Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study

Background

Anatomical study of the relationship among the cervical nerve roots, intervertebral disc, and lateral mass is important for the neurosurgeon to avoid complications of posterior cervical foraminotomy.

Methods

Six adult cadavers were studied. The muscles of the back of the neck were removed to expose the cervical vertebrae posteriorly from C3 to C7. We measured the length, height, extent, and angulations of the nerve roots from the medial point of the facet (MPF) after a total laminectomy, then after one-half facetectomy. The height, width, anteroposterior diameter of the lateral mass, then the height and anteroposterior diameter of the neural foramen were also measured.

Results

After total laminectomy from C3 to C7, all measures were taken from MPF showed that the mean length of the exposed root was 6.5–8.8 mm while vertical distance was 4–5.4 mm and the horizontal distance was 5.1–7.1 mm. Following a medial one-half facetectomy; the mean length of the exposed root was 8.9–12.3 mm, the vertical distance was 5.5–7.3 mm while the horizontal distance was 7.1–9.8 mm. The mean angulations of the nerve roots were 50.9–53.3º. There was a significant difference after total laminectomy and medial one-half facetectomy.

Conclusion

Anatomic and morphologic study of the cervical nerve roots and their relationships to the lateral mass and the intervertebral disc are useful landmarks to reduce the operative complications of the posterior foraminotomy.     

Repair of the torn distal biceps tendon by endobutton fixation

Background:

A number of techniques have been described to reattach the torn distal biceps tendon to the bicipital tuberosity. We report a retrospective analysis of single incision technique using an endobutton fixation in sports persons.

Materials and Methods:

The present series include nine torn distal biceps tendons in eight patients, fixed anatomically to the radial tuberosity with an endobutton by using a single incision surgical technique; seven patients had suffered the injuries during contact sports. The passage of the endobutton was facilitated by using a blunt tipped pin in order to avoid injury to the posterior interosseous nerve. The patients were evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) score and Mayo elbow score.

Results:

The average age of the patients was 27.35 years (range 21–42 years). Average follow-up was 41.5 months (range 24–102 months). The final average flexion extension arc was 0°–143°, while the average pronation and supination angles were 77° (range 70°–82°) and 81° (range 78°–85°), respectively at the last followup. All the patients had a Disabilities of the Arm, Shoulder and Hand (DASH) score of 0 and a Mayo elbow score of 100 each. All the seven active sports persons were able to get back to their respective game. There was no nerve injury or any other complication.

Conclusions:

The surgical procedure used by us is a simple, safe and reproducible technique giving minimal morbidity and better cosmetic results.     

Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects

Purpose

This study aimed to establish radiographic standard values for cervical spine morphometry, alignment, and range of motion (ROM) in both male and female in each decade of life between the 3rd and 8th and to elucidate these age-related changes.

Methods

A total of 1,230 asymptomatic volunteers underwent anteroposterior (AP), lateral, flexion, and extension radiography of the cervical spine. There were at least 100 men and 100 women in each decade of life between the 3rd and 8th. AP diameter of the spinal canal, vertebral body, and disc were measured at each level from the 2nd to 7th cervical vertebra (C2–C7). C2–C7 sagittal alignment and ROM during flexion and extension were calculated using a computer digitizer.

Results

The AP diameter of the spinal canal was 15.8 ± 1.5 [mean ± standard deviation (SD)] mm at the mid-C5 level, and 15.5 ± 2.0 mm at the C5/6 disc level. The disc height was 5.8 ± 1.3 mm at the C5/6 level, which was the minimum height, and the maximum height was at the C6/7 level. Both the AP diameter of the spinal canal and disc height decreased gradually with increasing age. The C2–C7 sagittal alignment and total ROM were 13.9 ± 12.3° in lordosis and 55.3 ± 16.0°, respectively. The C2–C7 lordotic angle was 8.0 ± 11.8° in the 3rd decade and increased to 19.7 ± 11.3 in the 8th decade, whereas the C2–C7 ROM was 67.7 ± 17.0° in the 3rd decade and decreased to 45.0 ± 12.5 in the 8th decade. The extension ROM decreased more than the flexion ROM, and lordotic alignment progressed with increasing age. There was a significant difference in C2–C7 alignment and ROM between men and women.

Conclusions

The standard values and age-related changes in cervical anatomy, alignment, and ROM for males and females in each decade between the 3rd and 8th were established. Cervical lordosis in the neutral position develops with aging, while extension ROM decreases gradually. These data will be useful as normal values for the sake of comparison in clinical practice.     

Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique

Background:

Though adequate literature is present depicting the results of pedicle screw-rod instrumentation using top loading systems for correction of adolescent idiopathic scoliosis (AIS), using the rod rotation technique, few published data is available regarding side loading systems used for a similar purpose. We report a retrospective study of a cohort of patients with strict inclusion criteria who underwent surgical correction of AIS with side-opening pedicle screw-rod posterior instrumentation using the axial translation technique of curve correction to assess the efficacy of side opening system for scoliosis correction with regards to patient satisfaction, Cobb''s angle correction and spinal balance.

Materials and Methods:

Clinical and radiological outcomes were measured in 14 consecutive patients (3 males, 11 females) with an average age of 14.0 years (range 9 to 23 years). They were followed up for an average period of 13.0 months (range – 2.2 to 28.5). All patients underwent posterior instrumentation only with pedicle screws used as anchor points. Hybrid constructs using hooks/wires or curves requiring anterior release were excluded from the study. All levels were not instrumented – more screws were put on the concavity and in the peri-apical region. Radiological evaluation was done by whole spine standing AP, lateral radiograms preoperatively and 1, 3, 6 and12 months after surgery. Cobb''s angles were measured and the spinal balance was noted. Clinical evaluation was done by SRS questionnaire. The complications were documented.

Results:

The mean preoperative Cobb''s angle was 58.35° (range – 44 to 72°), which came down postoperatively to 23.45° (range – 10 to 38°) signifying a mean correction of 59.57% (range – 26.92 to 76.17%). Clinical outcomes were evaluated using the SRS – 30 questionnaires. The values of mean pre- and postoperative scores are 3.68 and 4.18, showing an improvement of 0.5 points. Other than one patient of superficial wound infection, which healed with antibiotics, there was no major complication. No patient had neurological deterioration.

Conclusion:

Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS.     

Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions

Background:

Anterior decompression with posterior instrumentation when indicated in thoracolumbar spinal lesions if performed simultaneously in single-stage expedites rehabilitation and recovery. Transthoracic, transdiaphragmatic approach to access the thoracolumbar junction is associated with significant morbidity, as it violates thoracic cavity; requires cutting of diaphragm and a separate approach, for posterior instrumentation. We evaluated the clinical outcome morbidity and feasibility of extrapleural retroperitoneal approach to perform anterior decompression and posterior instrumentation simultaneously by single “T” incision outcome in thoracolumbar spinal trauma and tuberculosis.

Patients and Methods:

Forty-eight cases of tubercular spine (n = 25) and fracture of the spine (n = 23) were included in the study of which 29 were male and 19 female. The mean age of patients was 29.1 years. All patients underwent single-stage anterior decompression, fusion, and posterior instrumentation (except two old traumatic cases) via extrapleural retroperitoneal approach by single “T” incision. Tuberculosis cases were operated in lateral position as they were stabilized with Hartshill instrumentation. For traumatic spine initially posterior pedicle screw fixation was performed in prone position and then turned to right lateral position for anterior decompression by same incision and approach. They were evaluated for blood loss, duration of surgery, superficial and deep infection of incision site, flap necrosis, correction of the kyphotic deformity, and restoration of anterior and posterior vertebral body height.

Results:

In traumatic spine group the mean duration of surgery was 269 minutes (range 215–315 minutes) including the change over time from prone to lateral position. The mean intraoperative blood loss was 918 ml (range 550–1100 ml). The preoperative mean ASIA motor, pin prick and light touch score improved from 63.3 to 74.4, 86 to 94.4 and 86 to 96 at 6 month of follow-up respectively. The mean preoperative loss of the anterior vertebral height improved from 44.7% to 18.4% immediate postoperatively and was 17.5% at final follow-up at 1 year. The means preoperative kyphus angle also improved from 23.3° to 9.3° immediately after surgery, which deteriorated to 11.5° at final follow-up. One patient developed deep wound infection at the operative site as well as flap necrosis, which needed debridement and removal of hardware. Five patients had bed sore in the sacral region, which healed uneventfully. In tubercular spine (n=25) group, mean operating time was approximately 45 minutes less than traumatic group. The mean intraoperative blood loss was 1100 ml (750–2200 ml). The mean preoperative kyphosis was corrected from 55° to 23°. Wound healing occurred uneventful in 23 cases and wound dehiscence occurred in only 2 cases. Nine out of 11 cases with paraplegia showed excellent neural recovery while 2 with panvertebral disease showed partial neural recovery. None of the patients in both groups required intensive unit care.

Conclusions:

Simultaneous exposure of both posterior and anterior column of the spine for posterior instrumentation and anterior decompression and fusion in single stage by extra pleural retroperitoneal approach by “T” incision in thoracolumbar spinal lesions is safe, an easy alternative with reduced morbidity as chest and abdominal cavities are not violated, ICU care is not required and diaphragm is not cut.     

The INDUS knee prosthesis �C Prospective multicentric trial of a posteriorly stabilized high-flex design: 2 years follow-up

Background:

The anatomical and morphological differences and high-flexion daily activities in the Asian population have since ever prompted for development of customized knee replacement systems. INDUS knee system has advantages both of high-flex designs and is developed by keeping the anatomical variations of the native population in mind. The purpose of this study is to analyze the 2-year follow-up results using the INDUS prosthesis.

Materials and Methods:

Two hundred and ninety-seven knees in 276 patients were prospectively analyzed. There were 65 men (72 knees) and 211 (225 knees) women with a mean age of 64.56 years. Two hundred and forty-five knees had primary osteoarthritis, 48 knees had rheumatoid arthritis, and four knees had post-traumatic arthritis. Clinical parameters, including the Knee Society scores (knee score and function score), range of motion, post-operative anterior knee pain, and complications were recorded. Pre- and post-operative serial radiographs were analyzed for limb alignment, component positioning, and evidence of loosening.

Results:

The patients were followed-up for an average of 2.59 years (range, 2–3.3 years). The mean knee score and the mean function score were significantly improved from a pre-operative value of 39.4 points and 46.7 points to a post-operative value of 87 points and 86 points, respectively (P value <0.05). Two hundred and thirty four knees had no anterior knee pain while 63 knees had mild to moderate pain, but none of the patients requested any intervention for the same. Of the 276 patients (297 knees), 79 knees had flexion above 140°, 167 had a flexion range of 130–140°, 27 had a flexion range of 100–130°, and 24 knees had a flexion < 100°, with the mean range of movement being 132.9°. Improvements in the range of movement were retained over time and a total of 205 patients (224 knees, 75.7%) could squat or sit cross-legged at the final follow-up. The mean tibiofemoral angle was 8.5°±6.9° of varus pre-operatively and 5.4°±2.2° of valgus (3–7° of valgus) at the final follow-up, with no loss of alignment noted in any case. One knee underwent revision for late infection while another knee had periprosthetic supracondylar fracture treated with plate fixation.

Conclusions:

Use of the INDUS knee prosthesis has a favorable short-term outcome, with a mean range of 135° flexion and excellent knee scores.     

Clinical outcome of shoulder muscle transfer for shoulder deformities in obstetric brachial plexus palsy: A study of 150 cases

Background:

Residual muscle weakness, cross-innervation (caused by misdirected regenerating axons), and muscular imbalance are the main causes of internal rotation contractures leading to limitation of shoulder joint movement, glenoid dysplasia, and deformity in obstetric brachial plexus palsy. Muscle transfers and release of antagonistic muscles improve range of motion as well as halt or reverse the deterioration in the bony architecture of the shoulder joint. The aim of our study was to evaluate the clinical outcome of shoulder muscle transfer for shoulder abnormalities in obstetric brachial plexus palsy.

Materials and Methods:

One hundred and fifty patients of obstetric brachial plexus palsy with shoulder deformity underwent shoulder muscle transfer along with anterior shoulder release at our institutions from 1999 to 2007. Shoulder function was assessed both preoperatively and postoperatively using aggregate modified Mallet score and active and passive range of motion. The mean duration of follow-up was 4 years (2.5–8 years).

Results:

The mean preoperative abduction was 45° ± 7.12, mean passive external rotation was 10° ± 6.79, the mean active external rotation was 0°, and the mean aggregate modified Mallet score was 11.2 ± 1.41. At a mean follow-up of 4 years (2.5–8 years), the mean active abduction was 120° ± 18.01, the mean passive external rotation was 80° ± 10.26, while the mean active external rotation was 45° ± 3.84. The mean aggregate modified Mallet score was 19.2 ± 1.66.

Conclusions:

This procedure can thus be seen as a very effective tool to treat internal rotation and adduction contractures, achieve functional active abduction and external rotation, as well as possibly prevent glenohumeral dysplasia, though the long-term effects of this procedure may still have to be studied in detail clinico-radiologically to confirm this hypothesis.

Level of evidence:

Therapeutic level IV     

Medium term results of Avon patellofemoral joint replacement

Background:

Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review of 45 consecutive patellofemoral replacements performed in 41 such patients, between June 2002 and January 2007.

Materials and Methods:

All patients were operated by single surgeon (SM) or under his supervision. All forty five patients had minimum three year followup and had the data collected prospectively. No patient was lost to followup. This data was later collated by review of notes, radiographs, and a clinical followup. The patients were assessed using knee function score and Melbourne patellofemoral score.

Results:

The average followup was 4.5 years. The preoperative average Melbourne (Bartlett) score was 10 (range 5-21). Preoperative knee functional score averaged 57 (range 23–95). The average range of movement was 116° (range 100°–140°). Postoperatively, the average Melbourne knee score improved to 25 (range 11–30), while the knee function score was 85 (range 28 – 100). The difference was statistically significant (P<0.05). Eighty-five percent rated the result as good or excellent, while 12% rated it as fair. Five percent thought the result was poor. The most common complaint was clicking at 40° of flexion (n=7). Six patients underwent arthroscopic lateral release, which improved the symptoms in four patients. Two knees were revised one due to progression of tibiofemoral arthritis and the other due to persistent clicking, yielding a survival rate of 95.6% at an average five year followup.

Conclusion:

The Avon patellofemoral joint replacement provides predictably good results and excellent survivorship in the medium term, for isolated patellofemoral arthritis. However, progression of tibiofemoral arthritis remains unpredictable and therefore patient selection is crucial to ensure success. Clicking remains a potential problem and can compromise the postoperative results in upto 15% of the cases.     

Scoliosis after thoracotomy/sternotomy in children with congenital heart disease

Context:

Congenital heart disease (CHD) patients bear a higher risk of scoliosis during their lifetime compared to their normal counterparts. On the other hand, operation on chest wall has been shown to increase the risk of scoliosis. However, the data are inconclusive. The present retrospective analysis is undertaken to determine the frequency of post-thoracotomy/sternotomy scoliosis in children with CHD.

Materials and Methods:

One hundred and eighty children with CHD who underwent thoracotomy/sternotomy and had a minimum followup of 3 years in a teaching center from 1997 to 2010 were recruited. After operation, all the patients were regularly examined for the development of scoliosis. 102 patients underwent thoracotomy and 78 sternotomy. Student''s t test, Chi-square test, Fisher''s exact test were used for statistical analyses.

Results:

Eighty-eight males and 92 females with a mean age of 9.95 ± 2.31 (range: 5–15) years were enrolled. The mean age at operation was 2.59 ± 1.66 (range: 0–9) years and the mean follow-up period was 7.36 ± 2.12 (range: 5–13) years. Scoliosis was confirmed in two patients (1.1%): 1 (1%) in the thoracotomy group (a 12-year-old female operated 2 years earlier with a spinal 22° convexity to the right and 78° kyphosis) and another (1.1%) in the sternotomy group (an 8-year-old female operated during her neonatal period with a spinal 23° convexity to the left).

Conclusion:

Scoliosis is not a common finding among the operated children with CHD in our center.     

Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality?

Introduction

Direct apical vertebral rotation represents an important goal of posterior surgery for thoracic adolescent idiopathic scoliosis (AIS), so as to obtain a better cosmetic effect and to avoid posterior thoracoplasty. However, the real effectiveness in correction of vertebral rotation, using posterior only procedures, is still open to debate. The aim of the present study is to compare the correction of axial apical rotation obtained with direct rotation procedure versus simple concave rod rotation, in patients treated by posterior fusion for thoracic AIS using pedicle screw-only construct.

Materials and methods

A retrospective review was performed on a total of 62 consecutive patients (one single institution, three different surgeons) affected by AIS, who had undergone a posterior spinal fusion with pedicle screw-only instrumentation between January 2005 and April 2008 at the reference center. All cases presented a main thoracic curve (Lenke type 1 and 2). The angle of rotation (RAsag) of the apical vertebra was measured from the preoperative and last follow-up axial CT. According to the derotation procedure, two groups were identified: a direct vertebral rotation group (DR group; n = 32 patients) and a simple concave rod rotation group (No-DR group; n = 30 patients). There were no statistical differences between the two groups, in terms of age, Risser’s sign, curve patterns, Cobb main thoracic (MT) curve magnitude and flexibility, extension of fusion, offset measurements on the coronal plane and sagittal preoperative contour.

Results

All 62 patients were reviewed at an average follow-up of 3.7 years (range 2.5–4.2 years). The DR group compared to the No-DR group showed a significantly better final correction of apical vertebral rotation (DR 63.4 % vs. No-DR 14.8 %; p < 0.05) and a greater final correction (61.3 vs. 52.4 %; p < 0.05) with better maintenance of the initial correction (−1.7° vs. −1.9°; ns) of the main thoracic curve. Concerning the coronal balance, there was the same aforementioned trend of better results in the DR group, with less final apical MT vertebra translation (DR 2.2 cm vs. No-DR 4.1 cm), greater overall change (preop-final) of lower instrumented vertebra (LIV) coronal tilt (−14.9° vs. −11.1°; p < 0.05); the final global coronal balance (C7–S1) resulted quite better in DR group, but without a significant difference. The T5–T12 kyphosis angle was quite similar in both group before surgery (DR 16.8° vs. No-DR 17.5°) and was little lower at final follow-up evaluation in direct vertebral rotation group (14.5° vs. 16.5°). The T10–L2 sagittal alignment angle was similar in each group before surgery (12.5° in DR vs. 11.8° in No-DR), and at the latest follow-up averaged 5.3° versus 8.2°, respectively. Lumbar lordosis was similar in each group before surgery (DR −42° vs. No-DR −44.1°) and at the final follow-up evaluation (−45.9° vs. −43.2°). At the latest follow-up, SRS-30 and SF-36 findings were similar between the two groups. The complication rate was higher in the simple concave rod rotation group (13.3 vs. 9.3 %), related in two cases to thoracoplasty, which was never utilized in direct rotation patients.

Conclusions

The direct vertebral rotation obtained significantly better final results, when compared to simple concave rod rotation, both concerning correction of apical vertebral rotation and magnitude of MT curve. On the other hand, the DR group presented a little reduction in T5–T12 kyphosis at follow-up, in comparison with concave rod rotation procedure. Both procedures were found to be satisfying from patients’ perspective. Nevertheless overall complication rate was higher in the simple concave rod rotation group, related mainly to thoracoplasty (2 cases), which was never necessary in direct rotation patients.     

The modulation of spinal growth with nitinol intervertebral stapling in an established swine model

Purpose

Anterior spinal stapling for the treatment of adolescent idiopathic scoliosis has been shown to slow progression in small curves; however, its role in larger curves remains unclear. The purpose of this study was to evaluate the effectiveness of nitinol staples to modulate spinal growth by evaluating the two-dimensional and three-dimensional morphological and histological effects of this method in a well-established porcine model.

Methods

Three immature Yucatan miniature pigs underwent intervertebral stapling. Two staples spanned each of three consecutive mid-thoracic discs and epiphyses. Monthly radiographs were obtained. Computed tomography (CT) was conducted at harvest after 6 months of growth. Measurements of wedging and height for each disc and vertebral body were conducted. Micro CT was used to compare physeal closure between stapled and non-stapled levels. Histology of the growth plate also compared the hypertrophic zone thickness for control and stapled vertebrae.

Results

After 6 months of stapled growth, the average coronal Cobb angle of the stapled segments increased by 7.7 ± 2.0° and kyphosis increased by 3.3 ± 0.6° compared to preoperative curves. Increased vertebral wedging and decreased disc height (p < 0.001) were noted in stapled regions. Overall, 26 ± 23 % of each growth plate was closed in the stapled segments, with 6 ± 8 % closure in the unstapled levels. No difference was observed regarding the hypertrophic zone height when comparing instrumented to uninstrumented levels, nor was a difference recognized when comparing right versus left regions within stapled levels alone.

Conclusions

Six months of nitinol intervertebral stapling created a mild coronal and sagittal deformity associated with reduced vertebral and disc height, and increased coronal vertebral and sagittal disc wedging.     

Outcome of complex tibial plateau fractures treated with external fixator

Background:

Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application.

Materials and Methods:

Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6–60 months).

Results:

Clinical results were evaluated according to the Rasmussen''s criteria. Average healing time was 13.69 weeks (range 12– 28 weeks). Mean knee range of motion was 122.60° (range 110°–130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor.

Conclusion:

We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.     

Subtrochanteric valgus osteotomy in developmental coxa vara

Background:

Valgus subtrochanteric osteotomy is the gold standard surgical treatment of developmental coxa vara. Nevertheless, there has been no consensus on the method of fixation and osteotomy details. In the literature, there are few reports on employing rigid internal fixation methods that preclude the need of postoperative immobilization. We present early radiologic and clinical outcome of a modified Y shaped subtrochanteric valgus osteotomy fixed with precontoured DCP.

Patients and Methods:

Ten patients with 10 hips of developmental coxa vara were subjected to a corrective Y-shaped subtrochanteric valgus femoral osteotomy. All the cases were fixed by a precontoured small dynamic compression plate (DCP). There were six males and four females. The right hip was affected in four patients and the left hip in six. The average age at the presentation time was 5.1 years (range 4–9 years). Clinical evaluation was done by IOWA hip score.

Results:

Clinically, the IOWA hip score improved postoperatively significantly (P<.05). The average preoperative head shaft angle was 94° (range 85°-100°) and the average post-operative head shaft angle was 120° (range 115°-125°). Postoperatively, the average epiphyseal-Hilgenreiner angle and the head-shaft angle fell into the normal values. No recurrence of deformity was reported.

Conclusion:

The Y-shaped subtrochanteric valgus osteotomy with rigid internal fixation precludes the use of external immobilization attained satisfactory clinical and radiologic results with no evidence of deformity recurrence on the short-term follow-up.     

Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures

Introduction

Idiopathic scoliosis affects the locomotor system; however, it can considerably impair the function of cardiovascular and respiratory systems. The aim of the study was to assess parameters indicating the physical capacity of adolescent girls with mild or moderate idiopathic scoliosis.

Materials and Methods

The study included 97 girls, aged 10–18 years: 70 girls, aged 13.84 ± 2.2 years, with idiopathic thoracic scoliosis (Cobb angle 10°–40°) formed the study group and 27 healthy girls, aged 13.2 ± 1.9 years, formed the control group. The girls underwent the Physical Work Capacity 170 (PWC170) test on a cycle ergometer based on two 5-min submaximal physical effort events. The maximum oxygen intake was calculated and expressed in l/min and ml/kg/min. The impact of the curvature angle value, of the number of vertebrae within the curve and of the number of the curves on the physical capacity parameters was analyzed.

Results

The maximal oxygen intake (l/min) and PWC170 (W; W/kg) values were considerably lower in girls with scoliosis of 25°–40° than in the control group. No significant differences were observed between girls with mild scoliosis (10°–24°) and the control group. Statistical analysis did not show any significant impact of the number of vertebrae affected by scoliosis and the number of curvatures on VO₂max (l/min; ml/kg/min) and the PWC170 (W) indicator. In the group of girls with scoliosis involving more than nine vertebrae, the PWC170 (W/kg) indicator was significantly lower than in the control group. A similar correlation was observed between girls with double-curved scoliosis and the control group (p < 0.05).

Conclusion

The maximum oxygen intake and the output during the PWC170 test is lower in girls with moderate scoliosis than in the control group. The value of maximum oxygen intake and output obtained during the PWC170 test in girls with mild scoliosis does not differ significantly from the values obtained in the control group. The number of vertebrae involved in scoliotic deformation and the number of curvatures cause significant decrease in only the relative value of the output obtained during an exercise test.     

Double dome osteotomy for the treatment of cubitus varus in children

Purpose

The purpose of this study was to report double dome osteotomy used to correct paediatric cubitus varus and to avoid lateral prominence after correction.

Methods

Eighteen children with cubitus varus underwent double dome osteotomy. Preoperative templating created from radiographs was used to determine the bone cuts. Double dome osteotomy created a proximal and distal cut, then varus deformity and sagittal alignment were corrected. The osteotomies were fixed with K-wires and immobilised in a long-arm cast. Radiographics and clinical histories were evaluated. Ulno-humeral angle pre and postoperative, range of motion and lateral prominent index were evaluated.

Results

The osteotomy was performed in 18 patients, with an average age of 7.5 years. All patients ended up with flexion of 130° or greater with full and symmetrical pronation and supination. The average ulno-humeral angle difference compared to the uninjured side was 3.27°. The mean of the lateral prominent index was −0.91. The mean follow up was 50.3 months (30–115 months). All of the patients had excellent clinical and radiographic alignment. No revisions were made in this series. One transient radial nerve palsy and one superficial infection occurred.

Conclusion

This series demonstrates that double dome osteotomy can provide reliable correction of varus deformity and prevent lateral prominence with a minimal complication rate.     

Apoptosis of endplate chondrocytes in post-laminectomy cervical kyphotic deformity

Purpose

The present study was performed to establish an animal model of cervical kyphosis after laminectomy (C2–C5), and to determine the role of endplate chondrocytes apoptosis in cervical kyphosis after laminectomy.

Methods

Twenty-four 3-month-old sheep were randomly divided into two groups: the laminectomy group (n = 12), and the control group (n = 12). The cervical spine alignment was evaluated on a lateral cervical spine X-ray using Harrison’s posterior tangent method before surgery and at follow-up. Cartilaginous endplate chondrocyte apoptosis was confirmed using transmission electron microscopy and terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labelling.

Results

The mean preoperative cervical curvature (C2–5) in the surgery group was −15.8°. The cervical curvature was 19.1° at 3 months post-operation and decreased to 20.2° at the final follow-up postoperatively. The cervical curvature was significantly decreased in the laminectomy group compared with the control group at the last follow-up (P < 0.001), which was a direct indication of kyphotic change. The incidence of apoptotic cells in the surgery group was significantly higher at the 3- and 6-month follow-up than the incidence in the control group.

Conclusions

The frequency of endplate chondrocyte apoptosis in the laminectomy group was significantly higher than in the control group, indicating that chondrocyte apoptosis may play a pivotal role in the progress of post-laminectomy cervical kyphosis.