Crankshaft Phenomenon refers to the loss of three-dimensional correction of the scoliotic curve which occurs after the back spine fusion is done to children who have not completely reached the skeletal maturity. Patients with infantile and juvenile idiopathic scoliosis are at the highest risk; however, this phenomenon also occurs in adolescents who are immature at the time of surgery. The aim of this study was to determine the relationship between the age of operated patients and the possible postoperative progression of scoliotic incurvation (The Crankshaft’s Phenomenon) after surgical correction of adolescent idiopathic scoliosis. The retrospective-prospective study was performed among 48 patients with adolescent idiopathic scoliosis, randomised selected, with both sexes included. All analyzed patients underwent a surgical correction of scoliosis through rear access, using the Isola's or the SSE (Spine System Evolution) implants. Correlation between presurgical and postsurgical values (at the end of the physiological growth) ​​of spine scoliosis part Cobb's Angle is investigated. The increase of the scoliotic part curvature (an average of 16.22%) in patients operated in the period of the intensive growth of the spine can be expected due to the ratio of the measured quantities of Cobb 's Angle, and the postoperative control examination in this group showed highly positive statistical correlation with r = 0.97 correlation factor . The less increase of the curvature of the spine (an average of 7.52 %) can be expected in patients operated in the period of stagnating growth of the spine and the relationship between measured values ​​of Cobb 's Angle and the postoperative control examination in this group showed a highly positive statistical correlation (correlation factor r = 0.98) as well. Individual size of the postoperative spinal curvature do not condition the size of the possible progression of the curvature.

Aim To establish presence of segmental instability in patients operated with standard discectomy comparing measurement of translation and rotation on postoperative functional radiographs of lumbosacral spine with reference values,and to explore difference between patients operated on one or two levels. Methods The study included 71 patients, who were operated due to herniated lumbar disc. They were divided into two groups operated on one level (group A) or two adjacent levels (group B). All patients had been imaged in a standing position with functional lateral radiography. Radiographic images were digitized and then computerized measurement of translation and rotation was made. Measurement data were compared between the groups and with reference values obtained in healthy adults. Results Standard lumbar discectomy leads to an increase in translation, however, it reached statistical significance only for L4/L5 level and a decrease of rotation, which showed statistical significance for all samples, relative to the reference values. There was no statistically significant difference in the values of translation and rotation between the groups for corresponding levels, except for the value of the rotation for L4/L5 level as adjacent, unoperated level. Comparison of translation and rotation between the operated and adjacent levels did not show a statistically significant difference. When it comes to comparing the measured and predicted translation, there was a statistically significant difference only at the L5/S1 as anunoperated level. Conclusion Standard discectomy does not lead to radiologically significant segmental instability, and two-level surgery has not caused more pronounced signs of instability comparing to onelevel surgery.

Introduction Crankshaft phenomenon is determined as a loss of three-dimensional correction of the scoliosis curve, which occurs after posterior fusion in children who have not completely finished skeletal growth. Dubousset named this phenomenon when he noticed that the entire spine and torso gradually turn and deform anterior spine, which continues to grow and rake around the axis of the fusion mass. This is mostly seen in infantile and juvenile idiopathic scoliosis, however this also occur in adolescents who are immature at the time of the last fusion. Aim To analyze this phenomenon in adolescents who have not finished skeletal growth and were operated for idiopathic scoliosis. Material and Methods This retrospective–prospective study analyzed 48 randomly selected adolescents operated for idiopathic scoliosis in Clinic for Orthopaedic and Traumatology in Tuzla between 1996 and 2011. Patients operated only with a posterior stabilization and fusion were divided into two groups. One group consisted of adolescents with intensive growth (12 years for girls and 14 years for boys) and another group consisted of adolescents at final stage of skeletal growth (14 years for girls and 16 years for boys). We measured Cobb angle at standard X-rays performed in an upright posture immediately after the surgery and at the latest X-rays done at the end of skeletal growth at the age of 18 years. Results Increasing Cobb angle was noted in 53% of studied patients. In group A higher values of Cobb angle noted in 69.56% examinees and in 36% in group B. When we analyzed both groups Cobb angle increased from preoperative 19.6 degrees to postoperative 22 degrees (2.4 degrees—12.2%) (r = 0.98), In group A preoperative Cobb angle increased from preoperative 20.6% degrees to postoperative 24 degrees (3.4 degrees—16.22%) (r = 0.97), while in group B from 18.60 to 20 degrees (1.4 degrees—7.52%) (r = 0.98). Conclusion Postoperative deformity progression of anterior column in adolescents operated for idiopathic scoliosis could be seen even if the stable fusion achieved. The risk for progression is higher in younger patients.

Abstract OBJECTIVE: Anomalies of vertebrobasilar vessels arise as early embryonal developmental deteriorations. The majority of them concern the position, origin and shape of the basilar artery. Therefore the present study was carried out to find out the variations in position and shape of the basilar artery using Magnetic Resonance Imaging and CT Angiography. MATHERIAL AND METHODS: The study included 130 consecutive patients, adults of both sexes, treated in UKC Tuzla. Patients were divided into two groups. In one group (100) were patients without aneurysm in the vertebrobasilar tree, and in the second group (30) patients with aneurysm. RESULTS: Three types of variations in the shape of basilar artery were recorded: those with arched course, S-shaped course, and the straight course type. All the three types are approximately of the same percentage prevalence in the group of subjects without aneurysm in the vertebral-basilar tree, as well as in the group with aneurysm. Basilar artery at 89.33% of respondents was located in medial or in paramedial position. CONCLUSION: Attention is drawn to the practical importance of such variations as a possible source of diagnostic errors during cerebral arteriography. We highlight the morphological aspects of the basilar artery, the knowledge of which would help neurosurgeons safely diagnose, as well as plan and execute vascular bypass and shunting procedures for the treatment of stenosis, aneurysms and arteriovenous malformations.

ABSTRACT Introduction: The morphological anatomy of the posterior circulation is very complex and variable. Aims of this research were to document the morphological anatomy of the posterior circulation along with variations in the Bosnian population, in patients with or without aneurysm. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery were taken. The second aim was to determine the possible relationship between diameters of the area with subsequent aneurysm formation. Material and Methods: The study involved 60 consecutive patients, adults of both sexes, treated in the UKC Tuzla.The patients were divided into two groups. One group consisted of the patients without aneurysm of basilar artery, and the other group of patients with aneurysm. All the 60 patients were treated by means of MRI angiography. Results: The mean diameter of the vertebral artery was 2,43 mm; 3.61 mm on the right and 2,83 mm; 3,94 mm on the left. The diameter of the basilar artery varied from 3, 8 mm; 3, 43 mm. The diameter of the posterior cerebral arteries 2, 5 mm; 2,52 mm on the right and 2,46 mm; 2,62 mm on the left. Conclusions: We have documented the various morphometry variations as well as the differences of the anatomy in this area in Bosnian population as compared to the medicine literature.

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

UNLABELLED Anatomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. THE AIM of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). MATERIAL AND METHODS The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. RESULTS AND DISCUSSION Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form ofv. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. CONCLUSION The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.