Search Results (9)

Background: Early-onset scoliosis (EOS) is a severe spinal deformity that can compromise thoracic development and pulmonary function if left untreated. While Mehta casting is widely used to manage deformity non-surgically in young children, its effects on spinal and thoracic growth remain underexplored. Methods: In this retrospective case series, 15 children with EOS underwent serial elongation–derotation–flexion (EDF) Mehta casting. Radiographic assessments were performed pre-treatment, post-casting, and at follow-up, including measurements of Cobb angle, rib–vertebral angle difference (RVAD), Th1–Th12 spinal length, coronal chest width (CCW), and space available for lung (SAL). Growth rates were estimated based on the duration of treatment. Correlation analyses were conducted to examine associations between baseline deformity and structural outcomes. Results: Serial casting reduced the mean Cobb angle by 22.2° and RVAD by 15.5°. During treatment, measurable increases were observed in Th1–Th12 length (mean: 2.93 cm), CCW (1.12 cm), SAL-L (2.60 cm), and SAL-R (2.98 cm). Estimated annual growth was significantly greater in children with lower initial Cobb and RVAD values. In contrast, total casting duration showed no consistent correlation with growth outcomes. Conclusions: Mehta casting is effective not only in correcting spinal deformity but also in supporting thoracic and axial growth in children with EOS. Early application in flexible, less severe curves may optimize structural outcomes and preserve thoracic development during early growth. Full article

Background: Femoral torsional malalignment is a common cause of in-toeing and out-toeing in children, often leading to gait disturbances, functional limitations, and increased risk of falls. Traditionally, osteotomy was the only surgical option for correction. A minimally invasive technique known as rotational guided growth (RGG) has recently been introduced to address these malalignments. This study aims to assess the effectiveness of rotational femoral malalignment correction by rotational epiphysiodesis with tension band 8-plates (Orthofix, Verona, Italy). Methods: Eleven patients with in-toeing and out-toeing (19 femurs) were treated using RGG with 8-plates. The 8-plates were applied laterally and medially, with screws placed above and below the growth plate of the distal femur, angled obliquely to the long axis of the bone in opposite directions. Changes in foot progression angle (FPA), femoral version, the alteration in the angle between the 8-plates, and the rate of correction were recorded. Results: All patients reported functional gait improvement. The FPA was corrected from a mean of 32 degrees to 7 degrees, the femoral version improved from a mean of 60 degrees to 22 degrees. The angle between the 8-plates changed from a mean of 75 degrees to 28 degrees, with a correction rate of 4.1 degrees per month. The average time for correction was 11 months. No complications were observed during the treatment. Conclusions: RGG using 8-plates is a novel, minimally invasive surgical technique that effectively corrects rotational femoral deformities and may serve as a preferred alternative to derotational osteotomy in growing patients. Full article

Introduction: Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. Material and Methods: We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Conclusions: Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia. Full article

Background: Although several biomechanical studies have been reported, few clinical studies have compared the efficacy of monoaxial and polyaxial pedicle screws in the surgical treatment of adolescent idiopathic scoliosis (AIS). This study aims to compare the radiological and clinical outcomes of mono- and polyaxial pedicle screws in the surgical treatment of AIS. Methods: A total of 46 AIS patients who underwent surgery to treat scoliosis using pedicle screw instrumentation (PSI) and rod derotation (RD) were divided into two groups according to the use of pedicle screws: the monoaxial group (n = 23) and polyaxial group (n = 23). Results: The correction rate of the main Cobb’s angle was higher in the monoaxial group (70.2%) than in the polyaxial group (65.3%) (p = 0.040). No differences in the rotational correction of the apical vertebra were evident between the two groups. SRS-22 scores showed no significant differences according to the type of pedicle screws used. Conclusions: The use of polyaxial pedicle screws resulted in coronal, sagittal, and rotational correction outcomes comparable to those associated with the use of monoaxial pedicle screws for surgical treatment using PSI and RD to treat moderate cases of AIS. Full article

Direct vertebral rotation (DVR) is the most widespread method to correct axial vertebral rotation. Differential rod contouring (DRC) also includes derotation, but not to the same extent as DVR. DVR requires additional surgical effort with potential consequences, which are absent in DRC; moreover, the data concerning the clinical benefits of apical derotation are not convincing. In the present study, clinical and radiological outcomes were compared in patients who underwent surgery for adolescent idiopathic scoliosis (AIS), having DVR and DRC vs. DRC only. In total, 73 AIS patients with curves of 40–85°, consecutively operated on by one surgeon, participated in this study and were followed up over 2 years. Scores from the SRS-22 questionnaire were analysed, the angles of trunk rotation (ATR) were measured with an inclinometer and a radiographic assessment of coronal and sagittal spinal profiles was conducted. In 38 cases, only DRC was performed, and in 35 DRC was performed and followed by DVR; the groups did not differ from an epidemiological point of view. Total SRS-22 scores after 2 years were similar in both groups (4.23 (±0.33) in DRC vs. 4.06 (±0.33) in DRC/DVR, p = 0.1). In all components of SRS-22, the differences were minor, with p being way above 0.05. The mean ATR in the DRC/DVR group was slightly smaller (8 ± 4°) than that of the DRC group (10 ± 5°), p = 0.16. Radiographic analysis did not show significant differences. The coronal curve was corrected by 66 ± 12% for DRC and 63 ± 15% for DVR, p = 0.28. Thoracic kyphosis in the DRC/DVR group increased by 1°, whereas in the DRC group the average kyphosis increased by 5° with a p value of 0.07. The complication rates were similar in both groups. This investigation did not show any advantages of the combination of DRC and DVR in scoliosis correction over DRC only, both radiologically and clinically, yet it affected intraoperative parameters, extending the operation time with only a minor increase in blood loss. Full article

Despite advancements in instruments and surgical techniques for adolescent idiopathic scoliosis (AIS) surgery, conventional open scoliosis surgery (COSS) is usually required to achieve satisfactory deformity correction using various distinct surgical techniques, such as rod derotation, direct vertebral rotation, facetectomies, osteotomies, and decortication of the laminae. However, COSS is accompanied by significant blood loss and requires a large midline skin incision. Minimally invasive surgery (MIS) has evolved enormously in various fields of spinal surgery, including degenerative spinal diseases. MIS of the spine has some advantages over conventional surgery, such as a smaller incision, less blood loss and postoperative pain, and lower infection rates. Since the introduction of MIS for AIS in 2011, MIS has been reported to have comparable outcomes, including correction rate with some usual advantages of MIS. However, several complications, such as dislodgement of rods, wound infection, and hypertrophic scar formation, have also been reported in the initial stages of MIS for AIS. We devised a novel approach, called the coin-hole technique or minimally invasive scoliosis surgery (MISS), to minimize these complications. This article aimed to introduce a novel surgical technique for AIS and provide a preliminary analysis and up-to-date information regarding MISS. Full article

This paper proposes an imaging algorithm for synthetic aperture radar (SAR) mounted on a high-speed maneuvering platform with squint terrain observation by progressive scan mode. To overcome the mismatch between range model and the signal after range walk correction, the range history is calculated in local polar format. The Doppler ambiguity is resolved by nonlinear derotation and zero-padding. The recovered signal is divided into several blocks in Doppler according to the angular division. Keystone transform is used to remove the space-variant range cell migration (RCM) components. Thus, the residual RCM terms can be compensated by a unified phase function. Frequency domain perturbation terms are introduced to correct the space-variant Doppler chirp rate term. The focusing parameters are calculated according to the scene center of each angular block and the signal of each block can be processed in parallel. The image of each block is focused in range-Doppler domain. After the geometric correction, the final focused image can be obtained by directly combined the images of all angular blocks. Simulated SAR data has verified the effectiveness of the proposed algorithm. Full article

No previous studies have suggested a reliable criterion for determining the addition of a concomitant pelvic osteotomy by using a large patient cohort with quadriplegic cerebral palsy and a homogenous treatment entity of femoral varus derotational osteotomies (VDRO). In this retrospective study, we examined our results of hip reconstructions conducted without a concomitant pericapsular acetabuloplasty in patients with varying degrees of hip displacement. We wished to investigate potential predictors for re-subluxation or re-dislocation after the index operation, and to suggest the indications for a simultaneous pelvic osteotomy. We reviewed the results of 144 VDROs, with or without open reduction, in 72 patients, at a mean follow-up of 7.0 (2.0 to 16.0) years. Various radiographic parameters were measured, and surgical outcomes were assessed based on the final migration percentage (MP) and the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) grades. The effects of potential predictive factors on the surgical outcome was assessed by multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis was also performed to determine whether a threshold of each risk factor existed above which the rate of unsatisfactory outcomes was significantly increased. In total, 113 hips (78.5%) showed satisfactory results, classified as MCPHCS grades I, II, and III. Thirty-one hips (21.5%) showed unsatisfactory results, including six hip dislocations. Age at surgery and preoperative acetabular index had no effects on the results. Lower pre- and postoperative MP were found to be the influential predictors of successful outcomes. The inflection point of the ROC curve for unsatisfactory outcomes corresponded to the preoperative MP of 61.8% and the postoperative MP of 5.1%, respectively; these thresholds of the pre- and postoperative MP may serve as a guideline in the indication for a concomitant pelvic osteotomy. Our results also indicate that the severely subluxated or dislocated hip, as well as the hip in which the femoral head is successfully reduced by VDRO but is still contained within the dysplastic acetabulum, may benefit from concomitant pelvic osteotomy. Full article

Multi-channel beam-steering synthetic aperture radar (multi-channel BS-SAR) can achieve high resolution and wide-swath observations by combining beam-steering technology and azimuth multi-channel technology. Various imaging algorithms have been proposed for multi-channel BS-SAR but the associated parameter estimation and error calibration have received little attention. This paper focuses on errors in the main parameters in multi-channel BS-SAR (the derotation rate and constant Doppler centroid) and phase inconsistency errors. These errors can significantly reduce image quality by causing coarser resolution, radiometric degradation, and appearance of ghost targets. Accurate derotation rate estimation is important to remove the spectrum aliasing caused by beam steering, and spectrum reconstruction for multi-channel sampling requires an accurate estimate of the constant Doppler centroid and phase inconsistency errors. The time shift and scaling effect of the derotation error on the azimuth spectrum are analyzed in this paper. A method to estimate the derotation rate is presented, based on time shifting, and integrated with estimation of the constant Doppler centroid. Since the Doppler histories of azimuth targets are space-variant in multi-channel BS-SAR, the conventional estimation methods of phase inconsistency errors do not work, and we present a novel method based on minimum entropy to estimate and correct these errors. Simulations validate the proposed error estimation methods. Full article