Unexpected findings in cervical spine in spondylometaphyseal dysplasia Sutcliff type FN1-related.

The autosomal dominant spondylometaphyseal dysplasia Sutcliff type or corner fracture type FN1-related is characterized by a combination of metaphyseal irregularities simulating fractures ("corner fractures"), developmental coxa vara, and vertebral changes. It is linked to heterozygous mutations in FN1 and COL2A1. Vertebral changes as delayed vertebral ossification, ovoid vertebral bodies, anterior vertebral wedging, and platyspondyly have been observed in this condition, while odontoid abnormalities have not been reported. We report an odontoid anomaly in a girl with SMD-CF FN1-related showing the heterozygous variant c.505T>A; p.(Cys169Ser), presenting at 11.9 years of age with acute quadriparesis. Images showed spinal cord compression and injury associated with os odontoideum and C1-C2 instability. She required decompression and instrumented occipitocervical stabilization, suffering from residual paraparesis. This paper describes the first case of SMD-CF FN1-related accompanied by odontoid anomalies.

Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study.

Study design: Retrospective review of multicentric data. Objectives: To estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study. Methods: This retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries. From each hospital's deformity registry, the following patient data were extracted: demographics, main curve Cobb angle, Lenke Classification at the initial visit and time of surgery, time from indication-for-surgery to surgery, curve progression, Risser skeletal-maturity score and causes for surgical cancelation or delay. Surgeons were asked if they needed to change the original surgical plan due to curve progression. Data also were collected on each hospital's waiting list numbers and mean delay to AIS surgery. Results: 66.8% of the patients waited over six months and 33.9% over a year. Waiting time was not impacted by the patient's age when surgery first became indicated (p = 0.22) but waiting time did differ between countries (p < 0.001) and hospitals (p < 0.001). Longer time to surgery was significantly associated with increasing magnitude of the Cobb angle through the second year of waiting (p < 0.001). Reported causes for delay were hospital-related (48.4%), economic (47.3%), and logistic (4.2%). Oddly, waiting time for surgery did not correlate with the hospital's reported waiting-list lengths (p = 0.57). Conclusion: Prolonged waits for AIS surgery are common in Latin America, with rare exceptions. At most centers, patients wait over six months, most commonly for economic and hospital-related reasons. Whether this directly impacts surgical outcomes in Latin America still must be studied.

Hemivertebra Resection in Small Children. A Literature Review.

STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate the lowest possible age to resect an HV in very young patients with a congenital deformity. METHODS: We sought to retrieve all studies reporting age at HV excision in patients with congenital scoliosis. Studies written in English were included. No publication date restrictions were imposed. A search of the PubMed and LiLacs databases was conducted. Additionally, a hand search was performed to supplement the database search. RESULTS: We found 140 articles. Twenty two studies were included into the final assessment. There was considerable heterogeneity in the included studies, both regarding age and the surgical techniques used. There was also a broad spectrum of recommendations regarding suggested age for treatment. The youngest patient undergoing resection and fusion was 3 months of life at the time of surgery. CONCLUSION: How young a patient could and should be submitted to HV resection surgery is still a matter of debate in the literature. Prophylactic surgery might be a proper treatment for young children with congenital scoliosis before malformation becomes a deformity, adding no additional neurological, vascular, or anesthesia-related complications. The defect can be treated early while the deformity is treated late.

Evaluation of outpatient halo-gravity traction in patients with severe scoliosis: development of a monitoring device.

INTRODUCTION: Patients with severe spinal deformities represent a major clinical and surgical challenge. Halo-gravity traction (HGT) is a traditional method to correct the deformity prior to surgery. Typically, children undergoing HGT remain in the hospital until surgery. Therefore, it has been suggested to treat these children at lower level healthcare centers or even at home. The aim of this study was to develop a tool to assess patient adherence to HGT together with a program to analyze traction results. MATERIALS AND METHODS: An original recording system was designed with an Arduino Nano®. The data extracted from the memory card were compiled into a text file and then analyzed with the MatLab R2018a MathWorks®. RESULTS: Five patients receiving HGT for severe scoliosis were asked to use the device both in the wheelchair and in bed to evaluate its usefulness. CONCLUSIONS: A device was developed to monitor the use of HGT at home. The device provides information on the time of HGT use and the traction weight placed throughout the day, as well as on the correct functioning of the system in bed and in the wheelchair.

Sistema de barras magnéticas. Resultados y complicaciones / Magnetically-controlled growing rods. Outcomes and complications

Introducción: El uso del sistema de barras magnéticas para el tratamiento de la escoliosis de comienzo temprano es un método utilizado en los últimos 10 años; su eficacia está respaldada por la bibliografía, pero no está exento de complicaciones. Objetivo: Analizar retrospectivamente una serie de 37 pacientes tratados con barras magnéticas en escoliosis de comienzo temprano. Materiales y Métodos: Se realizó un estudio retrospectivo entre 2014 y 2019. Se dividió a los pacientes en: grupo 1 (procedimientos primarios con barras magnéticas) y grupo 2 (conversiones de sistema tradicional a barras magnéticas). Resultados: Se incluyó a 19 niñas y 18 niños (edad promedio 8 años al operarse), las etiologías fueron variadas. Entre el grupo 1 (n = 28) y el grupo 2 (n = 9), el seguimiento promedio posoperatorio fue de 3.6 años. El valor angular promedio preoperatorio de escoliosis era de 64° (rango 39°-101°) y el de cifosis, de 51° (rango 7°-81°). El valor angular promedio de escoliosis en el posoperatorio inmediato fue de 41° (rango 17°-80°) y el de cifosis, de 34° (rango 7°-82°). Se produjeron 2 roturas de barra y una cifosis de unión proximal, 2 aflojamientos de tornillos proximales, una falla del sistema de distracción de barras magnéticas y una infección del sitio quirúrgico. Conclusiones: Nuestros resultados preliminares, aunque son a corto plazo, sugieren que la barra magnética podría ser un método eficaz en este tipo de enfermedad. Nivel de Evidencia: IV

Introduction: Magnetic Expansion Control (MAGEC) Spinal Growing Rods are a novel treatment for early-onset scoliosis (EOS). Although its efficacy is supported by the literature, it is not without complications. Materials and Methods: The aim of this study was to retrospectively analyze a series of 37 cases treated with MAGEC between 2014 to 2019. We performed a retrospective study and divided the population into two groups: GI (primary procedures with MAGEC) and GII (conversions from traditional system to MAGEC). Results: The study included 19 girls and 18 boys with a mean age of 8 years and a variety of etiologies. The average postoperative follow-up time for Group I (n=28) and Group II (n=9) was 3.6 years. The average preoperative angular value (AV) of scoliosis was 64° (39°-101°) and kyphosis 51° (7°-81°). The postoperative scoliosis AV was 41° (17°-80°) and kyphosis 34° (7°-82°). We found 2 rod ruptures and one proximal union kyphosis, two proximal screw loosenings, one MAGEC distraction system failure, and one surgical site infection. Conclusions: Although our preliminary results are short term, they suggest that MAGEC could be an effective method. Level of Evidence: IV

Neuromuscular lordoscoliosis: an unusual response to post-operative halo-gravity traction.

PURPOSE: To report the results of prolonged post-operative halo-gravity traction in a patient in whom the surgery had to be interrupted unexpectedly and for whom subsequently specific clinical circumstances contraindicated completion of the surgical procedure. METHODS: The patient was a 15-year-old male with severe cervico-dorsolumbar lordoscoliosis who was being studied for associated diffuse axonal injury. He performed halo-gravity traction for 12 weeks. Subsequent surgical management consisted of occipito-lumbar posterior instrumented fusion. During the surgical approach, electrocardiographic changes with hemodynamic decompensation were detected that did not improve with anesthetic reanimation. The intervention was stopped, the surgical wound was closed, and the patient was transferred to the intensive care unit (ICU). It was decided that a revision surgery with the aim to continue with the previous strategy would imply a high risk of perioperative morbidity and mortality. RESULTS: Orthopedic management was decided upon consisting of continued halo-gravity traction with wheelchair modification at home, which was extended to a period of 12 months because of the good results obtained in terms of cervicothoracic realignment. Two years after halo-gravity discontinuation, clinical and radiographic occipito-cervical alignment was good and the patient conserved certain occipito-cervical range of motion and had the capacity of maintaining a horizontal gaze. CONCLUSION: We considered the outcome extraordinary and relevant in this complex and unusual patient. A longer follow-up will provide more data regarding the final outcome of this treatment.

Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría / Multimodal perioperative pharmacological protocol in pediatric spine surgery

Introducción: La cirugía de columna es uno de los procedimientos con mayor morbimortalidad dentro de la población pediátrica; el manejo farmacológico del dolor en dicha población aún no se encuentra estandarizado. La analgesia multimodal trata de responder a esta problemática. Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolo multimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños. Materiales y métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA. Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna. Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales. Nivel de Evidencia: II

Introduction: Spine surgery has one of the highest morbimortality rates in the pediatric population. Pain management has not been standardized on said population. Multimodal analgesia (MMA) was developed to resolve that problem. Objective: To develop, based on a systematic review, a detailed and original pain management multimodal pharmacology protocol for pre and post-operative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery. Materials and methods: We conducted a systematic review of full texts in English and Spanish from PubMed, Embase, Cochrane Library, and LiLacs Database from 2000 to 2021. We used the PRISMA flow diagram. Results: From a total of 756 papers, 38 were included in the final evaluation. Considering the bioethical difficulties to develop a manuscript from clinical trials with drugs and drug combinations in the pediatric population, we developed an original and detailed pain management protocol for pre and postoperative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery. Conclusion: Based on a systematic review, we succeeded in developing a simple and easily reproducible perioperative multimodal pain management protocol (intra and extrahospital), intending to expedite the patient's functional recovery and reduce global socioeconomic costs.Keywords: Spine surgery; pediatrics; post-operative pain; multimodal analgesia. Level of evidence: II

Algunos desafíos en mucopolisacaridosis tipo I / A few challenges in mucopolysaccharidosis type I

Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care

A few challenges in mucopolysaccharidosis type I. / Algunos desafíos en mucopolisacaridosis tipo I.

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care.

Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto.

Nuevas recomendaciones para el cuidado de los pacientes con mucopolisacaridosis tipo I / New recommendations for the care of patients with mucopolysaccharidosis type I

Dados los avances sobre mucopolisacaridosis Icon posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario

Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up

New recommendations for the care of patients with mucopolysaccharidosis type I. / Nuevas recomendaciones para el cuidado de los pacientes con mucopolisacaridosis tipo I.

Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up.

Dados los avances sobre mucopolisacaridosis I con posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario.

Histiocytosis in the pediatric spine: a clinical and radiographic analysis of 50 patients.

STUDY DESIGN: Descriptive, retrospective. Scientific level of evidence IV. OBJECTIVES: The aim of this study was to evaluate a consecutive case series of 50 pediatric patients with LCH of the spine. Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans cells in different organs. Incidence in children range from 2 to 10 cases per million. In the current literature, few series evaluate LCH in the pediatric spine. MATERIAL AND METHODS: A consecutive case series of 50 pediatric patients with LCH of the spine treated at our hospital between 1984 and 2016, with a follow-up of at least 2 years, was analyzed. Sex, age, clinical and radiographic presentation, number of lesions, treatment, complications, and outcome were assessed. RESULTS: Fifty patients, 26 boys and 24 girls, were evaluated. Mean age was 5 years and 2 months (6 months to 13 years and 3 months). 27 patients had a single spinal lesion while 23 had 2 or more lesions. A total of 100 vertebrae were involved. The thoracic spine was the most affected. The most frequent lesion location was in the vertebral body in 88% of the cases. The symptoms were pain (87%), reduced range of motion, deformity, and neurologic deficit. Biopsy was performed in 48 patients. Thirty-nine patients received medical treatment, 28 used orthoses and six required surgery. Six patients (12%) recurred at a mean of 3 years and 5 months (range 2-12 years). In all cases, neurological symptoms, torticollis, and deformities resolved after medical or surgical treatment. CONCLUSIONS: Because of the variable presentation of the disease, ranging from a solitary isolated vertebral lesion to polyostotic and multisystemic involvement, a multidisciplinary team is required to have an adequate management of these patients and to obtain good results.

Surgical treatment of segmental spinal dysgenesis: a report of 19 cases.

STUDY DESIGN: Retrospective review. OBJECTIVE: To describe clinical presentation, surgical management, long-term results, and complications in patients with segmental spinal dysgenesis (SSD). In addition, we sought to emphasize early surgery for this complex congenital abnormality. SSD is a rare congenital malformation characterized by focal stenosis, spinal subluxation, kyphosis, and absence of the nerve roots. Neurologic function ranges from normal to complete paraplegia. Progression of the deformity and neurologic deterioration is the rule. METHODS: An independent spinal surgeon reviewed the complete records of 19 patients with SSD, between 1998 and 2015 at a single institution. Mean follow-up was 10 years and 6 months (2-14 years). RESULTS: We evaluated 11 males and 8 females, with a mean age of 2 years and 9 months (5 months-15 years). The dysgenetic segment involved an average of 2.9 vertebrae (1-5); the upper thoracic region was most commonly involved in ten cases. Fifteen patients had severe spinal stenosis. 14 patients presented neurological deficits and 15 patients had associated organ and musculoskeletal anomalies.Twenty-seven surgeries were performed, a mean of 1.76 procedures (1-5) to obtain solid fusion. Neurologic function improved in four, deteriorated in three, and remained unchanged in 12 patients Seven complications were recorded. CONCLUSION: We strongly recommend decompression and fusion as soon as possible to preserve or prevent neurologic deterioration. Although challenging, it was possible to achieve a solid instrumented fusion in all cases; however, a high rate of patients may deteriorate or not recover neurological status after surgery. LEVEL OF EVIDENCE: Level IV evidence.

Long-term results of hemivertebra excision: How does the spine behave after the peak of puberty?

INTRODUCTION: Early hemivertebra (HV) excision and posterior spinal fusion (PSF) is advocated as the treatment of choice in congenital kyphoscoliosis. We assessed global spinal balance and spinal deformity status once the pubertal peak has taken place, in children with a history of HV excision and PSF at age younger than 5 years. METHODS: Twenty-seven children with congenital kyphoscoliosis without co-existing proximal/distal congenital spinal abnormalities who underwent HV excision and PSF of ≤ 5 levels at age younger than 5 years and who had reached the peak of puberty at the last follow-up visit were evaluated. RESULTS: Twenty-seven HV excision were performed. Mean age at surgery was 3 years and 2 months. A mean of 3.2 segments were fused. Imbalance of the trunk was observed in 80% of thoracic and 75% of thoracolumbar HV excision. No arthrodesis technique (4 cases) presented 100% of spine decompensation. All children younger than 2 years at the time of surgery developed spinal imbalance. Eighteen patients (67%) had global spine imbalance; 81% male population and 63% of the female population. Mean age at surgery was 3 years + 2 months. Mean age of the patients at the time of the study was 15 years + 5 months. Mean follow-up was 12 years + 3 months. CONCLUSION: Many of these patients developed spinal imbalance and scoliosis worsened at the final follow-up. Early age at surgery, preoperative scoliosis severity, HV location, no arthrodesis technique, and the adding-on phenomenon may be involved.

Selective Fusion in Lenke 1 B/C: Before or After Menarche?

STUDY DESIGN: A retrospective, comparative study. OBJECTIVE: To determine the radiological behavior of the lumbar curve in selective fusions in premenarchal girls with adolescent idiopathic scoliosis (Lenke 1 B/C). METHODS: A retrospective, comparative study was conducted. Selective fusion was performed in 21 patients younger than 18 years. The patients were divided into 2 groups: group A, after menarche (n = 12) and group B, before menarche (n = 9). Angles (preoperative, and at 1 and 2 years postoperatively) of the fused thoracic curves and the corresponding lumbar curves were measured and compared. For statistical analysis, the t test was used with a significance level of P < .05. RESULTS: Mean preoperative angle value of the proximal/main thoracic curve was 61° in group A and 57° in group B (P = .44), and 21° and 20°, respectively, in the first year postoperatively (P = .61). Mean preoperative angle value of the lumbar curve was 43° in group A and 42° in group B (P = .87), while at 1 year after surgery, this curve was 19° in both groups (P = 0.91), and at 2 years postoperatively, the curve was 16° in group A and 17° in group B (P = .75). CONCLUSIONS: Over a 2-year follow-up, we did not find significant radiological differences in lumbar curves between patients who underwent surgery before and after menarche.

Infection Recurrence in Instrumented Spinal Fusion in Children.

STUDY DESIGN: Level 4 retrospective case series. OBJECTIVES: Surgical site infection (SSI) is one of the main complications of instrumented spinal fusion. The aim of our study was to evaluate infection recurrence (same bacteria) or reinfection (different bacteria) in posterior spinal fusion in children. METHODS: A retrospective study was conducted to evaluate patients who were successfully treated for SSI after instrumented spinal fusion due to deformity, with irrigation and debridement (I&D) procedures, followed by antibiotic therapy, with a follow-up of at least 2 years. RESULTS: Overall, 29 patients with a mean age of 14 + 3 years were evaluated. Preoperative diagnosis was nonidiopathic scoliosis in 23, idiopathic scoliosis in 5, and Scheuermann's disease in 1 patient. The etiology was Gram-positive cocci (40.9%), Gram-negative bacilli (27.2%), and polymicrobial infection (31.8%). A mean of 1.5 (1-3) I&D procedures were performed. Intravenous antibiotic treatment was given for a mean of 15.8 (4-86) days, followed by oral treatment for a mean of 335.1 (0-1095) days. Mean follow-up was 5 + 2 years (2 to 14 + 7 years) during which 28 patients were cured (96.6%) and 1 patient developed reinfection (3.4%). This reinfection was treated with oral clindamycin for 6 months. After the infection persisted, the decision was to remove the implants. CONCLUSIONS: In this series of 29 pediatric patients who underwent instrumented spinal fusion due to deformity, we reported one case of reinfection (3.4%). Given that 96.6% of infections were resolved, we suggest treatment with I&D procedures with retention of implants to treat acute SSI.

¿Cuál es el porcentaje de utilización de herramientas de evaluación de competencias quirúrgicas en las residencias de ortopedia y traumatología de la Argentina? / What is the percentage of use of surgical skills assessment tools in orthopedic and traumatology residencies in Argentina?

Objetivo: El objetivo primario fue conocer la actual aplicación de instrumentos de evaluación de competencias quirúrgicas en las residencias acreditadas por la AAOT (Asociación Argentina de Ortopedia y Traumatología). Como objetivos secundarios, se describieron los tipos de herramientas utilizadas, el conocimiento de los diferentes instrumentos de evaluación y qué tipo de evaluación se utiliza para la promoción de año. Se analizó si existen diferencias en las características entre las residencias que evalúan las competencias quirúrgicas y las que no. Materiales y métodos: Se realizó un estudio descriptivo, para lo cual se diseñó una encuesta enfocada en mostrar cuántas residencias evalúan las competencias quirúrgicas con una herramienta formal. Además, a través de ella, se logró responder a los objetivos secundarios. La encuesta se envió a los responsables docentes de las 123 residencias acreditadas por la AAOT. Resultados: Se obtuvieron 105 (85,4%) respuestas, el 59% utiliza algún tipo de herramienta para evaluar las competencias quirúrgicas. Solo el 12,9% de las herramientas utilizadas evalúan las competencias quirúrgicas en forma específica y el resto lo hace con un puntaje general. Un 61% conoce las herramientas disponibles. Para la promoción de año, la mayoría utiliza evaluaciones periódicas múltiples para competencias clínicas y quirúrgicas (63,8% y 67,6%, respectivamente). No hubo diferencias significativas en las características de las residencias que evalúan las competencias quirúrgicas y las que no. Conclusión: El 59% de las residencias implementa algún puntaje o formulario para evaluar las competencias quirúrgicas, solo el 12,9% las evalúa en forma específica, y el resto lo hace con un puntaje subjetivo global. Nivel de Evidencia: IV

Objective: The primary objective was to evaluate the current application of surgical competency (SC) assessment tools in residences accredited by the AAOT (Argentine Association of Orthopaedic and Traumatology). There was also interest in knowing the types of assessment tools used, the knowledge of the different evaluation instruments and what type of evaluation they use for the promotion of the year. We analyzed whether there were differences in the characteristics between the residences that evaluate the SCs and those that do not. Materials and methods: A descriptive study was carried out, for which a survey was developed focused on assessing how many residences evaluate the SCs with a formal tool. In addition, through the survey it was possible to answer the secondary objectives. It was sent to the chief of residency of the 123 accredited residencies. Results: 105 (85.4%) responses were obtained, 59% (62) used some type of tool for the evaluation of the SC. Only 12.9% (8/62) of the tools used evaluate the SC in a specific way but the majority assed them with a general score. 61% (64/105) know the tools available. for the promotion of the year, the majority use multiple periodic evaluations for clinical and surgical competencies (63.8% and 67.6% respectively). No significant differences were found in the characteristics of the residences that evaluate SC and those that do not. Conclusions: 59% of the residences implement some score or tool for the evaluation of SC, the majority perform the evaluation with a subjective global score. Only the 12.9% evaluate the SC specifically. Level of Evidence: IV

Crecimiento guiado con barras magnéticas en pacientes con escoliosis de inicio temprano. Reporte preliminar / Guided growth with magnetic rods in early onset scoliosis. Preliminary report

Introducción: El tratamiento de las escoliosis de inicio temprano guiado con barras magnéticas permite realizar distracciones no invasivas y ambulatorias. El objetivo de este estudio fue evaluar nuestra primera serie de casos con escoliosis de inicio temprano tratados con el sistema de barras magnéticas. Materiales y Métodos: Se realizó una revisión de casos tratados con el sistema de barras magnéticas entre 2014 y 2018. Se formaron dos grupos: grupo I (procedimientos primarios con barras magnéticas) y grupo II (conversiones de sistema tradicional a barras magnéticas). Resultados: Se evaluó a 19 pacientes. La edad promedio en el momento de la cirugía era de 7 años y 4 meses, con un seguimiento promedio de 2 años y 7 meses. El grupo I tenía 12 pacientes y el grupo II, 7 pacientes. Los valores angulares promedio preoperatorio y posoperatorio inmediato de la escoliosis fueron 62° y 42°, respectivamente; los de cifosis, 49° y 34°, respectivamente. La distancia T1-T12 fue de 160 a 176 mm. La distancia T1-S1 fue de 285 a 317 mm. Hubo una complicación: protrusión del implante e infección, y fue necesario retirar el material (grupo II). Conclusiones: Los resultados preliminares sugieren que es un método seguro y eficaz. Si bien los resultados a corto y mediano plazo son alentadores, persisten algunos desafíos importantes e incógnitas en relación con el comportamiento mecánico del implante en un seguimiento prolongado. Nivel de Evidencia: IV

Introduction: Early onset scoliosis (EOS) treatment with the magnetically controlled growing rod (MCGR) system allows for the use of non-invasive outpatient distractions. The purpose of this study was to assess our first series of EOS patients treated with MCGRs. Materials and methods: We conducted a review of EOS cases treated with MCGRs between 2014 and 2018. The study population was divided into two groups: Group I, patients undergoing primary MCGR insertion; Group II, patients undergoing conversion from conventional growth system to MCGR. Results: The study population consisted of 19 patients. The average age at the time of surgery was 7 years and 4 months, with an average post-operative follow-up of 2 years and 7 months. Group I consisted of 12 patients and Group II of 7 patients. The mean preoperative scoliosis angle was 62° and immediate postoperatively was 42°. The mean preoperative kyphosis angle was 49°and immediate postoperatively was 34°. The average preoperative T1-T12 length was 160mm and immediate postoperatively was 176mm. The average preoperative T1-S1 length was 285mm and immediate postop-eratively was 317mm. There was 1 late complication, an implant protrusion with an associated infection, in a neuropathic scoliosis patient (Group II) who required implant removal. Conclusion: Our preliminary results suggest that the MCGR system is a safe and effective method. Although the short- and medium-term results are encouraging, further studies are warranted to overcome important and unknown challenges regarding the mechanical behavior of the implant in the long term. Nivel de Evidencia: IV

Aneurysmal Bone Cysts of the Spine in Children: A Review of 18 Cases.

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim of this study was to evaluate the clinical presentation, treatments, outcome, complications, and recurrence rate in the surgical and nonsurgical management of spinal aneurysmal bone cyst (ABC) in a series of 18 pediatric patients. METHODS: Between 1988 and 2014, we evaluated 18 pediatric patients diagnosed with ABC confirmed by pathology studies. We analyzed clinical and radiological features, non-surgical and surgical treatment, outcome, and complications. RESULTS: The series included 12 male and 6 female patients with a mean age of 10 years and 4 months, with a mean follow-up of 5 years. Location of the ABC was lumbar in 8, cervical in 7, thoracic in 2, and sacral in 1 case. Axial pain was the most common symptom followed by radicular involvement. Surgery was performed in the presence of spine instability or neurological involvement (tumor resection) and in the remaining, nonsurgical treatment (percutaneous intralesional injection of methylprednisolone and calcitonin). Recurrence was observed in 4 patients requiring reintervention. There were no procedure-related complications. CONCLUSION: In patients without neurological involvement or spinal instability, nonsurgical treatment is the treatment of choice. Total or subtotal removal combined with posterior instrumented spinal fusion is recommended in cases with a neurological deficit. Both procedures have shown good long-term results.

Scoliosis in spinal muscular atrophy: is the preoperative magnetic resonance imaging necessary?

PURPOSE: To determine the prevalence of intraspinal alterations in scoliosis due to Spinal Muscular Atrophy (SMA). METHODS: Cross-sectional, observational, descriptive study. Fifty-six patients with SMA diagnosis required surgical treatment due to scoliosis. INCLUSION CRITERIA: scoliosis/kyphoscoliosis > 50 degrees in the coronal plane, clinical characteristics of Spinal Muscular Atrophy, accurate diagnosis by means of molecular or genetic study. Prior to the spinal surgery, and to find related intraspinal alterations, MRI of the spine and posterior cranial fossa was performed. RESULTS: Forty females, 16 males, mean age 11 years (range 6-14 years). 94% of the patients had Spinal Muscular Atrophy type 2. The mean angle value was 81 degrees (range 53-122 degrees) in the coronal plane and 62 degrees (range 35-80 degrees) in the sagittal plane. The prevalence of intraspinal alterations was 1.78%. One patient with cervical hydromyelia and no neurological surgical procedure prior to the spinal deformity surgery was reported. CONCLUSIONS: In the context of preoperative planning and strategy of patients with scoliosis due to Spinal Muscular Atrophy, MRI may have not to be requested.