IntroductionA major concern of orthopedic surgeons in managing children with idiopathic scoliosis with a minor curvature is identifying how many and which curves will progress to severe deformities requiring treatment [1, 3-12, 14, 15]. Accurate identification of curves destined to progress requires a clear understanding of the natural history of idiopathic scoliosis. In this regard, school screening has been a powerful tool for the identification of children who may have scoliosis, as well as for providing information on the course of the disease over time [10, 11, 15, 17-19, 21, 22]. The vast majority of the children, however, show no spinal deformity, and of the scoliotic curves detected through school screening, only a percentage are destined to progress to clinical significance. Various factors have been associated with curve progression, although it is not clear to what extent they can be used in predicting the course of the natural history of the scoliotic curve. As a Abstract In a 5-year prospective study on idiopathic scoliosis, an attempt was made to elucidate the natural history of the disease and to determine which factors contribute to curve progression. A total of 85,622 children were examined for scoliosis in a prospective school screening study carried out in northwestern and central Greece. Curve progression was studied in 839 of the 1,436 children with idiopathic scoliosis of at least 10°detected from the school screening program. Each child was followed clinically and roentgenographically for one to four follow-up visits for a mean of 3.2 years. Progression of the scoliotic curve was recorded in 14.7% of the children. Spontaneous improvement of at least 5°was observed in 27.4% of them, with 80 children (9.5%) demonstrating complete spontaneous resolution. Eighteen percent of the patients remained stable, while the remaining patients demonstrated nonsignificant changes of less than 5°in curve magnitude. A strong association was observed between the incidence of progression and the sex of the child, curve pattern, maturity, and to a lesser extent age and curve magnitude. More specifically, the following were associated with a high risk of curve progression: sex (girls); curve pattern (right thoracic and double curves in girls, and right lumbar curves in boys); maturity (girls before the onset of menses); age (time of pubertal growth spurt); and curve magnitude (≥ 30°). On the other hand, left thoracic curves showed a weak tendency for progression. In conclusion, the findings of the present study strongly suggest that only a small percentage of scoliotic curves will undergo progression. The pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress.

The complexity of pelvic anatomy and the extent of tumor growth makes treatment of patients with primary bone sarcomas in the pelvis difficult in terms of local control. Before the 1970s, most tumors in the bony pelvis were surgically treated with hindquarter amputation. Currently, improved techniques for clinical staging, adjuvant treatments, evolutions in metallurgy, and development of new surgical techniques make limb-salvage surgery and reconstruction possible alternatives to hemipelvectomy and resection-arthrodesis. The advantages of amputation over resections at the pelvis are a lower incidence of complications, a limited area at risk for recurrence, and a faster recovery time compared with all but the most limited pelvic resections. The disadvantages, especially after periacetabular resections, are leg-length discrepancy and impaired hip and gait function. The indication for limb salvage is the ability to obtain wide margins without compromising survival and function. Although having to resect the sciatic nerve to obtain adequate margins does not always mean that an amputation should be performed, the combination of a major pelvic resection and the functional consequences of sciatic nerve resection results in an extremity usually not worth saving; loss of femoral nerve function does not result in a significant gait disturbance, especially if the hemipelvis is stable. Reconstruction options after major pelvic resections have also evolved, but they remain difficult, especially when the acetabulum is involved.

Sixty patients were treated using a multilevel spinal instrumentation system. Spine arthrodesis was done posteriorly in all patients using a combination of two rods, hooks, screws, and cross-link plates. The Galveston technique was used in three patients. Five patients presented with late deep wound infections 1 to 5 years postoperatively. Two patients presented with a local subcutaneous abscess, whereas the remaining patients had a local drainage. Exploration revealed pus lining the instrumentation surface, at least one loose cross-link nut, and local hardware corrosion and metal infiltration of the surrounding tissues. All patients had a satisfactory bony arthrodesis, so instrumentation was removed. Intraoperative cultures revealed three coagulase-negative Staphylococci, one Acinetobacter baumani, and one Peptostreptococcus. A continuous irrigation system with antibiotics was placed for 5 days in all patients in combination with intravenous antibiotics and oral antibiotics. All patients responded to the treatment, with no recurrence of the infection after removal of the instrumentation. Although the exact nature of these infections requires additional investigation, the findings suggest a correlation between instrumentation failure and loosening and late infection. Bone involvement was not observed and removal of instrumentation was a reliable means of treatment.

One hundred fourteen patients (66 men and 48 women; mean age, 49 years) underwent spine stabilization using a dynamic neutralization system between January 1999 and August 2010 for degenerative disk disease, spinal instability, or spinal stenosis. Mean follow-up was 6.8 years (range, 1-11 years). Seven patients were lost to follow-up. Radiological examination and clinical evaluation, including the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were performed.Mean Oswestry Disability Index score improved from 57% (severe disability) preoperatively to 22% (moderate disability) postoperatively. Mean Roland-Morris Disability Questionnaire score improved from 52% preoperatively to 35% postoperatively; 79 (74%) patients declared themselves very satisfied with the end result of the operation. Postoperatively, 27 (25%) patients experienced complications, including screw loosening (n=22), infection (n=2), back (n=5) and leg (n=2) pain, and endplate vertebral fracture (n=1). Three patients with screw loosening, 2 with deep infection, and 1 with severe persistent back and leg pain underwent rigid spine arthrodesis.Dynamic neutralization systems can be considered for degenerative disk disease, spinal instability, and stenosis. Patient satisfaction with the procedure is excellent. However, in the long term, the complication rate, most commonly screw loosening, is high and reoperations are common. In this setting, long-term follow-up is recommended, and the use of this system should be reconsidered.