[Polish nomenclature of lumbar disc disease]. / Polskie mianownictwo choroby dyskowej Iedzwiowego odcinka kregoslupa.

Lumbar disc herniation is one of the most common damage of musculoskeletal system. The incidence of pain of lumbosacral spine is estimated approximately on 60-90% in general population, whereas the incidence of disc herniation in patients experiencing low back pain is about 91%. Despite the high incidence and uncomplicated pathogenesis of disc disease there is a problem with the nomenclature. In the vast majority of cases, the naming confusion stems from ignorance of the etiology of low back pain. Different terminologies: morphological, topographical, Radiological and Clinical are used interchangeably. In addition, diagnosis is presented in a variety of languages: Polish, English and Latin. Moreover, the medical and traditional language are used alternately. The authors found in Polish literature more, than 20 terms to describe lumbar disc herniation. All of these terms in the meaning of the authors are used to determine one pathology--mechanical damage to the intervertebral disc and moving the disc material beyond the anatomical area.

[Scoliosis in Rett syndrome--own experience]. / Skolioza u chorych z zespolem Retta--doswiadczenia wlasne.

Rett syndrome (RS) is a rare genetic disorder affecting only girls. The prevalence is 1:15000. The most characteristic features of RS are: lack of development, wringing of the hands. Musculoskeletal system is also affected and scoliosis remains the biggest challenge. Aim of paper is to describe the curve progression pre-operatively, course of surgery and finally radiological and subjective results of treatment. Postoperative follow-up was 3.1 year. We describe a series of 9 girls with RS and scoliosis treated surgically in single Institution. All presented scoliosis that increased with a rate of mean 16.1 degrees per year. Preoperatively curves ranged from 52 degrees up to 120 degrees Cobb angle. Curve pattern was similar in all cases, long thoraco-lumbar curve with thoracic hyperkyphoisis. All girls underwent surgery. Posterior fusion with Luque-Galvestone technique, posterior hybdrid fusion or anterior fusion was performed depending on the degree of scoliosis. Surgery and postoperative period were uneventful. Mean blood loss was 650 ml; mean obtained correction was 38%, with minimal correction loss at final follow-up. No additional surgery was required. Most caregivers were subjectively satisfied with surgery. Scoliosis in RS patients is progressive, with a high annual rate. Surgery should be performed I cases of curves of 40-50 degrees in specialized centers. The procedure is safe, and does not affect general condition nor deteriorate neurological status. In non-ambulant patients fusion should be carried out to the pelvis.

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.