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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.

Purpose of the Study: Degenerative disc disease (DDD) is a spinal condition resulting from degeneration of the intervertebral discs. It is associated with symptoms of sciatica, back pain and leg weakness and also with degenerative instability of the spine. To arrest the degenerative cascade of disc disease, and taking into consideration stress placed on the adjacent discs managed by decompression and stabilisation by instrumented fusion, the lumbar spine was treated by dynamic posterior stabilisation of the segments affected. Based on the classification described by Dubois et al., the Dynesys system was used. The aim of this study was to evaluate the mid-term results of this method in DDD patients., Material and Methods: In the 2002-2007 period, 102 patients (65 men and 37 women; average age, 54 years) underwent surgery for problems due to DDD manifested by pain, neurological findings and radiographic evidence of degenerative changes in the spine. The classification of age-related changes, as described by Dubois et al. and Kirkaldy-Willis, showed that type 4 and type 6 of DDD (64% disc degeneration with spinal canal stenosis) were most common. After surgery using the Dynesys system, the patients were followed up for an average of 36 months. Patient examination included: pre- and post-operative medical history, clinical, radiographic (including magnetic resonance imaging/MRI) and neurological examination, and the pain and functional status assessment using the visual analog scale (VAS) and Oswestry disability index (ODI), respectively. A total of 146 lumbar spine segments were surgically treated in 102 patients, the L4-L5 segment being treated most frequently, with a total of 61 interventions at this level. Radicular pain before surgery was reported by 40 patients. The average operative blood loss was 1013.8 ml and patients stayed in the hospital for an average of 13.8 days. There were 15 post-operative complications treated. After surgery, the patients participated in a. special rehabilitation programme and were allowed full weight-bearing after 3 months., Results: At 36 months of follow-up, the improvement as against the pre-operative condition included a drop in the average VAS value from 7.3 to 4.7 and that in the average ODI from 54.5 to 39.9. The results were statistically analysed using ANOVA software and the t-test and Bartlet test (level of significance set at 0.05). The improvement in the patients' health status was statistically significant during all 3-year post-operative period. As shown by the MRI findings obtained from repeated examination in 26 patients, the use of the Dynesys system resulted in the post-operative disappearance of disc bulging and the restoration of the posterior longitudinal ligament and space in the lumbar spinal canal. The surgery had no positive effect on disc regeneration, but improved peridiscal marrow oedema of that lumbar segment in the way described by Modic et al., Discussion: In patients with DDD, stabilisation of the lumbar spine by instrumented rigid fusion often results in increased biomechanical stress and damage to the segments adjacent to the area of fusion. The use of dynamic stabilisation devices, including the Dynesys system, reduces this potential risk. The Dynesys system is also effective in the treatment of DDD combined with spinal stenosis in elderly patients, as reported by other authors. A certain risk associated with Dynesys use may lie in disc height reduction in the anterior segment by up to 0.7 mm, thus producing a fulcrum pin effect. Despite this risk factor, dynamic stabilisation in DDD patients will considerably improve the quality of their lives., Conclusions: The results of 102 patients, with 146 segments treated by posterior dynamic neutralisation using the Dynesys system, show that this method improved subjective feelings, morphological findings and pain and functional status in the patients with DDD in the three-year post-operative period. This had a good effect on the quality of life in these patients.

Purpose of the Study: The aim of the study was to evaluate the quality of life in patients treated for degenerative lumbar spinal stenosis at 3 years of follow-up., Material and Methods: Between October 2005 and 2008, answers to Oswestry, quality-of-life (SF-36) and VAS questionnaires were obtained from 117 patients indicated for lumbar spine surgery due to spinal stenosis. There were 52 men and 65 women, with an average age of 62 years. For future evaluation, the patients were placed into three groups according to the surgical treatment used: simple decompression with posterolateral fusion using autograft (69 patients); decompression and instrumented posterior fusion completed with autograft (21 patients); decompression and posterior dynamic stabilisation using the Dynesys system (27 patients). The patients were asked to respond to the three questionnaires again at 6, 12, 24 and 36 months of follow-up and to rate their willingness to undergo the surgery again on a 1-to-5 scale (from definitely yes to definitely no)., Results: In all three groups, the Oswestry disability index (ODI) significantly improved from the average pre-operative value of 53 to 39 post-operatively. This remained constant at 12 months (ODI 38), 24 months (ODI 38) and 36 months (ODI 37) after surgery. The SF-36 questionnaire also showed significant improvements in both categories covering components of physical and mental health. The VAS-based assessment of satisfaction with life and back and leg pain, however, did not provide such convincing results. The marking of satisfaction with surgery outcome was 1-2 in 71 % of the patients, and "only" 9.5 % of them would have never undergone the surgery again (marked 5). The L4-L5 segment was the most frequently treated region, and monosegmental decompression with fusion was the technique used most often., Discussion: Our results are in agreement with the data reported in the national and international literature, including the number of patients studied and the results obtained from the Oswestry and SF-36 questionnaires. The assessment of life satisfaction using the VAS score has not been found in the literature. Our VAS back pain and leg pain scores slightly differed from the literature data, since no significant improvement in them was recorded. In assessing the patient's quality of life after lumbar spinal surgery, it is necessary to take into consideration also co-morbidities and external factors. CONCLUSIONS The results presented here show that lumbar spine surgery results in a significant improvement of life quality and has an irreplaceable role in the treatment of patients with degenerative spinal disease. However, three-year results do not provide enough evidence of the real stabilisation of patients' health state and thus the follow-up study is to be continued.

Purpose of the Study: In a retrospective study, to analyze long-term radiographic results of two surgical procedures used to treat congenital scoliosis., Material and Methods: A total of 685 patients with congenital scoliosis were treated at the Department of Orthopaedic Surgery, Bohunice Teaching Hospital in Brno, between 1976 and 2007. Of these, 102 patients, with an average age of 6.6 years at the time of surgery, were treated by simple bony fusion, and 22 children, with an average age of 10.2 years, underwent instrumented hemivertebra excision via simultaneous anterior and posterior exposures involving fixation with cannulated compression screws and a wire loop. The follow-up periods for the former and latter groups were 14.2 and 12.1 years, respectively., Results: In the patients treated by simple bony fusion, the mean correction rate was 22.1 %, with Cobb angle values averaging from 44.2 degrees pre-operatively to 38 degrees post-operatively; the correction loss was 3.9 degrees at the last follow up. In the patients with hemivertebra excision, the mean correction rate was 61 %, with pre- and post-operative values of 51.3 degrees and 20.3 degrees , respectively, and a correction loss of 1.1 degrees at the last follow-up., Discussion: The early detection of a deformity and simple bony fusion in low-magnitude curves can prevent progression of scoliosis and allows for maintenance of a compensated spine. Hemivertebra excision with compression instrumentation results in a better surgical correction of the deformity. The average 61 % correction rate achieved in our patients is in agreement with the results reported by authors using the same surgical technique, as well as with the results of posterior hemivertebra resection. The best correction, 78 %, has been achieved with surgery at a very young age. Complications associated with the two techniques are rare., Conclusions: Congenital scoliosis due to failure off either formation or segmentation is indicated for surgical treatment at young age. Its early detection and subsequent surgical treatment at young age. Its early detection and subsequent surgical correction of the curve result in a long-term maintenance of a compensated spine. Instrumented hemivertebra excision provides the highest rate of correction, particularly if carried out before 3 years of age.

PURPOSE OF THE STUDY Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients’ preoperative difficulties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated – especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients’ clinical outcomes and difficulties. MATERIAL AND METHODS The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease – lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. RESULTS In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically significant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically significant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A significant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically significant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignificant. DISCUSSION The authors confirmed significant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confirm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the findings of other published manuscripts. The authors failed to confirm a significant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. CONCLUSIONS Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically significant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. [ABSTRACT FROM AUTHOR]