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SAŽETAK Adultne deformacije kralježnice značajno pridonose morbiditetu, napose starije popupacije. Iako je spektar uzroka raznolik najčešće se radi o novonastalim deformacijama na temelju degenerativnih promjena kralježnice. Osim bolova, osjećaja napetosti i drugih neugodnih simptoma, adultne deformacije rezultiraju biomehaničkim poremećajima, smanjenom pokretljivosti, a ponekad i neurološkim deficitima. Sveukupno, deformacije kralježnice u odraslih osoba uzrokuju značajnu onesposobljenost i lošiju kvalitetu života (fizičku i psihičku), dok su s druge strane u svakodnevnoj kliničkoj praksi relativno zanemarena patologija odrasle dobi. Stoga u ovom radu dajemo natativni pregled najnovijih spoznaja o etiopatogenezi, kliničkoj slici, slikovnoj dijagnostici, liječenju (konzervativnom i kirurškom) i postoperativnoj rehabilitaciji bolesnika s adultnim deformacijama najčešćih uzroka., SUMMARY Adult deformities of the spine, especially in older population, significantly contribute to morbidity of these patients. Although the spectrum of causes is diverse, most often these are newly formed deformations based on degenerative changes of the spine. Apart from pain, feelings of tension and other unpleasant symptoms of adult deformity, they result in biomechanical disorders, reduced mobility, and sometimes neurological deficits. Overall, spinal deformities in adults cause significant disability and poor quality of life (physical and psychological), while on the other hand, they are relatively neglected in everyday practice. Therefore, in this paper we give a narrative review of the latest findings on etiopathogenesis, clinical picture, imaging diagnostics, treatment (conservative and surgical), and postoperative rehabilitation of patients with adult spine deformities of the most common causes.

Cilj ovog presječnog istraživanja je utvrditi kvalitetu života (QOL) i razinu tjelesne aktivnosti djece mlađe školske dobi s juvenilnim idiopatskim artritisom (JIA) na lokaciji Primorsko-goranske županije u usporedbi sa zdravim vršnjacima te utvrditi koje su najizraženije razlike među njima vezane za kakvoću života. Metode: Istraživanje je provedeno na 13-ero djece s JIA-om s popisa liječene na Klinici za dječju reumatologiju i 17-ero zdrave djece iz osnovne škole. Djeca su bila u dobi između 8-14 godina. Svi sudionici, uključujući njihove roditelje, ispunili su upitnike za procjenu razine svoje tjelesne aktivnosti (Physical Activity Questionnaire for Children; PAQ-C) i kvalitetu života (Quality of life Pediatric Quality of Life InventoryTM Generic Core Scale; Rheumatology Module Scale). Rezultati su pokazali statistički značajne razlike u kakvoći života vezanoj za fizičko funkcioniranje/zdravlje (p =0,033), školske aktivnosti (p = 0,008) i psihosocijalno zdravlje (p = 0,033) između JIA i kontrolne skupine. Odgovori iz reumatološkog upitnika otkrili su statistički značajnu razliku u kakvoći života vezanoj za bol (p = 0,041), dnevne aktivnosti (p = 0,011), liječenje (p = 0,002), zabrinutost (p = 0,0006) i komunikaciju ( p = 0,0002) između JIA i kontrolne skupine. JIA skupina pokazala je značajno nižu razinu tjelesne aktivnosti (p = 0,008). Otkrivena je statistički značajna (p = 0,0000) povezanost između kakvoće života vezane za bol i one vezane za fizičko funkcioniranje/zdravlje (r = 0,94), emocionalno funkcioniranje (r = 0,71), socijalno funkcioniranje (r = 0,74) ), funkcioniranje u školi (r = 0,56) i psihosocijalno zdravlje (r = 0,80). Zaključci: Rezultati istraživanja sugeriraju da JIA utječe na kakvoću života u gotovo svim područjima oboljele djece mlađe školske dobi, te da su najveće razlike prema zdravim vršnjacima prisutne u kakvoći života vezanoj za brigu o svom zdravlju i komunikaciju o njihovoj bolesti., The aim of this cross sectional study was to assess the quality of life (QOL) and level of physical activity in primary school children with juvenile idiopathic arthritis (JIA) in the Primorje-Gorski Kotar County as compared to healthy peers, and to identify the most pronounced differences in QOL between them. The study included 13 children with JIA recruited from the paediatric rheumatology clinic and 17 healthy children from primary school. The children were aged 8-14 years. All participants, including their parents, completed questionnaires to assess the level of their physical activity (Physical Activity Questionnaire for Children; PAQ-C) and QOL (Pediatric Quality of Life Inventory (PedsQLTM) Generic Core and Rheumatology Module scales). Study results showed statistically significant differences in the QOL associated with physical functioning/health (p=0.033), school activities (p=0.008) and psychosocial health (p=0.033) between JIA and control groups. Responses in the rheumatologic questionnaire revealed a statistically significant difference in the QOL associated with pain (p=0.041), daily activities (p=0.011), treatment (p=0.002), concern (p=0.0006) and communication (p=0.0002) between JIA and control groups. The JIA group showed a significantly lower level of physical activity (p=0.008). There was a statistically significant (p=0.0000) correlation between the QOL associated with pain and the QOL associated with physical functioning/health (r=0.94), emotional functioning (r=0.71), social functioning (r=0.74), school functioning (r=0.56) and psychosocial health (r=0.80). In conclusion, study results suggested JIA to affect QOL in almost all domains in the affected primary school children, with the greatest differences from their healthy peers being recorded in the QOL associated with worrying and communicating about their illness.

Sacral stress fractures are divided into fatigue fractures and insufficiency fractures. Fatigue fractures occur in a normal bone exposed to abnormal or repetitive stresses, whereas insufficiency fractures occur in weakened bones under normal stress and with no underlying trauma. Sacral insufficiency fractures are often overlooked causes of nonspecific lumbosacral back pain, especially in elderly women with underlying osteoporosis. In addition to old age and postmenopausal osteoporosis, other conditions which reduce bone mineral density and present risk factors for the occurrence of insufficiency fractures include: long-term glucocorticoid and bisphosphonates therapy, long-term vitamin D insufficiency and osteomalacia, renal osteodystrophy, primary hyperparathyroidism, Paget’s disease, long-term immobilisation and radiotherapy for the treatment of malignant diseases. There are no typical clinical signs to suggest sacral stress fracture. These fractures are often associated with degenerative diseases of the spine and intervertebral disc, and they are often accompanied by pre-existing osteoporotic vertebral compression fractures. Plain radiographs of the spine and pelvis, which are the first step in diagnostic imaging, are usually non-diagnostic when it comes to sacral fractures. Due to radicular pain symptoms, magnetic resonance imaging of the lumbosacral spine is the next step in diagnosis, in which sacral fractures are often revealed as accidental findings. In this paper, we shall present a case of an elderly patient with multiple comorbidities and multiple risk factors, in whose case physical therapy did not prove to be effective. During diagnostic testing, a subsequent MRI showed an accidental finding confirming the sacral fracture. Furthermore, we shall highlight the importance of early detection of sacral stress fracture in high-risk patients, in order to avoid unnecessary, and sometimes invasive, diagnostic procedures and to reduce the possibility of possible complications. The imaging method of choice for the diagnosis of sacral stress fractures is MRI., Stresne prijelome (engl. stress fractures) možemo podijeliti na prijelome zamora ili stresne prijelome u užem smislu (engl. fatigue fractures) i na prijelome u oslabljenoj kosti (engl. insufficiency fractures). Prijelomi zamora nastaju u zdravoj kosti zbog dugotrajnog ponavljanja neprimjerenog opterećenja, dok prijelomi u oslabljenoj kosti nastaju spontano, odnosno bez prethodne traume. Prijelomi sakruma u oslabljenoj kosti često su neprepoznat uzrok križobolje i boli u zdjelici, posebice u žena starije dobi s osteoporozom. Osim starije dobi i postmenopauzalne osteoporoze, rizični čimbenici za prijelom u oslabljenoj kosti jesu dugotrajna terapija glukokortikoidima i bisfosfonatima, dugotrajan teži nedostatak vitamina D i osteomalacija, renalna osteodistrofija, primarni hiperparatiroidizam, Pagetova bolest, dugotrajna nepokretnost i radioterapija zbog maligne bolesti. Specifični klinički znakovi stresnog prijeloma sakruma ne postoje. Ovakvi prijelomi često su udruženi s degenerativnim promjenama kralježnice i intervertebralnog diska, a često su prisutni i osteoporotični prijelomi kralježaka. Na standardnim radiogramima kralježnice i zdjelice, koji su prvi korak u slikovnoj dijagnostičkoj obradi, prijelomi sakruma najčešće se ne uočavaju. Zbog često prisutnih radikularnih simptoma sljedeći dijagnostički korak jest magnetska rezonancija lumbosakralne kralježnice na kojoj su prijelomi sakruma najčešće slučajan nalaz. Prikazujemo bolesnicu s multiplim komorbiditetima i višestrukim čimbenicima rizika kod koje je zbog prolongirane križobolje provedena fizikalna terapija s nezadovoljavajućim učinkom. Tijekom obrade učinjena je magnetska rezonancija gdje je kao slučajan nalaz potvrđen prijelom sakruma. Ističemo važnost ranog prepoznavanja rizičnih skupina pacijenata čime se postiže izbjegavanje suvišnih, katkad i invazivnih dijagnostičkih postupaka. Slikovna metoda izbora za dijagnozu stresnog prijeloma sakruma jest magnetska rezonancija.