to C6, while 16.3% of patients received implants at 2 levels. There was a significant improvement from baseline to 3, 6, 12, and 24 months of follow-up in all QoL assessments. After implantation, the mean disc height at the affected level increased by 0.19 from baseline (0.22) to 3 months (0.41) and remained constant up to 24 months (P < .001). Mean disc height of levels above and below the implant remained comparable at baseline and follow-up. A total of 63 adverse events (44 patients) was recorded, of which 7 (11.1%) were related to the Prestige disc, instrumentation, or procedure; 41 (65.1%) were unrelated; and 15 (23.8%) had an unknown relation. CONCLUSIONS: In line with published findings, our study shows significant improvement in outcomes in the first 3 months after Prestige disc implantation with improvements maintained throughout the study.

[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.

Lengthening of congenital forearm stumps.

The Ilizarov device and distraction osteogenesis method became very useful in correction and elongation of forearm defects. Two cases of forearm elongation with congenital transverse defect are described. The construction of the device is provided. During follow-up examination, 2 and 7 years after the treatment, good clinical results were achieved in both patients with the use of upper limb prosthesis employing the patient's own elbow joint. Presented application of the Ilizarov method can significantly improve possibilities for the use of prosthesis in patients with congenital upper limb defects and result in better cosmetic and functional outcome.

Limb lengthening in fibular hemimelia type II: can it be an alternative to amputation?

The purpose of our study was to analyze limb lengthening in fibular hemimelia type II. Ten patients underwent 16 tibia lengthenings. The mean tibia shortening was 5.8 cm. We used the Ilizarov technique in all cases. The mean follow-up time was 7.2 years. The mean lengthening was 23% of the former length. The healing index was 50.8 days/cm. In the final examination six patients were skeletally mature, equal limb length and functional foot positioning were achieved in four of them. Complications were observed during 14 lengthenings (87.5%). Although lengthening in fibular hemimelia is difficult, elongation with axis and foot correction may offer an alternative to amputation.

[Clinical use of pedobarographic examination--own experience and review of literature]. / Zastosowanie kliniczne badania pedobarograficznego--doswiadczenia wlasne i przeglad literatury.

Pedobarography has been used for measuring underfoot pressure during the standing and during the gait. It is a non-invasive method, valuable for foot diseases and defects diagnosing and treatment monitoring. Pedobarography is used in examination of children and adults feet. The authors have introduced the clinical possibility of employment of this method and proposed its use for foot examination in orthopaedics, traumatology, rehabilitation, rheumatology, diabetology and neurology.

Concentration of estradiol in girls with idiophatic scoliosis.

Background. Idiopathic scoliosis is one of the most often diagnosed by orthopaedists forms of spine cord deformations. Our knowledge about epidemiology and aetiology of this disease is still not broad enough. Authors have focused on the analysis of a factor that may influence initiation and progress of scoliosis. Material and methods. Levels of estradiol in healthy and scoliotic girls aged 11-14 have been compared. Medium angle of the curve measured in Cobb's classification was 33 degrees 11 degrees (10 degrees -60 degrees ). Results. Comparison of analysed parameters between both groups has shown significant differences in estradiol levels. Medium level of the hormone in the control group was 50,030 pg/ml (sx=18,586) and was significantly higher than the level of hormone in the group of children with scoliosis where it equalled 28,201 pg/ml (sx=15,628). Conclusion. These results indicate a possible influence of estradiol secretion disorders during gender development on initiation and progression of the lateral curvature of the spine.

Association of Calcium and Phosphate Balance, Vitamin D, PTH, and Calcitonin in Patients With Adolescent Idiopathic Scoliosis.

STUDY DESIGN: A cross-sectional study of 2 groups of patients with scoliosis, and an age-matched control group was conducted. Each of the groups such as patients with adolescent idiopathic scoliosis (AIS) as well as control group were divided additionally into 2 groups: premenarcheal and postmenarcheal girls. OBJECTIVE: The aim of the study was to determine the levels of 25-OH-vitamin D3, calcium and phosphate, parathyroid hormone (PTH), and calcitonin in serum of pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls. SUMMARY OF BACKGROUND DATA: The primary etiology and pathogenesis of AIS remains unknown. It is assumed that vitamin D deficiency and genetic predisposition, for example, polymorphisms of vitamin D receptor, have a great significance. Vitamin D plays a key role in skeletal development and prevents bone atrophy, affects the absorption of calcium, maintains calcium-phosphate homeostasis, and the bone matrix mineralization. Its deficiency can result in a wide variety of skeletal deformities, low bone mass, and then leads to the disappearance of bone. Defects in trabecular bone structure and/or bone mineralization are the main features of scoliosis. Some studies have reported that Vitamin D deficiency is common among patients with AIS. The mechanism of Vitamin D action on scoliosis development is still unclear. METHODS: Determination of serum 25-OH-D3 levels was performed using high-performance liquid chromatography chromatography; concentrations of calcium and phosphate were measured using colorimetric methods, and concentration of PTH and calcitonin was measured using ELISA system. RESULTS: Reduction in the serum levels of 25-OH-D3 and calcitonin in girls with AIS compared with healthy girls was demonstrated. CONCLUSION: The phosphate-calcium balance and PTH level seem to be normal in patients with AIS. The calcitonin level in girls with AIS is 2-fold lower than in healthy subjects. It is possible that the deficiency of vitamin D can be involved in AIS. LEVEL OF EVIDENCE: 4.

History of scoliosis treatment in Malopolska.

This article discusses the history of treatment for idiopathic scoliosis in the Malopolska region of Poland. Surgical treatment began in the period between the two world wars, when it was introduced by associate professor Juliusz Zaremba, later the first Head of the Orthopedic Clinic at the Academy of Medicine in Cracow. Zaremba was succeeded in that post by Prof. Janina Markowa, who maintained the Clinic's profile, in which scoliosis treatment was a prominent part. In 1976, scoliosis treatment was commenced at the Orthopedic Center in Zakopane, which has now become the only center in the Malopolska region for the treatment of spinal disorders in children.

The natural history of idiopathic scoliosis.

Background. The natural history of idiopathic scoliosis is a crucial issue in the planning and assessment of different treatment methods. This article presents the evaluation of scoliotic deformity in immature patients who have been in observation without any treatment. Material and methods. 159 patients (128 girls, 31 boys) were examined between 1971 and 2002. Skoliosis was diagnosed at a mean age of 6 years 4 months (range 2.1-8.10), and observation was concluded at a mean age of 16 years 11 months (range 14.6-20.3). The mean follow-up was 10 years 5 months. The prognostic factors analyzed were: age, sex, Cobb angle, Mehta angle, apical vertebral rotation, specific rotation, Risser test. The progression and regression of curvature was analyzed in different biological age periods, and was measured by calculating the difference in the Cobb angle on successive x-rays divided by the interval between x-rays. Results. The mean progression of curvature before age 5 was 5.7 degrees per year; in the 6-10 age bracket, 2.3 degrees per year; in the 11-15 age bracket, 7.4 degrees per year; in the >15 age bracket, 0.3 degrees per year. The mean progression for patients with Risser 1 was 8.8 degrees per year; Risser 2, 7.3 degrees per year; Risser 3, 5.1 per year; Risser 4, 2.1 degrees per year; Risser 5, 0.3 degrees per year. Conclusions. The progression of curvature in idiopathic scoliosis is variable, and is influenced by age. Knowledge of the natural history of idiopathic scoliosis is a crucial tool in predicting the development of spinal curvature. The Risser test and biological age are the only effective predictors of progression.

[A comparison of radiological outcomes in the surgical treatment of thoraco-lumbar scoliosis by anterior "bone on bone" and posterior spondylodesis]. / Porownanie wynikow radiologicznych operacyjnego leczenia skrzywien piersiowoledzwiowych w skoliozach idiopatycznych metoda spondylodezy tylnej i przedniej "kosc na kosc"

Background. The goal of surgical treatment in idiopathic scoliosis is to assure maximal correction of the curvature with a minimal number of spine segments fused. There are two main methods of spondylodesis: anterior and posterior. Material and methods. We compared radiological outcomes after surgical treatment of idiopathic thoraco-lumbar scoliosis by the anterior method called "bone on bone" and the posterior method using derotating fusion. Group I consisted of patients operated by the posterior technique, while Group II consisted of patients operated by the anterior "bone on bone" technique. Results. In Group I, the mean range of fusion was 7 vertebrae. After surgery the mean curve was 23 degrees (61% correction), while at 1-year follow-up the mean angle was 26 degrees . In Group II, the mean range of fusion was 4 vertebrae. After surgery the mean angle was 15 degrees (78% correction), while at one-year follow-up the mean angle was 16 degrees . Conclusions. The "bone on bone" method of anterior fusion gave greater correction and a shorter range of fusion compared to the posterior approach. At one-year follow-up no major loss of correction was noticed in either group.

[Endoscopic procedures in spinal surgery]. / Zabiegi endoskopowe w chirurgii kregoslupa.

Background. The anterior approach to the spine enables good correction and stabilization of the anterior spinal column. The broad application of the anterior procedure via thoracotomy caused problems, however, due to the gravity of the surgical procedure. The introduction of transthoracic endoscopy has made it possible to avoid the disadvantages of open surgery. Material and methods. Between 2000 and 2003, 129 endoscopic operations were performed in our hospital on 125 patients, suffering from idiopathic scoliosis (77 patients), congenital scoliosis (8), scoliosis in systemic diseases (6), neuromuscular scoliosis (3), cardiogenic scoliosis (1), Scheuermann's kyphosis (8), pathological spine fracture (6), spondylodiscitis (4), chylothorax (2), pectus excavatum - MIRPE technique (10). The mean age at surgery was 15 years, range 4-62. The mean follow-up was 17 months, range 5-36. Results. In the whole group, the mean duration of endoscopy was 112 minutes, and mean intraoperative blood lose was 126 ml. Stable fusion was obtained in all patients. The duration of endoscopic procedures was shorter than the open technique, and intraoperative blood loss was lower. A decreased need for analgesics was also noted after surgery. Conclusions. The advantages of the endoscopic spinal procedure are its minimally invasive nature, good visualization of the operative area, decreased blood loss, and decreased need for analgesics.

Early outcome in the surgical treatment of idiopathic scoliosis by "bone on bone" anterior interbody fusion.

Background. The aim of our study was to evaluate a new surgical method developed by Robert Gaines for the treatment of idiopathic scoliosis, called the "bone on bone" procedure. Material and methods. We examined 100 patients (81 female and 19 male) selected from 259 scoliotic patients operated at our center between 2002 and 2004. The mean age at surgery was 16 years and 2 months (range: 12 yrs, 2 months to 39 yrs). The mean follow-up was 18 months (range: 15-24). The average range of fusion was 5 vertebrae (range 3-6). The mean Cobb angle was 63 degrees (range: 49 degrees -98 degrees ). The mean Cobb angle of upper secondary curve was 32 degrees (range: 9 degrees -70 degrees ), the lower 32 degrees (range: 7 degrees -740). The mean apical vertebral rotation (AVR) was 30 degrees (range: 15 degrees -55 degrees ), apical vertebral translation (AVT) 58 mm (range: 8-110). The average thoracic kyphosis was 19 degrees (range: 8 degrees -40 degrees ), and lumbar lordosis 23 degrees (range: 18 degrees -38 degrees ). Technical note. The anterior transthoracic and /or retroperitoneal approach was performed; all discs on the apex of curvature were removed and no bone grafts were used (fusion by contact of vertebrae surfaces). Transvertebral screws were implanted with stabilization by means of a rod. Results. After surgical treatment the mean Cobb angle was 27 degrees (range 0 degrees -58 degrees ), and the correction of the base angle was 58%. The mean Cobb angle of the upper secondary curve was 25 degrees (range: 4 degrees -60 degrees ), the lower 19 degrees (range: 1 degrees -56 degrees ). The average AVR was 20 degrees (range: 5 degrees -45 degrees ), correction was 33%. The mean AVT was 16 mm (range: 0-62 mm), accounting for a 72% correction of basic translation. The average kyphosis after surgical treatment was 26 degrees (range: 15 degrees -45 degrees ), lordosis 20 degrees (range: 7 degrees -35 degrees ). After a mean 18 months follow-up, the average Cobb angle was 31 degrees (range: 0 degrees -73 degrees ), with average 12% loss of correction. The mean upper secondary curve was 25 degrees (range: 5 degrees -62 degrees ), the lower 21 degrees (range: 2 degrees -55 degrees ). The average thoracic kyphosis was 28 degrees (range: 14 degrees -48 degrees ), lordosis 21 degrees (range: 7 degrees -37 degrees ). The mean AVR and AVT remained at the same level after follow-up. Conclusions. The "bone on bone" procedure allows the surgeon to decrease the number of segments involved in spinal fusion, and gives high correction of idiopathic scoliosis with a low rate of operative complications.

Slipped capital femoral epiphysis in identical twins - a case report.

Background. The pathoetiology of slipped capital femoral epiphysis (SCFE) has not been thoroughly established. Hormonal and genetic causes are the primary theories under discussion. There are some publications considering the occurrence of SCFE in identical twins. Material and methods. 15-year-old identical twins were admitted to our Department complaining of pain in the left groin and limping. A-P and axial x-rays presented slippage of the left capital femoral epiphysis. Results. Reposition and Kirschner pin fixation were performed in both patients with good clinical outcome. The follow-up period was 4 years. Conclusions. When SCFE occurs in one of a pair of identical twins it is prudent to take the second child under careful observation.

"Bone-οn-Bone" surgical reconstruction of moderate severity, flexible single curve adolescent idiopathic scoliosis: continuing improvements of the technique and results in three scoliosis centers after almost twenty years of use.

The "bone-on-bone" reconstruction for adolescent idiopathic scoliosis is reviewed in this article. Extensive use over the past 18 years has identified it's functional benefits outstanding clinical results, and very limited complications. This is an extensive update of it's application, since it's introduction, 18 years ago.

Surgical management of moderate adolescent idiopathic scoliosis with ApiFix®: a short peri- apical fixation followed by post-operative curve reduction with exercises.

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13-16 years with curves between 43°-53° and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.