[Sagittal Profi le of the Spine in Patients after Lumbar Stabilisation Surgeries]. / Sagitální profi l pátere u pacientu po stabilizacních operacích bederní pátere.

PURPOSE OF THE STUDY: Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients' preoperative diffi culties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated - especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients' clinical outcomes and diffi culties. MATERIAL AND METHODS: The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease - lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. RESULTS: In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically signifi cant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically signifi cant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A signifi cant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically signifi cant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignifi cant. DISCUSSION: The authors confi rmed signifi cant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confi rm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the fi ndings of other published manuscripts. The authors failed to confi rm a signifi cant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. CONCLUSIONS: Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically signifi cant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. KEY WORDS: sagittal profi le, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

[Surgical Treatment of Degenerative Lumbar Stenosis and Spondylolisthesis: Clinical Practice Guideline]. / Chirurgická lécba degenerativní lumbální stenózy a spondylolistézy: klinický doporucený postup.

PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.

[Reliability of the Evaluation of MRI Examinations after the Treatment of Chondral Defects in the Knee Joint]. / Spolehlivost hodnocení vysetrení na magnetické rezonanci po osetrení chondrálních defektu kolenního kloubu.

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.

[Two-Year Results of Modified AMIC Technique for Treatment of Cartilage Defects of the Knee]. / Dvouleté výsledky modifikované AMIC techniky v lécbe chondrálních defektu kolenního kloubu.

PURPOSE OF THE STUDY Damage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODS The prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTS The total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSION In recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obtained by other authors using both the original method and the modified AMIC technique. CONCLUSIONS The modified AMIC technique using the cell-free type I collagen-based implant appears to be a safe, accessible and onestage technique to treat localised chondral and osteochondral defects of the knee joint up to the size of 8 cm2. Key words: hyaline cartilage, chondral defect, AMIC, scaffold, knee.

[Current Options and Importance of Imaging of the Hyaline Articular Cartilage of the Knee Prior to the Surgery - a Different Perspective of an Orthopaedic Surgeon and a Radiologist]. / Soucasné moznosti a význam zobrazování hyalinní chrupavky kolenního kloubu pred operacním zákrokem ­ rozdílný pohled ortopeda a radiologa.

The authors present an overview of the commonly used techniques and new trends of the cartilage imaging, especially postoperatively, and also discuss the potential of MRI imaging of the cartilage from the perspective of an experienced orthopaedic surgeon. In conclusion, the authors propose possible explanations for the potential discrepancies between the MRI and the arthroscopic findings. Hyaline cartilage damage and subsequent reparation of this tissue is one of the topical issues of orthopaedics and traumatology. Due to the expanding possibilities of treatment of this tissue and a relatively good effect of the surgery, the number of patients indicated for magnetic resonance imaging prior to the surgery has been on an increase. To make a decision concerning the subsequent type of treatment, it is necessary to get an idea of the cartilage cover condition, articular surfaces and also of the associated pathologies. The degree of cartilage damage can be assessed by arthroscopy or magnetic resonance imaging, which provides also the possibility of the subchondral lesion detection. Thanks to the noninvasive nature of the MRI examination, it has become the most important method in full imaging of the articular cartilage. The MRI of the cartilage has many options and at present the evaluation of the hyaline cartilage should be an integral part of each MRI examination of joints. For a more accurate assessment of the cartilage there are several advanced techniques available that can be used not only for preoperative diagnostics, but also for monitoring after the surgery. Key words: hyaline cartilage, magnetic resonance, arthroscopy.

[Growth Guidance System in Treatment of Early Onset Scoliosis]. / Systémy usmernovaného rustu v lécbe raných detských skolióz.

PURPOSE OF THE STUDY The Growth Guidance System (GGS) represent a relatively new alternative to the traditional growing systems used for the treatment of early onset scoliosis. Ranking among the main aims of this surgical treatment is a three-dimensional correction of the deformity, maintenance of spinal growth and postponement of the necessity of final treatment by spondylodesis. MATERIAL AND METHODS Our study retrospectively evaluates the results of surgical correction in a group of 35 patients treated by GGS technique. The group consisted of patients with idiopathic, neuromuscular and syndromic spine deformity with the average age of 8 years and 2 months at the time of the surgery. The time of the follow-up is 3 years and 5 months on average. We evaluated the correction of the curve itself, the growth of the spine measured in the thoracic and lumbar part separately, and the growth of the trunk as a whole in the mentioned range on X-ray pictures. RESULTS The average correction of the scoliotic curve was 67%, from 75 preoperative degrees to 20 postoperative degrees. After the first operation 11% elongation of the trunk (from 321 mm to 356 mm) was reached, the thoracic spine was elongated by 10% (from 196 to 217 mm) and the lumbar spine was elongated by 11% (from 125 to 139 mm). The elongation of the trunk by 16% (from 322 to 375 mm) was observed in the cohort of patients with two years postoperative follow-up (21 patients). The total protraction of the trunk by 21% (from 318 to 386 mm) was reached in patients treated by definitive fusion (7 patients). DISCUSSION There is a very low number of studies analysing the long-term clinical results with the use of GGS. The first pilot results indicate that it is a technique allowing to achieve at least comparable results in correction of frontal plane compared with the distraction type of instrumentations. A negative aspect of this method is the abrasion of metal followed by metallosis. The new types of fixation screws enable more effective sliding of rods, maintenance of continuity of body grow by the shifting of rods as well as lower abrasion of the instrumentation. CONCLUSIONS The main advantage of GGS is the limited continuous growth of the spine, partial three-dimensional correction of the deformity, minimisation of inevitable reoperations under general anaesthesia and the possibility to quit a brace. Key words: growth guided system, early onset scoliosis, distraction, spinal growth, spondylodesis.

[Proximal Row Carpectomy - Five-Year Results]. / Proximální karpektomie ­ petileté výsledky.

PURPOSE OF THE STUDY This study aims to evaluate the results of patients treated by proximal row carpectomy at a follow-up of at least 5 years after the surgery. MATERIAL AND METHODS A total of 25 patients were treated by proximal row carpectomy for degenerative changes of the wrist as a consequence of the previous trauma or avascular necrosis of the lunate bone, of whom 21 patients underwent a follow-up examination at least 5 years postoperatively. Proximal row carpectomy was indicated in 15 patients for SLAC wrist, in 4 patients for avascular necrosis of the lunate bone, in 1 patient for SNAC wrist, and in 1 patient for inveterate dislocation of the wrist. The follow-up clinical and radiological examinations were performed at least 5 years after the surgery. The range of wrist motion, grip strength, presence of pain at rest or pain under loads, total clinical score according to the Green and O'Brien scoring system, patient satisfaction with the outcome of surgery were assessed. By fluoroscopy the range of wrist motion, degenerative changes of the radiocapitate joint, and translation of the capitate bone with respect to the distal radius were evaluated. RESULTS Postoperative improvements in the range of motion and grip strength were confirmed. Also, the pain relief at rest and under loads was achieved. Five years after the surgery, most of the patients (85.6%) reported an overall improvement. The total clinical score according to the Green and O'Brien scoring system improved from 35.8 preoperatively to 63.1 postoperatively. DISCUSSION The advantage of this procedure is a low percentage of complications, relative technical simplicity, maintenance of functional motion of the wrist, satisfactory grip strength, and pain relief. There are no complications related to the implant, no risk of a non-union. CONCLUSIONS As shown by our results obtained 5 years after the surgery as well as the published data, in the indicated cases the proximal row carpectomy is an appropriate surgical technique to treat the degenerative changes of the wrist. In most of the patients, favourable functional results and pain relief can be expected. Key words:proximal row carpectomy, SLAC wrist, SNAC wrist, avascular necrosis of the lunate bone, dislocation of the wrist.

[S2 Alar-Iliac Screws in Fixation and Correction of Combined Neuromuscular Spinal and Pelvic Deformities]. / S2 alar-iliac srouby pri fixaci a korekci kombinovaných neuromuskulárních deformit pátere a pánve.

PURPOSE OF THE STUDY Neuromuscular deformities of the spine represent surgically uneasy to solve problems as well as serious handicaps causing sitting instability, pressure ulcers as well as pain. The aim of our study is to conduct a retrospective clinical analysis of the results of surgical correction of these deformities. This paper presents the use of a recent technique of sacral-alar-iliac (S2AI) screws and its comparison with other techniques of pelvic stabilisation. MATERIAL AND METHODS The group of 41 patients treated surgically with S2AI screws technique and transpedicular or hybrid instrumentation of the spine consisted of patients with the primary diagnosis of muscular dysthrophy, spinal muscular atrophy, cerebral palsy and some other neuromuscular diseases. The results of pelvic obliquity correction and scoliotic correction in combined neuromuscular deformities of the spine and pelvis were analysed. The technique of S2AI screws implantation and the possibility of their free-hand technique implementation were presented. RESULTS In the followed-up group of patients an average correction of pelvic obliquity by 81% (from 29.1 degrees before the operation to 5.6 degrees after the operation) was reported. On average, 74% correction of scoliotic spine deformity was achieved (from 83.3 degrees before the operation to 22.5 degrees after the operation). In both the cases neither a significant loss of correction at the minimum one-year follow-up nor any serious complications associated with grappling of pelvic fixation were observed. DISCUSSION The S2AI screws offer at least the same stability and ability of correction as iliac screws and at the same time they provide significantly better results compared with the older methods of pelvic fixation such as the Galvestone technique. With a good knowledge of the surgical technique and anatomical aspects this technique can be applied in the form of a free-hand technique. Navigation as well as robotic techniques can help with the accurate positioning of the S2AI screw. Transfixation of sacroiliacal syndesmosis in patients with a neuromuscular handicap does not lead to deterioration of their mobility. CONCLUSIONS Simultaneous stabilisation of spine and pelvis makes it possible to achieve a good quality correction of the deformity and good clinical results over a long period of time. It allows for stability of the sitting position of the patients and improves the quality of their lives. Nowadays, the S2AI screws are considered to be biomechanically the best quality pelvic fixation, eliminating subcutaneous prominence of the instrumentation and reducing the risk of skin decubitus. Key words:neuromuscular deformity, sacral-alar-iliac screw, pelvic obliquity, stabilization, scoliosis.

[Scheuermann's Hyperkyphosis - Posterior-Only Surgical Approach Using the Smith-Petersen Osteotomies]. / Scheuermannova hyperkyfóza ­ operacní lécba solitárne zadním prístupem s vyuzitím Smith-Petersenových osteotomií.

PURPOSE OF THE STUDY Evaluation of efficiency and safety in surgically treated patients with Scheuermann hyperkyphosis using posterior-only surgical approach. MATERIAL AND METHODS Our study retrospectively evaluates the results of surgical correction in group of 20 patients with Scheuermann's hyperkyphosis, with an average age of 13 years and 8 month and with follow-up 4 years and 5 month. We evaluated changes of thoracic kyphosis as well as lumbar lordosis in correlation with surgical correction. Furthermore we compared ability of kyphosis to be corrected while performing reclination X-rays befroe surgery in comparation with rate of surgical correction. RESULTS The average correction of thoracic kyphosis was 52% - from preoperative 92° to postoperative 44°. We observed of 36% improvement of correction while surgically corrected in comparision with preoperative recklination X-ray pictures. Secondary correction of lumbar lordosis was from preoperative 84° to posoperative 55°. DISCUSSION Conservative treatment of hyperkyphosis offers only limited treatment results. Combined surgical approach with anterior release and posterior stabilization increase risk of anterior approach and secondary decreasing of lung capacity. Posterior vertberal osteotomies allows quality release and preparation for consecutive correction. Transpedicular instrumentation makes possible segmental correction of kyphotic spine using compression method. CONCLUSIONS Posterior-only surgical approach in combination with vertebral osteotomies allow efective and safe correction of hyperkyhosis in Scheuermann disease. Key words: Scheuermann, hyperkyphosis, transpedicular screws, osteotomy, posterior approach.

[The Use of BTB Allograft in Revision Reconstruction of the Anterior Cruciate Ligament and Its Success Rate in Terms of Subjective Patient Satisfaction]. / Úspesnost kadaverózních náhrad predního zkrízeného vazu kolenního kloubu se zamerením na subjektivní spokojenost pacientu.

PURPOSE OF THE STUDY A retrospective evaluation of the success rate of revision ACL reconstruction performed using BTB allograft in terms of the life expectancy of the procedure up to and over five years from surgery. MATERIAL AND METHODS Over a ten-year period, from 2003 to 2013, we performed 47 revision ACL reconstruction surgeries. The majority of the primary ACL reconstructions using BTB autografts were not performed at our site. The group observed included 16 women (34%) and 31 men (66%). The women were aged between 25 and 48 years, the median age being 32.5, and the men were aged between 25 and 46 years with the median age of 35. We were able to make a full pre- and post-operative evaluation of 22 out of 47 patients who underwent secondary ACL reconstruction surgery using a cadaverous BTB graft. This evaluation included an objective clinical testing and a subjective evaluation of the function and stability of the knee joint using the Tegner activity score, Lysholm score, and a modified Cincinatti score. The set of 22 patients was split into two groups: up to five years from revision surgery and over five years from the procedure. RESULTS In the group of patients who were fully evaluated within five years of revision reconstruction there was an average improvement of 16.4 points on the Cincinatti score, 19.9 points on the Lysholm score, and an upward movement averaging 1.5 levels on the Tegner activity score. In the over five years from surgery category the average improvement was 15.5, 15.9, and 1.2 levels upward movement, respectively. We were unable to prove a significantly increased level of failure in BTB allografts after five and more years from revision ACL reconstruction. DISCUSSION The two strongest factors affecting the life expectancy of ACL replacements are the age of the patient and the type of the graft used, allograft or autograft. The most at risk, in terms of how long the graft will last, is the age group of 10 - 19 years old. With each ten-year increase in age the risk of rupture is reduced more-or-less by half. Patients with ACL allograft replacement show a fourfold increased risk of the graft rupturing. The younger and more active the patient requiring revision ACL reconstruction is, the greater the need for an autograft. If an allograft has been used in revision reconstruction on an athlete, a great emphasis must be placed on the necessity of delaying the return to previous sporting activities for at least nine months. CONCLUSIONS The mid-term results of revision ACL reconstruction show that, subject to reasonable levels of stress, a correctly performed procedure using cadaverous BTB grafts is a good option to restore the stability of the knee joint over a period of five years and more from surgery. An increased incidence of reruptures or greater insufficiency of the cadaverous graft were not evident in our group after five and more years. The risk of cadaverous grafts failure is just like in the autologous replacement directly linked to the return to sport interval, frequency and intensity of stress to which the graft is subjected over a long period of time. The risk of rerupture is always higher in allograft reconstructions that have already stood in need of restructuring for a longer period of time. For this reason, a delay in returning to sports activity must be emphasized. As a rule, we recommend a return to full athletic training only after nine months to a year after surgery. Key words: anterior cruciate ligament, revision ACL reconstruction, tendon graft insufficiency, BTB autograft insufficiency, BTB allograft of the ACL, cadaverous BTB graft, ACL graft rerupture.

[Management of Osteochondral Lesions of the Ankle Joint by Implantation of Autologous Chondrocytes]. / Lécba osteochondrálních lézí hlezenního kloubu metodou implantace autologních chondrocytu.

UNLABELLED: PUPOSE OF THE STUDY The treatment of osteochondral lesions of weight-bearing joints remains a serious therapeutic challenge, largely due to the minimal ability of articular hyaline cartilage to regenerate. The authors present the long-term clinical and MRI results of treating deep chondral and osteochondral defects of the ankle joint by the method of implantation of autologous chondrocytes in the form of a solid chondrograft. MATERIAL AND METHODS The method of solid chondrograft implantation in the ankle joint was used in our Department from the year 2003. Between 2003 and 2013, this method was used in 31 patients, 16 men and 15 women. Their average age at the time of implantation was 29 years (16 to 50 years). The follow-up period ranged from 16 to 145 months (average, 57 months). The clinical outcome was evaluated using the Mazur questionnaire. At follow-up all patients underwent regular MRI examinations and the results were assessed on the basis of Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Twelve patients required a second-look arthroscopy. RESULTS A comparison of the Mazur pre-operative scores with those obtained at 1, 2 and 5 years post-operatively showed marked improvement of ankle joint function. The average pre-operative value of 30.0 (based on responses of 31 patients) increased to the average of 89.7 (based on results of 11 patients). At 1 year post-operatively, the average MOCART score for a group of 18 patients was 78.3; at 5 post-operative years, the average value for nine patients examined was 77.0. Complete filling of defects at 1 year of follow-up was found in 88.1% and , at 5 years, it was recorded in 83.3% of the patients examined. DISCUSSION The articular hyaline cartilage is a highly differentiated tissue and its ability of repair is very limited. Therefore every damage to the articular surface should be regarded as a pre-arthritic condition// disease. Currently, there are several options of treating a damaged articular cartilage, but none of them makes its complete healing certain. A lot of studies concerned with longterm results of implanting autologous chondrocytes in the knee are available in the literature, but only few authors present long-term clinical and radiographic outcomes of ankle joint treatment similar to ours. CONCLUSIONS Based on our clinical and MRI results, the method of autologous chondrocyte implantation can be recommended since it has good long-term results, provides repair of articular cartilage and allows for patients' return to activities of daily living. KEY WORDS: chondral defect, hyaline cartilage, autologous chondrocyte, ankle joint.

[Does an Independent Predictor of In-Hospital Mortality Exist for Patients with Isolated Proximal Femoral Fracture? A Retrospective Two-Year Observational Study]. / Existuje nezávislý prediktor nemocnicní smrtnosti pacientu s izolovanou frakturou proximálního konce femuru? Retrospektivní dvouletá observacní studie.

PURPOSE OF THE STUDY: The primary objective of the study was to find out in-hospital mortality in patients undergoing surgery for proximal femoral fracture. The secondary objective was to identify independent predictors of in-hospital mortality. MATERIAL AND METHODS: A retrospective single-centre observational study PROXIMORT of patients operated on for isolated proximal femoral fracture at the University Hospital (FN) Brno in the years 2011 and 2012. The 30-day and overall one-year mortality in the study group and the impact of observed parameters on mortality were also assessed. The observed parameters were: patient age and sex, ASA score, time from injury to surgery (hr), daily (7-20 hr) or night (20-7 hr) time of surgery, type of anaesthesia (general vs spinal), initial haemoglobin and haematocrit levels, intra-operative administration of blood products and vasopressors, and erudition of the anaesthesiologist and surgeon. To evaluate the relationship of in-hospital mortality to the observed characteristics, we used univariate logistic regression modelling and odds ratio, using SPSS 22 software (IBM, USA). RESULTS: Data were obtained from 414 patients and 369 patients were included (male, n = 91; female, n = 278). Due to exclusion criteria, 45 patients were excluded (not an isolated injury). In-hospital mortality was 6.5% (n = 24), 30-day mortality was 8.4% (n = 31) and total mortality of the study group was 35.8% (n = 132). Statistically significant effects on in-hospital mortality included: older age of the patient (p = 0.013), ASA score of 3 or more (p = 0.002) and general anaesthesia administration (p = 0.043). For 30-day mortality, this was older age (p = 0.012), ASA score of 3 and more (p < 0.001), general anaesthesia administration (p < 0.001), lower weight (p = 0.028), lower BMI (p = 0.006) and intra-operative administration of vasopressors (p = 0.023). The influence of other observed parameters on post-operative mortality was not statistically significant. DISCUSSION: In-hospital mortality in the PROXIMORT study was 6.5% (95% confidence interval (CI) 4.2 to 9.5%), which was significantly higher than in-hospital mortality in unselected surgically treated patients in the Czech Republic, as reported in the EuSOS study (2.3% with 95% CI 0.9 to 3.7%). Administration of general anaesthesia was determined as an independent predictor of in-hospital and 30-day mortality, which was concordant with the results of meta-analysis published by Rodgers et al. and Barbosa et al in 2013. Postponing surgery for perioperative optimisation had no effect on mortality according to the PROXIMORT study. Patorn et al. have supported this conclusion by the results of a selected group of patients with surgery delayed for more than 24 hours; the patients mortality, regardless of anaesthesia, was up to 2.5%. CONCLUSIONS: The PROXIMORT study identified the higher patient age, ASA score of 3 and more and general anaesthesia administration as independent predictors of in-hospital mortality.

[Long-term results of surgery for cervical spondylotic myelopathy using open-door laminoplasty]. / Dlouhodobé výsledky operacního resení cervikální spondylogenní myelopatie pomocí "open-door" laminoplastiky

PURPOSE OF THE STUDY Cervical spondylotic myelopathy (CSM) is a serious disease which, in its advanced form, can markedly disable the patient. The aim of the present work was a prospective evaluation of a group of CSM patients treated by open-door laminoplasty. MATERIAL AND METHODS We evaluated 89 patients (59 men and 30 women; average age, 62 years; range, 39 to 81 years) who underwent surgery in the years 2001 to 2011. The average follow-up was 76 months. The patients were examined neurologically, radiologically, by magnetic resonance imaging (MRI) or CT. All of them had quadruparetic disability and showed signs of myelopathy on MRI examination. We used a modified Hirabayashi technique of open-door laminoplasty. We evaluated the surgery time, intra-operative blood loss, neurological deficit on the modified Japanese Orthopaedic Society (mJOA) scale, intra- and postoperative complications, neck pain (NP) and extremity pain (EP) on the visual analogue scale (VAS) and a radiographic sagittal profile change after laminoplasty. RESULTS The average operative time was 117 minutes and the average intra-operative blood loss was 330 ml. The average mJOA score of 12.7 before surgery improved to 14.4. Two patients (2.25 %) showed persisting deterioration of neurological symptoms, conditions of six patients (6.75 %) were assessed as stable and the remaining 81 patients (91 %) showed varying degrees of both subjective and objective amelioration/improvement. Infection was recorded as the most frequent complication (7.8 %). C5 paresis reported in the literature did not occur in our group. One patient (1.1 %) had a moderate epidural haemorrhage. The pre-operative VAS NP score of 5.4 improved to 3.2 and the VAS EP score of 7.7 improved to 4.4. The average value for the radiographic sagittal profile changed from -18.2 pre-operatively to -16.5 post-operatively. CONCLUSIONS Laminoplasty remains the basic surgical option for CSM treatment, particularly in progressive cases of the disease, in multi-segmental disease, and in need to preserve or restore cervical spine alignment Key words: cervical spondylotic myelopathy, laminoplasty, Hirabayashi open-door technique, mJOA score, complications, VAS.

[Most frequent causes of autologous graft failure in anterior cruciate ligament replacement]. / Nejcastejsí príciny selhání autologních náhrad predního zkrízeného vazu kolenního kloubu.

PURPOSE OF THE STUDY: The aim of this retrospective study was to present a comprehensive overview of the causes of bone-tendon-bone (BTB) autograft failure after primary anterior cruciate ligament (ACL) reconstruction. MATERIAL AnD METHODS: Between 2003 and 2013, we performed revision ACL replacement in 47 patients who had undergone primary BTB autograft ACL reconstruction in other hospitals. The group consisted of 16 women (aged 25 to 48 years) and 31 men (25 to 46 years). Surgery was performed on the right knee in 26 and on the left knee in 21 patients. In each of the 47 patients, two different assessments were made: 1. Analysis of causes of failure based on surgical protocols and/or intra-operative video records taken during most of the procedures. 2. Evaluation of bone tunnel location on lateral knee radiograms, using the method described by Harner for femoral tunnels and that reported by Stäubli and Rauschning for tibial tunnels. RESULTS: The most frequent cause of knee instability, occurring in 51.1% of the patients, was new trauma to the knee. nontraumatic instability in the remaining 48.9% was due to insuffiiency of the graft, and resulted from an incorrect surgical technique (42.5%) or biological causes (6.4%). The most common surgical mistake found was incorrect bone tunnel placement in the tibia or femur, with a malpositioned femoral tunnel being most frequent. This was diagnosed in 32 patients (68.1% of all patients) and, in 17, was the main or major cause of BTB graft failure. DISCUSSION: Based on relevant literature data and our experience, principles for prevention of graft failure after ACL reconstruction can be summarised as follows: 1. harvest of a suffiiently strong BTB autograft 2. accurate anatomical bone tunnel placement 3. appropriate tension of the BTB autograft 4. preventing graft impingement 5. secure graft fiation 6. early functional rehabilitation with an accent on delaying full weight-bearing on the knee (6 to 9 months post-operatively) CONCLUSIONS: New trauma to the knee is the most frequent cause of BTB autograft failure after ACL reconstruction. This can be avoided by participating in a professionally guided rehabilitation programme and not returning to sports activities earlier than 9 months after ACL reconstruction. The most common technical error in ACL reconstruction is non-anatomical tunnel placement in the tibia and femur. Femoral tunnel malposition is most frequent while incorrect tibial tunnel placement, which does not inflence graft failure so much, is less common.

[Comparison of two surgical methods for treatment of idiopathic thoracic scoliosis - anterior versus posterior approaches]. / Srovnání výsledku dvou typu operacního lécení idiopatických hrudních krivek - prední versus zadní výkon.

PURPOSE OF THE STUDY: The aim of this retrospective randomised study is a comparison of two surgical approaches (anterior versus posterior) for the treatment of idiopathic thoracic scoliosis by corrective spondylodesis with segmental instrumentation in adolescents aged 13 to 20 years. MATERIAL AND METHODS: The study included patients with right-sided idiopathic thoracic scoliosis (Cobb's angle, 40°-70°; Lenke type I). The group of patients treated from the posterior approach by fusion and segmental instrumentation, involving the use of a hybrid, tworod system or screws only, comprised 31 girls with an average age of 14.5 years (group 1). In this group three instrumentation systems were used. The patients treated from the anterior approach, which included thoracotomy for disc excision, fusion and segmental instrumentation with a one- or two-rod system, consisted of 25 girls and six boys with an average age of 15.3 years (group 2). In this group four instrumentation systems were employed. In all patients radiographs were evaluated before surgery, immediately after the procedure and then every 12 months. The evaluation also included the operative time, blood loss, length of hospital stay, hospital costs and complications. The random selection was based on casting lots. Some patients indicated for the anterior approach withdrew after receiving detailed information on this procedure and therefore patients operated on from the anterior approach before the study had begun were enrolled. The statistical comparison of the results of anterior and posterior procedures was made using the two-sample t-test or Wilcoxon's test. The Shapiro-Wilk test was used for normality testing and Fisher's F-test for the equality of variances. The paired t-test or non-parametric paired Wilcoxon's test was employed for testing two variables within each group. The level of significance was set at 0.05. RESULTS In group 1, anteroposterior radiographs showed, on the average, 54.3° before surgery, 18.7° immediately after it and 19.1° at one year after surgery. The sagittal profile before surgery was T5 +30.0° T12 -57.7° S1; the surgery resulted in reducing thoracic kyphosis by 9.5° and lumbar lordosis by 14.2°. The average operative time was 245.8 min, intra-operative blood loss was 1095.2 ml and drained blood loss was 636.9 ml. The average hospital stay lasted 10.2 days. In group 2, anteroposterior radiographs had the average values of 53.7° pre-operatively, 23.6° post-operatively and 25.9° at one year after surgery. The pre-operative sagittal profile was T5 +21.5° T12 -54.2° S1 and, post-operatively, thoracic kyphosis increased by 7.0° and lumbar lordosis decreased by 2.2°. The average operative time was 226.8 min, intra-operative and drained blood losses were 1095.2 ml and 636.9 ml, respectively, and length of hospital stay was 15.5 days.. In group 2, the operative time and intra-operative blood loss were lower and post-operative drained blood loss (due to longer duration of chest drainage) was higher than in group 1. All findings were statistically significant. Significant differences between the groups were also found in the costs of implants and hospital stay because, for the posterior approach, they were higher by a total of 68 466 CZK and 52 250 CZK, respectively. DISCUSSION: In the frontal plane, thoracic kyphosis corrections through either surgical approach are comparable; in the sagittal plane, surgery from the posterior approach results in reducing thoracic kyphosis and that from the anterior approach produces a mild increase in it. CONCLUSIONS: In terms of surgical treatment selection, the anterior approach is more economical and requires spinal fixation and instrumentation to a lesser extent. However, prolonged chest wound drainage results in a longer hospital stay. The majority of idiopathic scoliosis cases are indicated for a posterior approach. In scoliosis with marked hypo-kyphosis or lordosis, an anterior approach can be considered because it produces an increase in thoracic kyphosis.

[Treatment of deep cartilage defects of the knee with autologous chondrocyte transplantation: long-term results]. / Lécba osteochondrálních defektu kolenního kloubu metodou implantace solidního chondrograftu - dlouhodobé výsledky.

PURPOSE OF THE STUDY: The authors present the long-term results of surgical treatment of deep chondral defects of the knee (medial or lateral femoral condyle). They used the transplantation of autologous cultured chondrocytes in the form of a solid chondral graft. MATERIAL AND METHODS: Indications for autologous chondrocyte transplantation most frequently included acute trauma to the knee. Patients with chondral lesions categorized as grades IIIa and IIIb by the Noyes-Stabler classification were indicated for this treatment. A small sample of healthy cartilage was harvested arthroscopically from the non-weight-bearing area of the knee and was sent to the Tissue Bank for chondrocyte cultivation. After 4 to 5 weeks the cultured chondrocytes were formed into a solid chondral graft, implanted at the damaged site of the medial or lateral femoral condyle and fixed with fibrin glue (Tissucol). RESULTS: Fifty-two patients, 34 males and 18 females (average age, 29 years range, 17 to 45 years) were treated using this method in the period from 2001 to 2009. Follow-up was 6 to 84 months, with an average of 46 months. Thirteen patients were examined by magnetic resonance imaging (MRI) 7 to 39 months (average, 19 months) after the implantation. Full incorporation the chondrograft was observed in 12 patients (92.3%). The clinical results were evaluated by the Lysholm scoring system (1, 2 and 5 years after the operation) and showed significant improvement. In 24 patients, the chondrograft quality was evaluated by immunohistochemical methods in samples taken by second-look arthroscopy from the borders of implantation sites. Hyaline chondral tissue was detected in 100% samples by microscopic examination, and collagen type II was present in 100% samples examined by imnunohistochemistry using haematoxylin-eosin staining. CONCLUSIONS: A significant improvement in knee function was recorded when the pre-operative and final follow-up stages were compared. The autologous chondrocyte transplantation showed a potential for the treatment of large cartilage defects. The excellent results achieved allowed the patients to return to normal activity levels.This method is also convenient when ligament reconstruction is necessary during one operation.

[Dynamic neutralization using the Dynesys system for treatment of degenerative disc disease of the lumbar spine]. / Osetrení degenerativního onemocnení bederní pátere metodou dynamické neutralizace systémem Dynesys.

PURPOSE OF THE STUDY: Degenerative disc disease (DDD) is a spinal condition resulting from degeneration of the intervertebral discs. It is associated with symptoms of sciatica, back pain and leg weakness and also with degenerative instability of the spine. To arrest the degenerative cascade of disc disease, and taking into consideration stress placed on the adjacent discs managed by decompression and stabilisation by instrumented fusion, the lumbar spine was treated by dynamic posterior stabilisation of the segments affected. Based on the classification described by Dubois et al., the Dynesys system was used. The aim of this study was to evaluate the mid-term results of this method in DDD patients. MATERIAL AND METHODS: In the 2002-2007 period, 102 patients (65 men and 37 women; average age, 54 years) underwent surgery for problems due to DDD manifested by pain, neurological findings and radiographic evidence of degenerative changes in the spine. The classification of age-related changes, as described by Dubois et al. and Kirkaldy-Willis, showed that type 4 and type 6 of DDD (64% disc degeneration with spinal canal stenosis) were most common. After surgery using the Dynesys system, the patients were followed up for an average of 36 months. Patient examination included: pre- and post-operative medical history, clinical, radiographic (including magnetic resonance imaging/MRI) and neurological examination, and the pain and functional status assessment using the visual analog scale (VAS) and Oswestry disability index (ODI), respectively. A total of 146 lumbar spine segments were surgically treated in 102 patients, the L4-L5 segment being treated most frequently, with a total of 61 interventions at this level. Radicular pain before surgery was reported by 40 patients. The average operative blood loss was 1013.8 ml and patients stayed in the hospital for an average of 13.8 days. There were 15 post-operative complications treated. After surgery, the patients participated in a. special rehabilitation programme and were allowed full weight-bearing after 3 months. RESULTS: At 36 months of follow-up, the improvement as against the pre-operative condition included a drop in the average VAS value from 7.3 to 4.7 and that in the average ODI from 54.5 to 39.9. The results were statistically analysed using ANOVA software and the t-test and Bartlet test (level of significance set at 0.05). The improvement in the patients' health status was statistically significant during all 3-year post-operative period. As shown by the MRI findings obtained from repeated examination in 26 patients, the use of the Dynesys system resulted in the post-operative disappearance of disc bulging and the restoration of the posterior longitudinal ligament and space in the lumbar spinal canal. The surgery had no positive effect on disc regeneration, but improved peridiscal marrow oedema of that lumbar segment in the way described by Modic et al. DISCUSSION: In patients with DDD, stabilisation of the lumbar spine by instrumented rigid fusion often results in increased biomechanical stress and damage to the segments adjacent to the area of fusion. The use of dynamic stabilisation devices, including the Dynesys system, reduces this potential risk. The Dynesys system is also effective in the treatment of DDD combined with spinal stenosis in elderly patients, as reported by other authors. A certain risk associated with Dynesys use may lie in disc height reduction in the anterior segment by up to 0.7 mm, thus producing a fulcrum pin effect. Despite this risk factor, dynamic stabilisation in DDD patients will considerably improve the quality of their lives. CONCLUSIONS: The results of 102 patients, with 146 segments treated by posterior dynamic neutralisation using the Dynesys system, show that this method improved subjective feelings, morphological findings and pain and functional status in the patients with DDD in the three-year post-operative period. This had a good effect on the quality of life in these patients.

[Quality of life in the patients treated for degenerative lumbar spinal stenosis: a three-year follow-up study]. / Kvalita zivota u pacientu po operaci degenerativní spinální stenózy bederní pátere po 3 letech sledování.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the quality of life in patients treated for degenerative lumbar spinal stenosis at 3 years of follow-up. MATERIAL AND METHODS: Between October 2005 and 2008, answers to Oswestry, quality-of-life (SF-36) and VAS questionnaires were obtained from 117 patients indicated for lumbar spine surgery due to spinal stenosis. There were 52 men and 65 women, with an average age of 62 years. For future evaluation, the patients were placed into three groups according to the surgical treatment used: simple decompression with posterolateral fusion using autograft (69 patients); decompression and instrumented posterior fusion completed with autograft (21 patients); decompression and posterior dynamic stabilisation using the Dynesys system (27 patients). The patients were asked to respond to the three questionnaires again at 6, 12, 24 and 36 months of follow-up and to rate their willingness to undergo the surgery again on a 1-to-5 scale (from definitely yes to definitely no). RESULTS: In all three groups, the Oswestry disability index (ODI) significantly improved from the average pre-operative value of 53 to 39 post-operatively. This remained constant at 12 months (ODI 38), 24 months (ODI 38) and 36 months (ODI 37) after surgery. The SF-36 questionnaire also showed significant improvements in both categories covering components of physical and mental health. The VAS-based assessment of satisfaction with life and back and leg pain, however, did not provide such convincing results. The marking of satisfaction with surgery outcome was 1-2 in 71 % of the patients, and "only" 9.5 % of them would have never undergone the surgery again (marked 5). The L4-L5 segment was the most frequently treated region, and monosegmental decompression with fusion was the technique used most often. DISCUSSION: Our results are in agreement with the data reported in the national and international literature, including the number of patients studied and the results obtained from the Oswestry and SF-36 questionnaires. The assessment of life satisfaction using the VAS score has not been found in the literature. Our VAS back pain and leg pain scores slightly differed from the literature data, since no significant improvement in them was recorded. In assessing the patient's quality of life after lumbar spinal surgery, it is necessary to take into consideration also co-morbidities and external factors. CONCLUSIONS The results presented here show that lumbar spine surgery results in a significant improvement of life quality and has an irreplaceable role in the treatment of patients with degenerative spinal disease. However, three-year results do not provide enough evidence of the real stabilisation of patients' health state and thus the follow-up study is to be continued.

[Neurological findings in patients treated surgically for spinal metastatic disease]. / Zhodnocení neurologických nálezu u pacientu operovaných pro metastatické postizení pátere.

PURPOSE OF THE STUDY: We present a group of patients with spinal metastatic disease surgically treated at our department, with an evaluation of their neurological outcomes in relation to the initial disease and the surgical technique used. MATERIAL: Between 1989 and 2007 we operated on 748 patients with spinal tumour. Of these, 380 had metastatic disease. The Frankel classification system was used to assess neurological status. METHODS: Based on the Tomita prognostic score, the metastatic disease was evaluated and appropriate surgical procedure was selected (biopsy, posterolateral decompression, posterolateral decompression with stabilisation, somatectomy, or vertebrectomy/spondylectomy). The neurological findings before and after surgery and at follow-up were assessed. RESULTS: Of the 368 patients evaluated, four were pre-operatively classified as Frankel grade A, 29 as grade B, 99 as grade C, 82 as grade D and 159 patients as grade E. Post-operative outcomes were: Frankel grade A, 6 patients B, 27 C, 78 D, 79 and E, 178 patients. Surgery resulted in neurological deterioration by 3 degrees of the Frankel scale in two patients (0.5%), 2 degrees in three patients (0.8%), and by 1 degree in 17 patients (4.6%). Improvement was recorded: by 1 degree in 57 patients (15.5%), 2 degrees in 10 (2,7%) and 3 degrees in two patients (0.5%). Of 23 patients who underwent biopsy, neurological status improved in one (4.3%) and deteriorated also in one patient (4.3%). Of the 85 patients treated by posterolateral decompression, improvement was recorded in 25 (29.4%) and deterioration in two (2.4%). Of the 73 patients undergoing posterolateral decompression with stabilisation, neurological findings improved in 15 (17.9%) and deteriorated in five (6.0%). In the group of 103 patients treated by vertebrectomy, neurological findings improved in 13 (12.6%) and deteriorated in eight (7.8%). At an average follow-up of 15 months, 208 (55.7%) patients presented themselves of these, improvement in neurological status was recorded in 16 (7.8%) and deterioration in eight (3.9%), as compared with the pre-operative values. DISCUSSION: Any comparison with the literature data is difficult, because both the criteria of indication for surgery and the method of treatment differ considerably. Improvement in neurological status was achieved in 69 patients (18.8%). CONCLUSIONS: Metastatic tumours of the spine present a serious diagnosis, with pain often being the first sign of a malignant disease. The degree of neurological deficit, primary tumour site and the extent of metastatic spinal disease (objectively evaluated on the basis of the Tomita score) should determine whether the patient will be operated on or not and, if so, whether a radical or mere palliative procedure will be used. An important factor is multidisciplinary cooperation of attending physicians both preoperatively and during the post-operative care of cancer patients.

[Simple bony fusion or instrumented hemivertebra excision in the surgical treatment of congenital scoliosis]. / Prostá kostená fúze versus instrumentovaná hemivertebrektomie v operacní lécbe kongenitálních skolióz.

PURPOSE OF THE STUDY: In a retrospective study, to analyze long-term radiographic results of two surgical procedures used to treat congenital scoliosis. MATERIAL AND METHODS: A total of 685 patients with congenital scoliosis were treated at the Department of Orthopaedic Surgery, Bohunice Teaching Hospital in Brno, between 1976 and 2007. Of these, 102 patients, with an average age of 6.6 years at the time of surgery, were treated by simple bony fusion, and 22 children, with an average age of 10.2 years, underwent instrumented hemivertebra excision via simultaneous anterior and posterior exposures involving fixation with cannulated compression screws and a wire loop. The follow-up periods for the former and latter groups were 14.2 and 12.1 years, respectively. RESULTS: In the patients treated by simple bony fusion, the mean correction rate was 22.1 %, with Cobb angle values averaging from 44.2 degrees pre-operatively to 38 degrees post-operatively; the correction loss was 3.9 degrees at the last follow up. In the patients with hemivertebra excision, the mean correction rate was 61 %, with pre- and post-operative values of 51.3 degrees and 20.3 degrees , respectively, and a correction loss of 1.1 degrees at the last follow-up. DISCUSSION: The early detection of a deformity and simple bony fusion in low-magnitude curves can prevent progression of scoliosis and allows for maintenance of a compensated spine. Hemivertebra excision with compression instrumentation results in a better surgical correction of the deformity. The average 61 % correction rate achieved in our patients is in agreement with the results reported by authors using the same surgical technique, as well as with the results of posterior hemivertebra resection. The best correction, 78 %, has been achieved with surgery at a very young age. Complications associated with the two techniques are rare. CONCLUSIONS: Congenital scoliosis due to failure off either formation or segmentation is indicated for surgical treatment at young age. Its early detection and subsequent surgical treatment at young age. Its early detection and subsequent surgical correction of the curve result in a long-term maintenance of a compensated spine. Instrumented hemivertebra excision provides the highest rate of correction, particularly if carried out before 3 years of age.