Stefan Gavriliu - Academia.edu (original) (raw)

Papers by Stefan Gavriliu

Romanian Medical Journal, 2018

Obiective. Articolul prezintă dificultăţile ȋntâlnite ȋn cadrul tratamentului scoliozelor exotice... more Obiective. Articolul prezintă dificultăţile ȋntâlnite ȋn cadrul tratamentului scoliozelor exotice şi variantele optime de tratament al acestei patologii. Material şi metodă. Prezentarea unui caz de scolioză exotică cu bloc vertebral cu hemivertebre la nivel T6-T11, fuziuni şi agenezii costale pe partea concavă, vertebre ȋn fluture la nivel L1-T12, hemivertebră la nivel L2 şi rahischizis lombar ce asocia şi o lamă osoasă diastematomielică la nivel T12-L1 operată, ce a necesitat reintervenţia chirurgicală. Rezultate. Deciziile chirurgicale neoptimizate fiecărei patologii ȋn parte pot duce la agravarea evoluţiei şi ridică dificultăţi ȋn tratamentul ulterior. Discuţii. Rezecţia hemivertebrei şi fuziunea spinală limitată la 2 nivele este varianta optimă de tratament a scoliozelor congenitale ce poate asigura redresarea curburii scoliotice şi oprirea progresiei acesteia. Dispozitivul VEPTR este varianta cea mai eficientă de asigurare a unei dezvoltări pulmonare compatibile cu viaţa ȋn cadrul sindromului de insuficienţă toracică. Concluzii. Scoliozele exotice reprezintă o patologie provocatoare ce necesită previziune a dezvoltării pentru a putea alege un tratament optim, ce să asigure creşterea şi dezvoltarea atât a cavităţii toracice şi a pulmonului cât şi a coloanei vertebrale.

Romanian Medical Journal, 2018

Introducere. Hemivertebra reprezintă malformaţia prin defect de formare cu importante repercusiun... more Introducere. Hemivertebra reprezintă malformaţia prin defect de formare cu importante repercusiuni asupra creşterii şi dezvoltării normale a rahisului, a cărei abordare conservatoare nu ȋmpiedică progresia curburii scoliotice. Material şi metodă. Prezentarea tehnicii chirurgicale ce presupune rezecţia hemivertebrei prin abord unic posterior cu rahisnteză segmentară pe segment spinal scurt, descrisă de Ruff şi Harms, aplicată ȋn cazul a 12 hemivertebre (9 pacienţi). Rezultate. Corecţia curburii scoliotice obţinută postoperator a fost de 70,56%, similar corecţiei descrise ȋn literatură pentru tehnica descrisă, ce s-a menţiunt la reevaluarea de 1 an. Discuţii. Comparând tehnica cu celelalte variante de tratament descrise ȋn literatură, fuziune in situ posterioară sau antero-posterioară cu sau fără instrumentare, hemiepifiziodeză convexă anterioară şi posterioară combinată sau rezecţia hemivertebrei prin abord dublu, antero-posterior, putem nota faptul că rezecţia hemivertebrei prin abord unic posterior şi instrumentarea segmentară spinală este superioară ȋn ceea ce priveşte rezultatele, evoluţia şi a numărului mai mic de complicaţi postoperatorii. Concluzii. Tehnica descrisă reprezintă la ora actuală "golden standard"-ul pentru corecţia precoce a curburii scoliotice, ȋnaintea apariţiei modificărilor structurale secundare, ce permite o corecţie bună, cu o rahisinteză minimă, ce păstrează mobilitatea şi creşterea cvasinormală a rahisului.

Scoliosis, 2015

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 ve... more Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45°± 8, and 25°± 8 at final follow up. The following is a report on three adolescent females aged 13-16 years with curves between 43°-53°and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22-33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.

SN Comprehensive Clinical Medicine, 2021

To report two very similar cases of exotic congenital scoliosis associating diastematomyelia trea... more To report two very similar cases of exotic congenital scoliosis associating diastematomyelia treated at different ages by different spinal approaches. The approach of these patients should be a multidisciplinary one due to the neurological and orthopedic problems. We present two cases of exotic congenital scoliosis with very similar spinal congenital defects located in the lower thoracic and lumbar area associating diastematomyelia. The age at surgery was 4 years in the first case and 12 years in the second case, respectively. Both cases were approached in a one-stage surgical procedure. The first step was the resection of the bony diastematomyelia, followed by spinal synthesis. Diastematomyelia was successfully resected in both cases, but scoliotic curve correction was poor due to improper spinal synthesis, in the first case, and old age at surgery moment, in the second case. Diastematomyelia resection is critical as the first surgical step. The presence of multiple spinal malformations, especially when present in a long spinal area, and older patients at surgery moment are predictors of poor results of scoliotic curve correction and spinal growth.

International Journal of Orthopaedics, 2021

Background: Congenital scoliosis is nowadays addressed by many surgical solutions. There are rare... more Background: Congenital scoliosis is nowadays addressed by many surgical solutions. There are rare cases presenting with mixed vertebral defects associated with Thoracic Insufficiency Syndrome (TIS). The presence of mixed vertebral defects may present with a very high progressive potential, inducing a severe scoliotic curve which impairs the development of the thoracic cage. Additionally, these cases may associate rib fusions which will further impair the development of the lung in these patients. The unique surgical solution in these cases is represented by VEPTR (Vertical Expandable Prosthesis Titanium Rib) devices able to expand the thorax and to control the scoliotic curve. Material and methods: The surgical technique of the VEPTR device in a rib-to-spine construct consists in a distraction based device able to expand the thorax on the concave side of the scoliosis by consecutive distractions and, secondary, to control de scoliotic curve. The upper module of the device is placed ...

International Journal of Orthopaedics, 2019

52 EOS patients, operated by different treatment methods (2003-2014) has been analyzed. The serie... more 52 EOS patients, operated by different treatment methods (2003-2014) has been analyzed. The series included congenital, idiopathic infantile and one syndromic scoliosis. Surgical procedures consisted in hemivertebral resection concomitant with instrumentation, the use of VEPTR or Shilla devices or combinations of these. The follow-up period ranged 4-15 years. The patients were investigated by clinical and imagistic exams. 15 patients with poor clinical and radiological results after surgery were identified (worsening of the curve, extended fusion with a short, stiff spine, impaired trunk imbalance and/or pseudarthrosis). RESULTS: The possible identified therapeutic issues included: the use of surgical techniques which resulted in extended posterior fusion, the choice of an possibly poor surgical technique, improper or faulty applied implants. CONCLUSIONS: Complications and possible postoperative evolutions related to the chosen therapeutic decision should be very thorough taken into account before any procedure. A poor strategy treatment of these deformities decreases quality of life. The prognosis is variable, depending on the cause inducing the deformity. That's why the treatment should be individualized for each EOS patient. An improper treatment may produce real disasters or cuts short any therapeutic chance, maybe the only one available, in order to ensure the best life quality obtainable.

International Journal of Orthopaedics, 2020

Fully segmented hemivertebra represents one of the most frequent cause of congenital scoliosis. T... more Fully segmented hemivertebra represents one of the most frequent cause of congenital scoliosis. This spinal malformation requires in many cases surgery and nowadays the golden standard is represented by posterior hemivertebra resection and segmental posterior fusion. The technique is a demanding one, but with proper preoperative planning and careful surgery, it ensures good results. Some tips and tricks are useful to avoid poor results and re-interventions.

Journal of medicine and life

This paper is a retrospective study on 8 patients admitted and treated in Paediatric Surgery and ... more This paper is a retrospective study on 8 patients admitted and treated in Paediatric Surgery and Orthopaedics Clinic of "M. S. Curie" Hospital Bucharest between 1997 and 2007. The patients with malignant bone tumors (table 1.) were studied by sex, tumor type, location, age at the moment of diagnosis, age at the moment of the last evaluation, type of surgery, external fixator implanted, complications, results and survival period. We also considered for each patient the extent of the tumor to diaphysis, soft tissue involvement, involvement of physis and epiphyseal invasion, articular extent, vessels and nerves invasion, presence of metastases and local skin invasion. The certain diagnosis was based on pathological anatomy exam, because clinical and imagistic data were not decisive in each case. There were studied only those patients who received external fixators, the only method to achieve oncological safe resection and osteoarticular recontruction. We used monoplanar or ci...

Journal of medicine and life

Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbala... more Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95% of the cases) and the shortening of hipotensive factors (5% of the cases) are responsible for the production mechanism of renovascular hypertension in children. In order to make an early diagnosis regarding the renovascular hypertension in all children suffering from renovascular illnesses, blood pressure must be taken correctly and repeatedly. This paper is a case study on 19 children with renovascular hypertension, aged between 2 and 15 years old. Most cases were divided into two groups: subjects aged 4-7 years old and subjects aged 8-12 years old. Each group represents 34.2% of all cases. The diagnosis of renovascular hypertension in those 19 children was established after correctly taking the blood pressure and comparing it with the normal values for each age. Hypertension was diagnosed before knowing its cause in...

Journal of medicine and life

Salter Harris Fractures type, especially type I and II are treated by orthopedic reduction in the... more Salter Harris Fractures type, especially type I and II are treated by orthopedic reduction in the emergency room or operating room, under general anesthesia, followed by plaster immobilization. Neglected or incorrectly treated fractures, leading to malunion and radiocarpal subluxations which require surgical procedure. This paper proposes to evaluate the correctly applied orthopedic treatment and the expose of an original surgical technique in case of neglected and incorrectly treated fractures, leading to mal-unions and impediments in the radiocarpal mobility and aesthetics. we studied a group of 238 children with Salter Harris fractures type I and II, treated in "M.S. Curie" Emergency Hospital for Children, Bucharest. Out of the studied group, 200 children were treated by orthopedic reduction and immobilization in a plaster device. Malunions present within 38 children due to neglected or mistreated fractures, underwent open reduction with internal osteosynthesis by a tec...

European Spine Journal, 2014

Even if diastematomyelia is a rare condition, it always has to be identified in case of diagnosin... more Even if diastematomyelia is a rare condition, it always has to be identified in case of diagnosing and treating a case of congenital scoliosis. The consequence of missing the diagnosis of such a malformation may be devastating to the involved patient. This paper wants once again to make aware the physicians of the eventual presence of a spinal dysraphic malformation when dealing with a congenital spinal malformation. The presence of diastematomyelia was noticed in two of our cases, one with congenital scoliosis and another with congenital kyphoscoliosis. First of all in these cases, we performed the resection of the bony septum, followed by spinal fusion in a single-stage surgical procedure. We noticed no complications during and after surgery related to the resection of the bony septum. In both patients, we obtained partial correction and stabilization of the congenital spinal malformation after a safe excision of the bony septum. Diastematomyelia is a rare condition. It has to be taken into consideration when dealing with a congenital scoliosis. The first step in the surgical procedure has to be the resection of the diastematomyelic septum. In case of a scoliosis ranging up to 30° and not presenting a progressive potential, the expectative-evaluation attitude is a correct one.

Scoliosis, 2015

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 ve... more Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13-16 years with curves between 43°-53° and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.

Romanian Medical Journal, 2018

Obiective. Articolul prezintă dificultăţile ȋntâlnite ȋn cadrul tratamentului scoliozelor exotice... more Obiective. Articolul prezintă dificultăţile ȋntâlnite ȋn cadrul tratamentului scoliozelor exotice şi variantele optime de tratament al acestei patologii. Material şi metodă. Prezentarea unui caz de scolioză exotică cu bloc vertebral cu hemivertebre la nivel T6-T11, fuziuni şi agenezii costale pe partea concavă, vertebre ȋn fluture la nivel L1-T12, hemivertebră la nivel L2 şi rahischizis lombar ce asocia şi o lamă osoasă diastematomielică la nivel T12-L1 operată, ce a necesitat reintervenţia chirurgicală. Rezultate. Deciziile chirurgicale neoptimizate fiecărei patologii ȋn parte pot duce la agravarea evoluţiei şi ridică dificultăţi ȋn tratamentul ulterior. Discuţii. Rezecţia hemivertebrei şi fuziunea spinală limitată la 2 nivele este varianta optimă de tratament a scoliozelor congenitale ce poate asigura redresarea curburii scoliotice şi oprirea progresiei acesteia. Dispozitivul VEPTR este varianta cea mai eficientă de asigurare a unei dezvoltări pulmonare compatibile cu viaţa ȋn cadrul sindromului de insuficienţă toracică. Concluzii. Scoliozele exotice reprezintă o patologie provocatoare ce necesită previziune a dezvoltării pentru a putea alege un tratament optim, ce să asigure creşterea şi dezvoltarea atât a cavităţii toracice şi a pulmonului cât şi a coloanei vertebrale.

Romanian Medical Journal, 2018

Introducere. Hemivertebra reprezintă malformaţia prin defect de formare cu importante repercusiun... more Introducere. Hemivertebra reprezintă malformaţia prin defect de formare cu importante repercusiuni asupra creşterii şi dezvoltării normale a rahisului, a cărei abordare conservatoare nu ȋmpiedică progresia curburii scoliotice. Material şi metodă. Prezentarea tehnicii chirurgicale ce presupune rezecţia hemivertebrei prin abord unic posterior cu rahisnteză segmentară pe segment spinal scurt, descrisă de Ruff şi Harms, aplicată ȋn cazul a 12 hemivertebre (9 pacienţi). Rezultate. Corecţia curburii scoliotice obţinută postoperator a fost de 70,56%, similar corecţiei descrise ȋn literatură pentru tehnica descrisă, ce s-a menţiunt la reevaluarea de 1 an. Discuţii. Comparând tehnica cu celelalte variante de tratament descrise ȋn literatură, fuziune in situ posterioară sau antero-posterioară cu sau fără instrumentare, hemiepifiziodeză convexă anterioară şi posterioară combinată sau rezecţia hemivertebrei prin abord dublu, antero-posterior, putem nota faptul că rezecţia hemivertebrei prin abord unic posterior şi instrumentarea segmentară spinală este superioară ȋn ceea ce priveşte rezultatele, evoluţia şi a numărului mai mic de complicaţi postoperatorii. Concluzii. Tehnica descrisă reprezintă la ora actuală "golden standard"-ul pentru corecţia precoce a curburii scoliotice, ȋnaintea apariţiei modificărilor structurale secundare, ce permite o corecţie bună, cu o rahisinteză minimă, ce păstrează mobilitatea şi creşterea cvasinormală a rahisului.

Scoliosis, 2015

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 ve... more Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45°± 8, and 25°± 8 at final follow up. The following is a report on three adolescent females aged 13-16 years with curves between 43°-53°and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22-33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.

SN Comprehensive Clinical Medicine, 2021

To report two very similar cases of exotic congenital scoliosis associating diastematomyelia trea... more To report two very similar cases of exotic congenital scoliosis associating diastematomyelia treated at different ages by different spinal approaches. The approach of these patients should be a multidisciplinary one due to the neurological and orthopedic problems. We present two cases of exotic congenital scoliosis with very similar spinal congenital defects located in the lower thoracic and lumbar area associating diastematomyelia. The age at surgery was 4 years in the first case and 12 years in the second case, respectively. Both cases were approached in a one-stage surgical procedure. The first step was the resection of the bony diastematomyelia, followed by spinal synthesis. Diastematomyelia was successfully resected in both cases, but scoliotic curve correction was poor due to improper spinal synthesis, in the first case, and old age at surgery moment, in the second case. Diastematomyelia resection is critical as the first surgical step. The presence of multiple spinal malformations, especially when present in a long spinal area, and older patients at surgery moment are predictors of poor results of scoliotic curve correction and spinal growth.

International Journal of Orthopaedics, 2021

Background: Congenital scoliosis is nowadays addressed by many surgical solutions. There are rare... more Background: Congenital scoliosis is nowadays addressed by many surgical solutions. There are rare cases presenting with mixed vertebral defects associated with Thoracic Insufficiency Syndrome (TIS). The presence of mixed vertebral defects may present with a very high progressive potential, inducing a severe scoliotic curve which impairs the development of the thoracic cage. Additionally, these cases may associate rib fusions which will further impair the development of the lung in these patients. The unique surgical solution in these cases is represented by VEPTR (Vertical Expandable Prosthesis Titanium Rib) devices able to expand the thorax and to control the scoliotic curve. Material and methods: The surgical technique of the VEPTR device in a rib-to-spine construct consists in a distraction based device able to expand the thorax on the concave side of the scoliosis by consecutive distractions and, secondary, to control de scoliotic curve. The upper module of the device is placed ...

International Journal of Orthopaedics, 2019

52 EOS patients, operated by different treatment methods (2003-2014) has been analyzed. The serie... more 52 EOS patients, operated by different treatment methods (2003-2014) has been analyzed. The series included congenital, idiopathic infantile and one syndromic scoliosis. Surgical procedures consisted in hemivertebral resection concomitant with instrumentation, the use of VEPTR or Shilla devices or combinations of these. The follow-up period ranged 4-15 years. The patients were investigated by clinical and imagistic exams. 15 patients with poor clinical and radiological results after surgery were identified (worsening of the curve, extended fusion with a short, stiff spine, impaired trunk imbalance and/or pseudarthrosis). RESULTS: The possible identified therapeutic issues included: the use of surgical techniques which resulted in extended posterior fusion, the choice of an possibly poor surgical technique, improper or faulty applied implants. CONCLUSIONS: Complications and possible postoperative evolutions related to the chosen therapeutic decision should be very thorough taken into account before any procedure. A poor strategy treatment of these deformities decreases quality of life. The prognosis is variable, depending on the cause inducing the deformity. That's why the treatment should be individualized for each EOS patient. An improper treatment may produce real disasters or cuts short any therapeutic chance, maybe the only one available, in order to ensure the best life quality obtainable.

International Journal of Orthopaedics, 2020

Fully segmented hemivertebra represents one of the most frequent cause of congenital scoliosis. T... more Fully segmented hemivertebra represents one of the most frequent cause of congenital scoliosis. This spinal malformation requires in many cases surgery and nowadays the golden standard is represented by posterior hemivertebra resection and segmental posterior fusion. The technique is a demanding one, but with proper preoperative planning and careful surgery, it ensures good results. Some tips and tricks are useful to avoid poor results and re-interventions.

Journal of medicine and life

This paper is a retrospective study on 8 patients admitted and treated in Paediatric Surgery and ... more This paper is a retrospective study on 8 patients admitted and treated in Paediatric Surgery and Orthopaedics Clinic of "M. S. Curie" Hospital Bucharest between 1997 and 2007. The patients with malignant bone tumors (table 1.) were studied by sex, tumor type, location, age at the moment of diagnosis, age at the moment of the last evaluation, type of surgery, external fixator implanted, complications, results and survival period. We also considered for each patient the extent of the tumor to diaphysis, soft tissue involvement, involvement of physis and epiphyseal invasion, articular extent, vessels and nerves invasion, presence of metastases and local skin invasion. The certain diagnosis was based on pathological anatomy exam, because clinical and imagistic data were not decisive in each case. There were studied only those patients who received external fixators, the only method to achieve oncological safe resection and osteoarticular recontruction. We used monoplanar or ci...

Journal of medicine and life

Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbala... more Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95% of the cases) and the shortening of hipotensive factors (5% of the cases) are responsible for the production mechanism of renovascular hypertension in children. In order to make an early diagnosis regarding the renovascular hypertension in all children suffering from renovascular illnesses, blood pressure must be taken correctly and repeatedly. This paper is a case study on 19 children with renovascular hypertension, aged between 2 and 15 years old. Most cases were divided into two groups: subjects aged 4-7 years old and subjects aged 8-12 years old. Each group represents 34.2% of all cases. The diagnosis of renovascular hypertension in those 19 children was established after correctly taking the blood pressure and comparing it with the normal values for each age. Hypertension was diagnosed before knowing its cause in...

Journal of medicine and life

Salter Harris Fractures type, especially type I and II are treated by orthopedic reduction in the... more Salter Harris Fractures type, especially type I and II are treated by orthopedic reduction in the emergency room or operating room, under general anesthesia, followed by plaster immobilization. Neglected or incorrectly treated fractures, leading to malunion and radiocarpal subluxations which require surgical procedure. This paper proposes to evaluate the correctly applied orthopedic treatment and the expose of an original surgical technique in case of neglected and incorrectly treated fractures, leading to mal-unions and impediments in the radiocarpal mobility and aesthetics. we studied a group of 238 children with Salter Harris fractures type I and II, treated in "M.S. Curie" Emergency Hospital for Children, Bucharest. Out of the studied group, 200 children were treated by orthopedic reduction and immobilization in a plaster device. Malunions present within 38 children due to neglected or mistreated fractures, underwent open reduction with internal osteosynthesis by a tec...

European Spine Journal, 2014

Even if diastematomyelia is a rare condition, it always has to be identified in case of diagnosin... more Even if diastematomyelia is a rare condition, it always has to be identified in case of diagnosing and treating a case of congenital scoliosis. The consequence of missing the diagnosis of such a malformation may be devastating to the involved patient. This paper wants once again to make aware the physicians of the eventual presence of a spinal dysraphic malformation when dealing with a congenital spinal malformation. The presence of diastematomyelia was noticed in two of our cases, one with congenital scoliosis and another with congenital kyphoscoliosis. First of all in these cases, we performed the resection of the bony septum, followed by spinal fusion in a single-stage surgical procedure. We noticed no complications during and after surgery related to the resection of the bony septum. In both patients, we obtained partial correction and stabilization of the congenital spinal malformation after a safe excision of the bony septum. Diastematomyelia is a rare condition. It has to be taken into consideration when dealing with a congenital scoliosis. The first step in the surgical procedure has to be the resection of the diastematomyelic septum. In case of a scoliosis ranging up to 30° and not presenting a progressive potential, the expectative-evaluation attitude is a correct one.

Scoliosis, 2015

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 ve... more Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13-16 years with curves between 43°-53° and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.