Marco Crostelli

Aneurysmal Bone Cysts: Treatment with Direct Percutaneous Ethibloc Injection. Long-Term Results

Abstract Purpose: To assess the efficacy and long-term results of Ethibloc treatment in aneurysmal bone cysts (ABC). Methods: Thirteen patients with ABC were treated with direct percutaneous Ethibloc injection. Four patients had only one injection and the other nine patients from two to four injections. No severe complications were observed; in two patients a local leakage of Ethibloc from the cyst into the soft tissues occurred but it was temporary and the consequent inflammation self-healed without residua and sequelae. Imaging follow-up lasted from 6 to 67 months and included conventional radiology (CR) and magnetic resonance imaging (MRI), both used in the presurgical phase. Results and Conclusions: All images demonstrated a remarkable shrinkage of the cystic lesion and bone cortex thickening. In all patients, circumscribed areas of lucency persisted at radiography, corresponding to residual cystic areas without fluid–fluid levels at MRI. Pain, which was present in all the patients before treatment, was relieved within a month. According to our experience, direct percutaneous Ethibloc injection is effective in the treatment of ABC and can be recommended as the first-choice treatment. Due to its higher sensitivity MRI must be included either in the pretreatment phase to study the multilocular structure or in the imaging follow-up to evaluate the efficacy of Ethibloc in persistently non-responsive areas.

AIS and spondylolisthesis

IntroductionThe association of scoliosis and spondylolisthesis is well documented in literature; the nature and modalities of the relationship of the two pathologies are variable and not always clear. Also, etiologic particulars of scoliosis associated with spondylolisthesis are not well defined, even in cases where scoliosis is called idiopathic. In this paper, we review previous literature and discuss the different aspects of the mutual relationship of scoliosis and spondylolisthesis in the adolescent age.Materials and methodsIt is a common notion that the highest occurrence of scoliosis associated with spondylolisthesis is at the lumbar level, both in adolescent and in adult patients. It is probable that the scoliosis that is more heavily determined by the presence of spondylolisthesis is at the lumbar level and presents curve angle lower than 15° Cobb and mild rotation. The scoliosis with curve value over 15° Cobb that is present at the lumbar level in association with spondylolisthesis probably is not prominently due to spondylolisthesis: in these cases, spondylolisthesis is probably only partially responsible for scoliosis progression with a spasm mechanism and/or due to rotation of slipping “olisthetic” vertebra.DiscussionWe think that the two pathologies should be treated separately, as stated by many other authors, but we would highlight the concept that, whatever be the scoliosis curve origin, spasm, olisthetic or mixed together, this origin has no influence on treatment. The curves should be considered, for all practical effects, as so-called idiopathic scoliosis. We think that generally patient care should be addressed to treat only spondylolisthesis or only scoliosis, if it is necessary on the basis of clinical findings and therapeutic indications of the isolated pathologies, completely separating the two diseases treatments.ConclusionsScoliosis should be considered as an independent disease; only in the case of scoliosis curve progression over time, associated scoliosis must be treated, according to therapeutic principles of the care of any so-called idiopathic scoliosis of similar magnitude, and a similar approach must be applied in the case of spondylolisthesis progression or painful spondylolisthesis.

Can early diagnosis and partial meniscectomy improve quality of life in patients with lateral discoid meniscus

OBJECTIVES To evaluate clinical and radiographic mid-term outcomes and improvement in quality of life in pediatric patients affected by LDM and who underwent partial or total/subtotal meniscectomy. MATERIALS AND METHODS 28 patients (12 M, 16 F), mean age 8.3 years old (range: 6-13) affected by LDM with symptoms and/or meniscal tears, mean follow up: 2 years and 4 months (range: 24-52 months). Symptoms included: pain, swelling, articular block, limitation to knee extention, meniscal instability and formation of meniscal cysts. 23 patients treated with partial meniscectomy, 5 by total/subtotal meniscectomy. All of them have been clinically evaluated using the Ikeuchi scale and the POSNA questionnaire; for radiological evaluation we used the Tapper-Hoover grading scale. RESULTS Ikeuchi: In 23 patients underwent partial meniscectomy: 21 excellent and 2 good; in 5 patients underwent total/subtotal meniscectomy: 1 excellent, 2 good and 2 average. POSNA presurgical mean score: partial meniscectomy: 70 (range 66.8-73.6), total/subtotal meniscectomy: 58.7 (56.9-62.2). POSNA presurgical mean score: partial meniscectomy: 92.4 (range 88.7-98), total/subtotal meniscectomy: 81.2 (range 78.3-85.6). Tapper-Hoover: in 23 patients underwent partial meniscectomy: 17 were classified grade I, 5 grade II, 1 grade III; in 5 patients underwent total/subtotal meniscectomy: 2 were classified grade II and 3 grade III. These ones evidenced further signs of chondromalacia on articular surfaces, in the lateral area of knee joint. DISCUSSION Significant improvement in quality of life, evidenced in all patients (p = 0.048 in those underwent total/subtotal meniscectomy, p = 0.011 in those underwent partial meniscectomy), but especially in patients who underwent partial meniscectomy with absence of meniscal tears (p = 0.033), supports how important can be early diagnosis of LDM in childhood. We assert that early diagnosis and conservative treatment (partial meniscectomy) could reduce risks in development of chondromalacia, in those patients affected by LDM, because of its association with better clinical, radiographic and in quality of life mid-term results.

The 8th Supplement of the Italian Spine Society/Scoliosis Study Group (SICV&GIS)

Spine surgery in Italy has greatly evolved in the last few decades in terms of surgical techniques, equipment, instrumentation systems, and ability to define and manage complex clinical pictures. In fact, any physician dealing with spinal diseases must be aware of the expected consequences of their management, to understand the course of the disease. Such an awareness will allow the surgeons to undertake the appropriate measures necessary for the best patient care and therefore to improve the outcomes. Spine surgery typically represents a field of shared competence between orthopaedic surgeons and neurosurgeons, even though the recent interest of the scientific community towards the management of spinal deformities has seen a renewed interest by the orthopaedic community towards it. This Supplement shows current approaches to various spinal problems: degenerative spine diseases, fractures, infections and deformities. We are pleased that the Supplement explores some “cutting edge” topics such as the recent advances in three-planar spinal deformity corrections, as well as alternative methods of deformity corrections. We also emphasize a newer vertebral body necrosis classification system and the guidelines for its management, aimed to the recognition of this poorly understood disease; hopefully the proposed classification may drive the clinicians to its recognition and suggest a standardized management. Another paper explores the contest of pyogenic spinal infections, the epidemiological and clinical features, the prognostic factors and the long-term outcomes in a wide cohort of patients. We also selected manuscripts on the topics of trauma that regard the role of vertebroplasty in respect to the conservative treatment, the extra-spinal associated lesions, and the performance of different instrumentations in these settings of patients. Other manuscripts show a contemporary approach to minimally invasive spine surgery in the setting of the degenerative spine; the positive outcomes are the results of standardized approaches and careful selection of patients. We believe that the content of this Supplement will be interesting to the surgeons dedicated to the treatment of spine diseases. We would like to thank all the contributing authors for their interesting manuscripts. Once more, these articles outline the clinical and scientific standards of the Italian Spine Community.

The 7th Italian supplement: a selection from the Italian Spine Society and Scoliosis Study Group (SICV&GIS)

However, the difficulty to have access to the studies and experiences of the Italian surgeons is evident by the confrontation with foreign colleagues. Their contributions were mainly presented at the Annual Congress of the Society, and were published in Italian by the former official journal of the Society, named “Progresses in Spinal Diseases” (Progressi in Patologia Vertebrale): this made it difficult to find and study the manuscripts. For these reasons, I would like to thank Max Aebi once more. While being Editor-in-Chief of European Spine Journal in the past, which is recognized worldwide as one of the main journals in the field of spinal diseases, he stimulated and promoted the participation of our Society to the Journal by submitting manuscripts; moreover, he promoted the realization of a special issue with selected studies presented at the National Congress of the Society, and later on an issue with the best of the Italian scientific production in this field. As President of the SICV&GIS, I am therefore proud to present the manuscripts selected between some of those presented at our Annual Meeting, as well as selected studies submitted by Society Members. With regret, these represent only a small part of what has been produced this year by our colleagues. However, I do trust that these might mirror the quality of the scientific production of a society, whose main aim is to grow continuously by an internal dialectic discussion, and by the confrontation with international colleagues from all over the world.

Apophyseal and epiphyseal knee injuries in the adolescent athlete

OBJECTIVES In the context of pediatric sports injuries, the epiphyseal and apophyseal knee fractures represent rather peculiar lesions. The most frequently involved anatomical area is the knee. The peculiar function of the physis and the need to preserve their integrity, makes choosing what treatment methods to employ very important. Objective of this study is to assess the kind and the effectiveness of the most suitable treatment in the apophyseal and epiphyseal knee lesions occurring in the adolescents. MATERIALS AND METHODS From 2006 to 2011, were treated 41 patients (34 M-7 F) between the ages of 10 and 15, with a diagnosis of traumatic knee injury caused by sports activities. Traumatic physeal fractures of the distal femur, the proximal tibia and its anterior tuberosity and the avulsion of the intercondylar eminence were the lesions that occurred most frequently. The treatment belonged to the type of lesion: closed reduction or percutaneous fixation with K-wires/ screws and a femoral-podalic plaster cast, ORIF with K-wires/screws, arthroscopic reduction and internal fixation using absorbable screws. All the patients were given the POSNA questionnaire at the end of the follow up. RESULTS The follow up was on average 5 years (4-10 years). We considered as excellent the results obtained in 26 patients, as fair in 12 patients, in 1 case the result obtained was considered as poor. 2 caseswere lost during follow up. The average POSNA score at the end of the follow-up was 98.51. Any early complications recorded were the following: in 1 case infection of the K-wires 32 days after pinning and a reported compression of the popliteal neurovascular bundle, due to a displaced tibial physeal fracture. CONCLUSIONS Since sport during childhood and adolescence is now practiced more and more frequently, also at a competitive level, thesekinds of fractures in children between the ages of 10 and 15 have been occurring more often, especially in male patients. Sports traumatology of the knee in this age group is characterized by a typology of injuries that are very particular. The knowledge of the anatomy and physiology of children, with an appropriate diagnostic assessment, is essential to identify the most appropriate treatment options for each specific injury. As the nucleus of proximal tibial growth plate progressively closes from posterior to medial side, in patients between 11 and 13 years of age with an apophyseal displacement of the tibial tuberosity, you should always perform a CT exam, to exclude an intra-articular physeal fracture.