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Background.An obstruction of the distal part of the duodenum can occur because of the superior mesenteric artery syndrome (SMAS) after a surgical correction of scoliosis. It is essential to evaluate the risk factors and diagnose the SMAS in time because complications of this condition are life-threatening and it is associated with a high rate of morbidity. Diagnostics of the SMAS is challenging, because it is rare and its symptoms are non-specific. Therefore, in order to better understand the essence of this pathology and to make diagnosis easier we present a rare clinical case of the superior mesenteric artery syndrome after a surgical correction of neuromuscular scoliosis.The clinical case.A 12-year-old girl with a specific development disorder, sensory neuropathy and progressive kypho-scoliosis was admitted to Vilnius University Children’s Hospital. The patient had right side 50-degree thoracic scoliosis and an 80-degree thoracic kyphosis. She underwent posterior spinal fusion with hooks and screws from Th1 to L2. On the fourth day after the surgery the patient developed nausea and began to vomit each day 1-2 times per day, especially after meals. The SMAS was suspected and a nasogastric tube was inserted, stomach decompression and the correction of electrolytes disbalance were made. After the treatment, the symptoms did not recur and a satisfactory correction and balance of the spine were made in coronal and sagittal planes.Conclusions.It is extremely important to identify the risk factors of the SMAS and begin preoperative diet supplements before surgical correction of scoliosis for patients with a low body mass index. After the first episode of vomiting following the surgery, we recommend to investigate these patients for a gastrointestinal obstruction as soon as possible. Decompression of the stomach, enteral or parenteral nutrition, and fluid therapy are essential in treating the SMAS.

INTRODUCTION: Childhood spinal cord tumours may lead to spinal deformity. Rapid scoliosis progression, a left thoracic curve and early onset scoliosis are associated with an increased risk of intraspinal anomalies, therefore magnetic resonance imaging (MRI) should be performed. CASE PRESENTATION: A 1-year-old girl presented with progressive early onset scoliosis. MRI of the spine showed diffuse intramedullary lesion at vertebral level T5 – T11 and abnormal curvature of the thoracic spine to the right – 39-degree Cobb angle, after a few moths – 71-degree. Blood and cerebrospinal fluid examination ruled out a neuroinfection and autoimmune diseases. Histology revealed BRAF V600E-mutant pilocytic astrocytoma (PA) (IDH non-mutant), DNA methylation profiling – PA, MGMT promoter methylation – not detected, SNP-A karyotyping – normal. Treatment with weekly vinblastin was started due to non-operable tumour and progressive scoliosis. Spinal deformity was managed using serial casting with only mild correction of curvature. In the second case report, a 14-year-old boy either presented with progressive scoliosis. Spine x-ray showed abnormal curvature of the thoracic spine to the left - 89-degree Cobb angle and after a few years - 120-degree. MRI of the spine detected intramedullary tumour masses located at vertebral level T3-T5. Surgical resection revealed BRAF V600E-mutant PA (IDH, ATRX, TERT non-mutant), DNA methylation profiling – PA, MGMT promoter status – not methylated, SNP-A karyotyping – non-specific trisomy of chromosome 5. The patient was followed-up by routine spine MRI. However, after 8 months new spinal cord masses appeared. It was decided to correct scoliosis only after the total tumour removal. CONCLUSIONS: Intramedullary spinal tumours are overall rare in the pediatric population. Of these, PA accounts for the majority, however treatment remains challenging. BRAF V600E mutation has relatively high frequency in PA. This mutation identification opens more treatment options such as targeted therapy with BRAF V600E and MEK inhibitors for progressive disease.

In this article the authors present a method for the backbone recognition and modelling. The process of recognition combines some classical techniques (Hough transformation, GVF snakes) with some new (authors present a method for initial curvature detection, which they call the Falling Ball method). The result enables us to identify high-quality features of the spine and to detect the major deformities of backbone: the intercrestal line, centre sacral vertical line, C7 plumbline; as well as angles: proximal thoracic curve, main thoracic curve, thoracolumbar/lumbar. These features are used for measure in adolescent idiopathic scoliosis, especially in the case of treatment. Input data are just radiographic images, meet in everyday practice.

santraukaReikšminiai žodžiai: idiopatinė skoliozė, pedikuliniai sraigtai, fiksacija kabliukais, šoninio lenkimo rentgenogramos. Darbo tikslas. Įvertinti operacinio gydymo rezultatus pagal naudotus implantus. Įvertinus šoninio lenkimo rentgenogramas, išanalizuoti planuotus pooperacinius rezultatus. Tyrimo medžiaga ir metodai. Atlikta retrospektyvinė vaikų, operuotų VUVL Vaikų ortopedijos ir traumatologijos centre 1994-2005 metais ir 2012-2013 metais dėl idiopatinės paauglių skoliozės, analizė. Išanalizuota 60 atvejų. Ligoniai suskirstyti į dvi grupes po 30 pacientų. I grupė -atlikta nugarinė spondiliodezė, pedikulinė fiksacija sraigtais (2012-2013 m.), IInugarinė spondiliodezė, fiksacija kabliukais (1994-2005 m.). Rentgenogramose buvo matuotas stuburo iškrypimo laipsnis prieš ir iš karto po operacijos, nustatytas iškrypimo tipas pagal Lenke klasifikaciją, palygintas iškrypimo laipsnis atlikus šoni-nio lenkimo rentgenogramas su iškrypimo laipsniu po operacijos abiejose grupėse atskirai, palyginti abiejų grupių iškrypimo laipsniai po operacijos. Skaičiavimai atlikti SAS ir SPSS programomis. Rezultatai. Palyginome abi grupes prieš operaciją, nes iškrypimo kampai abiejose grupėse skiriasi. Krūtininėje dalyje iškrypi-mo laipsnis prieš operaciją vidutiniškai skiriasi, tačiau stuburo mobilumas krūtininėje stuburo dalyje prieš operaciją panašus (p = 0,054). Juosmeninėje dalyje abiejose grupėse nėra statistiškai reikšmingo skirtumo tarp grupių, iškrypimo laipsnis panašus (p = 0,6). Prieš operaciją I grupėje gauti tokie iškrypimo laipsnių vidurkiai: krūtininis -46,10º (± 14,01), juosmeninis -37,46º (± 12,80), krūtininis šoninio lenkimo -25,59º (± 13,44), juosmeninis šoninio lenkimo -13,19º (± 9,69). Po operacijos: krūtininis -11,62º (± 6,94), juosmeninis -9,46º (± 7,53). II grupėje prieš operaciją gauti tokie iškrypimo kampai: krūtininis -55,13º (± 13,67), juosmeninis -35,87º (± 10,20), krū-tininis šoninio lenkimo -32,47º (± 13,89), juosmeninis šoninio lenkimo -8,54º (± 9,05). Po operacijos: krūtininis -27,77º (± 8,72), juosmeninis -16,60º (± 9,79). I grupėje gauta 74,79 proc. korekcija, o II -49,65 proc. Nustatėme, kad pirmoje grupėje krūtininio iškrypimo korekcija vidutiniškai 13,97º didesnė negu šoninio lenkimo rentgenogramose (p < 0,001), juosmeninio iškrypimo -3,73º didesnė (p < 0,04). Antroje grupėje krūtininio iškrypimo korekcija 4,70º didesnė negu šoninio lenkimo rentgenogramose (p < 0,02), juosmeninio -8,06º mažesnė (p < 0,001). Išvados. Fiksuojant sraigtais, ir krūtininis, ir juosmeninis iškrypimai atsistato daugiau negu tikimasi pagal šoninio lenkimo rentgenogramas. Tačiau gavome, kad krūtininėje dalyje bent stuburo mobilumas panašus -p = 0,054. Taikant fiksaciją sraigtais, krūtininis iškrypimas atsistato vidutiniškai 25 proc. (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005). X-rays were measured cur-