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.

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.

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.

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.

[Femur lengthening with a telescopic intramedullary nail ISKD--method presentation and early clinical results]. / Wydluzanie kosci udowej przy zastosowaniu gwozdzia sródszpikowego samorozprezalnego ISKD--opis metody, wstepne wyniki leczenia.

INTRODUCTION: Limb discrepancy over 4 cm is an indication for limb lengthening. Surgical techniques rely on osteotomy, external stabilisation and gradual distraction. The ISKD (Intramedullary Skeletal Kinetic Distractor) nail allows distraction osteogenesis and no external fixator is required. AIM OF PAPER: Aims of paper are: presentation of limb elongation method with the ISKD device, and presentation of early own results. MATERIAL AND METHODS: Material consists of 5 patients, age 14-16 years, 3 boys and 2 girls, who underwent femur lengthening with the ISKD nail between 2005 and 2007. We evaluated: initial shortening, surgical procedure, complications, amount of lengthening, lengthening rate, distraction index, time of treatment and mobility of adjacent joints. RESULTS: Initial shortening was 4-11 cm. No surgical complications were observed, mean time of surgery was 145 minutes, mean blood loss--200 ml. In three patients difficulties with initial distraction required manipulations under general anaesthesia. Distraction was complicated in 3 cases--in two patients premature consolidation was noted; in one case the distraction rate was too high. Mean lengthening rate in the study group was 0.7 mm/day (0.6-0.7 mm/day). Mean distraction index was 41.7 days/cm (26.2-55 days/cm). Full weight bearing was allowed after mean 234 days (210-275 days). Transient decrease of adjacent joint mobility was observed. CONCLUSION: The fully implantable, telescopic ISKD eliminates the need of external fixation and associated complications. Early results of limb lengthening with ISKD are encouraging. Careful patient selection and preoperative planning is required. Further studies and longer follow-up periods are needed.

[Spontaneous anterior atlanto-axial subluxation--a case story]. / Samoistne przednie podwichniecie szczytowo-obrotowe--opis przypadku.

In this study, a case of 4.5 years' old girl with spontaneous dislocation of C1/C2 vertebrae probably due to congenital defect of C1-hypoplasia of the atlas anterior arch is presented. Treatment consisted of skull traction and slow reposition followed by surgical spinodesis C1 and C2. During examination after 1 year follow up period, patient was in good clinical condition, without any complaints. On radiograms the cervical spine was stable and of correct shape.

Indications and range of surgery in the treatment of spine metastatic tumours.

Background. Spine is the most common place of metastatic tumors in the skeletal system. Due to diagnostic problems and the risk of quickly increasing neurological defects, the treatment of metastatic spine tumors is a significant clinical problem. The goal of surgical treatment is decreasing pain, neurological improvement and achieving full spinal stability.
Material and methods. Material consists of 31 patients with metastases in spine, who underwent spine surgery. Tumors were placed in thoracic spine at 48% patients, at lumbar spine - 42% patients, and at cervical spine in 10% patients; one level was involved in 56% cases, two or more levels - in 44 % cases. Qualification for surgery contained: the type of primary tumor, the amount of metastases to the spine impairment of spinal biomechanics and overall patient's condition of the. Corporectomy with anterior stabilization (intervertebral cage) was performed at 13 patients, and with additional anterior implants at 2 cases. At 8 patients, with destabilization of posterior spinal column, in spite of corporectomy, posterior stabilization was done. Surgery from posterior approach was performed in 3 cases.
Results. After operation, we noted pain relief at 34% of patients, while in 14% of them transient increase of pain occurred. Neurological status worsened after surgery at 1 patient. We achieved proper spine stabilization, without the need of use of external orthoses at 30 patients. At one patients, reoperation with change of implants and the range of stabilization was necessary. The amount of complications correlated with patient's general condition at the time of surgery.
Conclusions. 1. The main condition of success in operative treatment of spinal metastatic tumors is individual patient's qualification for surgery, including the extent of disease and general patient's condition. 2. Good stabilization with use of implants is a necessary element of surgery of spinal metastases from both anterior and posterior approach.

Surgical treatment of cervical spine metastatic tumours - case report.

Background. Metastatic tumours to the cervical spine generate pathological fractures followed by spinal instability and are connected with significant risk of neurological defects.
The goal of this study was to asses the surgical treatment of 4 patients with metastatic tumours in the cervical spine.
Material and methods. Between 1999 and 2001 four patients underwent surgery due to metastatic tumours in cervical spine. Primary focus was following: breast - 2 patients, prostate - 1 patient, in one case primary tumor remained unknown. Spinal localization of tumors: axial dens, vertebral body and arch of C5, vertebral body of C6. Patients' age at the time of surgery ranged from 48 to 75 years. The severity of spinal cord lesion before treatment was estimated according to Frankel classification: type B - 1 patient, E - 3 patients. According to Harrington classification, we noted type IV in 3 cases and type V - in one case.
Tumour resection with anterior and posterior stabilization, with use of implants was performed at 2 cases, occipito-cervical stabilization was done at one case and tumor resection with anterior stabilization was done in one case.
Results. Patients' neurological status did not change after treatment. As a result of operative treatment, we achieved full spine stabilization in 3 cases. Destabilization of vertebral cage due to osteoporosis occurred in one case and reoperation with change of the implant was performed at the fifth day after primary surgery.
Conclusion. Performed operations enabled further specialistic oncologic and rehabilitation treatment.

[Surgical treatment of old C2 spinal fracture with C2/C3 subluxation using an anterior retropharyngeal approach--case report]. / Operacyjne leczenie zastarzalego zlamania C2 z podwichnieciem C2/C3 z zastosowaniem dostepu przedniego zagardlowego--opis przypadku.

A patient with an inverterate transpedicular fracture of atlas and C2/C3 subluxation, with stenosis of spinal canal by bone fragment, was operated using anterior retropharyngeal approach. Stabilization with interbody cage was performed. During follow up examination both clinical and radiological result was good. This surgical approach seems to be a comfortable approach to the upper cervical spine.