Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

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366 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY Pain on VAS and walking distance improved signifi - cantly at less than 2 years and remained unchanged at 4 years follow-up. Radiographically, spondylolisthesis did not progress and the motion segments remained stable. 2 patients showed screw-loosening at 1 year follow-up and underwent revision. Overall, patient satisfaction remained high as 93% and would undergo the same procedure again. In elderly patients with spinal stenosis and degenerative spondylolisthesis, decompression and dynamic stabilization lead to excellent clinical and radiologic results. It maintains enough stability to prevent progression of spondylolisthesis. Because no bone grafting is necessary, donor site morbidity, which is one of the main drawbacks of fusion is eliminated 138 FUNCTIONAL GENOMICS: REVISITING THE LINK BETWEEN SCOLIOSIS AND CONGENITAL HEART DISEASE I. Drosdov, R.J. Macfarlane, C.A. Ouzounis, E. Tsiridis, M.A. Gatzoulis Centre for Bioinformatics, School of Physical Sciences & Engineering, King’s College London, Strand, London, UK; Cardiovascular Division, British Heart Foundation Centre, James Black Centre, King\’s College London, Denmark Hill, London, UK; Academic Orthopaedic Unit, Leeds General Infirmary & Chapel Allerton Teaching Hospitals, Leeds, UK; School of Medicine, Section of Musculoskeletal Disease, Institute of Molecular Medicine, University of Leeds, Leeds, UK; Cardiovascular Division Congenital Heart Centre & Centre for Pulmonary Hypertension, The Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, UK Although previous lnks have been made between congenital heart disease (CHD) and scoliosis, the molecular mechanisms involved in this association are poorly understood. During development, it appears that embryos exhibiting spine deformations resulting in scoliosis also suffer from an array of cardiac defects. Additionally, idiopathic scoliosis in patients with CHD is thought to be a response to a physiological phenomenon such as an enlarged size or abnormal thrust of the heart. Despite the fact that molecular omics data have been accumulated that are relevant to these two independent phenotypes, there appears to be a gap in the literature of over two decades on this matter and no clear correlations of the omics data have been provided. To identify genes involved in CHD and scoliosis, we have performed an analysis of genomic annotations, functional genomics data and text mining, and derived an inferred network of 123 human genes and 175 known gene interactions. Of these, 20 genes are unique to CHD, 11 to scoliosis and 5 genes are common to both abnormalities. These genes are known to be involved in molecular signaling cascades that affect the development of the musculoskeletal system in humans and have been associated with disorders such as the Marfan or CHARGE syndromes. Our analysis sets the basis upon which investigations of this association can be performed at the molecular level, in order to both further understand the pathology and, in the future, develop suitable therapies for CHD/idiopathic scoliosis patients 139 CORRELATION OF THE VOLUME OF INJECTED CEMENT USING CEMENT AUGMENTED PEDICLE SCREWS WITH THEIR PULLOUT STRENGTH. A CADAVER STUDY P. Diaremes 1 , MC Kokkinakis 2 , A.A. Kurth 3 , K Kafchitsas 3 Klinikum Aschaffenburg, Aschaffenburg, Germany; Stoke Mandeville Hospital, Oxford, United Kingdom; Department of Orthopaedics and Orthopaedic Surgery, Johannes Gutenberg University Mainz, Germany The radiological and biomechanical assessment using cement augmented cannulated pedicle screw (Biomet ® , Omega 21 ® ) and the correlation of the cement volume to the pullout strength needed for each screw Cadaveric vertebrae of different lumbar levels were used. Through cannulated pedicle screw a defi nite volume of cement was applicated. The bone volume occupied by cement was assessed by means of segmentation after Computer Tomography. Biomechanical Pullout tests and statistical correlation analysis were then performed The maximum pullout strength was 1361 N and the minimum pullout strength was 172 N (SD 331 N). The maximum cement volume was 5,29 cm3 and the minimum 1,02 cm3 (SD 1,159).The maximum cement diameter was 26,6 cm and the minimum cement diameter was 20,7 cm (SD 1,744). There is statistically signifi cant correlation between the pullout strength and the injected cement volume (p
the presence of multi-level degenerative disease and the correction of cervical lordosis on the pre-operative dynamic radiographs. Patient demographics, co-morbidities and post-operative complications were recorded and analysed. Functional outcome was assessed by using the Japanese Orthopaedic Association (JOA) score. There were 37 male and 31 female patients with an average age 67.4 years. The average follow up period was 18 months. The mean pre-operative JOA score was 8.7, whereas the mean post-operative score was 12.1 on the latest follow-up visit. 9 patients had unsatisfactory clinical results and consequently underwent anterior procedures with signifi cant improvement. Complications included 1 epidural haematoma, 2 superfi cial infections and 4 cases of myofascial pain. In three cases there was mild dysfunction of the C5 nerve root which resolved spontaneously with conservative measures. In the present series of patients posterior decompression with laminectomies is an effective method for the management of cervical spondylotic myelopathy. 144 QUALITY OF LIFE OF THE SURGICALLY TREATED DEGENERATIVE LUMBAR SPINAL STENOSIS PATIENTS C. Copuroglou, M. Ozcan, B. Aykac, B. Yilmaz, Y. Gorgulu, E. Yalniz Department of Orthopaedic & Traumatology, Univesity of Trakya; Department of Neurology & Neurosurgery, Research & Training Hospital for Psychiatry Turkey Degenerative lumbar spinal stenosis is one of the most frequent surgical indications of spinal surgery in the elderly patient group. Because of the progression of the disease and neurologic defi ciencies, patients’ quality of life is affected. We aimed to evaluate the postoperative quality of life of the surgically treated spinal stenotic patients. Between 1998 and 2009, 38 patients, who were surgically decompressed and enstrumentated in our clinic were included to the study. The patients were preoperatively and postoperatively evaluated with Visual Analogue (Scale (VAS) and Japanese Orthopaedics Association (JOA) criterias. The same patient group were re-evaluated on the postoperative 6th month with Hamilton anxiety and depression scale, on the 12th month with short form-36 and Oswestry pain scoring scales to measure the quality of life. Mean age of 38 patients (31 female, 7 male) was 59.6 (range 44 to 82). Mean preoperative VAS was 7.97 and postoperative VAS was 2.28. The pain decreased 56.9%. According to JOA criterias, in 3 patients (7.89%) no recovery, in 13 patients (34.2%) less than 50% recovery and in 22 patients (57.8%) more than 50% recovery was obtained. On the 6th month, according to Hamilton anxiety and depression scale, in 12 patients anxiety and in 3 of these patients depression which needs treatment was observed. The pain of all the patients with anxiety recovered meaningfully (42.3%) but according to JOA, less than 50% recovery could be obtained. Surgically treated spinal stenosis patients improved clinically and radiologically and this affected the patients’ quality of life positively 145 SURGICAL TREATMENT OF KYPHOTIC DEFORMITY FOLLOWING OSTEOPOROTIC FRACTURES K. Zachariou, A. Morakis, M. Tsafantakis, A. Bountis, P. Agourakis, A. Kalabokis Scoliosis and Spine Department GNA ‘KAT’ To evaluate our results of treatment of kyphosis following osteoporotic fractures of the last 3 years. 28 women with a mean age of 63,2 years were treated for a painful kyphotic deformity of a mean Cobb angle 76,1°. They all had posterior fusion with pedicular screws and rods enhanced with autologous bone graft as well as allografts. Cement augmentation was used in a number of screws. A cell saver for auto transfusion and continuous neurophysiological monitoring was used intraoperatively in all cases. All patients fi tted with a thoracolumbar brace for 3 months. J BONE JOINT SURG [BR] 2011; 93-B:SUPP III HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 367 The postoperative mean Cobb angle was 45,2° (40,6% improvement). Pain questionnaires at a mean postoperative follow up of 16 months showed excellent results in 10 patients (35,71%), good in 8 patients (28,57%), satisfactory in 6 patients (21,42%) and poor results in 4 patients (14,28%). All patients were satisfi ed with the cosmetic result. 2 patients presented a postoperative infection that was treated with debridement and antibiotics. Kyphotic deformity following osteoporotic fractures may treated satisfactory with rods and pedicular screws with cement augmentation 146 COMPARISON OF THE RESULTS BETWEEN STANDARD DISCECTOMY AND MICRODISCECTOMY FOR LUMBAR DISK HERNIATION A. Hatzigiammakis, D. Kotzamitelos, E. Baburda, H. Sali, K. Tilkeridis, C. Boyiatzis Orthopaedic Department University General Hospital of Alexandroupolis We estimated the long term results of the different methods in chirurgical treatment of lumbar disk herniation in consideration with the presence or absence of degenerative changes and the grade in witch these factors infl uence the result of this kind of treatment. Seventy eight patents with lumbar disk herniation have been submitted in partial discectomy. The men were 42 and 36 women. The patients were separated in tow groups. In the fi rst group [48 patients,31 of them (A1) without degenerative changes, while the 17 (A2) with degenerative changes], was applied macrodiscectomi. In the second group [30 patients, 18 of them (B1) without degenerative changes and the 12 (B2) with changes], was applied microdiscectomi with use of magnifying lenses. The mean age during operation was 44 years (18-67) and 38years (24-62) respectively for the tow groups, and the mean time of follow-up was 7 years and 8 months (18 months-13years). For all patients, the operation was executed from the same surgeon. The elements that were evaluated were the Visual analog scale (VAS, O-10), the Oswestry Disability Index (ODI), as well as the complications during and after the operation and the cases that required a reoperation. In the fi rst group VAS score was improved from 9.1 to 3.1 and the ODI score was improved from 86% to 24.2%. In the second group VAS score was improved from 9 to 2.6 and the ODI score was improved from 84.2% to 19.2%. From all patients, subgroup B1 without degenerative changes, which was submitted in microdiscectomy presented the biggest improvement. We have had to reoperate 6 patients (7.8%). In cases of lumbar disk hernia both methods are appropriate and lead to a considerable improvement of the symptoms. Degenerative changes of the lumbar spine is a factor that leads in less satisfactory results 147 HYBRID INSTRUMENTATION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS P. Krallis, I. Kosmidis, S. Thoma, Ch. Chatziantonioy, A. Koutrouphinis, I. Hager Orthopaedic Clinic, “Penteli” General Hospital of Children Although pedicle screw instrumentation for the treatment of idiopathic scoliosis is very popular, hybrid constructs remain a safe and effective method of scoliotic curve correction. This retrospective study was undertaken to assess the outcomes of hybrid instrumentation in the treatment of idiopathic scoliosis. Forty three children underwent surgical correction for idiopathic scoliosis. Patients were evaluated at a minimum 2-year follow-up (range 2-9 years). Clinical and radiographic assessment was performed for all patients preoperatively, immediately postoperatively, one year after surgery and at the fi nal follow up. Radiographic parameters assessed included Cobb’s angle, coronal balance, translation of the apex vertebra, kyphosis, lordosis, angle in the T10 – L2 region and sagittal balance. Idiopathic scoliosis was classifi ed according to the King classifi cation system. All patients underwent posterior spinal fusion using hybrid instrumentation while 6 received, prior to the posterior fusion, anterior thoracic discectomies. Postoperatively overall Cobb’s angle correction was 59.5%. At the fi nal follow-up an average loss of the correction of 9.5% was recorded. Nevertheless, there was an overall correction of the translation of the apex vertebra and a satisfactory coronal balance improvement at the fi nal follow up compared to the immediate postoperative follow-up. Although a trend toward improved sagittal balance was noted, it was not statistically signifi cant. The surgical complications included 2 cases of deep wound infection. In addition one patient required revision and a longer fusion distally. Operative treatment of adolescent idiopathic scoliosis with hybrid instrumentation yields satisfactory clinical and radiological results. Therefore, it can be considered as a safe and effective method of treatment of adolescent spinal deformity 148 MELATONIN HORMESIS AND ITS ROLE IN IDIOPATHIC SCOLIOSIS AND OSTEOPOROSIS PATHOGENESIS. T.B. Grivas, E.S. Vasiliadis, A. Kaspiris, G. Triantafyllopoulos, R.G. Burwell Department of Trauma and Orthopaedics, “Tzanio” General Hospital; Department of Trauma and Orthopaedics, “Thriasio” General Hospital; The Centre for Spinal Studies & Surgery, Nottingham University Hospitals Trust, Queen\’s Medical Centre Campus, Nottingham NG7 2UH, UK Melatonin’s concentration is high in early childhood and declines gradually thereafter. In the elderly serum melatonin levels are very low. Melatonin, the “light of night”, among other functions is involved in human sexual maturation and in osteogenesis. Hormesis is the response of cells or organisms to an exogenous (eg drug or toxin) or intrinsic factors (eg hormone), where the factor induces stimulatory or benefi - cial effects at low doses and inhibitory or adverse effects at high doses [bimodal dose-response] or vice versa. At the age around 10 years, when idiopathic scoliosis may appear, the circulating melatonin level is about 120 pg/ml – positive hormesis for menses – and menarche appears. Melatonin defi ciency may result in a delay of the age at menarche and consequently the girl is susceptible to scoliosis. In these terms melatonin could be certainly involved in the scoliosis pathogenesis. Around the age of 45 years when the circulating melatonin levels are about 20 pg/ml – negative hormesis for menses, menopause starts and the woman has an increased risk for osteoporosis and fractures. It is documented the bone-protecting effect of melatonin in ovariectomized rats which can depend in part on the free radical scavenging properties of melatonin. Additionally, melatonin may impair development of osteopenia associated with senescence by improving non-rapid eye movement sleep and restoring GH secretion. Whether modulation of melatonin blood levels can be used as a novel mode of therapy for scoliosis and augmenting bone mass in diseases deserves to be studied 149 THE “THREE JOINT COMPLEX” MODEL FOR PROGRESSION OF IDIOPATHIC SCOLIOSIS T.B. Grivas, E.S. Vasiliadis, A. Kaspiris, G. Triantafyllopoulos Department of Trauma and Orthopaedics, “Tzanio” General Hospital; Department of Trauma and Orthopaedics, “Thriasio” General Hospital It was previously postulated that the IV disc wedging is a signifi cant progressive factor for mild IS curves. The present report introduces an innovative comprehensive model of IS curves progression based on intervertebral disc (IV) diurnal variation and the subsequent pathobiomechanics of the deforming “three joint complex”, where vertebral growth occurs.
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