Background: To describe routine surgical practice using Prestige LP Cervical Disc (Prestige disc) and patient outcomes for degenerative cervical disc disease in a multicenter 2-year prospective, observational study. Methods: Patient demographics and intraoperative data were collected; quality of life (QoL) (EQ-5D, EQ-VAS, and neck disability index), average disc height, and adverse events were assessed pre- and postoperatively at 3, 6, 12, and 24 months. Results: One hundred and ninety-four patients were enrolled (190 patients implanted; female: 67%; mean age: 44.0 years; mean body mass index: 25.6). Disc herniation was the most frequent indication for cervical arthroplasty (80.5%). Thirty-seven percent of patients experienced pain for > 1 year prior to baseline assessment. Mean procedure duration was 87.1 minutes, and mean blood loss was 43.8 mL. The majority (71.0%) of Prestige discs were implanted at level C5 to C6, while 16.3% of patients received implants at 2 levels. There was a significant improvement from baseline to 3, 6, 12, and 24 months of follow-up in all QoL assessments. After implantation, the mean disc height at the affected level increased by 0.19 from baseline (0.22) to 3 months (0.41) and remained constant up to 24 months (P < .001). Mean disc height of levels above and below the implant remained comparable at baseline and follow-up. A total of 63 adverse events (44 patients) was recorded, of which 7 (11.1%) were related to the Prestige disc, instrumentation, or procedure; 41 (65.1%) were unrelated; and 15 (23.8%) had an unknown relation. Conclusions: In line with published findings, our study shows significant improvement in outcomes in the first 3 months after Prestige disc implantation with improvements maintained throughout the study.

1. Ferlic P, Wansch J, Runer A, Liebensteiner M. Patella height is related to the morphology of the femoral trochlea. Knee Surg Sports Traumatol Arthrosc. 2016;24(Suppl 1):S21–S22. Google Scholar

Study Design.A cross-sectional study of 2 groups of patients with scoliosis, and an age-matched control group was conducted. Each of the groups such as patients with adolescent idiopathic scoliosis (AIS) as well as control group were divided additionally into 2 groups: premenarcheal and postmenarcheal girls.Objective.The aim of the study was to determine the levels of 25-OH-vitamin D3, calcium and phosphate, parathyroid hormone (PTH), and calcitonin in serum of pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls.Summary of Background Data.The primary etiology and pathogenesis of AIS remains unknown. It is assumed that vitamin D deficiency and genetic predisposition, for example, polymorphisms of vitamin D receptor, have a great significance. Vitamin D plays a key role in skeletal development and prevents bone atrophy, affects the absorption of calcium, maintains calcium-phosphate homeostasis, and the bone matrix mineralization. Its deficiency can result in a wide variety of skeletal deformities, low bone mass, and then leads to the disappearance of bone. Defects in trabecular bone structure and/or bone mineralization are the main features of scoliosis. Some studies have reported that Vitamin D deficiency is common among patients with AIS. The mechanism of Vitamin D action on scoliosis development is still unclear.Methods.Determination of serum 25-OH-D3 levels was performed using high-performance liquid chromatography chromatography; concentrations of calcium and phosphate were measured using colorimetric methods, and concentration of PTH and calcitonin was measured using ELISA system.Results.Reduction in the serum levels of 25-OH-D3 and calcitonin in girls with AIS compared with healthy girls was demonstrated.Conclusion.The phosphate-calcium balance and PTH level seem to be normal in patients with AIS. The calcitonin level in girls with AIS is 2-fold lower than in healthy subjects. It is possible that the deficiency of vitamin D can be involved in AIS.Level of Evidence: 4

IntroductionThe objective of the study is evaluation of usefulness of measuring angles of lumbar lordosis and thoracic kyphosis in adults suffering from the low back pain (LBP).AimThe aim of this paper is to show the usefulness of measuring the angles of anteroposterior curvatures of the spine with the Saunders electronic inclinometer, using a direct method of measurement, in the LBP patients treated in a rehabilitation outpatient clinic.Material and methodsThe sample group included 87 people suffering from LBP, treated in the outpatient rehabilitation clinic. The angle of lumbar lordosis (LL) and the angle of thoratic kyphosis (TK) were measured with the use of the Saunders inclinometer. The differences between the compared groups were assessed on the basis of the Pearson χ2 significance test.Results and discussionThe LL angular values were mostly included within the 20°–40° in both, men and women, and they were found in 72%–78% of the examined patients. Lower LL was found to occur more often in men, but the difference was not statistically significant. Statistically significant functional shortenings of lower limbs above 1cm were more often found in men (62.5%).Conclusions(1) An alteration of the spine shape in the sagittal plane can be regarded as one of the potential factors of the LBP risk. (2) Measurements of the LL and TK angular values seem to be a legitimate element of the orthopedic examination of the patients suffering from LBP. (3) Reduction of lumbar lordosis can be an LBP risk factor, particularly in men.

PURPOSE:In order to verify the potential association between the aetiopathogenesis of adolescent idiopathic scoliosis (AIS) and the process of sexual maturation, we determined the concentrations of oestrogens in pre- and postmenarcheal girls affected by this condition. AIS, occurring mostly in pubescent girls, is one of the most frequent forms of faulty posture. Therefore, it was assumed that the multifactorial pathomechanism of AIS involves significant deficiency of oestrogens.METHODS:The diagnosis of AIS was established on the basis of physical examination and analyses of radiograms. Concentrations of FSH, LH, oestrogens, progesterone, osteocalcin and RANKL were determined by ELISA. The activity of alkaline phosphatase (AP) was measured by kinetic method. The study included pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls.RESULTS:In premenarcheal scoliotic girls, the levels of FSH, LH and oestradiol were lower; the levels of progesterone, oestrone and oestriol were higher; and the concentrations of oestrone and oestriol were similar compared to premenarcheal controls. Higher levels of RANKL, osteocalcin and AP were observed in premenarcheal adolescents with AIS compared to controls. The concentrations of FSH, LH, oestradiol, and progesterone in postmenarcheal girls with scoliosis were lower, oestrone were slightly lower and oestriol did not differ compared with the control group. Significantly higher levels of RANKL, osteocalcin and AP were observed in postmenarcheal scoliotic adolescents compared with controls.CONCLUSIONS:There is an interdependence between the concentration of oestradiol and development of scoliosis. Determination of estradiol may have diagnostic value in the screening of spinal pathologies associated with AIS.

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10–12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves.

The “bone-on-bone” reconstruction for adolescent idiopathic scoliosis is reviewed in this article. Extensive use over the past 18 years has identified it’s functional benefits outstanding clinical results, and very limited complications. This is an extensive update of it’s application, since it’s introduction, 18 years ago.

The controversial practice of methylprednisolone (MP) application in acute spinal cord injury (ASCI) is gradually decreasing. This is a survey study designed to assess the current use of MP in ASCI in Poland.

1 Oddzial Neurochirurgii, Specjalistyczne Centrum Medyczne w Polanicy-Zdroju 2 Katedra Neurologii i Neurochirurgii, Wydzial Nauk Medycznych Uniwersytet Warminsko-Mazurski i Oddzial Neurochirurgii, Pomorskie Centrum Traumatologii w Gdansku 3 Katedra i Klinika Neurochirurgii i Neurochirurgii Dzieciecej, Uniwersytet Medyczny w Lublinie 4 Klinika Ortopedii i Traumatologii, Uniwersytet Medyczny w Poznaniu 5 Oddzial Neurochirurgii, Wojewodzkie Centrum Medyczne w Opolu 6 Katedra i Klinika Ortopedii i Rehabilitacji Collegium Medicum Uniwersytetu Jagiellonskiego w Zakopanem © J SPINE SURG 1 (5) 2013 Review article/Artykul poglądowy

Introduction. In the last two decades, we observe an increasing incidence of spine infections. In the clinical image, we observe full diversification of symptoms – from longstanding, slowly increasing pain in the back to sudden and acute beginnings with septic state, extremely acute pain of the spinal column and quickly increasing neurological losses. Indications for surgical intervention are: compressions of nervous tissue, lack of stability of the spine dependent on bone destruction, ineffectiveness of conservative procedure and treatment of the not receding pain. Aim. The introduction of metal implants in the area of spine infection still arises objection among some surgeons, especially when in ‘in-vitro’ tests a bacterial biofilm was detected on the surface of the metal, resistant to the action of antibiotics. The aim of our work is the evaluation of the results of surgical treatment of spine inflammatory processes in different age groups with the use of spine implants. Material and method: A group of 92 patients were examined, aged from 4 to 88, surgically treated due to spine inflammatory process. The diagnosis was made on the basis of radiological examinations: rentgenographic imaging, computer-assisted-tomography and magnetic resonance. In the surgical treatment, we applied different techniques depending on the localisation of the process and destructive changes within the spine. Corporectomy with stabilisation on titanum net and screws was made from frontal access – 57% patients, and discsectomy without implant – 9% of operated patients. Discsectomy without implant from posterior access was carried out in 8% patients, discsectomy with stabilisation PLIF method – 13% patients, and decompression of the spine canal and transpedicular stabilisation – 13% patients. In general, in 86% patients, we carried out an intervention with implant graft. Results: In 70% of the group after primary intervention, we achieved improvement of the clinical state, confirmed in rentgenographic and laboratory tests (OB, C-reactive protein, Lukocytosis). In the remaining group (30% patients) there were different disadvantageous symptoms, requiring other surgical interventions. The follow-up period amounted on average to 4 years and 2 months. Conclusions: Surgical treatment is a method of choice in patients with a lack of improvement in conservative treatment, with increasing spine deformity and neurological losses. Resection of inflammatory changes in healthy tissues and correct spine stabilisation with the use of implants are a condition for the cure of the inflammatory process.

Degenerative disc disease of the thoracic segment of the spine is a relatively rare phenomenon among numerous spine diseases. Thanks to the introduction of diagnostics and the application of magnetic resonance imaging (MRI), the diagnosis of the disease has increased. The range of symptoms differs very much from the chronic, non-specific pain and sudden neurological losses. Interventions related to thoracic discopathy constitute only 5% of surgeries of all disc diseases. In the surgical treatment of disc disease of the thoracic segment, there are no established standards of proceedings. In 1990, Mack et al. for the first time applied the thoracoscopy technique for spine interventions, and in 1995 Caputy et al. described VATS technique for thoracic discsectomy. In our study, we present 5 patients aged between 15 and 53 operated on by means of endoscopic technique, due to thoracic discopathy. Diagnosis was made on the basis of rentgenographic imaging and magnetic resonance imaging of the thoracic spine and electrophysiological and neurological tests. Indications for the intervention were the following: ailments, neurological defects and disorders in SSEP (Somato Sensoric Evoked Potentials) trace. The insufficient material does not allow neither for carrying out statistical research nor for carrying out comparison with other communications in literature, which are most often of a casuistic character.

Introduction: Palliative posterior decompression and instrumentation surgeries for spinal metastasis are effective in improving quality of life by providing good pain control and neurologic improvement.Preoperative embolization is usually performed because excessive blood loss is one of the main complications during the surgery.However, none of these studies have measured the effect of embolization on intraoperative blood loss in a single operative procedure.Aim: The purpose of this study was to evaluate the effectiveness of preoperative embolization in palliative posterior decompression and instrumentation surgery for spinal metastasis.Patients and methods: Forty-five patients were included in this study.Between 2000 and 2010, the patients underwent a palliative posterior decompression and instrumentation as the primary surgery for spinal metastasis in thoracolumbar spine.Not all of the patients had bleeding diathesis.One to three vertebral levels were decompressed by laminectomy and aggressive debulking of vertebral tumor.Five to seven vertebrae were stabilized using posterior instrumentation.Preoperative embolization was carried out on 23 patients (embolization group).In the embolization group, the primary tumors were in lung (7 patients), breast (4 patients), kidney (4 patients), prostate (2 patients) and the others (6 patients).The surgeries were carried out within 3 days after the embolization.The embolic materials were gelatin sponge, polyvinyl alcohol foam and metallic coils.The other 22 patients did not have the embolization (no embolization group).In the no embolization group, the primary tumor were in lung (8 patients), prostate (3 patients), colon (3 patients), breast (2 patients), the others (6 patients).Results: Angiography and embolization was performed in all 23 patients in the embolization group without causing neurologic deficit.The pain and neurologic symptoms in all 45 patients were relieved after their surgery.The average intraoperative blood loss was 520 ml (140-1380 ml) in the embolization group.This was significantly lower than 1059 ml (100-3260 ml) in the no embolization group (p \ 0.05).In the embolization group, the intraoperative blood loss was not correlated with tumor vascularization degree, embolization degree and time between embolization and surgery. Conclusion:The intraoperative blood loss, after preoperative embolization, was measured to be about the half of that without preoperative embolization.

The malformations of the nervous system being of a dysraphia nature constitute one of the most serious and most prevalent disorders at child’s age. They result from primary and secondary neurulation disorder and differenciation in the 18 – 48 day of pregnancy. Serious anatomic spine anomalies together with spinal cord anomalies ensue from this. The severity of the deformity is variable, and its ethiology not fully known yet. The complex of abovementioned disorders is known under the name of neurodysraphia. The condition, besides anatomic anomalies, characterizes itself with accompanying, varied neurological defects and co-existing other organs’ malformations. The dynamic of neurological changes is being observed during the development. The diagnostics is based on orthopedic and neurologic examination and review spine radiogram and specialist imaging tests: computer-assisted tomography, magnetic resonance imaging, computer-assisted myelo-tomography. Indications for surgical intervention are the following: prevalence or intensification of neurological symptoms and progression of spine deformity. On the basis of own material, we present the problems of diagnostics and treatment of dysraphia latent defects.

Introduction. One of the most serious problem of contemporary orthopedics is the treatment of changes of bone tissue density. This problem affected significant part of population especially women after the menopause. Bone structure disorders can cause a lot of local and general complications such as osteoporotical fractures. It is of great clinic importance to try to prevent such changes. Objective. This work is aimed at attempting to determine the effect of paraffin treatments on the degree of calcification of the bone tissue in healthy people and in people with postmenopausal osteoporosis. Material. In 2004, a series of pilot studies were carried out at the Physiotherapy Unit of the Academy of Physical Education in Krakow, in which two groups of subjects were employed in order to obtain an answer to the proposed hypotheses. Group one consisted of 44 healthy people, including 38 females, aged 21 – 34 (the average age 23 years), and 6 males, aged 22 - 28 (the average age 25 years). Group two was made up of 17 females with confirmed osteoporosis, aged 54 - 73 (the average age 67 years). Method. The method of the study included history taking by means of a specially prepared survey form, the filling in of which expressed willingness to participate in the research programme. Each subject, no matter which group they belonged to, had a four time bone mineral density measure, made by non-invasive quantitative ultrasonography within the area of the calcanean tubers of both limbs, first carried out before the series of the treatments and once again after 10, 20 and 30 treatments. Each subject also took part in a series of paraffin treatments carried out according to the recommendations of the specialist literature, concerning the methods of application, as well as indications and contraindications for such treatments. The statistical analysis working out the parameters achieved during the research ended the research programme. The statistical analysis included descriptive statistics (the arithmetic mean and the percentage change), the ANOVA analysis, a t-student test for paired data and the correlation coefficient. Results. Despite the considerable intensity of treatments, the statistical analysis of the parameters under the research did not reveal significant differences in the calcification of the calcaneal bone in the limb undergoing the treatment and the control limb. Such results were observed in both groups under the research. Conclusions. The paraffin treatments do not cause the decrease of the mineral density of the bone, both in healthy people and in people with osteoporosis.

The goal of treatment in scoliosis is not only curve correction. Restoration of normal sagittal alignment is also very important. Methods describing sagittal balance are various, they include measurement of thoracic kyphosis and lumbar lordosis, alignment of thoracolumbar junction and distance between plumb line from C7 and sacral bone. Goals of work: Evaluation the sagittal plane alignment after surgery in idiopathic scoliosis, type 5 and 6 according to Lenke classification; Establishing risk factors of bad end result. Material consists of 52 patients. The mean age at the time of surgery was 16 years with the follow up time of 4 years. There were 29 patients in first group, with Lenke type 5 and 23 patients in the second group, with type 6. The Cobb angle of structural curves was in Lenke 5 group 52.5o ± 5.9 and in Lenke 6 group − 54.4o ± 8,4 in thoracic spine and 66.3o ± 11.9 in lumbar spine. Preoperative thoracic kyphosis was 20.9o ± 6.9 and 29.3o ± 15.5. Lumbar lordosis was 42.5o ± 11.4 and 35.9o ± 11.4. Thoracolumbar junction was almost straight in first group; Th12-L2 angle was 0o ± 6.7 and slight kyphotic in second group: 4o ± 8.1. All the patients underwent posterior fusion with derotational instrumentation. Radiological assessment was performed using postero-anterior and lateral radiograms. Own scale of treatment result evaluation was introduced. Results: During control examination the thoracic kyphosis was 30.1o ± 7.8 and 27.8o ± 9.4 and lumbar lordosis was 40.3o ± 12.3 and 35.7o ± 9.9. During follow-up, the mean thoracolumbar junction angle was −4.4o ± 9.6 and −7.9o ± 9.9. Proper alignment of thoracolumbar junction was observed in 24 patients (82.8%) from first group and 21 patients (91%) from the second. Good results in sagittal plane were noted in 22 cases (76%) from Lenke 5 group and 21 cases (91%) from Lenke 6 group. The presence of pedicle srews in lumbar spine was bound with significantly better end result. Smaller lordosis, greater probability of bad result. Kyphotic thoracolumbar junction before surgery was connected with greater risk of bad result. The level of lower end of fusion was significantly important in pre-dicticting end result. Conclusions: Own method of describing result in sagittal plane allows better assessment of sagittal balance; There are several factors influencing end result in sagittal plane in scoliosis surgery; The best indicator of bad sagittal result is improper alignment of thoracolumbar junction.

Research objective. Retrospective study on patients treated with implantation of interspinous distractor. Aim. To present the difficulties and complications that occurred during treatment with an interspinous distractor InsWing and Coflex. Material. 36 patients with various types of complications from group of 160 operated during 2007- 2010 in our Hospital Results. Patients were divided into four main groups: 1) Difficulties during implantation of interspinous distractor occurred in 12 patients, of which - in 5 were related to anatomical abnormalities of spinous process, in 4 to aplasia of spinous process L5, In 3 too small interspinous space. 2) intraoperative complications occurred in 5 patients, of which – in 2 occured fracture of spinous process, In 2 rupture of supraspinous ligemant, in 1 violation of dura mater. 3) Early complication in the form of delayed healing was observed in 4 patients, 4) Late complications were noticed in 15 patients and it was – in 4 patients dislocation of an implant, in 2 rupture of supraspinous ligament, in 3 fracture of spinous process, in 1 spondylolysis, in 5 lack of improovement of the pain after surgery. Conlucions. Surgical treatment of lumbar spine disc disease with interspinous distractor is minimal invasive, safe, effective, charged with low risk of complications. Additionally, in case of failure, it does not close the possibility of treatment with other surgical methods.

Idiopathic scoliosis (IS), despite multidirectional therapy, involves a significant impairment of the quality of life of the patients. It is caused by pain syndromes frequently accompanying IS, the etiology of which has not been entirely discovered. The present research on environmental factors predisposing to pain syndromes in girls with IS involved analysis of 54 girls under ambulatory care, aged 14-17 (on average 15.3-years-old ±0.99). The patients’ natural environment was analysed, including time spent in a sedentary position during the day, sleeping time, time spent on physical activity during the week, regularity of meals consumed, as well as the quantitative composition of the diet. The research also concerned the location and characteristics of ailment reported, as well as pain intensity on the Numerical Rating Scale (NRS).

Introduction. Resection of tumours of the spinal canal performing laminectomy may lead to deformities in the sagittal plane. These deformities require surgical treatment in order to restore the normal sagittal profile. Aim of paper. This paper presents patients with a kyphotic spine deformity resulting from a laminectomy performed for tumour resection and the results of surgical treatment aiming to restore the normal sagittal balance. Authors basing on the literature and own observations identify the risk factors of deformity development. Material. Material consists of 5 patients, 3 women and 2 men, who underwent a resection of tumours of the spinal canal via laminectomy and who developer pathological kyphosis that required surgical treatment. Methods. We evaluated: age at initial surgery, type of resected pathology, extent of laminectomy, need of radiotherapy, onset and progression of deformity, sagittal balance, and concomitant spinal deformities type of surgery restoring normal spine profile. Results. The inital surgery in cases was performed under the age of 10 years. One female patient apart a kyphotic deformity of the cervico-thoracic junction had also scoliosis. In 3 cases the resected tumour was astrocytoma, in one osteoblastoma and in one a subdural cyst. The extent of laminectomy ranged from 2 to 5 levels. The location of laminectomy was cervico-thoracic junction in 2 patients, thoraco-lumbar junction in 1 patient and thoracic region in two patients. Radiotherapy was applied in 4 cases. The progression of the deformity was observed during growth spurt and ranged from 72° to 155°. Surgery for kyphosis correction was performer between the age 12 to 25 years. The final kyphosis angle ranged from 20° to 86°. No intraoperative complications were noted. In one case a loss of fixation in the lower end of the fusion was observed, a reoperation was required. The follow-up period after kyphosis correction ranged from 1 to 9 years. Conclusion. Laminectomy may lead to a pathologic kyphosis; the magnitude depends on several factors like age at surgery or extent of laminectomy. It is essential to control patients with risk factors and in cases of development of kyphosis surgical means are successful in achieving good sagittal balance.