Scoliosis occurs in about 0.2–0.6% of the general population. In the majority of cases the cause of this entity remains mostly unidentified. The search for the causes covers almost all aspects of its possible origin. We collected and systematised the contemporary theories and concepts concerning the aetiology of adolescent idiopathic scoliosis. Genetic and hereditary factors are commonly accepted as possible causes; however, the identification of the single gene responsible for the development of this condition seems impossible, which suggests multifactorial mechanism of its formation. Dysfunctions of the nervous system are recognised risks related to the development of scoliosis, but they are classified as belonging to a separate aetiological category. Scoliosis develops at the quickest rate during the child’s growth spurt, which prompted the research on the role of the growth hormone in scoliosis aetiology. Melatonin is another hormone that is studied as a possible factor involved in development of this entity. In cases of progressive scoliosis, increased activity of calmodulin—a protein that regulates the levels of calcium ions—has been observed. The scientists have characterised numerous qualitative and quantitative changes in the composition of the tissue of intervertebral discs, spinal ligaments and paraspinal muscles. Some of the theories, explaining the nature of this entity, presented in this review seem to have only a purely theoretical value; their proliferation only confirms the fact that the actual nature of this condition has not been unveiled yet, and suggests its multifactorial aetiology.

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Rationale:In the recent years, growing interest is focused on the use of platelet-rich plasma (PRP) in wound healing and tissue regeneration. There are a number of papers regarding the usefulness of PRP in the healing of ulcerations, skin injures, bone loss or distraction osteogenesis. Most authors emphasize the safety of PRP usage due to its authogenic nature.Patient concerns:We present a case of a 14 -year-old boy admitted to our department due to simple bone cyst of the distal tibia, qualified for injection of PRP into the cyst. PRP was separated with the use of Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems Hopkington, MA) according to the manufacturers’ manual. Immediately after separation during short-term IV anaesthesia, 3 mL of PRP was installed to the bone cyst under image intensifier control.Diagnoses:Within the first 24 hours after exposure to PRP, the skin rash appeared. Physical examination revealed the small red papular, regionally purpuric eruptions, mainly concentrated on the upper extremities and on more warmed regions of skin, in association with pharyngitis, tonsillar enlargement, mucopurulent discharge in the posterior pharynx and swelling of the eyelids.Interventions:As the patient received calcium citrate with the PRP injection additional calcium citrate test were performed. Skin prick testing (negative) was and an intradermal test was positive (10×13 mm). Treatment included Claritine (Loratidinum) and Clemastin (Clemastinum)—both antihistaminic drugs.Outcomes:All symptoms withdrew and the patient was released home after 4 days. The patient is in 6 years follow-up without any symptoms of allergic disease.Lessons:Our case shows that safety of use of PRP is not absolutely sure. The pure autologous tissue is safe, but preparation for its use can substantially decrease this safety. In our patient, only limited skin reaction to calcium citrate was observed, but general reaction leading to anaphylactic shock cannot be excluded. In order to reduce the risk of side effects skin test should be performed but as there were no records of allergic diseases on family and patients medical history this should apply to all patients.

BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

STRESZCZEnIEWstep. Sko lio zy wcze sno dzie cię ce z to wa rzy szą cy mi de for ma cja mi klat ki pier sio wej są wy jąt ko wo trud nym pro blemem lecz ni czym. Wcze sne le cze nie ope ra cyj ne jest za zwy czaj je dy nym ra cjo nal nym roz wią za niem. Wy ko rzy stu je się tech ni ki umo żli wia ją ce ta ką ko rek cję krę go słu pa i klat ki pier sio wej, któ ra za pew nił by ich dal szy wzrost. Jed nym ze sposo bów na pra wy jest za sto so wa nie sys te mu VEPTR (pio no we roz su wal ne że bro ty ta no we) za pro jek to wa ne go do dy na micznej sta bi li za cji klat ki pier sio wej i krę go słu pa. Ce lem na szej pra cy jest przed sta wie nie trud no ści i kom pli ka cji pod czas lecze nia ope ra cyj ne go de for ma cji krę go słu pa i klat ki pier sio wej u naj młod szych dzie ci z wy ko rzy sta niem sys te mu VEPTR.Ma te riał i me to dy. W Kli ni ce Or to pe dii Dzie cię cej UM w Lu bli nie eta po we le cze nie ope ra cyj ne z uży ciem sys te mu VEPTR za sto so wa li śmy u 12 dzie ci w wie ku od 3 do 9 lat (śred nio 5,25). Tro je dzie ci wy ma ga ło le cze nia tą me to dą z powo du wie lo miej sco wych wad wro dzo nych krę go słu pa, czwo ro z po wo du wcze śnie pro gre su ją cej sko lio zy ner wo wo -mię -śnio wej i pię cio ro z po wo du gar bu ki fo ty cze go w na stęp stwie prze pu kli ny opo no wo -rdze nio wej. Licz ba za bie gów ope racyj nych u jed ne go dziec ka wy no si ła od 4 do 10. Czas ob ser wa cji od 10 mie się cy do 4 lat (śred nio 2,5 ro ku). Za ob ser wowa ne nie po wo dze nia i po wi kła nia to: wy ła ma nie że bra (czte ro krot nie), per fo ra cja ta le rza ko ści bio dro wej przez hak miednicz ny (pię cio krot nie), od ma opłuc no wa (dwu krot nie), po now ny zrost że ber (dwu krot nie), zła ma nie im plan tu (dwu krotnie), de sta bi li za cja sta wu bio dro we go (1 raz), re ak cja tka nek na me tal (4 ra zy), zła ma nie in stru men ta rium (dwu krot nie).Wy ni ki i Wnio ski. Spe cy fi ka me to dy po wo du je, że przy jej sto so wa niu na le ży li czyć się z ró żny mi trud no ścia mi i powi kła nia mi mo gą cy mi nie kie dy wpły nąć na osta tecz ny wy nik le cze nia. Wła sne do świad cze nia, jak i da ne z pi śmien nic twa do wo dzą sku tecz no ści kli nicz nej sys te mu VEPTR. Pod kre ślić jed nak trze ba, że me to da le cze nia z uży ciem te go sys te mu jest roz wią za niem je dy nie cza so wym, któ re nie mo że na ru szać stra te gicz nych ele men tów ana to micz nych krę go słu pa wyko rzy sty wa nych póź niej w kla sycz nych roz wią za niach ope ra cyj nych. Zna jo mość ogra ni czeń me to dy i mo żli wo ści po jawie nia się trud no ści w le cze niu, po zwa la nam na za sto so wa nie pew nych mo dy fi ka cji, któ re spra wia ją, że spo sób ten jest na dal sku tecz nym roz wią za niem w eta po wym le cze niu de for ma cji klat ki pier sio wej i krę go słu pa u naj młod szych dzie ci.