Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials.

OBJECTIVE: To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN: Systematic review with meta-analysis. DATA SOURCES: MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS: We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS: Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER: CRD42022308267.

Universal two-point interaction of mediator KIX with 9aaTAD activation domains.

The nine-amino-acid activation domain (9aaTAD) is defined by a short amino acid pattern including two hydrophobic regions (positions p3-4 and p6-7). The KIX domain of mediator transcription CBP interacts with the 9aaTAD domains of transcription factors MLL, E2A, NF-kB, and p53. In this study, we analyzed the 9aaTADs-KIX interactions by nuclear magnetic resonance. The positions of three KIX helixes α1-α2-α3 are influenced by sterically-associated hydrophobic I611, L628, and I660 residues that are exposed to solvent. The positions of two rigid KIX helixes α1 and α2 generate conditions for structural folding in the flexible KIX-L12-G2 regions localized between them. The three KIX I611, L628, and I660 residues interact with two 9aaTAD hydrophobic residues in positions p3 and p4 and together build a hydrophobic core of five residues (5R). Numerous residues in 9aaTAD position p3 and p4 could provide this interaction. Following binding of the 9aaTAD to KIX, the hydrophobic I611, L628, and I660 residues are no longer exposed to solvent and their position changes inside the hydrophobic core together with position of KIX α1-α2-α3 helixes. The new positions of the KIX helixes α1 and α2 allow the KIX-L12-G2 enhanced formation. The second hydrophobic region of the 9aaTAD (positions p6 and p7) provides strong binding with the KIX-L12-G2 region. Similarly, multiple residues in 9aaTAD position p6 and p7 could provide this interaction. In conclusion, both 9aaTAD regions p3, p4 and p6, p7 provide co-operative and highly universal binding to mediator KIX. The hydrophobic core 5R formation allows new positions of the rigid KIX α-helixes and enables the enhanced formation of the KIX-L12-G2 region. This contributes to free energy and is the key for the KIX-9aaTAD binding. Therefore, the 9aaTAD-KIX interactions do not operate under the rigid key-and-lock mechanism what explains the 9aaTAD natural variability.

[Injury of upper cervical spine]. / Poranení horní krcní pátere.

Injuries of the upper cervical spine represent 1/3 of all cervical spine injuries and approximately 40 % result by the death. Every level of the cervical spine can be injured - fractures of condyles of the occipital bone (CO), atlantooccipital dislocation (AOD), fractures of the Atlas (C1), atlantoaxial dislocation (AAD) and fractures of the axis (C2). Most of cases in younger patients are caused by high-energy trauma, while by elderly people, because of the osteoporosis, is needed much less energy and even simple falls can cause the injury of the cervical spine. That´s why the etiology of injuries can be different. In younger patients are caused mainly by car accidents, motorcycle and bicycle accidents and pedestrian crashes by car and in elderly populations are the main reason falls. The mechanism of the injury is axial force, hyperflexion, hyperextension, latero-flexion, rotation and combination of all. The basic diagnostic examination is X ray in AP, lateral and transoral projection. But in the most of cases is CT examination necessary and in the suspicion of the ligamentous injury and neurological deterioration must be MRI examination added. Every injury of the upper cervical spine has its own classification. Clinical symptoms can vary from the neck pain, restricted range of motion, antalgic position of the head, injury of the cranial nerves and different neurologic symptoms from the irritation of nerves to quadriplegia. A large percentage of deaths is at the time of the injury. Therapy is divided to conservative treatment, which is indicated in bone injuries with minimal dislocation. In more severe cases, with the dislocation and ligamentous injury, when is high chance of the instability, is indicated the surgical treatment. We can use anterior or posterior approach, make the osteosynthesis, stabilisation and fusion of the spine. Complex fractures and combination of different types of injuries are often present in this part of the spine. Correct and early diagnosis with the best treatment option is necessary for successful result of the cervical spine injuries.

Effect of Prophylactic Fibrinogen Concentrate In Scoliosis Surgery (EFISS): a study protocol of two-arm, randomised trial.

INTRODUCTION: Fibrinogen is one of the essential coagulation factors. Preoperative lower plasma fibrinogen level has been associated with higher blood loss. Scoliosis surgery presents a challenge for the anaesthetic team, one of the reasons being blood loss and transfusion management. Recently, the prophylactic fibrinogen administration has been a debated topic in various indications. It has been described for example, in urological or cardiovascular surgery, as well as in paediatrics. This pilot study is focused on verifying the feasibility of potential large randomised trial and verifying the safety of prophylactic fibrinogen administration in paediatric scoliosis surgery. METHODS AND ANALYSIS: A total of 32 paediatric patients indicated for scoliosis surgery will be recruited. Participants will be randomised into study groups in a 1:1 allocation ratio. Patients in the intervention group will receive prophylactic single dose of fibrinogen, in addition to standard of care. Patients in the control group will receive standard of care without study medication prior to skin incision. The primary aim is to assess the safety of prophylactic fibrinogen administration during scoliosis surgery in children, the incidence of any adverse events (AEs) and reactions will be monitored during participation in the study. The secondary objective is to investigate the additional safety information, feasibility and efficacy of a prophylactic fibrinogen administration. The incidence of AEs and reactions according to selected adverse events of special interest will be monitored. All collected data will be subjected to statistical analysis according to a separate statistical analysis plan. ETHICS AND DISSEMINATION: This trial follows the applicable legislation and requirements for good clinical practice according to the International Conference on Harmonisation E6(R2). All essential trial documents were approved by the relevant ethics committee and national regulatory authority (State Institute for Drug Control) and their potential amendments will be submitted for approval. TRIAL REGISTRATION NUMBER: NCT05391412.

Anesthesia of a patient with congenital cataract, facial dysmorphism, and neuropathy syndrome for posterior scoliosis: A case report.

BACKGROUND: Congenital cataract, facial dysmorphism, and neuropathy (CCFDN) syndrome is an extremely rare multiorgan disorder. Characteristics include congenital cataracts, facial deformation, extremity deformities, and demyelinating neuropathy. CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures. There is a lack of published information about difficult airways in these patients. Difficult airways during intubation represent one of the most dreaded anesthesia complications: A "can not intubate, can not oxygenate" scenario. Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient. CASE SUMMARY: We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery. The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°. Her limitations included neuropathy and a scoliotic curve. This condition negatively impacted her quality of life. This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome. The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition. In total, one case report without any data about endotracheal intubation of patients with this condition was available. Endotracheal intubation in our case was uncomplicated. Another focus of our case was the prevention of possible complications associated with this syndrome, including rhabdomyolysis and seizures. Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics, especially in patients with certain types of myopathies. CONCLUSION: Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.

The relationship of hip loading asymmetry and radiological parameters of the spine in Lenke type 1 idiopathic scoliosis.

BACKGROUND: Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system. RESEARCH QUESTION: Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity? METHODS: 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity. RESULTS: Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05). SIGNIFICANCE: Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk.

Prospective Multiparametric Magnetic Resonance Monitoring of Changes in Lesions of Hyaline Cartilage of the Knee Joint After Treatment by Microfractures and Implantation of Biological Collagen Type I Matrix Implants .

RATIONALE AND OBJECTIVES: This study's aims were to depict changes in cartilage quality after surgical intervention using magnetic resonance (MR) examination and in content of glycosaminoglycans chains (GAGs) after two types of surgeries - chondral defect treatment by microfractures and scaffold implantation in combination with microfractures. MATERIALS AND METHODS: Twenty-five patients were studied: 14 with implants, 11 with microfractures. MR examination was made before surgery and 6, 12, and 18 months thereafter. Qualitative changes in cartilage were observed by means of delayed gadolinium enhanced magnetic resonance imaging of cartilage sequence using Gd-DTPA2- and Gd-DOTA. In each examination, GAGs content was determined at three locations: the defect, its surroundings, and a non-load-bearing reference area. RESULTS: Measured indices showed no statistically significant differences in changes within the defect area when comparing the two treatment types at individual time points of 6, 12, and 18 months. In the case of microfracture treatment, more substantial decrease in GAGs concentration occurred at month 6, whereas the greatest decline occurred at month 12 when using an implant. Change in GAGs content and decline in cartilage quality were substantial also in the reference area and close surroundings. CONCLUSIONS: Hyaline cartilage behaves as a unified whole, and change in GAGs content was marked also in locations with no morphological damage. Over the monitored period, no statistically significant difference between treatment types was noted as measured by GAGs content in the defect or its close surroundings. dGEMRIC is suitable for monitoring cartilage quality even if use of Gd-DTPA2- is not possible, because comparable results were achieved using Gd-DOTA.

3D kinematic analysis of patients' gait before and after unilateral total hip replacement.

PURPOSE: The purpose of the study was to describe changes in the kinematic parameters in the patients' gait after total hip replacement. METHODS: Research group of men in the end stage of osteoarthritis indicated to the THR (n = 10; age 54.1 ± 7.5 years; weight 92.2 ± 9.6 kg; height 179.7 ± 5.9 cm). All participants underwent a total of three measurements: before surgery, 3 and 6 months after the surgery. Using the 3D kinematic analysis system, the patients' gait was recorded during each measurement session and kinematic analysis was carried out. The parameters that were monitored included the sagittal range of motion while walking in the ankle, the knee and the hip joints of the operated and the unoperated limb, and the range in the hip joint's frontal plane, the rotation of pelvis in the frontal and transverse planes, as well as the speed of walking and the walking step length. RESULTS: Significant increases were found in sagittal range of motion in the operated hip joint, sagittal range of motion in the ankle joint on the unoperated side and in the walking step length of the unoperated limb. CONCLUSIONS: During walking after a THR, the sagittal range of motion in the ankle of the unoperated limb increases. Also, the range of motion in the sagittal plane on the operated joint increases, which is related to the lengthening of the step of the unoperated lower limb.

The titanium-made growth-guidance technique for early-onset scoliosis at minimum 2-year follow-up: A prospective multicenter study.

BACKGROUND: The management of early-onset scoliosis (EOS) remains a serious challenge in pediatric orthopedics. The growth-guidance system (GGS) is a surgical option that allows continuous growth along a rod, averting the need for repeated operative lengthening. OBJECTIVES: The objective of this study was to evaluate the outcomes of the GGS in the treatment of EOS. MATERIAL AND METHODS: A prospective study, including 81 patients from 4 departments treated with this method from 2013 to 2015, was conducted with a minimum follow-up period of 24 months. The follow-up data of 57 patients was available, thus the drop-out rate was 29.63%. There were 44 girls with a mean age of 10.03 years and 13 boys with a mean age of 8.04 years. RESULTS: The mean preoperative Cobb angle was 65.3° (range 36°-139°) was corrected to 23.7° (2°-94°), and at the end of the 2-year follow-up increased to 30.7° (8°-93°). The predominant proximal level of instrumentation was T5 and the distal was L1. The combined length of T1-T12 and T12-S1 increased on average by 33.19 mm in 24 months. The overall rate of serious complications was 43.86%. The most prevalent device-related complications were: the dislodgement of top screws because of the short length of the rod (14 cases), the implant failure (11 cases) and loss of correction (9 cases). CONCLUSIONS: The results show that the GGS used in this study allows for a good and stable correction while preserving the ability of the spine to grow in at least a 2-year follow-up. The complication rate is acceptable and comparable with other growth-friendly techniques. To date, this is the largest successful study on the use of titanium-made GGSs.

Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study.

BACKGROUND: This trial reports the 2-year and immediate postremoval clinical outcomes of a novel posterior apical short-segment (PASS) correction technique allowing for correction and stabilization of adolescent idiopathic scoliosis (AIS) with limited fusion. METHODS: Twenty-one consecutive female AIS patients were treated at 4 institutions with this novel technique. Arthrodesis was limited to the short apical curve after correction with translational and derotational forces applied to upper and lower instrumented levels. Instrumentation spanned fused and unfused segments with motion and flexibility of unfused segments maintained. The long concave rods were removed at maturity. Radiographic data collected included preoperative and postoperative data for up to 2 years as well as after long rod removal. RESULTS: All 21 patients are beyond 2 years postsurgery. Average age at surgery was 14.2 years (11-17 years). A mean of 10.5 ± 1 levels per patient were stabilized and 5.0 ± 0.5 levels (48%) were fused. Cobb angle improved from 56.1° ± 8.0° to 20.8° ± 7.8° (62.2% improvement) at 1 year and 20.9° ± 8.4°, (62.0% improvement) at 2 years postsurgery. In levels instrumented but not fused, motion was 26° ± 6° preoperatively compared to 10° ± 4° at 1 year postsurgery, demonstrating 38% maintenance of mobility in nonfused segments. There was no report of implant-related complications. CONCLUSIONS: PASS correction technique corrected the deformity profile in AIS patients with a lower implant density while sparing 52% of the instrumented levels from fusion through the 2-year follow-up.

Compartment syndrome and regional anaesthesia: Critical review.

Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive fasciotomy it can lead to neurological dysfunction and disability. The role of regional anaesthesia (RA) in patients at risk for ACS/ and in those with developed ACS is controversial. The aim of this critical review was to answer the question, whether regional anaesthesia can delay the diagnosis. The authors use an evidence-based approach to discuss these high risk patients in considering RA as a method of choice for effective analgesia. To the date of data collection, there was no single case report identified where RA alone led to delay in ACS diagnosis and surgical treatment. In four clinical cases, epidural analgesia can be associated with delayed ACS diagnosis. Frequent clinical evaluation and breakthrough pain despite a functional RA in combination with intracompartment pressure measurement remains the keystone of recommended management for patients at risk of ACS.

Analysis of Segmental Mobility Following a Novel Posterior Apical Short-Segment Correction for Adolescent Idiopathic Scoliosis.

STUDY DESIGN: A prospective, nonrandomized, multicenter study. OBJECTIVES: The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration. METHODS: This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery. RESULTS: Twenty-one female patients, mean age of 14.2 years (10.6-16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV. CONCLUSION: Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density. LEVEL OF EVIDENCE: 4.

Guided-growth implants in the treatment of early onset scoliosis. A pilot study.

BACKGROUND: The aim of treating children with early onset scoliosis is to guide the growth of the spine until the patients reach skeletal maturity. Regardless of its aetiology, progressive early-onset scoliosis requires multiple-stage surgery, usually at 6 to 12 months' intervals. However, precise coordination of the timing of each consecutive surgical procedure with the child's growth pattern is difficult, and the risk of complications that require additional surgery should be taken into account. The aim of this study is to present a new surgical method of treating early onset scoliosis which consists in a single-stage insertion of special implants that enable three-plane correction of spinal deformities, allows the spine to continue growing, does not require multi-stage surgical distractions, and ends after the growth period with a conventional spinal fusion. The results of this pilot study were obtained in a homogeneous group of patients treated identically by insertion of original implants guiding spinal growth. MATERIAL AND METHODS: The study involved 15 females and 2 males aged between 5 and 13 years (mean age: 9.8 years). All children in the study group had single-curve thoracic scoliosis. The duration of follow-up was between 6 and 40 months (mean duration: 18 months). The efficacy of the guided-growth implant treatment was assessed based on standard radiographs by evaluating the angle of the curvature, T1-S1 length, and apical vertebral rotation (AVR) 1. preoperatively, 2. postoperatively, and 3. in long-term follow-up. RESULTS: After surgery the scoliosis improved significantly in the range of 51% to 80% (mean improvement: 65%). The degree of the correction depended directly on the initial angle of curvature, which ranged from 56 to 95° (mean angle of curvature: 67°). During the entire follow-up period, twelve patients did not show any loss of correction, or the loss was within the bounds of measurement error. Because of a growth spurt, two female patients had to have the rods replaced with longer ones, since there was a risk that they might slide out of the farthest lower screws. In three patients further spontaneous improvement occurred during the follow-up period. Apical vertebral derotation was achieved during the surgery in all patients, and it was maintained throughout the follow-up period. All patients showed an increase in spinal length in the range of 7 to 40 mm (mean increase: 1mm/month). CONCLUSIONS: 1. The surgical method described by us provides for very good correction in the first stage of treatment. 2. The maintenance of the correction does not require the use of corrective braces or any indirect multi-stage surgical procedures. 3. The probability of complications during the insertion of the implants is not higher than that seen with conventional multi-stage treatment.

Risk factors of postural defects in children at school age.

INTRODUCTION AND OBJECTIVE: Postural defects increasingly more often concern children and adolescents at school age. The lack of prophylaxis and neglecting adequate procedures may lead to limitations of physical and motor abilities, back pain, or the development of severe spinal deformities. Recognition of the risk factors conducive to the occurrence of the disorder allows the creation of adequate conditions for the psychomotor development of children, as well as the elaboration and implementation of specified educational schemes directed at schools and parents. The study concerned determination of the risk factors for the development of postural defects in school age children. MATERIAL AND METHODS: The study was conducted by means of a diagnostic survey. The study group covered 380 children aged 14 (175 girls (46.1%) and 205 boys (53.9%))--selected at random from schools in eastern Poland and the Czech Republic. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: The BMI in the population examined was 20.2, on average (from 14-39). Respondents living in rural areas and small towns constituted 57.63% of the study group, while inhabitants of medium-size and large cities--42.37%. The majority of children in the study had been previously examined for the occurrence of postural defects (74.2%), whereas nearly every tenth child had never undergone such an examination. As many as 16.3% of adolescents did not know whether they had ever participated in a screening test. A defect was detected in 14.7% of children, in 56.6% no asymmetry was detected, while approximately 30% were not aware if their body posture was normal or not. CONCLUSIONS: 1. There is a relationship between physical activity of the child and the occurrence of postural defects. 2. There is a relationship between the economic standard of the family and awareness of own state of health. 3. There is a need for the creation of a system of education for parents and children concerning postural defects and risks resulting from these defects.

The role of the autonomic nervous system in the etiology of idiopathic scoliosis: prospective electron microscopic and morphometric study.

OBJECTS: The exact etiology of scoliosis is still unknown. The main purpose of this study is to search for the possible causation of scoliosis in the development changes of autonomic nervous structures. In this prospective study, we followed-up the changes in peripheral nerve structures and its discrepancies regarding the concavity and convexity of the scoliotic curve. MATERIALS AND METHODS: We evaluated 12 patients with the idiopathic scoliotic deformity and the control group of 3 patients without any scoliotic deformity. The samples from the peripheral nerves of the convexity and concavity of the scoliotic deformity were drawn during the surgical correction by using the transthoracic approach. The samples were examined by the electron microscopic method and morphometric statistical evaluation. RESULTS: In samples taken from the scoliotic convexity, 23.71% of myelinized nerve fibers (MNF), 12.21% of unmyelinized nerve fibers (UNF), and 5.0% of Schwann cells (SC) were found by the morphometric measurement. There were 17.36% of MNF, 5.82% of UNF, and 5.27% of SC in samples taken from the concavity and 29.9% of MNF, 19.9% of UNF, and 16.7% of SC in the control nonscoliotic samples. Statistically significant differences between both sides of scoliotic deformity (convexity and concavity) and differences between the scoliotic samples and the nonscoliotic control samples were found. In all scoliotic samples, significant morphologic changes were found, mostly in the myelin sheaths and axon fiber abnormalities compression. CONCLUSION: There are significant morphologic changes in spinal autonomic nervous structures in scoliotic patients. These findings can help us in the search for the etiology of scoliosis.