The objective of this study was to analyse the presentation, aetiology, conservative management, and outcome of non-tuberculous pyogenic spinal infection in adults. We performed a retrospective review of 56 patients (35 women and 21 men) of pyogenic spinal infection presenting over a 7-year period (1999-2006) to the Department of Spinal Surgery of Hesperia Hospital. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed. The mean age at presentation was 47.8 years (age range 35-72 years), the mean follow-up duration was 12.5 months. The most common site of infection was lumbar spine (n: 48), followed by the thoracic spine (n: 8). Most patients were symptomatic for between 4 and 10 weeks before presenting to hospital. The frequently isolated pathogen was Staphylococcus aureus in 31 of 56 cases (57.6%). Percutaneous biopsies were diagnostic in 57% of patients; the open biopsy was indicated if closed biopsy failed and when the infection was not accessible by percutaneous technique. The patients were managed by conservative measures alone, including antibiotic therapy and spinal bracing. The mean period of antibiotic therapy was 8.5 weeks (range 6-9 weeks), followed by oral antibiotics for 6 weeks. All patients had a supportive spinal brace for mean 8 weeks (range 6-10 weeks). The duration of the administration of oral antibiotics was dependent on clinical and laboratory evidence (white cell count, erythrocyte sedimentation rate, C-reactive protein) that the infection was resolved. The follow-up MR gadolinium scans were essential to monitor the response to medical treatment. The diagnosis of pyogenic spinal infection should be considered in any patient presenting with severe localised unremitting back and neck pain, especially when accompanied with systemic features, such as fever and weight loss and in the presence of elevated inflammatory markers. The conservative management of infection with antibiotic therapy and spinal bracing was very successful.

The severe dystrophic curve with anterior vertebral scalloping always requires combined anterior and posterior stabilization, particularly in younger patients, even if the sagittal curves have not become pathologic by the time of presentation.

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SUMMARY This is a report on the natural history of 109 patients with infantile spinal muscular atrophy (SMA). All 18 children with the severe form died, as did five of the 52 with the intermediate form. Functional ability was more or less stable in the 47 living patients with the intermediate form, but 16 of the 39 with mild SMA lost the ability to walk. Ventilatory function was severely impaired in those with intermediate SMA: orthopaedic treatment for scoliosis in this group did not prevent the curves from worsening with age. Scoliosis was also severe in patients with mild SMA who had stopped walking: surgical treatment in six cases resulted in stable correction of the spine, with functional and cosmetic improvement and without impairment of respiratory function. RÉSUMÉ Scoliose dans I'atrophie spinale infantile: histoire naturelle et prise en charge L'article rapporte l'histoire naturelle de 109 patients atteints d'atrophie musculaire spinale infantile (SMA). Tous les 18 cas d'atteinte sévère moururent ainsi que cinq sur 52 des formes intermédiates. Les capacités fonctionnelles furent plus ou moins stables chez les 47 survivants de forme intermédiaire mais la marche fut perdue pour 16 des 39 cas de forme modérée de SMA. La fonction respiratoire fut gravement atteinte dans les formes intermédiaires: le traitement orthopédique de la scoliose n'empêcha pas une aggravation des courbures avec l'âge, dans ce groupe. La scoliose fut également grave dans les formes modérées oú la marche était perdue: le traitement chirurgical dans six cas permit une correction vertébrale, avec amélioration fonctionnelle et esthétique, sans atteinte de la fonction respiratoire. ZUSAMMENFASSUNG Skoliose bei spinaler Muskelatrophie: Krankheitsverlauf und Behandlung Dies ist ein Bericht über den Krankheitsverlauf bei 109 Patienten mit spinaler Muskelatrophie (SMA). Alle 18 Kinder mit der schweren Form starben, sowie fünf von den 52 mit der mittelschweren Form. Bei den 47 lebenden Patienten mit der mittelschweren Form waren die motorischen Funktionen mehr oder weniger stabil, während 16 der 39 Kinder mit einer milden SMA nicht mehr laufen konnten. Die Atemfunktion war bei den Kindern mit der mittelschweren SMA stark beeinträchtigt: die orthopädische Behandlung der Skoliose in dieser Gruppe konnte eine Verschlechterung mit fortschreitendem Alter nicht verhindern. Die Skoliosen waren auch sehr ausgeprägt bei den Patienten mit milder SMA, die nicht mehr laufen konnten: das Ergebnis einer chirurgischen Behandlung in sechs Fällen war eine stabile Korrektur der Wirbelsäule mit funktioneller und kosmetischer Verbesserung und ohne Beeinträchtigung der Atemfunktion. RESUMEN Escoliosis en la atrofia muscular espinal: historia natural y manejo Se trata de un estudio sobre la historia natural de 109 pacientes con atrofia muscular espinal infantile (AMEI). Todos los 18 casos que sufrian la forma grave fallecieron, asi como cinco con forma intermedia. La habilidad funcional era más o menos estable en los 47 pacientes que vivian con la forma intermedi...

The cause of adolescent idiopathic scoliosis (AIS) in humans remains obscure and probably multifactorial. At present, there is no proven method or test available to identify children or adolescent at risk of developing AIS or identify which of the affected individuals are at risk of progression. Reported associations are linked in pathogenesis rather than etiologic factors. Melatonin may play a role in the pathogenesis of scoliosis (neuroendocrine hypothesis), but at present, the data available cannot clearly show the role of melatonin in producing scoliosis in humans. The data regarding human melatonin levels are mixed at best, and the melatonin deficiency as a causative factor in the etiology of scoliosis cannot be supported. It will be an important issue of future research to investigate the role of melatonin in human biology, the clinical efficacy, and safety of melatonin under different pathological situations. Research is needed to better define the role of all factors in AIS development.