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PURPOSE OF THE STUDY The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups. MATERIAL AND METHODS In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student’s T-test at the significance level of p = 0.05. RESULTS The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant. DISCUSSION In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients. CONCLUSIONS Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system. [ABSTRACT FROM AUTHOR]

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]

PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) “The Surgical Treatment of the Degenerative Diseases of the Spine”. MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondy-lolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Damage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODS The prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTS The total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSION In recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obtained by other authors using both the original method and the modified AMIC technique. CONCLUSIONS The modified AMIC technique using the cell-free type I collagen-based implant appears to be a safe, accessible and onestage technique to treat localised chondral and osteochondral defects of the knee joint up to the size of 8 cm2. [ABSTRACT FROM AUTHOR]

Oral allergic syndrome (OAS) arises from cross-reactivity between homologous allergen components in plant foods and grass or tree pollen. It manifests with mild symptoms localized in the oropharyngeal region, but anaphylaxis may occur rarely. In childhood, oral allergic syndrome is not explored as detailed as in adults. In our region, studies on these allergic diseases in childhood do not exist at all. The aim of our work was to investigate children with symptoms of oral allergic syndrome and to analyze its selected clinical and laboratory characteristics. Methods: The set consisted of 55 children with OAS manifestations and was comprised of 2 groups: group A, in which from patients with seasonal allergic rhinitis were selected patients with OAS (25 patients) on the basis of a clinical evaluation. Group B consisted of 30 children with seasonal allergic reactions and OAS. Each patient completed anamnestic data and underwent blood sampling for the selection of selected markers of allergy (total IgE, eosinophils, component resolved diagnosis). Results: The set consisted of 55 patients, 31 (56%) boys and 24 (44%) girls, median age 13 (3–18). OAS prevalence in Group A was 20.5%. The mean total IgE concentration was 470.7 IU/ml. Eosinophils were on average 5.43% in relative count, the average absolute count was 0.38 x 109/l. From species-specific inhalation allergens, the most patients were sensitized to Bet v 1 allergen of birch (43, 78.2%) and Phl p 1 allergen of timothy grass (33, 60.0%). From the cross-allergen, the majority of patients were sensitized to allergens from the PR-10 protein family, Mald 1 apple allergen (34, 61.8%), peanut Ara h 8 allergen (30, 54.5%) and Cor and 1 hazelnut allergen (30, 54.5%). A total of 6 patients (10.9%) had a history of a systemic allergic reaction. All of these patients were sensitized with a type-specific risk food allergen. Conclusion: The results of our observations are comparable to foreign studies with children with OAS from Central and Northern Europe. As the most common association within the OAS we prove the association birch-apple, peanuts and hazelnuts. Of the allergenic components, the majority of patients were sensitized with allergens from the PR-10 protein family. [ABSTRACT FROM AUTHOR]

Introduction: The influence of various levels of sedation depth on motor evoked potentials (MEP) reproducibility in youth is still unclear because of a lack of data. We tested the hypothesis that a deeper level of total intravenous anesthesia (TIVA) [bispectral index (BIS) 40 ± 5 compared to 60 ± 5] can affect surgeon-directed MEP and their interpretation in youths., Methods: All patients received TIVA combined with propofol and remifentanil. TIVA was initially maintained at a BIS level of 60 ± 5. The sedation anesthesia was deepened to BIS level 40 ± 5 before the skin incision. MEP were recorded and interpreted at both BIS levels. The primary endpoint was to evaluate the effect of the depth of sedation on the MEP reproducibility directed and interpreted by the surgical team in each patient separately. The secondary endpoint was to compare the relativized MEP parameters (amplitude and latency) in percentage at various levels of sedation in each patient separately. We planned to enroll 150 patients. Due to the COVID-19 pandemic, we decided to analyze the results of the first 50 patients., Results: The surgical team successfully recorded and interpreted MEP in all 50 enrolled patients in both levels of sedation depth without any clinical doubts. The MEP parameters at BIS level 40 ± 5, proportionally compared with the baseline, were latency 104% (97-110%) and the MEP amplitudes 84.5% (51-109%)., Conclusion: Preliminary data predict that deeper sedation (BIS 40 ± 5) does not affect the surgical team's interpretation of MEP in youth patients. These results support that surgeon-directed MEP may be an alternative when neurophysiologists are unavailable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hudec, Kosinová, Prokopová, Zelinková, Hudáček, Repko, Gál and Štourač.)

Purpose of the Study: The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups., Material and Methods: In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student's T-test at the significance level of p = 0.05., Results: The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant., Discussion: In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients., Conclusions: Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system., Key Words: adolescent idiopathic scoliosis, AIS, gait analysis, Gait Deviation Index, GDI.

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 diffi culties 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 diffi culties., 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 signifi cant 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 signifi cant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A signifi cant 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 signifi cant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignifi cant., Discussion: The authors confi rmed signifi cant 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 confi rm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the fi ndings of other published manuscripts. The authors failed to confi rm a signifi cant 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 signifi cant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory., Key Words: sagittal profi le, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

Objective: To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS)., Design: Systematic review with meta-analysis., Data Sources: MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022., Eligibility Criteria for Study Selection: Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE)., Results: We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE)., Conclusions: Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion., Prospero Registration Number: CRD42022308267., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Fibrinogen is one of the essential coagulation factors. Preoperative lower plasma fibrinogen level has been associated with higher blood loss. Scoliosis surgery presents a challenge for the anaesthetic team, one of the reasons being blood loss and transfusion management. Recently, the prophylactic fibrinogen administration has been a debated topic in various indications. It has been described for example, in urological or cardiovascular surgery, as well as in paediatrics. This pilot study is focused on verifying the feasibility of potential large randomised trial and verifying the safety of prophylactic fibrinogen administration in paediatric scoliosis surgery., Methods and Analysis: A total of 32 paediatric patients indicated for scoliosis surgery will be recruited. Participants will be randomised into study groups in a 1:1 allocation ratio. Patients in the intervention group will receive prophylactic single dose of fibrinogen, in addition to standard of care. Patients in the control group will receive standard of care without study medication prior to skin incision. The primary aim is to assess the safety of prophylactic fibrinogen administration during scoliosis surgery in children, the incidence of any adverse events (AEs) and reactions will be monitored during participation in the study. The secondary objective is to investigate the additional safety information, feasibility and efficacy of a prophylactic fibrinogen administration. The incidence of AEs and reactions according to selected adverse events of special interest will be monitored. All collected data will be subjected to statistical analysis according to a separate statistical analysis plan., Ethics and Dissemination: This trial follows the applicable legislation and requirements for good clinical practice according to the International Conference on Harmonisation E6(R2). All essential trial documents were approved by the relevant ethics committee and national regulatory authority (State Institute for Drug Control) and their potential amendments will be submitted for approval., Trial Registration Number: NCT05391412., Competing Interests: Competing interests: In the past 5 years, KV and RG have received honoraria for lecturing from CSL Behring., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.

Background: Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system., Research Question: Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity?, Methods: 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity., Results: Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05)., Significance: Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The nine-amino-acid activation domain (9aaTAD) is defined by a short amino acid pattern including two hydrophobic regions (positions p3-4 and p6-7). The KIX domain of mediator transcription CBP interacts with the 9aaTAD domains of transcription factors MLL, E2A, NF-kB, and p53. In this study, we analyzed the 9aaTADs-KIX interactions by nuclear magnetic resonance. The positions of three KIX helixes α1-α2-α3 are influenced by sterically-associated hydrophobic I611, L628, and I660 residues that are exposed to solvent. The positions of two rigid KIX helixes α1 and α2 generate conditions for structural folding in the flexible KIX-L12-G2 regions localized between them. The three KIX I611, L628, and I660 residues interact with two 9aaTAD hydrophobic residues in positions p3 and p4 and together build a hydrophobic core of five residues (5R). Numerous residues in 9aaTAD position p3 and p4 could provide this interaction. Following binding of the 9aaTAD to KIX, the hydrophobic I611, L628, and I660 residues are no longer exposed to solvent and their position changes inside the hydrophobic core together with position of KIX α1-α2-α3 helixes. The new positions of the KIX helixes α1 and α2 allow the KIX-L12-G2 enhanced formation. The second hydrophobic region of the 9aaTAD (positions p6 and p7) provides strong binding with the KIX-L12-G2 region. Similarly, multiple residues in 9aaTAD position p6 and p7 could provide this interaction. In conclusion, both 9aaTAD regions p3, p4 and p6, p7 provide co-operative and highly universal binding to mediator KIX. The hydrophobic core 5R formation allows new positions of the rigid KIX α-helixes and enables the enhanced formation of the KIX-L12-G2 region. This contributes to free energy and is the key for the KIX-9aaTAD binding. Therefore, the 9aaTAD-KIX interactions do not operate under the rigid key-and-lock mechanism what explains the 9aaTAD natural variability., (© 2021 Wiley Periodicals LLC.)

Rationale and Objectives: This study's aims were to depict changes in cartilage quality after surgical intervention using magnetic resonance (MR) examination and in content of glycosaminoglycans chains (GAGs) after two types of surgeries - chondral defect treatment by microfractures and scaffold implantation in combination with microfractures., Materials and Methods: Twenty-five patients were studied: 14 with implants, 11 with microfractures. MR examination was made before surgery and 6, 12, and 18 months thereafter. Qualitative changes in cartilage were observed by means of delayed gadolinium enhanced magnetic resonance imaging of cartilage sequence using Gd-DTPA2- and Gd-DOTA. In each examination, GAGs content was determined at three locations: the defect, its surroundings, and a non-load-bearing reference area., Results: Measured indices showed no statistically significant differences in changes within the defect area when comparing the two treatment types at individual time points of 6, 12, and 18 months. In the case of microfracture treatment, more substantial decrease in GAGs concentration occurred at month 6, whereas the greatest decline occurred at month 12 when using an implant. Change in GAGs content and decline in cartilage quality were substantial also in the reference area and close surroundings., Conclusions: Hyaline cartilage behaves as a unified whole, and change in GAGs content was marked also in locations with no morphological damage. Over the monitored period, no statistically significant difference between treatment types was noted as measured by GAGs content in the defect or its close surroundings. dGEMRIC is suitable for monitoring cartilage quality even if use of Gd-DTPA2- is not possible, because comparable results were achieved using Gd-DOTA., Competing Interests: Declaration of Competing Interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.

Purpose: The purpose of the study was to describe changes in the kinematic parameters in the patients' gait after total hip replacement., Methods: Research group of men in the end stage of osteoarthritis indicated to the THR (n = 10; age 54.1 ± 7.5 years; weight 92.2 ± 9.6 kg; height 179.7 ± 5.9 cm). All participants underwent a total of three measurements: before surgery, 3 and 6 months after the surgery. Using the 3D kinematic analysis system, the patients' gait was recorded during each measurement session and kinematic analysis was carried out. The parameters that were monitored included the sagittal range of motion while walking in the ankle, the knee and the hip joints of the operated and the unoperated limb, and the range in the hip joint's frontal plane, the rotation of pelvis in the frontal and transverse planes, as well as the speed of walking and the walking step length., Results: Significant increases were found in sagittal range of motion in the operated hip joint, sagittal range of motion in the ankle joint on the unoperated side and in the walking step length of the unoperated limb., Conclusions: During walking after a THR, the sagittal range of motion in the ankle of the unoperated limb increases. Also, the range of motion in the sagittal plane on the operated joint increases, which is related to the lengthening of the step of the unoperated lower limb.

PURPOSE OF THE STUDY Damage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODS The prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTS The total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSION In recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obtained by other authors using both the original method and the modified AMIC technique. CONCLUSIONS The modified AMIC technique using the cell-free type I collagen-based implant appears to be a safe, accessible and onestage technique to treat localised chondral and osteochondral defects of the knee joint up to the size of 8 cm2. Key words: hyaline cartilage, chondral defect, AMIC, scaffold, knee.

Background: The management of early-onset scoliosis (EOS) remains a serious challenge in pediatric orthopedics. The growth-guidance system (GGS) is a surgical option that allows continuous growth along a rod, averting the need for repeated operative lengthening., Objectives: The objective of this study was to evaluate the outcomes of the GGS in the treatment of EOS., Material and Methods: A prospective study, including 81 patients from 4 departments treated with this method from 2013 to 2015, was conducted with a minimum follow-up period of 24 months. The follow-up data of 57 patients was available, thus the drop-out rate was 29.63%. There were 44 girls with a mean age of 10.03 years and 13 boys with a mean age of 8.04 years., Results: The mean preoperative Cobb angle was 65.3° (range 36°-139°) was corrected to 23.7° (2°-94°), and at the end of the 2-year follow-up increased to 30.7° (8°-93°). The predominant proximal level of instrumentation was T5 and the distal was L1. The combined length of T1-T12 and T12-S1 increased on average by 33.19 mm in 24 months. The overall rate of serious complications was 43.86%. The most prevalent device-related complications were: the dislodgement of top screws because of the short length of the rod (14 cases), the implant failure (11 cases) and loss of correction (9 cases)., Conclusions: The results show that the GGS used in this study allows for a good and stable correction while preserving the ability of the spine to grow in at least a 2-year follow-up. The complication rate is acceptable and comparable with other growth-friendly techniques. To date, this is the largest successful study on the use of titanium-made GGSs.

Background: This trial reports the 2-year and immediate postremoval clinical outcomes of a novel posterior apical short-segment (PASS) correction technique allowing for correction and stabilization of adolescent idiopathic scoliosis (AIS) with limited fusion., Methods: Twenty-one consecutive female AIS patients were treated at 4 institutions with this novel technique. Arthrodesis was limited to the short apical curve after correction with translational and derotational forces applied to upper and lower instrumented levels. Instrumentation spanned fused and unfused segments with motion and flexibility of unfused segments maintained. The long concave rods were removed at maturity. Radiographic data collected included preoperative and postoperative data for up to 2 years as well as after long rod removal., Results: All 21 patients are beyond 2 years postsurgery. Average age at surgery was 14.2 years (11-17 years). A mean of 10.5 ± 1 levels per patient were stabilized and 5.0 ± 0.5 levels (48%) were fused. Cobb angle improved from 56.1° ± 8.0° to 20.8° ± 7.8° (62.2% improvement) at 1 year and 20.9° ± 8.4°, (62.0% improvement) at 2 years postsurgery. In levels instrumented but not fused, motion was 26° ± 6° preoperatively compared to 10° ± 4° at 1 year postsurgery, demonstrating 38% maintenance of mobility in nonfused segments. There was no report of implant-related complications., Conclusions: PASS correction technique corrected the deformity profile in AIS patients with a lower implant density while sparing 52% of the instrumented levels from fusion through the 2-year follow-up., Competing Interests: Disclosures and COI: K-Spine Inc. funded this study from 2012-14 prior to being acquired by K2M in 2015. L. Rehák received grants/research support from DePuy Synthes Spine and Kspine. M. Repko received grants/research support from Kspine. M. Grevitt received grants/research support from DePuy Synthes Spine and Medtronic and acted as a consultant for DePuy Synthes Spine. U. Aydinli received grants/research support from Kspine. A. Carl served on an advisory board or panel for K2M and Kspine and acted as a consultant and received other financial or material support (royalties, patents, stock options, etc.) from Kspine. C. Nnadi has no conflicts. B.A. Akbarnia was a stock or shareholder for Alphatec and Nuvasive; received grants/research support from DePuy Synthes Spine and Nuvasive; was a consultant for Ellipse Technology, K2M, and Kspine; served on an advisory board or panel for Kspine; and received other financial or material support (royalties, patents, stock options, etc.) from Kspine, Nuvasive, K2M, Ellipse Technology, and Depuy Synthes Spine. D. Crandall was a consultant for Ellipse Technology, Kspine, Medtronic, Spinewave, Stryker, and Zyga; served on an advisory board or panel for Kspine and on a speaker's bureau for Stryker; and received other financial or material support (royalties, patents, stock options, etc.) from Kspine and Medtronic. For the rest of coauthors nothing was disclosed. This study was Institutional Review Board–approved at each participating institution prior to initiation. The medical device stated in this manuscript is not cleared by US Food and Drug Administration.