Actually conservative treatment and/or minimal invasive surgical approach is considered the gold standard in the treatment of CF all around the world.

Two main italian pediatric hospitals (Bambino Gesù in Rome and Meyer in Florence) will present own series in order to realize how the two methods (Ponseti in Rome and Seringe in Florence) can be used, the right indications for each method and sharp limits as well.

The aim of this study is to compare two methods for evaluating their effectiveness and their applicability.

Neurological scoliosis differs from idiopathic type for some peculiar features that negatively affect operative time and blood loss during surgical treatment. To reduce the rate of complications in neurological scoliosis, an hybrid construct based on combined lumbar pedicle screws and Universal Clamps (UC) at thoracic levels can be used. The aim of our study was to assess the validity of the hybrid construct in neurological scoliosis treatment respect to technical success (deformity correction), operative time and blood loss, in a prospective series of patients with preoperative Cobb angle > 100°. Between 2002 and 2008 we treated 15 patients (3 M, 12 F) affected by neurological scoliosis with preoperative Cobb angle > 100° (107±4°) by hybrid construct. The mean age was 14 years (range 10–17). The etiology was cerebral palsy in 12 cases, Friedreich’s ataxia in 2 cases and Aicardi Syndrome in one case. All patients were treated by posterior access to stabilize each affected level, combining screws (Socore TM), UC and hooks in an hybrid construct. In 3 patients a secondary posterior access was achieved in order to strengthen the UC effect, adding a concave costotomy. Skull traction by sling and pelvic countertraction to control obliquity were used in all cases. Pelvic instrumentation provided iliosacral screw fixation according to Dubousset or iliac fixation in accordance with Sponseller. Two concave rods and one convex were used in all assembly. The average percentage of correction was 70% (32±7°). Mean operative time was 4 hours with mean blood loss of 1800 ml. We used a mean of 6 transpedicular screws (range 4–11), 7 UC (5–9) and 5 hooks (4–6) in our assembly. Mean follow-up time was 36 months (range 12–84), with an average loss of correction of 7°. The hybrid construct (lumbar transpedicular screws, thoracic Universal Clamps, pedicle-transverse hooks at the upper end of the curve) appears safe and effective in treatment of neurological scoliosis > 100°. This assembly provides a good correction of the deformity and reduces operative time, radiation exposure and blood loss respect to all-screws constructs. Sublaminar acrylic loops (Universal Clamp) have the same stress resistance in comparison with steel or titanium alloy sublaminar wires. Moreover, the simplicity of implant and tensioning of the strips is associated with the possibility of re-tensioning and progressive correction, providing a better capacity of managing the kyphotic component in case of thoracic lordosis. Among neurological scoliosis treatments, the hybrid construct can be considered a valid option due to the advantages of shortening the operative time and diminishing the risks of vascular and neurological complications.

Aims. Gene therapy research in the field of orthopaedics and traumatology have evolved during the last decade, leading to possible applications for the treatment of pathological conditions, such as bone fractures and cartilage defects. In particular, several gene transfer techniques have been employed so far for inducing bone formation in animal models of bone defects. Cell-based approaches, using in vitro and ex vivo genetically modified cells to be implanted in the animal, produced promising results as they enable the production of physiologic doses of an osteoinductive gene product into selected anatomical sites. In this study we used autologous skin fibroblasts, which are very simple to harvest and propagate in culture, transduced ex vivo with the new osteo-genic factor Lim Mineralization Factor-3 (Ad-LMP-3). These engineered cells produced successful bone healing when implanted by the use of a scaffold in rats, validating the in vivo osteoinductive properties of hLMP-3.

Methods. Primary dermal fibroblasts cultures were established using a 1cm² biopsy of shaved skin obtained from the abdomen of each rat after anesthesia. Semi-confluent primary fibroblasts were infected with either AdBMP-2 or AdhLMP-3 or both, using a overall multiplicity of infection (MOI) of 100 viral particles per cell. Cells transduced with Ad-eGFP at the same MOI were used as a viral infection control, while untreated cells served as a negative control. The transduced cells were harvested 24 hours after viral infection, resuspended in sterile PBS, let adsorbed on a Hydroxyapatite/Collagen scaffold and then implanted in a bone defect surgically performed in the mandible of immunocompetent rats. The animals were divided in 4 groups: 9 rats were treated with cells infected with AdLMP-3, 9 rats with cells infected with AdBMP-2 (positive controls), 9 rats with cells transduced with Ad-eGFP and 9 rats with untreated cells (controls). 3 Rats from each group were sacrified at 1, 2 and 3 months after the treatment and studied by x-rays, Micro-CT and histology (Von kossa and Alizarin staining).

Results. All the animals treated with LMP-3 showed healing of the bone defect after 3 months, as confirmed his-tologically and radiographically. On the contrary none of the controls showed bone formation at latest time point.

Conclusions. Recently, Lim Mineralization Proteins (LMP), coded by three different splice variants (LMP-1, LMP-2, LMP-3) of the same gene, have been identified as regulators of the osteoblast differentiation program. We have previously demonstrated that human LMP-3 (hLMP-3) contributes actively to bone formation, acting at least in part, through the BMP-2 signaling pathway, being capable of inducing differentiation of cells of mes-enchymal derivation towards the osteoblastic lineage, through the up-regulation of bone-specific genes, along with ectopic bone formation in vivo and mineralization in vitro. In this study we have analyzed the efficacy of an ex-vivo approach using autologous dermal fibroblasts infected with AdLMP-3. Engineered cells produced bone healing when implanted by the use of a scaffold in a rodent model, validating the in vivo osteoinductive properties of hLMP-3.

Aims: As inflammation plays a key role in the etiology of intervertebral disc degeneration, we suggest a possible contribution of pro-inflammatory gene polymorphisms in the pathogenesis of adolescent idiopathic scoliosis (AIS). The nucleus pulposus of scoliotic discs responds to exogenous stimuli by secreting interleukin-6 (IL-6) and other inflammatory cytokines. The association between matrix metalloproteinases (MMPs) and disc degeneration has been reported by several investigators. A human MMP-3 promoter 5A/6A gene polymorphism regulates MMP-3 genes expression, while the G/C polymorphism of the promoter region of IL-6 gene influences levels and functional activity of the IL-6 protein.

Methods: We conducted a case-control study to investigate whether the 5A/6A polymorphism of the MMP-3 gene and the G/C polymorphism of the promoter region of IL-6 gene were associated with susceptibility to AIS.

Results: The frequency of the 5A/5A genotype of MMP-3 gene polymorphism in patients with scoliosis was almost 3 times higher than in controls (30.2 % vs 11.2 %, p 0.001) and the frequency of the G/G genotype of IL-6 gene polymorphism in patients with scoliosis was almost 2 times higher than in controls (52.8 % vs 26.2 %, p < 0.001). 5A/5A genotype of MMP-3 gene polymorphism and G/G genotype of IL-6 gene polymorphism are independently associated with an higher risk of scoliosis (odds ratio respectively 3.34 and 10.54).

Conclusions: This is the first study that has evaluated the possibility that gene variants of IL-6 and MMPs might be associated with scoliosis and suggests that MMP-3 and IL-6 promoter polymorphisms constitute important factors for the genetic predisposition to scoliosis.