Introduction and Aims: Traditional treatment for adolescent hyperkyphosis, including Scheuermann’s disease, has included apical anterior spine release/fusion (ASF) prior to posterior instrumented fusion. We wished to reassess the need for ASF when using a posterior column shortening technique with a threaded rod compression instrumentation system. Method: PSF-only group: 17 patients, mean age 15.7 years (range 12.8–18.5), underwent posterior column shortening by chevron-shaped lamina resection and fusion using hybrid hook/screw, dual 4.8mm threaded compression rod instrumentation (TRI). A/PSF group: seven patients, mean age 15.4 years (14–16.8), underwent open or endoscopic ASF followed by posterior TRI. Fourteen of 24 patients had strict Sorensen criteria of Scheuermann’s. At mean follow-up of 30 months (range 24–56), patients were assessed for amount and maintenance of correction, sagittal balance, and evidence of pseudoarthrosis. Results: Mean pre-operative measured kyphosis in PSF-only was 79.6 degrees (range 67–90), and was corrected to 38.2 degrees (22–55) post-operative, and 37.1 degrees (22–50, 53%) at final follow-up. In the A/PSF group, pre-operative kyphosis was 79.0 degrees (62–93), corrected to 41.6 degrees (34–48) post-operative, and was 42.6 degrees (25–48, 46%) at final follow-up. There was no difference in the amount of correction (p=.28) or its maintenance between the two groups. Similarly, there were no differences between groups in assessing pre-operative and final T2-12 kyphosis (p=.13), T12-S1 lordosis (p=.98), or C7 sagittal balance (p=.10). The mean T10-L2 sagittal alignment was improved in the PSF-only patients (final kyphosis 7.8°) vs. 18.9° in the A/PSF patients (p=.04). There was a greater correction of Voutsinas’ index (PSF-only=.08, A/PSF=.15, p=.01) for the posterior-only group. No patient lost > eight degrees correction (range 12–8) between immediate post-operative and final follow-up, and no instrumentation complications occurred. Conclusion: Using posterior column shortening and larger diameter (4.8mm) threaded rods with hooks cephalad to the apex and screws caudal, we have found no advantage in correction from preliminary anterior apical release, nor a difference in maintenance of correction. ASF is unnecessary when adolescent hyperkyphosis/Scheuermann’s is treated by this technique

Scheuermann's kyphosis is a structural deformity of the thoracic or thoracolumbar spine, which can result in severe pain, neurological compromise and cosmetic dissatisfaction. Modern surgical techniques have improved correction through a posterior-only or antero-posterior approach but can result in significant morbidity. We present our results of the surgical management of severe Scheuermann's kyphosis by a single surgeon with respect to deformity correction, global balance parameters, functional outcomes and complications at latest follow-up. We included 49 patients, of which 46 had thoracic and 3 had thoracolumbar kyphosis. Surgical indications included persistent back pain, progressive deformity, neurological compromise and poor self-image. Fourty-seven patients underwent posterior-only and 2 antero-posterior spinal arthrodesis utilising Chevron-type osteotomies and hybrid instrumentation. Mean age at surgery was 16.0 years with mean postoperative follow-up of 4.5 years. Mean kyphosis corrected from 92.1o to 46.9o (p<0.001). Concomitant scoliosis was eliminated in all of the 28 affected patients. Coronal and sagittal balance was corrected in all patients. Mean blood loss was 24% total blood volume. Mean operation time was 4.3 hours with mean inpatient stay of 9 days. SRS-22 questionnaire improved from a mean preoperative score of 3.4 to 4.6 at 2 years, with high treatment satisfaction rates. Complications included one toxic septicaemia episode but otherwise no wound infections, no junctional deformity, no loss of correction and no requirement for re-operation. Posterior spinal arthrodesis with the use of hybrid instrumentation can safely achieve excellent correction of severe Scheuermann's kyphosis helping to relieve back pain, improve functional outcomes and enhance self-image

Purpose of the study. To investigate the efficacy of pedicle screw instrumentation in correcting spinal deformity in patients with quadriplegic cerebral palsy. Also to assess quality of life and functional improvement after deformity correction as perceived by the parents of our patients. Summary of Background Data. All pedicle screw constructs have been commonly used to correct adolescent idiopathic scoliosis. There is limited information on their effectiveness in treating patients with cerebral palsy and neuromuscular scoliosis. Methods. We reviewed the medical records and serial radiographs of 45 consecutive patients with quadriplegia who underwent spinal arthrodesis using pedicle screw/rod instrumentation and a standardised surgical technique (prospectively collected single surgeon's series). All patients were wheelchair bound with collapsing thoracolumbar scoliosis and pelvic obliquity. Twenty-eight patients had associated sagittal deformities. A telephone survey was performed by an independent investigator to assess parents' perception on surgical outcome. Results. Thirty-eight patients underwent posterior-only and 7 staged anteroposterior spinal arthrodesis. Mean age at surgery was 13.4 years (range 9-18.3) and mean postoperative follow-up 3.5 years (range 2.8-5). Pedicle screw instrumentation extended from T2/T3 to L5 with bilateral pelvic fixation using iliac bolts. Scoliosis was corrected from mean 82.5° to 21.4° (74.1%). Pelvic obliquity was corrected from mean 24° to 4° (83.3%). In posterior-only procedures, average blood loss was 0.8 blood volumes, ICU stay 3.5 days, and hospital stay 17.6 days. In anteroposterior procedures, average blood loss was 0.9 blood volumes, ICU stay 8.9 days, and hospital stay 27.4 days. Major complications included one deep infection and one re-operation to remove prominent implants but no deaths, no neurological deficit and no detected pseudarthrosis. Parents' survey demonstrated 100% satisfaction rate. Conclusion. Pedicle screw instrumentation can achieve excellent correction of spinopelvic deformity in quadriplegic cerebral palsy with low complication and re-operation rates and high parent satisfaction. Our study has demonstrated that spinal correction using segmental pedicle screw/rod constructs can be performed safely and with lesser major complications and reoperations compared to the traditionally used Unit rod or hybrid instrumentation. The greater degree of deformity correction and lesser rate of complications and reoperations due to non-union, prominent instrumentation or failed pelvic fixation using a pedicle screw compared to the Unit rod technique should be balanced against the increased implant cost

Introduction:. Circumferential arthrodesis of the spine may be achieved by posterior-only or anterior and posterior surgery. Posterior-based interbody fusions have significant limitations including unreliable improvement of segmental lordosis and variable rates of post-operative radiculopathy. Combined anterior and posterior surgery introduces significant cost and peri-operative morbidity. The purpose of this paper is to report the radiographic and clinical outcomes of posterior-based circumferential arthrodesis using a novel expandable interbody cage. Methods:. A prospective pilot clinical trial with one year follow-up of the only expandable cage approved by the FDA for interbody application. Clinical outcomes measured include ODI and VAS for back and leg. Radiographic outcomes include arthrodesis rates based upon CT scan. Statistical significance for change in health status was calculated using Student's t-test. Results:. 10 consecutive patients (11 levels) with lumbar degenerative pathology underwent circumferential arthrodesis with a transforaminal interbody approach. 10 of 11 levels were fused based upon CT scan. ODI scores improved a median of 37 to 20 at 6 months and 17 at one year (p = 0.0003). The VAS for back and leg pain likewise from 6 to 2 at 12 months (p = −.003). No patient reported an increase in leg pain from pre-op to post-op. One patient with a 2-level fusion had a non-union at 1 level requiring revision surgery. Conclusion:. Circumferential arthrodesis with a TLIF approach is an important technique for the management of lumbar degenerative pathology. The experience with a novel expandable TLIF cage demonstrates excellent results based upon clinical outcome and fusion rates. The expandable interbody cage allows in-situ height increase which is useful for optimizing clinical and radiographic outcomes in TLIF surgery

Purpose. To report the results of full vertebral column resection (VCR) for paediatric spinal deformity. Methods and Results. All VCR (n=47) for paediatric spinal deformity were retrospectively evaluated from four university hospitals performing these procedures in Finland between 2005 and 2010. After excluding single hemivertebra (n=25) and resections performed for patients with MMC (n=6), 16 patients with full VCR (mean age at surgery 12.9 yrs [6.5-17.9] AIS 1; NMS 3; Congenital scoliosis 3 primary, revision 4; Kyphosis congenital 2, global 2; NF1 scoliosis 1) were identified. Seven procedures were performed anteroposteriorly and nine posterior-only. Mean follow-up time 1.9 (0.6–5.5) years. Major Curve (MC) averaged preoperatively 85 (58–120) degrees, 31 (14-53) degrees at 6 months, and 37 (17-80) degrees at 2-year follow-up. MC correction averaged 61 (46-86)% in the AP and 64 (57-83)% in the PL group at 6 months and 54 (18-86)% and 60 (41-70)% at 2-yr FU, respectively (NS). Blood loss averaged 3400 (500-8200) mL (NS between groups). The mean SRS-24 total scores were 100 (92-108) for AP and 102 (95-105) for PL group. There was one paraparesis in the AP group necessitating urgent re-decompression with full recovery. One peripheral L5 motor deficit resolved fully within few days (PL). Two junctional kyphosis were observed (one in both group). One one-sided partial lower instrumentation pull-out was observed without need for revision. One pseudoarthrosis occurred in AP group needing revision. Conclusions. Full VCR is rarely needed for paediatric spinal deformity with an estimated incidence of 2.9/million/year. Posterior VCR allows better control of neural elements during 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.

The February 2014 Spine Roundup³⁶⁰ looks at: single posterior approach for severe kyphosis; risk factors for recurrent disc herniation; dysphagia and cervical disc replacement or fusion; hang on to your topical antibiotics; cost-effective lumbar disc replacement; anxiolytics no role to play in acute lumbar back pain; and surgery best for lumbar disc herniation.