The authors present the cases of monozygotic male twins with right-sided Legg-Calvé-Perthes disease (LCPD) with different formation of the lumbosacral junction. This is likely the fi rst description of a lumbosacral junction formation disorder associated with identical twins who were both treated for LCPD as children. The disease began at 6 and 9 years of age and during treatment as well as in adulthood signifi cantly different bone formation of the lumbosacral transitional vertebra, was observed in both brothers. Twin A has a unilateral right-sided fusion of the enlarged L5 transverse process with the ipsilateral sacral ala, twin B has a complete sacralization of the fi fth lumbar vertebra. The LCPD treatment outcomes in the twins were consistent with the results from large studies, i.e., age at the time of LCPD onset is the main factor infl uencing the prognosis, however the morphological difference in the transitional vertebrae in these monozygotic twins was signifi cantly. Key words: lumbosacral transitional vertebra, lumbosacral junction formation, sacralization of lumbar vertebra, megatransverse of vertebra L5.

• MeSH
• Lumbar Vertebrae diagnostic imaging   MeSH
• Child MeSH
• Twins, Monozygotic MeSH
• Sacrum diagnostic imaging   MeSH
• Humans MeSH
• Spinal Diseases * MeSH
• Legg-Calve-Perthes Disease * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH

Primární kostní lymfom je vzácná a překvapivá diagnóza. Představujeme případ 37leté ženy s difuzním velkobuněčným B-lymfomem (DLBCL) křížové kosti doplněný o snímky ze zobrazovacích metod a bioptický nález. Několik let před hospitalizací pacientku postihovaly spontánní fraktury a povšechné bolesti, zejména beder. Na základě toho bylo provedeno biochemické vyšetření krve, krevní obraz, třífázová scintigrafie skeletu pomocí 99mTc-HDP SPECT/CT, CT a MRI pánve. Biopsie z kosti křížové byla zpracována metodou formalinové fixace a zalití do parafínového bloku (FFPE), řezy byly obarveny pomocí standardních a imunohistochemických metod. Ke stagingu lymfomu bylo provedeno 18F-FDG PET/CT vyšetření. V 1. a 2. fázi třífázové kostní scintigrafie nebyla pozorována odchylka v krevní cirkulaci či tkáňové perfuzi. Avšak v kostní fázi SPECT/low dose CT byl pozorován defekt akumulace s lemem akumulace zvýšené, odpovídající ložisku osteolýzy s lemem zvýšené kostní přestavby. Histopatologicky byla stanovena diagnóza DLBLC, germinal center B-cell like (GCB-like) subtyp. Třífázová scintigrafie skeletu výrazně přispěla k odhalení primárního DLBCL v poměrně neobvyklé lokalizaci. Časné odhalení DLBCL a následná kombinovaná léčba vedla ke stabilizaci onemocnění.

Primary bone lymphoma is a very rare and surprising diagnosis. We present a case of 37years old woman with primary sacral diffuse large B-cell lymphoma (DLBCL), supplemented with images from imaging studies and histopathological report. Patient suffered from spontaneous fractures and pain for several years prior to the last hospitalisation. She underwent analysis of biochemical profile and blood count, a three-phase bone scintigraphy, pelvic CT and MRI. Biopsy from sacral bone was processed as formalin-fixed paraffin-embeded blocs (FFPE), sections were stained by standard and immunohistochemical methods. 18F-FDG PET/CT scan was performed for lymphoma staging. Three-phase bone scintigraphy did not show abnormity in blood circulation or tissue perfusion in the course of the first and second phase. However, in the delayed phase, we observed an accumulation defect with rim of higher radiotracer accumulation on SPECT/low dose CT corresponding to osteolytic focus with rim of increased bone remodelling. Histopathological examination led to diagnosis of DLBCL, germinal center B-cell like (GBC-like) subtype. A three-phase bone scintigraphy significantly helped to disclose DLBCL in atypical location. Early diagnosis of DLBCL was followed by appropriate treatment, which resulted in stabilization of disease.

• Keywords
• třífázová scintigrafie skeletu,
• MeSH
• Diagnostic Imaging methods   MeSH
• Lymphoma, Large B-Cell, Diffuse * diagnostic imaging   diagnosis   MeSH
• Adult MeSH
• Sacrum diagnostic imaging   pathology   MeSH
• Humans MeSH
• Radionuclide Imaging methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

PURPOSE OF THE STUDY To compare the outcomes of parallel and convergent iliosacral screw insertion into the body of vertebra S1 in the treatment of posterior pelvic arch injuries. MATERIAL AND METHODS Radiographs of 120 patients (43 women, 77 men), aged between 14-79 years, treated with iliosacral screw fixation for posterior pelvic ring fractures between 1.1.2009 and 31.12.2019 were reviewed for inclusion in the study. In each case two screws were inserted into the body of vertebra S1. The screws were inserted in either parallel or convergent orientation. Convergent orientation allows the threads of both screws to be interconnected. In this technique, the first screw is inserted into the centre of the body of vertebra S1 as a compression screw. The second screw is inserted as a positioning screw and is placed so that the threads of both screws lock together. We believe that the interlocking of the threads of both screws and contact of the second screw with three cortices (two of the iliac bone and one of the sacrum) increase the stability of the fixation. Migration of loosened screws was measured on radiographs of the pelvis obtained at six weeks and at three, six and twelve months postoperatively. Migration of five millimetres or more within the first six weeks was considered to be clinically significant. Only patients after primary fracture treatment and with a complete one-year follow-up were included in the study. Cases of non-union and failure of osteosynthesis of the anterior pelvic arch and patients with incomplete follow-up were excluded. The incidence of significant screw migration between the two techniques was compared using Fisher's exact test with a 5% level of significance. RESULTS Sixty-three patients (23 women, 40 men) aged 17 to 79 years were included in the study. Parallel screws were used in 24 patients (8 women, 16 men) and convergent screws were used in 39 patients (15 women, 24 men). Clinically significant migration occurred in nine (38%) patients after parallel insertions. In two of these cases there was unstable fixation of the anterior pelvic arch. Migration of convergently placed iliosacral screws occurred in four (10%) cases. In three of these cases this was due to unstable fixation of the anterior pelvic arch. The difference in screw migration between the two groups was shown to be significant (p = 0.0219). DISCUSSION Iliosacral screws ensure sufficient stability of the posterior arch in type B and C pelvic fractures provided that the anterior pelvic arch is stable. Convergent insertion of iliosacral screws may increase the stability of fixation. Minimally invasive surgery with sufficient stability may be advantageous for early treatment of patients after multiple trauma and in elderly patients. The weaknesses of this study are its relatively small number of patients, which prevented reliable statistical analysis of screw migration according to the type of pelvic fractures. The second main limitation is the failure to perform densitometric examination of the skeleton in patients with X-ray proven screw migration for confirmation of osteoporosis as one of the possible causes of fixation failure. CONCLUSIONS The results of the study suggest that convergent insertion of iliosacral screws into S1 is associated with a lower risk of screw migration and subsequent failure of fixation of the posterior pelvic arch. Key words: pelvic fracture, pelvic injury, iliosacral screw, parallel screws, convergent screws, migration of iliosacral screws.

• MeSH
• Adult MeSH
• Fractures, Bone * surgery   MeSH
• Bone Screws adverse effects   MeSH
• Sacrum diagnostic imaging   injuries   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pelvic Bones * injuries   MeSH
• Aged MeSH
• Fracture Fixation, Internal adverse effects   methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY An optimal technique to surgically treat high-grade high-dysplastic (HG HD)spondylolistheses remains disputable. There are multiple surgical procedures described, ranging from a simple posterior fusion in situ without fixation through a standalone anterior lumbar interbody fusion with the oblique insertion of a structural bonegraft to instrumented full reduction and 360-degree fusion. At our department, preference is given to the instrumented monosegmental reduction and fixation by a fixator with Schanz screws. The aim of this paper is a prospective clinical and radiological evaluation of the group of operated patients below 30 years of age with HG HD spondylolisthesis with a slip greater than 50%. MATERIAL AND METHODS In the period from 11/2007 to 2/2017, a total of 29 patients with HG HD spondylolisthesis always of the L5-S1 segment were treated at the Department of Spinal Surgery of the First Faculty of Medicine of the Charles University and the Teaching Hospital Motol. They were 10 men and 19 women aged 10 to 28 years, with the mean age of 18.4 years. In 27 patients reduction and single-segment fixation of L5-S1 were performed as primary treatment, in one case decompression and noninstrumented-fusion only was carried out and in one case in situ fixation of L4-L5-S1 for distinctive osteoporosis. RESULTS The average duration of posterior surgery without the reconstruction of the anterior column was 88.9 min, in case of anterior fusion it was 46.6 min and in case of only posterior approach and fusion with the reconstruction of the anterior column it was 141.5 min. The average blood loss in the posterior fusion without the reconstruction of the anterior column reached 384.3 ml, in the stand-alone anterior fusion it was 21.6 ml. and in the posterior fusion with the reconstruction of the anterior column 430.0 ml. In 27 patients in whom the reduction was carried out, a shift of the L5 vertebral body observed on the CT scan prior to the surgery was 64.3% on average, while postoperatively and also at 6 months after the surgery during the follow-up examination it was 8.1%. A clear bone posterolateral fusion was found by the CT examination after 4-6 months in all 29 patients (100%, N = 29), while bone intersomatic fusion was reported in 25 cases (96.2%, N = 26). Altogether 6.9% of residual neurological deficits were observed. The statistical processing of VAS values for lumbar back pain and ODI values before the surgery and after two years confirmed a significant improvement of the clinical condition (p < 0.001). When asked whether they would undergo the same surgery with their current experience with the treatment, all the 29 patients answered "yes" and stressed the functional as well as the aesthetic results of the surgery. DISCUSSION In agreement with the other authors, the PT, SS and PI values are measured and we consider the SA, SDSG LSA and Dubousset s LSA assessments to be essential. All the measured values showed statistically significant changes postoperatively, only the pelvic incidence(PI) value remained unchanged. In patients with HG HD spondylolisthesis, we prefer reduction and the 360-degree monosegmental fusion, in the case of sacral osteotomy always using the posterior approach, in the cases where osteotomy is not performed using the next anterior approach. Even in the cases of the most severe deformities, we prefer to maintain the body of L5 and, where necessary, rather shorten the sacrum, which in our opinion leads to a better aesthetic result. CONCLUSIONS The reduction by single-segment instrumentation is a suitable alternative to the surgical therapy of HG HD spondylolistheses in young patients. It provides a high success rate of bone fusion and good clinical results including the aesthetic aspects. The complications associated with full reduction are not markedly higher than in other surgical techniques. Key words:spondylolisthesis, HGHD, high-grade, high-dysplastic, reduction, pelvic incidence, pelvic tilt, sacral slope.

• MeSH
• Lumbar Vertebrae diagnostic imaging   surgery   MeSH
• Decompression, Surgical methods   MeSH
• Operative Time MeSH
• Child MeSH
• Adult MeSH
• Spinal Fusion instrumentation   MeSH
• Bone Screws MeSH
• Sacrum diagnostic imaging   surgery   MeSH
• Blood Loss, Surgical MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Neurosurgical Procedures MeSH
• Tomography, X-Ray Computed MeSH
• Prospective Studies MeSH
• Spondylolisthesis classification   diagnostic imaging   surgery   MeSH
• Bone Transplantation methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY Fragility fractures of the pelvic ring in the elderly population are a serious problem in orthopaedics. The treatment options range from conservative treatment to diverse operative options. We present a balloon guided new technique of implanting cement augmented screws aiming at improved implant anchorage and reduced cement leakage. MATERIAL AND METHODS We describe a new technique of balloon- guided cement augmented iliosacral screws. After the balloon has been insufflated and contrast medium has been instillated for leakage detection, iliosacral screws can safely be placed with a relevant cement depot. RESULTS All patients (n = 8) treated in this way were allowed to weight bear on both legs and mobilisation was tolerated the next day after surgery. In the post-operative controls including X-ray and CT scan we noticed no cement leakage. Pain level as measured by the visual analog scale was significantly reduced to pre- surgery (mean 7.6 pre-operatively, mean 2.5 postoperatively). In addition pain medication could be reduced gradually soon after surgery. CONCLUSIONS The described procedure to address fragility fractures of the pelvic ring is a safe and easy to handle method. There are three advantages: First the osteoporotic S1 vertebral body can by stabilised by the amount of cement; second the cement leakage can be prevented by the balloon-compaction of the cancellous bone and the possibility to control the created cavity with contrast medium; third the bone - screw interface is much stronger compared to other procedures and is biomechanically superior against vertical shear stress. In contrast to sacroplasty, the cement application is guided by the previous use of a balloon. Key words:pelvic ring, fragility fracture, osteoporosis, elderly.

• MeSH
• Early Ambulation MeSH
• Spinal Fractures diagnostic imaging   surgery   MeSH
• Bone Cements therapeutic use   MeSH
• Bone Screws * MeSH
• Sacrum diagnostic imaging   injuries   surgery   MeSH
• Humans MeSH
• Ilium diagnostic imaging   surgery   MeSH
• Osteoporotic Fractures diagnostic imaging   surgery   MeSH
• Radiography MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Weight-Bearing MeSH
• Check Tag
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH