BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Spinal deformity corrections in paediatric patients are long-lasting procedures involving damage to many tissues and long pain exposure; therefore, effective pain management after surgical treatment is an important issue. In this study, the effect of inclusion of local infiltration analgesia, as an integral part of the scheme in postoperative pain control, in children and adolescents, subjected to the spinal deformity correction procedure, was assessed. Thirty patients, aged 8 to 17 years, undergoing spinal deformity correction were divided into a study group, receiving a 0.25% bupivacaine solution before wound closure, and a control group (no local analgesic agent). Morphine, at the doses of 0.10 mg/kg of body weight, was administered to the patients when pain occurred. Pain scores, morphine administration, and bleeding were observed during 48 postoperative hours. The pain scores were slightly lower in a 0–4 h period in patients who received bupivacaine compared with those in the control group. However, no differences were observed in a longer period of time and in the total opioid consumption. Moreover, increasing bleeding was observed in the bupivacaine-treated patients (study group) vs. the control. Bupivacaine only modestly affects analgesia and, due to the increased bleeding observed, it should not to be part of pain control management in young patients after spinal deformity correction.

Background: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study was to review current literature according to this complication. Methods: PubMed, Cochrane Library, and Embase were systematically searched for relevant articles by two independent reviewers in January 2022. Every step of the review was done according to PRISMA guidelines. Results: A total of 3579 articles were found. Twenty four articles were included in this systematic review after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of wound-related problems (on average, 15.5%). Conclusion: The literature concerning the definitions, collection, and interpretation of data regarding EOS wound-related complications is often difficult to interpret. This causes problems in the comparison and analysis. Additionally, this observation indicates that data on the incidence of SSI may be underestimated. Awareness of the high rate of SSI of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

This paper presents the case of a 5-year-old child with severe haemophilia A treated for epidural bleeding into the CNS resulting from spine trauma. Every case of CNS trauma in children with haemophilia entails a high threat to life and limb, and as a priority requires factor VIII supplementation and further urgent diagnostics. Treating a child with CNS bleeding in the course of haemophilia requires the cooperation of a team of specialists, including a haematologist, radiologist, neurosurgeon, orthopedist and rehabilitation specialist. The treatment strategy in itself and selection of a conservative or surgical treatment method require an in-depth analysis. Supplementation treatment should be initiated immediately following the diagnosis of a head or spinal column injury, or after the onset of signs and symptoms indicating CNS bleeding.

Titanium (Ti) is currently the most common biomaterial used for orthopedic implants; however, these implants may cause deleterious immune response. To investigate the possible mechanisms involved in excessive inflammation, we assessed the activity of neutrophils and monocyte-derived macrophages (MDMs) during the insertion of the Ti implant in a sheep model. The study was conducted on 12 sheep, 4 of which were control animals and 8 were in the experimental group with inserted Ti implant. Neutrophil secretory response was estimated at two time points T0 before surgery and T1 1 h after implantation and was based on the release of enzymes from neutrophil granules and reactive oxygen and nitrogen species (RONS) generation. MDM function was evaluated 5 months after implantation, on the basis of RONS generation arginase activity and morphological changes. Moreover, the influence of some autologous neutrophil derived products, namely, antimicrobial neutrophil extract (ANE) and neutrophil degranulation products (DGP) on leukocytes was estimated. Our study revealed that Ti implant insertion did not cause any adverse effects up to 5 months after surgical procedure. Stimulation of neutrophil cultures with ANE decreased the enzyme release as well as superoxide generation. Treatment of MDM with ANE diminished superoxide and NO generation and increased arginase activity. On the other hand, MDM stimulated with DGP showed elevated superoxide and NO generation as well as decreased arginase activity. To summarize, ANE exerted an anti-inflammatory and pro-resolving effect on studied leukocytes, whereas DGP acted as pro-inflammatory.