Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation

Objective of the study. Scoliosis is one of the most common orthopedic diseases of childhood and adolescence, leading to disability and reducing the quality of life of the child. The prevalence of this nosological form in the structure of pediatric orthopedic pathology reaches 30 %. In 50 % of cases, the disease is characterized by a severe progressive course, especially in puberty. The aim of the study is to analyze scientific data for 2008–2024 on the use of electrical stimulation methods used in the treatment of scoliosis in children. In order to form a scientific review of modern methods of electrical stimulation for scoliosis in children, we searched for scientific papers on this topic from open electronic databases of scientific medical literature CyberLeninka and eLibrary. The main methods of physiotherapy used in the treatment of scoliosis in children are electrical treatment methods, among which the leading place is given to electrical stimulation. The advantage of electrical stimulation in scoliosis in children is to provide training of strength and tone of the back muscles on the side of the deformation. Electrical stimulation is indicated for scoliosis of I and II degrees. The greatest effect in the correction of scoliotic deformation of the spine in children is observed with the complex use of electrical stimulation and exercise therapy. This review presents the results of the use of electrical stimulation methods for scoliosis in children: sinusoidally modulated currents, diadynamic therapy, transcutaneous electrical neurostimulation, interference therapy, fluctuation and functional programmable electrical stimulation. Conclusions: The review concludes that the various methods of electrical stimulation presented in the review article are very diverse, have different effectiveness, and occupy an important place in personalized approaches to the treatment of children with scoliosis.

The use of inert head materials such as ceramic heads has been proposed as a method of reducing wear and corrosion products from the articulating surfaces in total hip arthroplasty, as well as from the stem‐head taper connection. The aim of the present study was to compare the blood metal ion levels in patients with Oxinium and CoCrMo modular femoral heads, as well as monoblock stainless steel Charnley prostheses at 10 years postoperatively. The 150 patients with osteoarthritis of the hip joint included in a randomized clinical trial were grouped according to femoral head material. One group (n = 30) had received the Charnley monoblock stainless steel stem (DePuy, UK). The other patients (n = 120) received a Spectron EF CoCrMo stem with either a 28 mm CoCrMo or Oxinium modular head (Smith & Nephew, USA). After 10 years, 38 patients had withdrawn, 19 deceased, 7 revised due to aseptic loosening and 5 revised due to infection. The 81 patients with median age of 79 years (70–91) were available for whole blood metal ion analysis. The levels of Co, Cr, Ni and Zr in the blood were generally low with all the head materials (medians <0.3 micrograms/L) and no statistical difference between the groups were found (p = .2–.8). Based on the low blood metal ion values in our study groups, no indication of severe trunnion corrosion in patients with CoCrMo heads was observed, neither was there any beneficial reduction in metal ion exposure with the Oxinium femoral heads.

There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents. A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy. The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24-3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06-0.78; p = 0.02). The operation time (mean difference [MD] = -34.37; 95% CI: -67.47 to -1.28; p = 0.04) and mean placement time per screw (MD = -3.11; 95% CI: -6.13 to -0.09; p = 0.04) and mean times for fluoroscopy (MD = -6.60; 95% CI: -8.66 to -4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss. Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.

Introduction. Scoliosis is one of the most common orthopedic diseases of childhood and adolescence, leading to disability and reducing the child’s quality of life. The prevalence of scoliosis in the structure of pediatric orthopedic pathology reaches 30 %. In 50 % of cases, the disease is characterized by a severe progressive course, especially during puberty. Aim. Studying the effectiveness of electrical stimulation methods for scoliosis in children to develop recommendations for their practical use based on the analysis of systematic reviews and randomized controlled trials. Materials and methods. The search was carried out using the database of evidence-based physiotherapy PubMed, Cyberleninka and eLIBRARY using the keywords: «electrical stimulation», «pulse currents», «scoliosis», «children» for the period from 2008–2024.Exclusion criteria: articles published on this topic before 2008. Main content. The main methods of physiotherapy used in the treatment of scoliosis in children are electrotherapy methods, among which electrical stimulation plays a leading role. The advantage of electrical stimulation for scoliosis in children is to provide training in the strength and tone of the back muscles on the side of the deformity. Electrical stimulation is indicated for scoliosis of I and II degrees. The greatest effect in the correction of scoliotic spinal deformity in children is observed with the combined use of electrical stimulation and exercise therapy. This review provides data on the relevance of medical rehabilitation of scoliosis in children, the mechanism of action of electrical stimulation, data on the effectiveness of using electrical stimulation methods for scoliosis in children: sinusoidal modulated currents, diadynamic therapy, transcutaneous electrical neurostimulation, interference therapy, fluctuarization and functional programmable electrical stimulation. Conclusion. Currently, a wide range of electrical stimulation technologies has been developed for the medical rehabilitation of children with scoliosis, among which sinusoidally modulated currents and diadynamic currents are most often used. Transcutaneous electrical neurostimulation, having a predominantly antinociceptive effect, also has an effect on muscle contractions. Functional programmable electrical stimulation of muscles is a promising technology for medical rehabilitation of children with scoliosis, requiring further study and scientific justification.

Scoliotic deformity in young children is a challenge for the spinal surgeon. Though traditional spinal correction and fusion techniques can improve these deformities, they inhibit growth of the spine. Nonfusion technologies are an effective approach to this problem. They not only correct the spinal deformity, but also allow the spine to keep growing and developing. These techniques include the growing rod, stapling, pedicle screw tethering, the vertical expandable prosthetic titanium rib (VEPTR), and multi-vertebrae wedge osteotomy. This is a review of advances in nonfusion techniques for the treatment of scoliosis in children.

Determination of metal ions in Paris polyphylla var. Yunnanensis by ICP-OES and its influence on hemostasis

Aim. The aim of the study is to evaluate the effectiveness of using a Chenot corset in the treatment of idiopathic scoliosis in children and adolescents. Materials and methods. Thirty-five patients aged 7 to 17 years, suffering from idiopathic scoliosis degree II-III, under our supervision, were included. The distribution according to gender was 8 boys and 27 girls. The range of the angle of scoliotic deformation before the appointment of the corset was from 21 to 47 degrees according to Cobb on the anterior-posterior x-ray of the spine performed standing. The average angle of deformation was 32 degrees. Results. Evaluation of the effectiveness of corset therapy was carried out after the patient had adapted to the orthosis (3 months after the appointment of the corset) and reached a wearing time of 1821 h per day on an x-ray of the spine performed in a standing corset. The average correction was 37.5%, and the average angle of deformation was reduced from 32 to 20 degrees.

Updates on surgical treatments for pediatric scoliosis

Objective To evaluate the primary clinical outcome of the new instrumentation growing rods of sliding pedicle screw system in the treatment of scoliosis in children.Methods From January 2009 to July 2011,10 patients with idiopathic scoliosis were treated using a new instrumentation growing rods of sliding pedicle screw system.There were 3 males and 7 females,aged from 4 to 12 years (average,7.8 years).Risser sign was grade 0 in all patients.There were 3 cases of single thoracic curve,6 cases of single thoracolumbar or lumbar curve,and 1 case of double thoracic curve.Before operation,the average coronal Cobb angle was 66.8°(range,38° to 85°),the average sagittal Cobb angle was 45.5°(range,38° to 66°),and the average sitting height was 48.6 cm (range,36 cm to 64 cm).During the follow-up period,some parameters were observed,such as coronal and sagittal Cobb angles,sitting height,complications and so on.Result Immediately after operation,the average coronal Cobb angle was 28°(range,17°to 39°) with the average correction rate of 56％(range,48％ to 65％),the average sagittal Cobb angle was 31° (range,25°to 39°),and the average sitting height was 56.8 cm (range,40 cm to 70 cm).All patients were followed up for 12 to 44 months (average,26.5 months).At final follow-up,the average sitting height increase by 2 cm,skin infection at the end of the rod occurred in 3 cases,which recovered after local dressing change,and shoulder imbalance occurred in 1 cases.There were no broken screws,broken rods and other internal fixation-related complications.Conclusion The new instrumentation growing rods of sliding pedicle screw system is effective and safe in the treatment of scoliosis in children. Key words: Scoliosis; Child; Spinal fusion; Internal fixators

IntroductionClinicians and patients must weigh the benefits of radiological imaging against the risks of radiation exposure in the diagnosis and treatment of scoliosis. This report aims to estimate the cumulative absorbed and equivalent dose of radiation in patients undergoing surgical treatment for scoliosis, and to present this as an estimated risk of cancer compared to background radiation levels.MethodsRetrospective review of estimated absorbed dose on the Computerised Radiology Information System (CRIS®). Patients undergoing surgical correction of scoliosis (age ≤ 25) from August 2010 to August 2015 investigated. Estimated absorbed dose [milligrays (mGy)] recorded. Pedicle screws inserted using image intensification. Equivalent dose [millisieverts (mSv)] and additional cancer risk calculated from the National Research Council document ‘Health risks from exposure to low levels of ionising radiation’ (2006).Results271 patients identified. Mean age 15 (range 2–25). Mean total absorbed dose 2136 mGy [standard deviation (SD) 1700 mGy]. Mean number of plain spine radiographs was 8 (SD 3) with total 1884 mGy exposure (SD 1609 mGy). Additional dose provided by CT (mean 0.17 episodes), plain chest and abdominal radiographs and image intensification. Mean number of image intensification episodes was 1.1 with mean estimated exposure 180 mGy (SD 238 mGy). Image intensification accounted for 8% of the estimated absorbed dose during treatment. Estimated mean effective dose delivered was 20.952 mSv equating to an additional cancer risk of 0.27–0.45%.ConclusionAdditional cancer risk from cumulative imaging is small and equivalent to approximately 8 years of natural background radiation. Use of image intensification for pedicle screw insertion is a minor contribution (8%) to the total patient dose.

Retrospective analysis. To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications. Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO). Growth-preserving strategies are attractive, but comorbidities raise the risk/benefit ratio. To our knowledge, no previous studies have focused on growth-preserving spine surgery in these children. From our multicenter patient group, we identified 27 children with cerebral palsy treated with GRs (single rod in 4; dual rods in 23 [15 extending to the pelvis]). We collected radiographical, surgical, hospital stay, and major complication data. We compared Cobb angle and PO improvement between patients with and without pelvic instrumentation via the Student t test (significance, P = 0.05). No patient required anterior spinal fusion. Average improvements for all patients (preoperative to latest follow-up) were: Cobb angle, 35° ± 23°; PO, 14° ± 19°; T1-S1 length, 7.9 ± 4.4 cm; and space available for lung ratio, 0.17 ± 0.21. For the 8 patients who underwent fusion, average improvements (preoperative to postfusion) were: Cobb angle, 43° ± 28°; PO, 2° ± 21°; T1-S1 length, 9.5 ± 6.0 cm; and space available for lung ratio, 0.26 ± 0.28. Pelvic GR fixation produced better PO correction (P < 0.001) but similar Cobb angle correction (P = 0.556). Hospital stays averaged 8.7 ± 12.1 days after initial surgery, 1.4 ± 2.5 days after lengthening (45% were outpatient procedures), and 13.4 ± 6.2 days after fusion. The most common complication was deep wound infection (30%). GRs via a posterior-only approach are effective. Constructs extending to the pelvis control PO more effectively. However, 30% of patients experienced deep wound infection.

Интраоперационный мониторинг при операционном лечении сколиоза у детей

Objective: To determine the efficacy and safety of growing rods in the treatment of scoliosis in children aged under 10 years. Methods: A retrospective review of medical records of patients under 10 with scoliosis, treated with growing rods from the period between 1997 and 2012. Results: We identified 35 patients treated with growing rods who met the selection criteria. The average age at the start of treatment was 5.9 ± 2.3 years. Most of the patients (51.4%) showed idiopathic etiology scoliosis. Pre-surgery and post-surgery radiographic change showed a 47.7% reduction in Cobb angle (p&gt;0.001). We identified 8 patients with some complication, the most prevalent being instrumentation failure (22.9%). The only predicting factor for post-operative complications was the total number of lengthenings performed (OR=7.03; CI 95% [1.1-45.4]; p=0.040). Conclusions: Treatment of scoliosis with growing rods in patients aged under 10 achieved a significant reduction in the magnitude of the deformity before final bone fusion. However, the rate of complications is rather high, therefore we recommend reducing the frequency of lengthenings to the minimum needed to maintain correction and longitudinal growth of the spine. Level of Evidence IV; Case series.

In twenty-one children with myelomeningocele and progressive scoliosis, treatment of scoliosis was attempted with a Boston type underarm brace. Thirteen children finished full brace treatment (average treatment time 2.5 years) and the patients were included in a follow-up more than 2 years after the end of treatment with no further progression of the scoliosis. Two patients are still undergoing brace treatment. Six children were operated due to continued progression of the scoliosis. Among 14 patients with scoliosis 45 degrees or less at the start of brace treatment, only 1 patient progressed and underwent operation. The brace had a temporary effect on severe scoliosis, decreasing the rate of progression. Complications were few. The brace caused decubitus ulcer in one patient, and two patients developed increased pressure of the urinary tract.

The influence on motoric skills of surgical treatment of scoliosis in 14 children with myelomeningocele was studied. Fifty percent of the children had increased flexion contractures of the hips at follow-up and all but one patient had impaired motor ability. There was no influence on ADL, but 57% of the children had lost some of their ambulation capacity. Postoperative physiotherapy is highly advisable. Intensive attempts to treat these children conservatively to prevent scoliosis progression is suggested.