Study design: A retrospective evaluation of screw position after double rod anterior spinal fusion in idiopathic scoliosis using computerised tomography (CT). Objective: To evaluate screw position and complications related to screw position after double rod anterior instrumentation in idiopathic scoliosis. Summary of Background Data: Anterior instrumentation and fusion in idiopathic scoliosis is gaining widespread use. However, no studies have been published regarding the accuracy of screw placement and screw related complications in double rod and double screw anterior spinal fusion and instrumentation in idiopathic thoracolumbar scoliosis surgery. Methods: CT examinations were performed after anterior spinal fusion and instrumentation in 17 patients with idiopathic scoliosis. The vertebral rotation at each level was measured. At each instrumented level the position of the screw and the plate relative to the spinal canal, relative to the neural foramen and relative to the aorta was measured. Complications related to screw position were registered. Results: 189 screws in 17 patients were evaluated. The average age of the patients was 31 years (range 15–53 years). Fourteen patients had a left convex thoracolumbar curve and three patients a right convex thoracolumbar curve. The mean lumbar apical rotation preoperatively was 27°. Malposition occurred in 23% of the total number of screws. Three screws were in the spinal canal (1%). This resulted in pain in the right leg. However, electromyography showed no abnormalities. On three levels there was contact between the instrumentation and the aorta. No vascular complications did occur. 113 screws (ten patients) were placed under fluoroscopic guidance and 76 screws (seven patients) were placed without use of fluoroscopy. No complications related to screw position were observed in the group in which the screws were placed under fluoroscopic guidance. Conclusions: Adequate placement of two screws in the vertebra in idiopathic scoliosis is a technically demanding procedure, which results in frequent malposition, fortunately with a low risk of neurological and vascular complications

Introduction. Scoliosis surgery is a life-changing procedure, but not devoid of perioperative complications. Often patients' scoring systems do not cover their real-life needs, including return to pre-surgery activity. Return to school, physical education (PE) is an important indirect marker of recovery. Although anterior spinal fusion (ASF) may have advantages, compared to posterior spinal fusion (PSF), because of motion-saved segments, there is a paucity of literature about post-operative return to school/PE in the compared groups. Aim. To determine the recovery time for patients with scoliosis who underwent anterior spinal fusion (ASF) and posterior spinal fusion (PSF). Design. Prospective cohort. Methods. Patients undergoing Adolescent Idiopathic Scoliosis (AIS) surgery from 2018–2019, were examined. We excluded no-AIS and over 18y patients. The Scoliosis Sports Survey validated questionnaire was administered post-operatively regarding return to school, PE and other physical activities. ASF and PSF groups were subcategorised into: Selective Anterior Thoracic Fusion (SATF), Thoracolumbar Fusion (TLF), Short Posterior Spinal Fusion (SPSF) and Long Posterior Spinal Fusion (LPSF) procedures. Hospital length of stay (HLOS) and ICU LOS were recorded. Results. A total of 81 patients were contacted and 43 responded to the survey. The different procedures, return to school / PE, HLOS / ICU LOS, costoplasty are all analysed as shown below in Table 1. Conclusions. Anterior and posterior fusions had similar return to school rates at 1–3 months. The TLF and 2-stages groups returned to school the quickest, whilst the SATF had the longest return time. PSF patients returned to PE faster than ASF. Costoplasty, did not affect return time to school and PE. Further research assessing shorter fusions benefits should be conducted. For any figures or tables, please contact the authors directly

Introduction. Thoracic wall surgery can cause severe pain and inhibition of coughing with effects. (1) Various local anaesthetic (LA) techniques have been tried successfully to mitigate the use of opioids alone. We believe this is the first time that a serratus plane block using an epidural catheter (SABER)has been studied in anterior spinal fusion (ASF) procedures. Our aim was to ascertain how it would affect ASF compared to gold standard posterior spinal fusion (PSF) surgery. Materials and Methods. We identified 43 patients from the years 2017 to 2019. 24 had ASF and 19 had PSF. Detailed data were collected on local anaesthetic infusion (LAI) SaBER, mean pain scores(MPS), morphine, chirocaine usage and hospital length of stay (HLOS). We divided the patients into 4 groups: Short PSF (SPSF), Long PSF (LPSF), Thoracic anterior fusion (TA) and Thoracolumbar anterior fusion (TLA) surgery. 4 patients in the SPSF and 4 in the LPSF group had LAI because they had a costoplasty. All patients in the anterior group had SaBER. Results. Mean morphine usage was higher in the ASF group. Mean LA usage was lowest in the TLA and highest in the LPSF group (see table). 12 and 24 hour MPS were lower in both anterior groups compared to posterior. Mean HLOS was similar in all groups. Conclusion. Despite painful costoplasties in the anterior group, LAI enabled lower MPS overall and similar HLOS between PSF and ASF groups. Consequently, ASF (with fewer fusion levels) can replace equivalent PSF with resultant less stiffness and increased mobility. Reduction in MPS may be further improved by investigating detailed protocols whereby boluses of LA are given in addition to LAI. This may lead to morphine sparing in the anterior group as has been seen in other studies on thoracic wall procedures. (2). For any figures or tables, please contact the authors directly

Thirteen consecutive patients with scoliosis, treated with anterior spinal fusion with a single rigid rod, were followed up clinically and radiographically for 19 months. The mean major curve, 52° preoperatively, improved to 10° at follow-up. The results of anterior single-rod spinal fusion in patients with idiopathic scoliosis are excellent. No development of kyphosis or incidence of hardware failure was seen

Introduction: The use of adjunctive techniques such as electrical stimulation may improve the rate of successful anterior lumbar interbody fusion. The purpose of this study was to determine if supplemental direct current electrical stimulation of a titanium anterior spinal fusion device increases the incidence and extent of bony fusion in a nonhuman primate model. Methods: Anterior lumbar interbody fusion was performed at the L5–L6 level in 35 adult pigtail macaque monkeys with iliac crest graft and either a titanium fusion device or a femoral allograft ring. The fusion devices of some animals received either high current (100μA) or low current (28μA) electrical stimulation using an implanted generator for the duration of the 12- or 26- week evaluation period. All animals were studied using AP and lateral radiographs, CT imaging, nondestructive mechanical testing, and qualitative and quantitative histology. Specimens were scored for presence of fusion according to a semi-quantitative scale (0 = No healing, 1 = Minimal consolidation, 2 = Consolidation, 3 = Bridging callus, 4 = Bridging callus with trabeculations, 5= Evidence of bony remodeling of callus). A similar scale was used to score the extent of fusion. Results: As shown in Table 1, both low and high current stimulation groups had generally increased incidence of bony fusion compared to the non-stimulated and femoral allograft ring groups. At 26 weeks, the extent of bony fusion increased with the devices from 43% to 75% in a dose-dependent fashion, compared to 25% with the femoral rings. Mechanical testing also demonstrated similar increases in mechanical stiffness in a dose-dependent fashion. Discussion: Adjunctive electrical stimulation of an anterior titanium spinal fusion device improved success rate and overall fusion quality compared to non-stimulated devices and femoral allograft rings. Stimulated devices may be particularly beneficial in patients with known risk factors for nonunion

INTRODUCTION: The use of adjunctive techniques such as electrical stimulation may improve the rate of successful anterior lumbar interbody fusion. The purpose of this study was to determine if supplemental direct current electrical stimulation of a titanium anterior spinal fusion device increases the incidence and extent of bony fusion in a nonhuman primate model. METHODS: Anterior lumbar interbody fusion was level in 35 adult pigtail macaque performed at the L. 5. –L. 6. monkeys with iliac crest graft and either a titanium fusion device or a femoral allograft ring. The fusion devices of some animals received either high current (100 μA) or low current (28 μA) electrical stimulation using an implanted generator for the duration of the 12- or 26-week evaluation period. All animals were studied using AP and lateral radiographs, CT imaging, nondestructive mechanical testing, and qualitative and quantitative histology. Specimens were scored for presence of fusion according to a semi-quantitative scale (0 = No healing, 1 = Minimal consolidation, 2 = Consolidation, 3 = Bridging callus, 4 = Bridging callus with trabeculations, 5= Evidence of bony remodeling of callus). A similar scale was used to score the extent of fusion. RESULTS: As shown in Table 1, both low and high current stimulation groups had generally increased incidence of bony fusion compared to the non-stimulated and femoral allograft ring groups. At 26 weeks, the extent of bony fusion increased with the devices from 43% to 75% in a dose-dependent fashion, compared to 25% with the femoral rings. Mechanical testing also demonstrated similar increases in mechanical stiffness in a dose-dependent fashion. DISCUSSION: Adjunctive electrical stimulation of an anterior titanium spinal fusion device improved success rate and overall fusion quality compared to non-stimulated devices and femoral allograft rings. Stimulated devices may be particularly beneficial in patients with known risk factors for nonunion

Introduction: Compared with open instrumented anterior spinal fusion for adolescent idiopathic scoliosis (AIS), endoscopic surgery offers clinical benefits that include reduced pulmonary morbidity and improved cosmesis. However, quantitative data on the radiological improvement of vertebral rotation using this method is limited. The aim of this study was to measure pre-operative and postoperative axial vertebral rotational deformity at the curve apex in endoscopic anterior instrumented scoliosis surgery patients using computed tomography (CT), and assess the relevance of these findings to clinically measured chest wall rib hump deformity correction. Methods: Between November 2002 and August 2005, twenty patients with right-sided thoracic curves underwent endoscopic single-rod anterior instrumented fusion. Pre and post surgical axial vertebral rotation was measured at the curve apex on preoperative and two-year postoperative CT using Aaro and Dahlborn’s method. Rib hump deformity correction was retrieved from a surgical database and correlated to the CT findings. Linear regression was used to investigate the correlation between apical vertebral rotation measured on CT and rib hump measured using a scoliometer. Results: The mean angle of correction achieved in axial vertebral body derotation at the apical vertebra as measured by CT was 7.9°. This equated to a 43% improvement (range 20–90%). The preoperative and postoperative clinical measurements i.e. rib hump deformity correction, correlated significantly with CT measurements using regression analysis (p=0.03) and the mean improvement in rib hump deformity was 55%. Conclusion: To our knowledge, this is the first quantitative CT study to confirm that endoscopic anterior instrumented fusion for AIS substantially improves the axial vertebral body rotational deformity at the apex of the curve. The margin of correction of 43% compares favourably historically published figures for all-hook-rod constructs in posterior spinal fusion. In addition, the CT measurements obtained significantly correlated to the clinical outcome of rib hump deformity correction

Study Aims: This study’s objectives were to measure pre-operative and postoperative axial vertebral rotational deformity at the curve apex in endoscopically-treated anterior-instrumented scoliosis patients using CT, and assess the relevance of these findings to clinically measured chest wall rib hump deformity correction. Introduction: Thoracoscopic instrumented anterior spinal fusion for adolescent idiopathic scoliosis (AIS) has clinical benefits that include reduced pulmonary morbidity, postoperative pain, and improved cosmesis. However, quantitative data on radiological improvement of vertebral rotation using this method is lacking. Methods: Between November 2002 and August 2005, 20 AIS patients with right-sided thoracic major curves underwent endoscopic single-rod anterior fusion. Preoperative and two-year postoperative CT was performed to assess axial vertebral rotation at the curve apex. Correlation between apical vertebral rotation measured on CT and rib hump measured using a scoliometer was assessed. Results: The mean angle of correction achieved in axial vertebral body derotation at the apical vertebra measured by CT was 7.9° and equated to 43% improvement. Preoperative and postoperative rib hump deformity correction correlated significantly with CT measurements using regression analysis (p=0.03). The mean improvement in rib hump deformity was 55%. Conclusion: We believe this is the first quantitative CT study to confirm that endoscopic anterior instrumented fusion for AIS substantially improves axial vertebral body rotational deformity at the apex of the curve. The margin of correction of 43% compares favourably with historically published figures of 24% for patients with posterior all-hook-rod constructs. CT measurements correlated significantly to the clinical outcome of rib hump deformity correction. Ethics: local committee approval. Statement of Interest: none

Purpose of the study: Data are scarce on the long-term outcome after anterior spinal fusion for idiopathic scoliosis in adolescents. The purpose of this study was to assess the clinical and radiological results obtained in a monocentric series using a single-phase fusion with pre-formed plates for the treatment of lumbar, thoracolum-bar and thoracic idiopathic scoliosis in adolescents. Material and method: This procedure was performed in 111 patients from 1975 to 1993. Complete clinical and radiological evaluations were available for 35 patients, 7 male and 28 female. The SRS-30 questionnaire (translated into French by the authors) and the Oswestry score were used to assess functional outcome. Radiographic data were collected by an independent observer who read the pre-, post- and last follow-up images. Full spine images were available to assess correction of the curvature, frontal and sagittal balance, pelvic parameters, and degenerative changes in the subjacent discs. Functional outcome was assessed in relation to the radiographic findings. Results: Mean follow-up was 22 years (range 16–31). Mean age at surgery was 14.5 years. At last follow-up, none of the patients were unemployed because of a spinal problem and 21 women had had one or more successful pregnancies. The mean SRS-30 score was 3.8/5 and correlated with the Oswestry score (13.8%). One patient underwent revision for disc herniation and one for posterolateral lumbosacral fusion because of persistent frontal imbalance. There as a fracture of the proximal screw in six patients with no sign of nonunion. At last follow-up, the mean Cobb angle was 14 (0–42). Frontal imbalance was noted in 18 patients, mean 12 mm. In the sagittal plane, three patients presented anterior imbalance. The pelvic parameters were within the range of the general population. Signs of L5-S1 disc degeneration were noted in ten patients, with no correlation with functional outcome. Conclusion: Anterior fusion gives good long-term functional results in the treatment of idiopathic scoliosis in adolescents. Patients can pursue a normal occupational and familial life. This technique has provided satisfactory correction in the frontal and sagittal planes

Purpose: Posterior spinal fusion (PSF), with or without anterior spinal fusion (ASF), in conjunction with Luque rod instrumentation (LRI) and Galveston technique is a common procedure in neuromuscular spinal deformity. However, few studies have specifically studied the long-term results and complications of Galveston technique. The purpose of this study was to analyze the long-term results of Galveston technique in combination with PSF, with or without ASF, and LRI in the correction of neuromuscular spinal deformity. We were specifically interested in the stability of the distal foundation, lumbosacral fusion, correction of the associated pelvic obliquity, and complications. Method: Analyzing our Pediatric Orthopaedic Spine Database between 1992–2006, we identified 107 consecutive patients with a neuromuscular spinal deformity who underwent a PSF, with or without ASF, and LRI including Galveston technique, who had a minimum of 2 years postoperative follow-up. There were 55 females and 52 males with a mean age at surgery of 13.5 ± 3.5 years. The mean follow-up was 7.8 ± 3.7 years. We analyzed the coronal and sagittal plane alignment and pelvic obliquity preoperatively, postoperatively, and at last follow-up. We recorded any complications directly related to the Galveston technique. Results: The mean preoperative major curve was 76 ± 21 degrees. At last postoperative follow-up, this measured 33 ± 16 degrees. The mean preoperative pelvic obliquity was 17 ± 10 degrees and at last follow-up 7 ± 6 degrees. Seven patients (6.5%) had Galveston technique complications: three rod breakages, three implant distal migrations and one patient with both rod breakage and distal migration. These occurred late and only one patient required revision surgery. Conclusion: The Galveston technique is an excellent procedure for lumbosacral stabilization in patients with neuromuscular spinal deformity. It provides a solid distal foundation for a lumbosacral fusion and for correction of spinal deformity and pelvic obliquity, with minimal complications

Summary of Background Data. Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) is associated with spinal manipulation in the surgical or conservative management of scoliosis. Purpose of the study. The aim of the present study was to investigate the prevalence of SMA syndrome in a cohort of 165 consecutive pediatric patients who underwent spine deformity surgery and had minimum 2-year follow-up. Material-Methods. The study group comprised 85 patients with idiopathic scoliosis, 20 patients with neuromuscular and 18 patients with miscellaneous or syndromic scoliosis, and 42 patients with congenital spinal deformities. Posterior spinal arthrodesis was performed in 94 patients, combined anterior/posterior in 60 patients, and anterior spinal fusion in 11 patients. Results. We identified 4 patients who developed SMA syndrome postoperatively. These were all markedly underweight, adolescent females; 2 patients had adolescent idiopathic scoliosis, one had neuromuscular, and one congenital scoliosis. Third generation instrumentation systems with derotational effect were used in 3 patients. The spinal arthrodesis in the patient with neuromuscular scoliosis was performed using bone graft followed by application of a spinal jacket. The symptoms developed at a mean of 3.7 days post-surgery and included nausea, vomiting, increased nasogastric aspirates, abdominal pain and distension. Conservative management with prolonged nasojejunal feedings achieved resolution of the symptoms in all but one patient, who required derotation of the duodenum and jejunum. There was no evidence of recurrence of the condition in any patient at the latest follow-up. Conclusions. The prevalence of SMA syndrome in our series was 2.4%. This draws attention to the significance of prevention of the condition by recognizing patients who are at a higher risk. An early diagnosis of the syndrome will allow for application of conservative methods and will increase the chances for a successful outcome

Many devices have been developed to enhance fusion and alignment of the spine in anterior spinal fusions. The Ulrich ‘Ivory’ interbody cage was introduced in 2000, and this report examines the results of the first 50 patients in whom it was used. The mean age of the 21 men and 29 women was 50.8 (24 to 74). A total of 82 cages were inserted. In 39 patients the indications for surgery were failed posterior fusions. One patient, who had undergone three previous surgical procedures, had post-laminectomy syndrome. Primary anteroposterior fusion for spondylolisthesis was performed in six patients. The remaining four had surgery for other reasons, including sagittal malalignment and failed Dynesys fixation. Evaluated radiologically, the fusion mass was good. Complications included one vascular injury, which required repair of the iliac artery. One patient developed pancreatitis and deep vein thrombosis. The posterior surface of S1 fractured in one patient. From six weeks to one year postoperatively, we saw five broken cages, three associated with grade II spondylolisthesis and two that had broken after trauma. Since then, the lateral supports of the cages have been strengthened. The cage is easy to insert, either laterally or anteriorly. The large contact surface makes for good bony ingrowth and no stress shielding. It is a useful alternative to other cages on the market, but should not be used as a ‘stand alone’ device

In a prospective non-randomised study, 28 patients underwent laparoscopic assisted transperitoneal anterior interbody fusion at the lumbosacral junction with the BAK cage over a 3-year period. In laparoscopic group, there were significantly lower blood losses (P< 0. 005), operating times [P< 0. 05], analgesic requirements [P< 0. 05] and postoperative rehabilitation [P< 0. 05). 8 patients developed post-operative nerve root pain, 5 of which settled with nerve root blocks, and there was 1 case of donor site infection. Intraoperative complications included 1 CIA tear, 2 CIV tears and 3 open conversions [11%]. 6 cases [24%] required further surgery at a mean of 14 months [range 4–29 months]. 20 laparoscopic cases completed a subjective self-assessment score with 4 [20%] excellent results, 5 [25%] good, 2 [10%] fair, 8 [40%] same and 1 [5%] worse. The preoperative Visual Analogue Pain Score [VAPS] and Oswestry Disability Index [ODI] were set at 100 for the purposes of analysing the results [n=number in brackets]:. Results show an improvement in the overall pain and disability. However, at two years patients still continued with some 65% of symptoms. Laparoscopic assisted anterior spinal fusion with the BAK device is safe and reliable with advantages that include reduced operating time, blood loss, post-operative analgesia requirements and hospitalisation. However, the clinical outcome does not appear to give superior results to other implants and we question whether it use as a stand-alone device is sufficient and would recommend posterior stabilisation to confer improved mechanical stability

Purpose: Determine the prevalence of complications in neuromuscular scoliosis surgery and to identify risk factors. We hypothesized that patients with smaller pre-operative curve magnitudes would have lower complication rates. Method: Our Pediatric Orthopaedic Spine Database identified a cohort of 151 consecutive patients with neu-romuscular scoliosis who underwent corrective surgery between 1992 and 2005 and had a minimum of 2 years of follow-up. Twenty-two patients (15%) were excluded; 20 patients with a diagnosis of myelodysplasia and two due to death during the follow-up period. Preoperative, operative, and postoperative factors were analyzed for any association with major complications and length of stay (LOS) utilizing stepwise logistic and multiple regression. Only factors with p-values < 0.05 remained in the analysis models. Odds ratios were calculated for significant dichotomous variables and receiver operator characteristic (ROC) curves were created for significant continuous variables. Results: There were 79 male and 50 female patients with a mean age at surgery of 13.4 years (range, 6 to 21 years). Eighty-seven patients (68%) underwent posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI). and 42 patients (32%) underwent anterior spinal fusion (ASF) and PSF with SSI. Mean follow-up was 46.4 months (range, 24 to 251 months). There were 45 major complications in 37 patients (29% prevalence). Non-ambulatory status (p < 0.05) and a high preoperative Cobb angle (p < 0.01) were associated with an increasing prevalence of major complications. Non-ambulatory patients were almost four times more likely to have a major complication (OR of 3.8, p < 0.05) in comparison to ambulatory patients. A pre-operative Cobb angle ≥ 60 degrees (p < 0.01) was the most accurate predictor for an increased risk for major complication. Patients undergoing PSF with SSI only or combined ASF and PSF with SSI on the same day who sustained one major (p < 0.05) or two minor (p < 0.01) complications had a significantly increased LOS. Conclusion: The prevalence of complications following surgery for neuromuscular scoliosis is high. Non-ambulatory status and higher preoperative Cobb curve magnitude are directly associated with an increased risk for major complication and indirectly associated with increased LOS

Introduction: Hurler syndrome (mucopolysaccharidosis type I) is an autosomal recessive disorder with characteristic progressive musculoskeletal manifestations termed dysostosis multiplex. These include dorsolumbar kyphosis with gibbus deformity, deficient femoral head ossification and acetabular dysplasia, valgus deformity of the knee, broad hands prone to carpal tunnel syndrome, pes planus and generalised joint contracture. Untreated, death occurs early in childhood. Therapeutic bone marrow transplantation (BMT) has improved life expectancy and now patients attain skeletal maturity. BMT, however, appears to have little influence on skeletal outcome, and optimum orthopaedic management is as yet uncertain. Methods: Nineteen patients treated by BMT at a mean of 10 months (range 3–19 months), have been followed over a mean of 93 months (range 3–196 months). Five patients are now adolescent. We describe the clinical and radiological features of these patients and detail orthopaedic procedures and their outcome. Descriptive statistical analysis is used, displaying mean values and standard deviation where appropriate. Results: All patients demonstrate characteristic acetabular dysplasia and failure of ossification of the superolateral femoral head. Nine have undergone bilateral pelvic and femoral derotation osteotomies at a mean of 48 months (range 24–105 months); mean acetabular angle preoperatively was 33 ± 3.8°. Five patients had pelvic osteotomy only. IN the remaining five patients, mean acetabular angle is 25 ± 3.3°. Genu Valgum of variable severity due to failure of ossification of the lateral aspect of the proximal tibial metaphysis is observed early. Four patients underwent medial epiphyseal stapling at a mean of 105 months. While most patients demonstrate thoracolumbar vertebral anomalies peculiar to Hurler syndrome, only five had had progressive scoliosis, two having had anterior spinal fusion at 37 and 72 months. Most patients experience symptoms of carpal tunnel syndrome from about 48 months. Only one patient has significant difficulty mobilising independently. Conclusions: Our findings reflect the variability of musculoskeletal problems seen in Hurler syndrome. This cohort represents one of the largest available for study, and ongoing review will clarify the natural outcome of the disease and help determine if and when orthopaedic intervention is appropriate

The lumbar spine consists of a mobile segment of 5 vertebrae, which are located between the relatively immobile segments of the thoracic and sacral segments. The bodies are wider and have shorter and heavier pedicles, and the transverse processes project somewhat more laterally and ventrally than other spinal segments. The laminae are shorter vertically than are the bodies and are bridged by strong ligaments. The spinous processes are broader and stronger than are those in the thoracic and cervical spine. Internal fixation as an adjunct to spinal fusion has become increasingly popular in recent years. Stainless steel or titanium plates or rods are longitudinally anchored to the spine by hooks or pedicle screws. Powerful forces can be applied to the spine through these implants to correct deformity. Implants provide immediate rigid spinal immobilization, which allows for early patient mobilization, and provides a more optimal environment for bone graft incorporation. Numerous clinical and experimental studies demonstrate higher fusion rates in patients with rigid internal fixation than in controls without instrumentation. Although various implants are available, pedicle fixation systems are the most commonly used implant type in the lumbosacral spine. The large size of the lumbar pedicles minimizes the number of instrumented motion segments required to achieve adequate stabilization. Many authors have reported loss of postoperative deformity correction after transpedicular screw fixation, ranging from 2.5 degrees to 7.1 degrees. The general preference is to stabilize the fractured vertebra by fusing one level above and one level below. With this technique, the rate of loss of correction is high. At our institution, we routinely stabilize the unstable thoracolumbar fractures by fusing one level above and one level below. In addition, we put screws into the pedicle(s) of fractured vertebrae. The reason for this is the following:. To correct the deformed body of the fractured vertebra for better load sharing. To make use of the pedicles of the fractured vertebra for superior rotatory stabilization. To avoid the need for the inclusion of additional levels, thereby preserving motion segments. To avoid the need for possible anterior spinal fusion and instrumentation. To obtain a better correction of a kyphotic deformity. Plain radiographs were analysed post operatively and compared for reduction of the fracture fragments and correction of kyphotic deformity to pre-operative films. 74 Patients were admitted with thoracolumbar spine fractures to our hospital. 48 Patients were surgically treated, and 34 patients were available for follow up. We found that inserting the pedicle screws into the fractured vertebra provided good stabilization for very unstable fractures. No loss of correction was seen in the follow up x-rays. We conclude that including the fractured vertebra into the fracture fixation device not only provides better fracture reduction, but also gives improved rotatory stability

Introduction: Historically, anterior spinal surgery for scoliosis has led to better coronal correction, though at the expense of sagittal alignment specifically at the thoracolumbar junction. The purpose of the study was to ascertain the effectiveness in maintenance of coronal and sagittal balance of anterior spinal surgery and instrumentation for AIS. Methods: 17 patients with idiopathic scoliosis treated with anterior spinal fusion using a single rod AO USS construct were reviewed in a retrospective fashion. Inclusion in study group required a minimum two years follow-up with complete radiographic and clinical follow up. Results: There were 14 lumbar curves of which seven were King I and seven thoracolumbar / lumbar curves. Seven patients had supplemental structural anterior support in the lumbar spine. Four had femoral allograft rings and three had cages (2 Harms, 1 Synex cages). Three thoracic curves were operated on of which two were King III, and one King II. The mean pre-operative Cobb angle was corrected from 48° to 14° post-op and 16° on the last follow-up (24 to 53 months) representing 71% of correction. Apical vertebral translation was corrected to 70%, comparable to the 60% correction of trunk shift at last follow-up. Sagittal contour of instrumented segment for the thoracic curve did not change. The pre-operative sagittal contour across the instrumented levels for the 14 1umbar was 5.6° of lordosis which changed to 0.5° of lordosis post-operatively. At last follow-up it was 2° of kyphosis. Specifically there were 7 of 14 that had greater that 10° of surgically induced kyphosis across the fusion mass. At last follow-up three patients had further kyphosis across the instrumented levels. The overall sagittal vertical axis did not change irrespective of the focal sagittal alignment. There was a net increase in lumbar lordosis below the fusion mass. Three patients had asymptomatic pseudoarthroses. There was no failure of instrumentation and no patient required further surgery. Conclusion: The authors conclude that single rod anterior spinal instrumentation for AIS is effective in maintaining coronal and sagittal alignment though one needs to pay particular attention to sagittal contour. The increase in lumbar lordosis below the fusion may well explain the maintained sagittal balance

Introduction: Open instrumented anterior spinal fusion for adolescent idiopathic scoliosis (AIS) is a proven technique for vertebral derotation that, compared with posterior spinal fusion procedures, invariably requires fewer distal fusion levels to be performed. With the advent and evolution of endoscopic anterior instrumentation, further clinical benefits are possible such as reduced pulmonary morbidity, improved cosmesis and less postoperative pain. However, quantitative data on the radiological improvement of vertebral rotation using this method is limited. The aim of this study was to measure preoperative and postoperative axial vertebral rotational deformity at the apex of the curve in endoscopic anterior instrumented scoliosis surgery patients using computed tomography (CT), and assess the relevance of these findings to clinically measured chest wall rib hump deformity correction. Methods: Between November 2002 and August 2005, adolescent idiopathic scoliosis patients with right-sided thoracic major curves were selected for endoscopic single-rod anterior fusion by the senior authors. Low-dose pre-operative CT was performed as described previously (1) and two-year postoperative CT was also performed on consenting patients in accordance with local ethical committee approval. The pre and post surgical axial vertebral rotation was measured at the curve apex using Aaro and Dahlborn’s method (2). Intraobserver and interobserver variability was assessed. Additional clinical information such as rib hump deformity correction and change in the Cobb angle was retrieved from a surgical database and correlated to the CT findings. Least squares linear regression was used to investigate the correlation between apical vertebral rotation measured on CT and rib hump measured using a scoliometer. Results: Twenty patients were included in the study. The mean angle of correction achieved in axial vertebral body derotation at the apical vertebra measured by CT was 7.9° (median preoperative angle 17.3° [range 12.5° to 27.3°] and median postoperative angle 10.3° [range 1.8° to 18.1°]. This equated to a 43% improvement (range 20–90%). The preoperative and postoperative clinical measurements i.e. rib hump deformity correction, correlated significantly with CT measurements using regression analysis (p=0.03) and the mean improvement in rib hump deformity was 55% (median preoperative 15.0° [range 10° to 30°] and median postoperative 7.0° [range 4° to 10°]). 95% confidence intervals for intraobserver and interobserver validity were within the ranges ±4.5° to ±6.4°. Discussion: We believe this is the first quantitative CT study to confirm that endoscopic anterior instrumented fusion for AIS substantially improves the axial vertebral body rotational deformity at the apex of the curve. The margin of correction of 43% compares more favourably than the historically published figure of 24% in a cohort of patients with all-hook-rod constructs used for posterior spinal fusion (3). Patient age and gender demographics, curve magnitude and curve types in the historical study were similar to our group, and an identical CT protocol for measuring vertebral derotation was utilised. In addition, the CT measurements obtained significantly correlated to the clinical outcome of rib hump deformity correction

Aims

Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal deformity surgery in a National Health Service.

Study Design: Retrospective study with clinical and radiological evaluation of 15 patients with congenital kyphosis or kyphoscoliosis who underwent anterior instrumented spinal fusion for posterolateral or posterior hemivertebae (HV). Objective: To evaluate the safety and efficacy of early surgical anterior instrumented fusion with partial preservation of the HV in the treatment of progressive congenital kyphosis in children below the age of 3. We discuss the management of patients presenting with neurological compromise. Summary of background data: A variety of treatments have been described in the literature for the treatment of congenital kyphosis due to HV. We report the results of our technique. Materials and Methods: Between 1997 and 2005 we have treated 15 consecutive patients with progressive congenital kyphosis with anterior instrumented fusion and strut grafting. 13 patients had a single posterolateral HV and 2 patients a single posterior HV. Of the 15 patients in the study, 5 were girls and 10 boys. Mean age at surgery was 22 months (range 8–33). Mean follow-up period was 6.8 years. 13 HV were located in the thoracolumbar junction (T10-L2) and 2 in the thoracic spine. Results: The average operating time was procedure was 150 minutes (range, 130 to 210 minutes). The average blood loss 180 mL (range, 100 to 330 mL), equivalent to a mean external blood volume loss of 15% (range, 11 to 24%). Preoperative segmental Cobb angle averaging 34 º at last follow up. Compensatory coronal cranial and caudal curves corrected by 50%. The angle of segmental kyphosis averaged 39º (range, 20º to 80º) before surgery and 21 º (range, 11º to 40º) at last follow up. This represents a 43% of improvement of the segmental kyphosis, and a 64% of improvement of the segmental scoliosis at last followup. One case with initial kyphosis of 80 º continued to progress and required revision anterior and posterior surgery. There were no neurologic complications. Key points:. In progressive congenital kyphoisis, early diagnosis and aggressive surgical treatment are mandatory for a successful result. Early treatment minimizes the risks of surgery. Anatomical and physiological pitfalls in the treatment of congenital kyphosis are discussed. Anterior instrumented fusion of congenital kyphosis provides sagital and coronal correction in very young children with low risk of complications