Tomasz Potaczek

Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones

INTRODUCTION Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. AIM OF PAPER Presentation of results of simple excision of symptomatic accessory navicular. MATERIAL AND METHODS Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. RESULTS The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. CONCLUSION Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index.

Study Design. Validation of a translated, culturally adapted questionnaire. Objective. To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients. Summary of Background Data. The ODI is among the most popular questionnaires used to evaluate back pain–related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated. Methods. The questionnaire was translated and culturally adapted by 2 independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland–Morris disability questionnaire, VAS for low back and leg and 3 Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled, and 84 of 164 (53%) returned the completed retest booklet within 2 to 14 days after the baseline test. There were no differences between the 2 groups in demographic and clinical parameters. Test-retest reliability, internal consistency, and construct validity were investigated. Results. The mean ODI (standard deviation [SD]) was 48.45 (18.94); minimum 2, maximum 94. The Cronbach &agr; for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the Roland–Morris disability questionnaire score was very good (r = 0.607, P < 0.001). The correlation with VAS back was fair (r = 0.37, P < 0.001) and with VAS leg was good (r = 0.56, P < 0.001). The tested ODI had excellent test-retest reliability, the intraclass correlation coefficient was 0.97 and standard error of measurements was 3.54, the resulting minimal detectable changes at the 95% confidence level was 10. Conclusion. The results of this study indicate that the Polish version of the ODI is a reliable and valid instrument for the measurement of disability in Polish-speaking patients with lower back pain.

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

BackgroundSpinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease.MethodsThis is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up.ResultsThe mean follow up period was 5.5 ± 2.9 years (range 1-10 years). The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142°) and 75.6 ± 26.7° (range 40° - 108°) respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage) on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105°) and 58.5 ± 27.7° (range 10° - 95°) respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4%) and 26.3 ± 21.2% (range 7.9 - 75%). Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°), and lordosis was 50.8 ± 18.6° (range 20° -79°). Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15°) postoperatively and did not change significantly during follow up.ConclusionsHuge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.

Effectiveness of Treatment of Idiopathic Scoliosis by SpineCor Dynamic Bracing with Special Physiotherapy Programme in SpineCor System.

BACKGROUND The SpineCor dynamic brace for the treatment of idiopathic scoliosis is designed to maintain the correct position of the spine and a new movement strategy for 20 hours per day. The SpineCor exercise system intensifies and complements the brace treatment. This study evaluated the effectiveness of a comprehensive treatment of idiopathic scoliosis involving the SpineCor system. MATERIAL AND METHODS The study assessed a group of 40 patients (38 girls and 2 boys) with idiopathic scoliosis treated with the SpineCor brace. The average age at beginning of treatment was 13.1 yrs (10-15). Minimum treatment time was 18 months. 28 participants met the SRS criteria. Angles of the curve before and after bracing based on imaging studies were measured at the beginning and end of the treatment, analyzed and compared. Rehabilitation focused on teaching active corrective movement throughout the brace treatment. A control group was formed of 33 patients, including 21 meeting the SRS criteria, who used the SpineCor dynamic brace but did not participate in the associated exercise programme. RESULTS Among patients from the exercise group who met the SRS criteria, 25% demonstrated reduced curve angles, 35.7% demonstrated curve progression and 39.3% showed stabilization (no change). Among patients meeting the SRS criteria from the control group, a decrease in curve angle was observed in 14.3% of the patients, curve progression in 57.1% and stabilization in 28.6%. CONCLUSIONS 1. The addition of a dedicated physiotherapy programme to SpineCor dynamic bracing improves the chances of obtaining a positive outcome. 2. It is necessary to further analyse the course of the comprehensive treatment, also with regard to other types of braces and kinesiotherapy programmes.

Comparison of Postoperative Period in Patients with Pectus Excavatum Treated with Nuss Technique and Ravitch Technique.

BACKGROUND Pectus excavatum (PE) is the most common defect of the chest wall. Surgery for PE can be performed with an open or endoscopic technique. The choice of the surgical approach influences the postoperative course. The aim of the paper is to analyze the postoperative period in two groups of patients treated for PE. Group 1 consisted of patients who underwent endoscopic surgery, and Group 2 was composed of patients who underwent open surgery. A secondary aim is to compare the surgical outcomes between the two groups. MATERIAL AND METHODS The study group consisted of 40 patients treated in a single centre that uses a uniform postoperative analgesic protocol. The duration of surgery, blood loss, duration of hospital stay, complications, pain intensity and consumption of opioid and non-opioid analgesics were analyzed. The mean duration of follow-up was 9 months (6 -25 months). RESULTS Age at surgery, weight and height did not differ between the groups. In Group 1 the duration of surgery and blood loss were lower than in Group 2. In Group 1 complications occurred in 25% of the patients. Pain intensity was higher in Group 1 (4.23 vs. 3.67), as was the consumption of strong opioids (0.52 mg/kg body weight vs. 0.25 mg/kg body weight). Subjective evaluation was satisfactory in 85% of the patients in Group 1 and 90% in Group 2. CONCLUSIONS 1. Both techniques led to a satisfactory outcome. 2. The duration of surgery and blood loss were higher in the open surgery group, but pain intensity and consumption of strong analgesics were higher among the patients treated with the endoscopic technique. 3. Preparation for surgery should involve planning appropriate analgesic treatment in the post-operative period.

Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up.

Cervical kyphosis in diastrophic dysplasia (DTD) is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results.

Severe Thoraco-lumbar Kyphoscoliosis Associated with Osteoporosis in Siblings - Case study.

The incidence of scoliosis among patients with certain systemic diseases is much higher than in the general population. Moreover, the onset of the scoliosis is in early childhood before the age of 5 and the deformity reaches extreme values. We present the clinical course of two siblings with multiple musculoskeletal deformities, osteoporosis, severe kyphoscolisis and an undiagnosed systemic disease. The onset of scoliosis was in the first months of life of both children, with a marked progression about the 8th month of life. Due to lower limb deformities, ambulation was delayed until the 5th year of life in the male sibling, and the girl remains non-ambulant. Both children had osteoporosis, which caused numerous fractures of the upper and lower limbs. Due to progression of the spinal deformity the boy underwent a posterior hemispondylodesis with instrumentation at the age of 7. The girl also underwent surgery at the age of 7, but instrumentation could not be placed successfully due to inadequate bone quality. The last follow-up to date has been at the age of 12 years for the female patient and 20 years for the male patient. The spinal deformity in the female has not progressed during the last 2-3 years. She has been on bisphosphonate therapy for two years and no new fractures have been noted. The male patient has undergone multiple surgeries for lower limb deformities and is an independent walker. His scoliosis remains stable, but a minor progression of kyphosis has been noted in the last year. The history of the two patients shows that not all early-onset deformities can be effectively treated and that osteoporosis is a crucial obstacle to this treatment.