• MeSH
• Analgesics administration & dosage   MeSH
• Back Pain surgery   etiology   pathology   therapy   MeSH
• Diagnosis, Differential MeSH
• Thoracic Vertebrae diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Spinal Diseases surgery   pathology   therapy   MeSH
• Neurilemmoma * surgery   diagnostic imaging   classification   pathology   MeSH
• Spine diagnostic imaging   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

PURPOSE OF THE STUDY The study aimed to draw up a diagnosis and treatment guidelines for the management of the most common compression fractures of the thoracolumbar spine in children. MATERIAL AND METHODS Between 2015 and 2017, pediatric patients with a thoracolumbar injury aged 0-12 years were followed up in the University Hospital in Motol and the Thomayer University Hospital. The age and gender of the patient, injury etiology, fracture morphology, number of injured vertebrae, functional outcome (VAS and ODI modified for children), and complications were assessed. An X-ray was performed in all patients, in indicated cases also an MRI scan was done, and in more severe cases a CT scan was obtained as well. RESULTS The average vertebral body kyphosis in patients with one injured vertebra was 7.3° (range 1.1°-12.5°). The average vertebral body kyphosis in patients with two injured vertebrae was 5.5° (range 2.1°-12.2°). The average vertebral body kyphosis in patients with more than two injured vertebrae was 3.8° (range 0.2°-11.5°). All patients were treated conservatively in line with the proposed protocol. No complications were observed, no deterioration of the kyphotic shape of the vertebral body was reported, no instability occurred, and no surgical intervention had to be considered. DISCUSSION Pediatric spine injuries are in most cases treated conservatively. Surgical treatment is opted for in 7.5-18% of cases, in dependence on the evaluated group of patients, age of the patients and philosophy of the department concerned. In our group, all patients were treated conservatively. CONCLUSIONS 1. To diagnose F0 fractures, two unenhanced orthogonal view X-rays are indicated, whereas MRI examination is not routinely performed. In F1 fractures, an X-ray is indicated, and an MRI scan is considered based on the age and extent of injury. In F2 and F3 fractures, an X-ray is indicated and subsequently the diagnosis is confirmed by MRI, in F3 fractures also a CT scan is performed. 2. In young children (under 6 years of age), in whom an MRI procedure would require general anaesthesia, MRI is not routinely performed. 3. In F0 fractures, crutches or a brace are not indicated. In F1 fractures, verticalization using crutches or a brace is considered in dependence on the patient's age and extent of injury. In F2 fractures, verticalization using crutches or a brace is indicated. 4. In F3 fractures, surgical treatment is considered, followed by verticalization using crutches or a brace. In case of conservative treatment, the same procedures as in F2 fractures are applied. 5. Long-term bed rest is contraindicated. 6. Duration of spinal load reduction (restriction of sports activities, or verticalization using crutches or a brace) in F1 injuries is 3-6 weeks based on the age of the patient, it increases with the age, with the minimum being 3 weeks. 7. Duration of spinal load reduction (verticalization using crutches or a brace) in F2 and F3 injuries is 6-12 weeks based on the age of the patient, it increases with the age, with the minimum being 6 weeks. Key words: pediatric spine injury, thoracolumbar compression fractures, children trauma treatment.

• MeSH
• Lumbar Vertebrae diagnostic imaging   surgery   MeSH
• Child MeSH
• Spinal Fractures * diagnostic imaging   etiology   MeSH
• Thoracic Vertebrae diagnostic imaging   surgery   MeSH
• Infant MeSH
• Fractures, Compression * diagnostic imaging   etiology   MeSH
• Kyphosis * surgery   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

Hlavním cílem tohoto souhrnného sdělení je ukázat, jakým směrem se ubíral vývoj klasifikací poranění thorakolumbální páteře, a zevrubný popis dvou nejběžněji užívaných moderních klasifikací – Thoracolumbar Injury Severity Scale and Score (TLICS) a AOSpine Classification for Traumatic Fracture of the Thoracolumbar Spine, jejich vzájemné porovnání a vyjasnění výhod, které přináší druhá jmenovaná. Součástí sdělení je i doporučení jednoduchého algoritmu, který umožňuje i méně zkušenému klinikovi rozlišit mezi poraněním indikovaným k terapii konzervativní a chirurgické.

The main goal of this comprehensive paper is to clarify the way of thoracolumbar spine The main goal of this summary paper is to describe the way of thoracolumbar spine injury classification development and to provide a detailed description of two of the most commonly used classifications - the Thoracolumbar Injury Classification and Severity Scale (TLICS) and the AOSpine Classification for Traumatic Fracture of the Thoracolumbar Spine, including their comparison and clarification of the merits introduced by the second one. The paper also formulates a recommendation of a simple algorithm enabling even less experienced clinicians to distinguish between an injury indicated for conservative treatment and one that requires surgery.

• MeSH
• Lumbar Vertebrae diagnostic imaging   injuries   MeSH
• Spinal Fractures * diagnostic imaging   classification   therapy   MeSH
• Thoracic Vertebrae diagnostic imaging   injuries   MeSH
• Humans MeSH
• Orthopedic Procedures methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Epidurální absces páteře je raritní onemocnění, které se objevuje především u imunokompromitovaných pacientů po operacích nebo úrazech páteře a pokud je diagnostikováno příliš pozdě, může vést k těžkému neurologickému deficitu nebo dokonce smrti. V literatuře jsou ovšem popsány i případy epidurálního abscesu páteře u pacientů s fistulující formou Crohnovy choroby. Představujeme kazuistiku mladé pacientky s Crohnovou chorobou a recidivujícím perianálním postižením, které bylo komplikováno vznikem epidurálního abscesu v oblasti hrudní páteře. I díky úzké spolupráci s ortopedy a neurology se podařilo gastroenterologům pacientku úspěšně léčit. Následně tak pacientce mohla být navrácena biologická léčba potřebná pro komplikovaný průběh Crohnovy choroby.

Spinal epidural abscess (SEA) is a rare disease that occurs mainly in immunocompromised patients after spinal surgery or spinal trauma and can lead to a severe neurological deficit or even death if diagnosed too late. However, cases of SEA have also been reported in patients with fistulising Crohn ́s disease (CD). We present a case of a young patient with CD and a history of relapsing perianal disease followed by a complication of SEA in the thoracic spine. In close cooperation with the orthopedists and the neurologists, the gastroenterologists have successfully treated the SEA in this patient, allowing her to return back to biological treatment for CD.

• Keywords
• epidurální absces páteře,
• MeSH
• Anti-Bacterial Agents administration & dosage   therapeutic use   MeSH
• Biological Therapy * methods   adverse effects   MeSH
• Crohn Disease * complications   therapy   MeSH
• Adult MeSH
• Epidural Abscess * diagnostic imaging   drug therapy   MeSH
• Thoracic Vertebrae diagnostic imaging   pathology   MeSH
• Clinical Laboratory Techniques methods   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Spine diagnostic imaging   pathology   MeSH
• Rectal Fistula drug therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

PURPOSE OF THE STUDY The Growth Guidance System (GGS) represent a relatively new alternative to the traditional growing systems used for the treatment of early onset scoliosis. Ranking among the main aims of this surgical treatment is a three-dimensional correction of the deformity, maintenance of spinal growth and postponement of the necessity of final treatment by spondylodesis. MATERIAL AND METHODS Our study retrospectively evaluates the results of surgical correction in a group of 35 patients treated by GGS technique. The group consisted of patients with idiopathic, neuromuscular and syndromic spine deformity with the average age of 8 years and 2 months at the time of the surgery. The time of the follow-up is 3 years and 5 months on average. We evaluated the correction of the curve itself, the growth of the spine measured in the thoracic and lumbar part separately, and the growth of the trunk as a whole in the mentioned range on X-ray pictures. RESULTS The average correction of the scoliotic curve was 67%, from 75 preoperative degrees to 20 postoperative degrees. After the first operation 11% elongation of the trunk (from 321 mm to 356 mm) was reached, the thoracic spine was elongated by 10% (from 196 to 217 mm) and the lumbar spine was elongated by 11% (from 125 to 139 mm). The elongation of the trunk by 16% (from 322 to 375 mm) was observed in the cohort of patients with two years postoperative follow-up (21 patients). The total protraction of the trunk by 21% (from 318 to 386 mm) was reached in patients treated by definitive fusion (7 patients). DISCUSSION There is a very low number of studies analysing the long-term clinical results with the use of GGS. The first pilot results indicate that it is a technique allowing to achieve at least comparable results in correction of frontal plane compared with the distraction type of instrumentations. A negative aspect of this method is the abrasion of metal followed by metallosis. The new types of fixation screws enable more effective sliding of rods, maintenance of continuity of body grow by the shifting of rods as well as lower abrasion of the instrumentation. CONCLUSIONS The main advantage of GGS is the limited continuous growth of the spine, partial three-dimensional correction of the deformity, minimisation of inevitable reoperations under general anaesthesia and the possibility to quit a brace. Key words: growth guided system, early onset scoliosis, distraction, spinal growth, spondylodesis.

• MeSH
• Lumbar Vertebrae diagnostic imaging   growth & development   surgery   MeSH
• Child MeSH
• Spinal Fusion * instrumentation   MeSH
• Thoracic Vertebrae diagnostic imaging   growth & development   surgery   MeSH
• Internal Fixators MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Radiography MeSH
• Retrospective Studies MeSH
• Scoliosis diagnostic imaging   physiopathology   surgery   MeSH
• Torso diagnostic imaging   growth & development   MeSH
• Age of Onset MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

Vady páteře dětí školního věku jsou velmi častým postižením a mohou být různého stupně a charakteristiky. Nestrukturální vadná držení těla jsou frekventním problémem dnešní populace a pramení nejčastěji z nedostatečné pohybové aktivity. Závažnější strukturální poruchy, vyjádřené hyperkyfózou a skoliózou, jsou postiženími vyžadujícími komplexní mezioborovou léčbu a nezřídka i operační řešení. Článek analyzuje klinické obrazy, vyšetřovací postupy i základní terapeutická schémata jednotlivých nejčastějších postižení páteře v tomto věku.

Spinal difficulties of school children are very common handicap varying between various levels and magnitude of structuraldamage. Non-structural affections is common problem in contemporary children population and is mostly caused by inadequatemovement activity. The most serious structural affections, such as hyperkyphosis or scoliosis, are serious diseases demandingcomplex interactive treatment that often includes surgery. The article analysis clinical images, evaluation methods as well as basictherapeutic schemes of different most common spinal lesions in children’s age.

• Keywords
• vadné držení těla,
• MeSH
• Child MeSH
• Thoracic Vertebrae diagnostic imaging   pathology   MeSH
• Kyphosis * diagnosis   pathology   therapy   MeSH
• Humans MeSH
• Adolescent MeSH
• Spinal Diseases diagnosis   classification   therapy   MeSH
• Spine diagnostic imaging   pathology   MeSH
• Posture * MeSH
• Scoliosis * diagnosis   pathology   therapy   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Publication type
• Review MeSH

STUDY DESIGN: A prospective, nonrandomized, multicenter study. OBJECTIVES: The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration. METHODS: This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery. RESULTS: Twenty-one female patients, mean age of 14.2 years (10.6-16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV. CONCLUSION: Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density. LEVEL OF EVIDENCE: 4.

• MeSH
• Child MeSH
• Spinal Fusion instrumentation   methods   MeSH
• Thoracic Vertebrae diagnostic imaging   physiopathology   surgery   MeSH
• Humans MeSH
• Adolescent MeSH
• Pedicle Screws MeSH
• Prospective Studies MeSH
• Radiography MeSH
• Retrospective Studies MeSH
• Range of Motion, Articular physiology   MeSH
• Scoliosis diagnostic imaging   physiopathology   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

PURPOSE: Innovative intraoperative imaging modalities open new horizons to more precise image acquisition and possibly to better results of spinal navigation. Planning of screw entry points and trajectories in this prospective study had been based on intraoperative imaging obtained by a portable 32-slice CT scanner. The authors evaluated accuracy and safety of this novel approach in the initial series of 18 instrumented surgeries in anatomically complex segment of cervico-thoracic junction. METHODS: We report on the single-institution results of assessment of anatomical accuracy of C5-T3 pedicle screw insertion as well as its clinical safety. The evaluation of total radiation dose and of time demands was secondary endpoint of the study. RESULTS: Out of 129 pedicle screws inserted in the segment of C5-T3, only 5 screws (3.9 %) did not meet the criteria for correct implant positioning. These screw misplacements had not been complicated by neural, vascular or visceral injury and surgeon was not forced to change the position intraoperatively or during the postoperative period. Quality of intraoperative CT imaging sufficient for navigation was obtained at all spinal segments regardless of patient´s habitus, positioning or comorbidity. A higher radiation exposition of the patient and 27 min longer operative time are consequences of this technique. CONCLUSIONS: The intraoperative portable CT scanner-based spinal navigation is a reliable and safe method of pedicle screw insertion in cervico-thoracic junction.

• MeSH
• Surgery, Computer-Assisted methods   MeSH
• Thoracic Vertebrae * diagnostic imaging   surgery   MeSH
• Cervical Vertebrae * diagnostic imaging   surgery   MeSH
• Humans MeSH
• Orthopedic Procedures instrumentation   methods   MeSH
• Pedicle Screws * MeSH
• Tomography, X-Ray Computed methods   MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

In our study we focused on the axial rotation of vertebra in transversal plane, because of its important part in development of scoliosis. We have studied the mutual motion of two adjacent vertebrae. If the position of the lower vertebra in the transversal cross-section is regarded as the starting position, then the position of the upper vertebra is described as a result of rotation along the centre of rotation. We were interested in potential fulcrum positions of rotation with regard to the safety of spinal cord that can be endangered by change of spinal canal cross section. From transversal MRI cuts of idiopathic scoliosis we measured real dimensions of spinal cord and canal in thoracic and lumbar spine. Vertebrae rotation was verified by means of simple geometric 2D models with various positions of rotation centres. We applied real average parameters of thoracic and lumbar vertebra. Rotation angles in the models were selected with regard to the range of particular rotations during common movement of healthy spine – 6°/3° thoracic/lumbar vertebra. Further, rotation of thoracic vertebra by 15° was chosen, which is rotation characteristic of scoliosis. The results showed that usually used centre of rotation in the middle of vertebral body is not applicable.

• MeSH
• Lumbar Vertebrae abnormalities   anatomy & histology   diagnostic imaging   MeSH
• Thoracic Vertebrae abnormalities   anatomy & histology   diagnostic imaging   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Models, Structural MeSH
• Spine abnormalities   anatomy & histology   diagnostic imaging   MeSH
• Rotation MeSH
• Scoliosis diagnostic imaging   MeSH
• Torsion Abnormality diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Seat Belts MeSH
• Accidents, Traffic * MeSH
• Spinal Fractures diagnostic imaging   MeSH
• Thoracic Vertebrae diagnostic imaging   physiopathology   injuries   MeSH
• Humans MeSH
• Protective Devices * adverse effects   MeSH
• Dogs * MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Dogs * MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Case Reports MeSH