The prevalence and anatomy of accessory navicular bone: a meta-analysis.

PURPOSE: There have been over 40 descriptions of the common developmental variants of the accessory ossicles of the feet. Although predominantly asymptomatic, they sometimes may be linked to painful conditions. One of the most common accessory ossicles in the foot is the accessory navicular bone (AN), located on the medial side of the foot. Our research provides a first meta-analysis on this topic that establishes its frequency by contrasting 39 studies from across the globe. METHODS: Up to February 2024, PubMed and Embase databases were thoroughly searched for research on the AN. Eligible data regarding AN prevalence was extracted. This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 39 studies, 11,015 patients, and 36,837 feet were analyzed in our study. The pooled prevalence estimate (PPE) of AN was found to be 17.5% (95%CI: 11.5-25.7) and 12.6% (95%CI: 10.1-15.5) in patients and feet analyses, respectively. Accessory navicular occurred bilaterally in 50.0% of patients, with similar distribution in gender-based groups (21.1% of males and 22.0% of females were confirmed with AN). Accessory navicular was most prevalent in the East Asian population (38.4%) and least prevalent in North Americans (8.0%). No significant differences in AN prevalence were found when comparing different imaging modalities (X-ray and cadaver dissection). CONCLUSION: Accessory navicular is a common finding in imaging studies. Its prevalence depends on the population covered by the study but is not affected by the patient's gender or the imaging modality utilized for AN assessment.

Prevalence and characteristics of lumbar ribs: a meta-analysis with anatomical and clinical considerations.

BACKGROUND: Lumbar ribs (LR) are a rare and relatively unknown anatomical abnormality of the lumbar spine. The literature provides better understanding regarding other spinal congenital variations like cervical ribs or lumbosacral transitional vertebrae, which are rather commonly recognised conditions. Thus, this meta-analysis aimed to provide data on prevalence and key characteristics of LR. METHODS: Relevant databases were systematically searched for studies reporting the prevalence, laterality and geographic distribution of LR. No exclusion criteria based on language and date of original articles were employed. The pooled prevalence estimates (PPE) were calculated using a random-effects model. To assess the between-study heterogeneity, the I2 statistic and Chi-square test were utilized. Throughout the investigation, the PRISMA guidelines were adhered to scrupulously. Evaluation of the included studies' reliability was made with the AQUA tool. RESULTS: In total, 9 studies were included in this meta-analysis. The pooled prevalence estimate (PPE) of LR was 2.1% (95%CI: 1.0-4.6). In studies based on CT imaging, LR were found in 1.6% (95%CI: 0.6-4.3) of patients and in Xray based studies in 2.1% (95%CI: 0.4-11.1) of patients. Lumbar ribs were bilateral in majority of individuals (65.4%, 95%CI: 39.4-84.6) and could be most frequently encountered in Europe with PPE of 2.8% (95%CI: 3.0-20.0), then in East Asia with PPE of 1.5% (95%CI: 1.0-19.2) and Middle East with PPE of 1.1% (95%CI: 0.6-20.0). CONCLUSIONS: The findings of our study indicate that LR are a common anatomical variation of lumbar spine, contrary to previous beliefs. In a clinical practice, when a patient presents with a non-specific low back pain, a possible occurrence of LR should be taken into consideration. The presence of LR may be misleading for surgeons and result in wrong-level spine surgeries.

Anticytokine Treatment of Rheumatoid Arthritis: An Observational Report.

Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology, characterized by symmetrical arthritis, and deterioration of articular cartilage and epiphyses leading to progressive destruction and deformation of joints, resulting in disability. The purpose of this chapter is to evaluate the effects of treatment with anti-inflammatory biologic medication, Enbrel (Etanercept), during therapeutic rehabilitation in RA patients. The sample comprised 10 hospitalized patients (8 females and 2 males) of the mean age of 32.2 ± 13.4 years treated with Enbrel in 2008-2010. The drug was administered subcutaneously in a dose of 50 mg once a week. Outcomes consisted of differences in the Disease Activity Score (DAS-28) and the degree of joint impairment based on the Health Assessment Questionnaire (HAQ) noted 2 months after treatment onset. The average pre-/post-treatment DAS-28 score was 4.1/2.6, with improvement in 9 patients. The average HAQ score was 1.5/0.6, respectively. We conclude that treatment with Enbrel significantly reduces RA activity and improved joint impairment. The beneficial influence of the drug enabled an earlier commencement of physical rehabilitation, which may have a preventive bearing on the development of disability.

Investigation of Impact of Walking Speed on Forces Acting on a Foot-Ground Unit.

Static and dynamic methods can be used to assess the way a foot is loaded. The research question is how the pressure on the feet would vary depending on walking/running speed. This study involved 20 healthy volunteers. Dynamic measurement of foot pressure was performed using the Ortopiezometr at normal, slow, and fast paces of walking. Obtained data underwent analysis in a "Steps" program. Based on the median, the power generated by the sensors during the entire stride period is the highest during a fast walk, whereas based on the average; a walk or slow walk prevails. During a fast walk, the difference between the mean and the median of the stride period is the smallest. Regardless of the pace of gait, the energy released per unit time does not depend on the paces of the volunteers' gaits. Conclusions: Ortopiezometr is a feasible tool for the dynamic measurement of foot pressure. For investigations on walking motions, the plantar pressure analysis system, which uses the power generated on sensors installed in the insoles of shoes, is an alternative to force or energy measurements. Regardless of the pace of the walk, the amounts of pressure applied to the foot during step are similar among healthy volunteers.

Inter-observer and intra-observer reliability in the radiographic measurements of paediatric forefoot alignment.

BACKGROUND: Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric forefoot angle measurements. MATERIAL AND METHODS: Six forefoot angles in 34 AP standing paediatric foot radiographs were measured by 5 researchers. A classic statistical analysis with use of IBM SPSS Statistics 25 was performed and a new method with two-way analysis of variance was applied. RESULTS: Results of statistical analysis revealed the properties of a subjective assessment related to specific angles. Kilmartin's angle, calcaneus-fifth metatarsal angle and first ray angle are the most reliable; metatarsus adductus angle should be used with great caution in pediatric population. Engel's angle is the most difficult for measuring and measurement error is the highest. CONCLUSION: The power of paediatric forefoot measurements is various. Several angles are reliable, while Engle's angle is the most doubtful.

Effect of Preoperative SpineCor® Treatment on Surgical Outcome in Idiopathic Scoliosis: An Observational Study.

BACKGROUND Idiopathic scoliosis is a three-dimensional deformity of the spine. We investigated the effect of preoperative treatment with SpineCor® dynamic brace on the efficiency of surgical correction from a posterior approach in adolescent idiopathic scoliosis. MATERIAL AND METHODS This was a retrospective observational study. Participants were 53 girls who underwent surgery from posterior approach due to idiopathic adolescent scoliosis, divided into a study group (Group A, 27 girls) and a control group (Group B, 26 girls). Girls in the study group had previously undergone treatment with the SpineCor® brace. Outcome measures were amount of correction and coronal balance based on anteroposterior plain radiographs obtained prior to surgery, at 1 week after surgery, and at 12 months after surgery. RESULTS In both groups, satisfactory deformity correction was achieved after surgery (Group A, 73%±12 vs. Group B, 68%±16) and at 12-month follow-up (75%±12 vs. 68%±12, respectively), with no statistically significant differences identified. Directly after surgery, patients preoperatively treated with the SpineCor® brace displayed smaller coronal balance deviation compared with the preoperative measurement, with significant differences in the outcome achieved at 1 week after surgery in Group B. At 12-month follow-up, both groups had significant coronal balance improvement. CONCLUSIONS This is the first study assessing the effect of dynamic brace treatment on scoliosis surgery. The study shows that a history of preoperative treatment with the SpineCor® dynamic brace does not affect the amount of the achieved correction of AIS directly after surgery or at 12-month follow-up, but it does facilitate faster restoration of normal coronal balance.

Quantitative Analysis of Foot Plantar Pressure During Walking.

BACKGROUND There are many methods of dynamic analysis of foot loading, however, we still need a simple, easily applicable system for foot plantar pressure analysis. In this study we asked the question: "Can a new system for foot evaluation, the ITE System, provide a good quantitative dynamic foot pressure analysis? Can it be used in clinical practice?". MATERIAL AND METHODS Twenty healthy volunteers, 8 females and 12 males, aged 20 to 25 years old took part in this study. Normal static foot loading was tested using a typical pedobarographic platform, followed by a dynamic analysis using the foot-pressure ITE System. A new algorithm for data analysis (from 8 sensors) was proposed. RESULTS The sum of all maximal values from sensors was 11.71 N mean, with relatively low standard deviation (SD) of 1.81. Loading of sensor 1 (heel) was the highest - on average 29.84%. Sensor 2 (medial midfoot) received the lowest loading - normal range for this segment would be 0-4%. The manner of loading heel/toes, dynamics of changes in loading during gait was quite diverse; when analyzing courses of changes on sensors, 4 gait patterns were observed. CONCLUSIONS Use of the ITE System creates a new possibility for dynamic foot evaluation, drawing from pedobarography and methods of gait analysis. The proposed data analysis algorithm is simple and can be applied in all cases. Normally, 30% of the sum of all pressures during stance phase falls on the rearfoot; 39% falls on forefoot.

[Long-term consequences of resection of 1/3 proximal epiphysis of child's right tibia--a case study]. / Odlegle nastepstwa resekcji 1/3 nasady blizszej kosci piszczelowej prawej u dziecka--opis przypadku.

Authors report a case of a patient with varus deformity of right knee, caused by wide resection of proximal metaphysis and epiphysis of right tibia. Afore mentioned procedure led to loss of right knee joint integrity, with its lateral instability, shortening, and axis deviation of right tibia. Surgical treatment of this complications was performed in several stages and took about 5 years, starting from temporal, lateral hemiepiphysiodesis of proximal tibial epiphysis, subacute epiphysiolysis of proximal tibial epiphysis and high valgus tibia osteotomy, at the end finished with medial tibia condyle reconstruction with autogenic graft and osteoconductive substances. The proper mechanical and anatomical axis of the right limb, with full stability and movement of right knee was achieved after those surgeries. The process of treatment of lower extremity axis deviation takes long time, frequently involves several surgeries and needs firm cooperation between doctor and patient.

Changes in Selected Radiographic Parameters in Feet after Arthroplasty of First Metatarsophalangeal Joint (MTP-1) - Pilot Study.

BACKGROUND: Hallux rigidus is found in more than 2% of individuals aged 50 and above. As this condition progresses, mobility in the first metatarsophalangeal (MTP-1) joint decreases, leading practically to rigid fixation of the toe in the plantar flexion position, while pain and joint deformity caused by osteophytes intensify over time. Surgical approaches for hallux rigidus include joint arthroplasty of the first metatarsophalangeal joint, which is commonly employed. This study aimed to assess selected radiographic parameters of the foot before and after MTP-1 joint arthroplasty. MATERIAL AND METHODS: The study involved 15 patients (15 feet), comprising 11 women and 4 men, at an average age of 54.7 years (range: 43 to 70). All participants underwent arthroplasty of MTP-1 using the Tornier FGT endoprosthesis. Various radiologic parameters were examined, including the hallux valgus angle, intermetatarsal angle, Horton's index, Meary's angle, Nikolaev's angle, and hallux angle in a lateral view. RESULTS: Radiological measurements were analysed using the R3.6.2 statistical package (R Core Team, 2019). After surgery, Horton's index showed a significant increase, rising from 7.2 to 8. Additionally, the HVA-L angle increased from 11.26 to 14.4. CONCLUSION: Arthroplasty of MTP-1 produces significant changes in radiographic parameters of foot statics.

[Methylprednisolone- acute spinal cord injury, benefits or risks?]. / Metyloprednizolon ­ ostre urazy rdzeniakregowego, korzysci czy zagrozenia ?

Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of methylprednisolone is the result of many cellular changes. Methylprednisolone is used in many diseases, such as rheumatic diseases, autoimmune diseases, allergic, anaphylactic shock, asthma. Methylprednisolone was also used in patients with spinal cord injury, in order to minimize neurological damage. While in the above mentioned fields of medicine is undeniable role of methylprednisolone, whereas its use in the treatment of traumatic spinal cord injury within the last few years raises a lot of controversy, and in most cases, the side effects of its use outweigh the potential benefits. 

How back pain influences daily activities and quality of life: Incidence of back pain related to age.

Low back pain is a prevalent global musculoskeletal issue, with a lifetime prevalence ranging from 49% to 70% in adults. Traditionally associated with adults, recent field surveys indicate comparable prevalence rates in children and adolescents, challenging earlier assumptions. Non-specific low back pain, where the source cannot be identified through diagnostic imaging, accounts for about 80%-90% of cases. Studies have shown that over 80% of adolescents with low back pain exhibit no underlying pathology. The prevalence of low back pain in younger populations varies widely, influenced by study methodology, age, and pain types. Research suggests that back pain prevalence in adolescents increases with age, with a shift in attitudes considering it is not necessarily indicative of specific issues. Level of evidence: level V.

Tumors and infections of the growing spine.

The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. Level of evidence: level 4.

Caudal Regression Syndrome-A Narrative Review: An Orthopedic Point of View.

Abnormalities in cellular differentiation during embryo-fetal period may lead to various malformations of the spine. Caudal regression syndrome (CRS) is a group of defects with premature growth/development termination of the vertebral column. CRS can be divided into three types: sirenomelia, complete absence of the sacrum and partial absence of the sacrum. Genitourinary and gastrointestinal anomalies are common, with neurogenic bladder and bowel incontinence. Treatment of patients with CRS is complex and multidisciplinary and should be comprehensive. The most common orthopedic problems are: spinal deformity (kyphosis and scoliosis), spinopelvic instability and lower limbs deformities.

The Influence of Surgical Correction of Idiopathic Scoliosis on the Function of Respiratory Muscles.

Background and objective: It is important to introduce respiratory exercises to the therapy of patients after the surgical treatment of adolescent idiopathic scoliosis. Surgical correction is the best way to prevent hypoxia in scoliosis, but whether pulmonary rehabilitation increases the effectiveness of scoliosis surgery has not yet been confirmed. Therefore, the aim of the study was to evaluate the function of respiratory muscles after surgical correction of idiopathic scoliosis. Methods: The study involved 24 patients, aged 13.6 ± 0.6. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using the Mikro RPM. In all patients, before the procedure, 7 days after and 3 months after the procedure, the MIP and MEP were measured. Results: MIP was the lowest 7 days after the procedure; it was 45.28 cmH2O and was statistically significantly lower compared to the measurement before the procedure (p < 0.001) and 3 months after the procedure (p < 0.001). Conclusions: The degree of curvature of the spine before the procedure does not significantly affect initial values of the strength of respiratory muscles. The level of MIP is not dependent on the type of surgery.

Clinical and Radiological Evaluation of Results of Surgical Correction of Forefoot Adduction by Cuneiform and Cuboid Osteotomy Using Radiological Forefoot Measurements.

BACKGROUND: Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge. MATERIAL AND METHODS: This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients'/care-givers' subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin's angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9). RESULTS: The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin's angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients. CONCLUSIONS: 1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first meta-tarsal, calcaneal-fifth metatarsal and Kilmartin's angles appear to be good radiologic indicators of correction.

Upper Limb after Forearm Lengthening in Patients' and Physicians' Perspective.

BACKGROUND: The goal of this study was to perform a functional (subjective) and radiological evaluation of patients who had undergone forearm lengthening by distraction osteogenesis years before. MATERIAL AND METHODS: Eleven patients with forearm shortening of various etiology were enrolled. They had undergone a total of 21 lengthening procedures. A retrospective analysis of radiological data was conducted and a subjective evaluation was accomplished by using a modified QuickDASH-9 questionnaire. RESULTS: Average bone lengthening was 3.54cm, and mean lengthening index was 40.53day/cm. Eight pa-tients answered the questionnaire at a mean of 7.8yrs after the treatment. The mean questionnaire score was 9.75pts (of 36). Four patients rated the overall function of the affected limb as improved following distraction, while 3 patients were not able to see any improvement. One patient reported that the lengthening had impaired limb function. With regard to cosmetic aspects, 4 patients reported a worsening after the lengthening procedure while 3 patients reported improvement and 1 patient did not note any changes. CONCLUSIONS: 1. Despite deformities and functional limitations, patients after forearm lengthening only occasionally suffered from moderate intensity pain. 2. The radiological outcomes were positive and the rate of complications was low. 3. The radiological outcomes did not match patient-declared functional and cosmetic results.

Spine duplication or split notochord syndrome - case report and literature review.

Context: Spine duplication is a rare condition, with various extents and severe additional anomalies. The goal of this study was to describe a unique case of a boy with split notochord syndrome who was followed up from birth until maturity. Findings: Physical examination at birth showed defects of the abdominal wall and cloacal exstrophy with visible urether outlets. A transposed anus was present in the perineal region. Split bony elements of the spine with nonpalpable sacral bone were noted. A soft, skin-covered lump, with the consistency of a lipoma, was present in the sacral area. There was asymmetry of the lower limbs: the left was hypoplastic, with a deformed foot and hip. Computed tomography revealed a normal shape of the Th12 and L1 vertebrae, whereas the L2 was split. Downward from L3, there were two vertebrae at each level, with two spinal canals. The spinal cord divided into two "semicords" at the level of L1. Neurologic status and the shape of the spine remained unchanged during puberty. The last follow-up was performed at the age of 18 years. He managed to walk independently in prosthesis with visible limping. Conclusion: Spine deformities are always suspected in neonates with lipoma in the sacral region, which may sometimes be serious. Walking ability and quality of life depend on neurologic deficits; even with long duplication and double sacrum, walking can be a feasible option.

Imipramine Influences Body Distribution of Supplemental Zinc Which May Enhance Antidepressant Action.

Zinc (Zn) was found to enhance the antidepressant efficacy of imipramine (IMI) in human depression and animal tests/models of depression. However, the underlying mechanism for this effect remains unknown. We measured the effect of intragastric (p.o.) combined administration of IMI (60 mg/kg) and Zn (40 mg Zn/kg) in the forced swim test (FST) in mice. The effect of Zn + IMI on serum, brain, and intestinal Zn concentrations; Zn transporter (ZnT, ZIP) protein levels in the intestine and ZnT in the brain; including BDNF (brain-derived neurotrophic factor) and CREB (cAMP response element-binding protein) protein levels in the brain were evaluated. Finally, the effect of IMI on Zn permeability was measured in vitro in colon epithelial Caco-2 cells. The co-administration of IMI and Zn induced antidepressant-like activity in the FST in mice compared to controls and Zn or IMI given alone. This effect correlated with increased BDNF and the ratio of pCREB/CREB protein levels in the prefrontal cortex (PFC) compared to the control group. Zn + IMI co-treatment increased Zn concentrations in the serum and brain compared to the control group. However, in serum, co-administration of IMI and Zn decreased Zn concentration compared to Zn alone treatment. Also, there was a reduction in the Zn-induced enhancement of ZnT1 protein level in the small intestine. Zn + IMI also induced an increase in the ZnT4 protein level in the PFC compared to the control group and normalized the Zn-induced decrease in the ZnT1 protein level in the hippocampus (Hp). The in vitro studies revealed enhanced Zn permeability (observed as the increased transfer of Zn through the intestinal cell membrane) after IMI treatment. Our data indicate that IMI enhances Zn transfer through the intestinal tract and influences the redistribution of Zn between the blood and brain. These mechanisms might explain the enhanced antidepressant efficacy of combined IMI/Zn treatment observed in the FST in mice.

New criteria of radiological assessment of treatment outcomes in idiopathic scoliosis.

INTRODUCTION: The aim of surgical treatment in idiopathic scoliosis is correction, solid fusion and restoration of normal sagittal alignment of the spinal curves. The goal of this paper is to formulate a new uniform approach to evaluation of treatment outcomes in idiopathic scoliosis patients, considering not only the degree of correction but also coronal and sagittal balance. MATERIAL AND METHODS: A retrospective analysis was performed of radiographs of 150 patients with idiopathic scoliosis (136 females and 14 males). The mean thoracic curve was 56.1 degree and mean lumbar curve was 51.2 degree. All patients underwent posterior fusion with derotational instrumentation. The follow-up period was 3.7 years. The authors used their own radiological criteria for assessing surgical treatment outcomes separately for the coronal and sagittal planes and in both planes collectively. RESULTS: The degree of correction achieved was 61.8% in the thoracic spine and 66.6% in the lumbar spine. Good coronal plane outcomes were achieved in 97 patients (65%), and poor outcomes were seen in 53 (35%) cases. Good sagittal plane outcomes were achieved in 112 cases (75%), with poor outcomes in 38 (25%) patients. Good composite outcomes were noted in 76 cases (51%), and poor composite outcomes were achieved in 24 patients (16%) with ambiguous outcomes in 50 (33%). Apical vertebral translation in lumbar spine >or=35 mm, L4 angle >10 degree and lower fusion end at the L3 level are risk factors for a poor outcome. CONCLUSIONS: The proposed system for evaluation of radiological outcomes provides unequivocal results, not only accounting for the degree of correction, but also enabling quantitative evaluation of spinal balance in the coronal and sagittal planes.

Treatment of idiopathic scoliosis exceeding 100 degrees - comparison of different surgical techniques.

BACKGROUND: The treatment of scoliosis exceeding 100 degrees remains a challenge. Anterior fusion only may lead to low correction and screw plowing, posterior fusion only may cause the cranckshaft phenomenon in skeletally immature patients. Two-stage surgery is advocated, comprising anterior release and posterior fusion. MATERIAL AND METHODS: The aim of the paper is to compare treatment outcomes in patients with a >100% primary curve treated between 1984 - 2004 with one of the following techniques: halo-femoral traction with posterior fusion (Group I; n=124 patients), anterior release with halo-femoral traction and posterior fusion (Group II; n=32), single stage anterior release and posterior fusion (Group III; n=20), and posterior fusion only (Group IV; n=19). Correction and loss of correction were assessed radiologically. Additional surgical procedures and the presence of complications were also recorded. The fusion techniques were compared. Mean post-operative follow-up duration was 3.9 years, ranging from 2 to 15.3 years. RESULTS: Correction was highest in Group II and Group III (52.7% and 51.7%, respectively); vs. Group I and Group IV (45.8% and 38.7%, respectively). The loss of correction at final follow-up was lowest in Group II and Group III (2% and 3.3%), and highest in Group I and Group IV (6.4% and 15.6%, p<0.05). In all groups, the use of derotational instrumentation increased correction (59.7% C-D vs. 37% Wisconsin vs. 24.5% Harrington-Luque) and decreased loss of correction (4% C-D vs. 5% Harrington-Luque vs. 28% Wisconsin). Rates of neurological complications were similar in all groups; no persistent deficits were noted. CONCLUSIONS: Anterior release with halo traction and posterior fusion is the optimal treatment of severe scoliosis. If halo traction is contraindicated, single stage anterior release and posterior fusion should be performed. Contemporary instrumentation techniques result in higher correction rates and better curve stability.