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Study design Scoliotic and herniated human intervertebral disc tissue obtained intraoperatively was cultured, and the medium was analyzed for the production of monocyte chemoattractant protein-1 and interleukin-8. Objectives This study was conducted to determine whether the human intervertebral disc is capable of spontaneous production of the chemokines monocyte chemoattractant protein-1 and interleukin-8. Summary of background data Lumbar disc herniations undergo spontaneous regression with time. This is believed to occur via macrophage-mediated phagocytosis of herniated disc material. Monocyte chemoattractant protein-1, a chemotactic agent for macrophages, has recently been identified in rat intervertebral disc tissue. Methods Disc material obtained from patients undergoing surgery for scoliosis and sciatica was cultured using a serumless technique, and the medium was subsequently analyzed for levels of monocyte chemoattractant protein-1 and interleukin-8. Results Monocyte chemoattractant protein-1 and IL-8 were detected in both control and herniated disc specimens. Noncontained herniations produced higher levels of chemokines than those with an intact anulus. Conclusions Human intervertebral disc tissue is capable of spontaneously producing the proinflammatory chemokines monocyte chemoattractant protein-1 and interleukin-8. These are chemotactic for macrophages and capillaries and may explain the ingrowth of granulation tissue seen in spontaneous disc herniation resorption.

A 13-year-old adolescent presented for correction of an 85-degree idiopathic thoracic scoliosis. She was known to have Prader-Willi syndrome. Previous general anaesthesia for non-spinal surgery had been uneventful. On two occasions following uneventful induction and total intravenous anaesthesia (TIVA) maintenance, she developed severe recalcitrant bradycardia with hypotension that was resistant to anticholinergics, inotropes and vasopressors upon prone positioning. Immediate resolution occurred upon a return to the supine position. On each occasion, she emerged from anaesthesia with no untoward sequelae. Cardiac investigations, including echocardiography, electrocardiography (ECG), troponin and creatine kinase-MB fraction levels were all within the normal range, and ventricular function was good. It was necessary to urgently proceed with the surgery as the scoliosis was progressive, with risks of cardiovascular and respiratory compromise. Additionally, she was scheduled to recommence growth hormone therapy postoperatively to treat her growth retardation. Ultimately, she received propofol for induction of anaesthesia and TIVA with propofol and remifentanil infusions for the maintenance of anaesthesia. Post-induction, a transvenous pacing wire was placed under ECG guidance. A transoesphageal probe was inserted and cardiac function monitored throughout the procedure. Upon prone positioning, she again developed a bradycardia which responded to pacing and surgery was carried out uneventfully. Clinical examination and extensive investigations had failed to demonstrate any specific underlying cause for her repeated positional arrhythmia. Therefore, we deduced that the bradycardia was due to a hypervagal response provoked by prone positioning and because of the severity of the scoliosis. We are unaware of reports of such a complication in the literature.Keywords: anaesthesia, cardiovascular, scoliosis, bradycardia, pacing

Pelvic osteotomy has a small role to play in the management of Legg-Calvé-Perthes disease. Residual acetabular dysplasia or incongruity can be corrected by rotational acetabuloplasty. In skeletally immature patients this can be performed by complete or incomplete innominate osteotomies. We present the case of a 12-year-old child with residual acetabular dysplasia, resulting from Legg-Calvé-Perthes disease, which was treated by a triple pelvic osteotomy performed by a small single anterolateral incision.

The primary aims were to develop a simplified three-dimensional model of the thoracolumbar spine and to predict the influence of axial rotation at different levels of the spine on the resultant scoliotic curve, using King's classification as a comparator.A three-dimensional mathematical model of the simplified thoracolumbar spine (constant size vertebral body without posterior elements) was developed using anatomical data from the published literature. The influence of rotational displacement of the motion segments at various levels of the spine was studied by applying different axial rotations, using a three-dimensional homogeneous transformation matrix method.The result of the model show the correlation of the deformity in lower regions of the spine (lumbar) with the geometrical changes in upper regions of the spine (thoracic), associated with the continuous alteration in direction of the vertebral axis of rotation along the spine. The final curvature of the scoliotic spine is influenced by both the degree of axial rotation in each region and the spatial deformation of the spine (e.g. kyphotic shape and extent of lateral deformity). Qualitatively, the model is capable of producing different categories of the spinal deformity based on King's classification.A three-dimensional analysis of spinal shape demonstrates the important relationship between induced vertebral rotation and the resulting deformity. The effect of rotational displacement on the overall configuration of thoracolumbar spine during juvenile growth was assessed and demonstrates close correlation with deformities of the lower regions of spine.

Dedicated skate parks have led to an increase in pediatric fractures referred to the authors' unit. The authors performed a prospective analysis of all patients presenting to their unit with fractures sustained while Rollerblading or skateboarding over a 5-month period. Epidemiologic data, user experience, wearing of protective gear, place of injury, and mechanism of injury were collected. Fracture type and its treatment were also recorded. The findings indicated that the use of skate parks is associated with a significant increase in the severity of fracture. This was not related to mean length of experience, age, or sex. The use of skate parks had an increased relative risk of 8.35 for fractures requiring manipulation or invasive orthopedic treatment. Only 5% of children were wearing some form of limb/joint protective gear. The authors believe there should be closer supervision and training of children and more emphasis on limb protective gear. The current high incidence of significant skate park injuries will otherwise continue, with implications for the well-being of these children and the burden on the healthcare system.