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Background Early versions of spinal muscular atrophy (SMA) scoliosis correction surgery often involved sublaminar devices. Recently, the utilization of pedicle screws has gained much popularity. Pedicle screws are generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit their application in the thoracic spine, resulting in a hybrid construct involving pedicle screws and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis are often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in patients with SMA scoliosis. Methods We retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2017. The radiographic assessments included deformity correction and progressive changes in the major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of construct. Results Thirty-three patients were included in this study. There were 14 and 19 patients in the wiring and hybrid construct groups, respectively. The hybrid construct group demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p p p p = 0.002). Conclusion This study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation as well as less major curve progression than sublaminar wire instrumentation alone in patients with SMA scoliosis. Level of evidence III

Hybrid constructs represent substantial progress in tissue engineering (TE) towards producing implants of a clinically relevant size that recapitulate the structure and multicellular complexity of the native tissue. They are created by interlacing printed scaffolds, sacrificial materials, and cell-laden hydrogels. A suitable biomaterial is a polycaprolactone (PCL); however, due to the higher viscosity of this biopolymer, three-dimensional (3D) printing of PCL is slow, so reducing PCL print times remains a challenge. We investigated parameters, such as nozzle shape and size, carriage speed, and print temperature, to find a tradeoff that speeds up the creation of hybrid constructs of controlled porosity. We performed experiments with conical, cylindrical, and cylindrical shortened nozzles and numerical simulations to infer a more comprehensive understanding of PCL flow rate. We found that conical nozzles are advised as they exhibited the highest shear rate, which increased the flow rate. When working at a low carriage speed, conical nozzles of a small diameter tended to form-flatten filaments and became highly inefficient. However, raising the carriage speed revealed shortcomings because passing specific values created filaments with a heterogeneous diameter. Small nozzles produced scaffolds with thin strands but at long building times. Using large nozzles and a high carriage speed is recommended. Overall, we demonstrated that hybrid constructs with a clinically relevant size could be much more feasible to print when reaching a tradeoff between temperature, nozzle diameter, and speed, This research was funded by FPI-CAR-2014, granted by the Government of La Rioja (Spain) and research funding Nos. 266486, 273689, and 273689 (FINSKIN) by the Academy of Finland (Finland). “Instituto de Estudios Riojanos” (Spain) also funded parts of this research.

Background In patients with Marfan syndrome (MFS), surgical correction of spinal deformities with hooks and/or pedicle screws involves a higher rate of complications than in patients with adolescent idiopathic scoliosis. Therefore, sublaminar instrumentation is often a last resort option. This study wants to assess the ability of sublaminar fixation to achieve three-dimensional scoliosis correction and spine stabilization compared with hook and/or pedicle screw systems. Methods Twenty-one MFS patients who underwent posterior spinal fusion at a highly specialized medical center in 1995-2017 were divided into two different groups retrospectively evaluated at a minimum follow-up of 2 years. Group 1 (8 patients) was composed by hooks and screws instrumentation, while Group 2 (13 patients) was composed by hook or pedicle screw system associated to sublaminar wires/bands. Radiological (correction and long-term stability) and general endpoints (mean blood loss, surgery time, and complications) were compared between the groups. Results The degree of correction compared with the preoperative status was satisfactory with both approaches, although the difference between them was not significant. No significant differences were found for general endpoints between groups. Conclusion Our data suggest that scoliosis correction with sublaminar fixation is not inferior to treatment with hooks and/or pedicle screws. Level of evidence III.

Poly(L-lactic acid), PLLA, a synthetic biodegradable polyester, is widely accepted in tissue engineering. Hyaluronic acid (HA), a natural polymer, exhibits an excellent biocompatibility, influences cell signaling, proliferation, and differentiation. In this study, HA crosslinking was performed by immersion of the polysaccharide in water-acetone mixtures containing glutaraldehyde (GA). The objective of this work is to produce PLLA scaffolds with the pores coated with HA, that could be beneficial for bone tissue engineering applications. PLLA tridimensional scaffolds were prepared by compression molding followed by salt leaching. After the scaffolds impregnation with soluble HA solutions of distinct concentration, a GA-crosslinking reaction followed by inactivation of the unreacted GA with glycine was carried out. An increase on surface roughness is shown by scanning electron microscopy (SEM) with the addition of HA. Toluidine blue staining indicates the present of stable crosslinked HA. An estimation of the HA original weight in the hybrid scaffolds was performed using thermal gravimetric analyses. FTIR-ATR and XPS confirmed the crosslinking reaction. Preliminary in vitro cell culture studies were carried out using a mouse lung fibroblast cell line (L929). SEM micrographs of L929 showed that cells adhered well, spread actively throughout all scaffolds, and grew favorably. A MTS test indicated that cells were viable when cultured onto the surface of all scaffolds, suggesting that the introduction of crosslinked HA did not increase the cytotoxicity of the hybrid scaffolds., Contract grant sponsor: Portuguese Foundation for Science and Technology (FCT) through POCTIContract grant sponsor: FEDER programs including project ProteoLight; contract grant number: PTDC/FIS/68517/2006Contract grant sponsor: European Union funded STREP Project HIPPOCRATES; contract grant number: NMP3-CT-2003-505758Contract grant sponsor: European NoE EXPERTISSUES; contract grant number: NMP3-CT-2004-500283Contract grant sponsor: Spanish Ministry of Science (The FEDER financial support); contract grant number: MAT2007-66759-C03-01The authors acknowledge the funding for research in the field of Regenerative Medicine through the collaboration agreement from the Conselleria de Sanidad (Generalitat Valenciana) and the Instituto de Salud Carlos III (Ministry of Science and Innovation). The European Union Financing, as part of the SOCRA-TES/Erasmus program is also gratefully acknowledged.