Aims

High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.

Summary of background data. The development of a spinal deformity, usually affecting the coronal and occasionally the sagittal balance of the spine is a recognised complication of paralysis following a spinal cord injury (SCI) occurring in childhood.

Purpose of the study. The aim of the present study was to report our experience on the surgical treatment of patients who developed a paralytic spinal deformity secondary to SCIs occurring in childhood.

Material-Methods. Our study cohort comprised 18 consecutive patients with a paralytic spinal deformity as a consequence of a SCI. The cause of paralysis in this group of patients included a traumatic incident in 10 patients, spinal cord tumour in 6 patients, vascular injury to the neural cord during cardiac surgery in one patient, and meningitis in one patient. Twelve patients presented with high- or mid-thoracic paraparesis, which was complete in all but two patients. Six patients developed tetraparesis, which was incomplete in 3 of these patients.

Results. Fourteen patients underwent surgical correction of their spinal deformities; 11 patients had a scoliosis, 2 had a lordoscoliosis, and one had a kyphosis. The mean age at spinal arthrodesis was 13.4 years. Eleven patients underwent a posterior spinal fusion alone and 3 patients underwent a combined anterior and posterior spinal arthrodesis. Posterior spinal instrumentation with bilateral Luque rods and segmental fixation with sublaminar wires was used in all but one patient who was stabilised with the use of third generation spinal instrumentation. The spinal fusion extended to the sacrum in 10 of the 14 patients (71.4%) using the Galveston technique of intra-iliac pelvic fixation.

None of the patients developed postoperative wound infections, either early or late. There were no major medical complications following surgery in this group of patients that would result in prolonged intensive care unit or hospital stay. Four of the 14 patients (28.6%) who had initially undergone a posterior spinal arthrodesis alone developed an asymptomatic pseudarthrosis with failure of the instrumentation. The non-union was treated successfully in 2 of these 4 patients with a combined anterior and posterior spinal fusion. The repair of the pseudarthrosis was performed through a repeat posterior spinal fusion in the remaining 2 patients and one of these patients necessitated a second revision procedure to address recurrence of the non-union.

Conclusions. The high rate of pseudarthrosis (28.6%) recorded in the present series suggests that a combined anterior and posterior spinal arthrodesis could be considered as the initial treatment of choice for patients who are at a good general medical condition to tolerate anterior surgery and who have severe deformities. If pseudarthrosis develops following an isolated posterior spinal fusion, this can be treated more effectively by a combined anterior and posterior revision procedure with the use of instrumentation, which can increase the chances for a successful outcome.

Summary of Background Data: The craniofacial malformations described by Goldenhar can be associated with congenital anomalies of the vertebrae. This non-random association of abnormalities represents unilateral errors in the morphogenesis of the spine, as well as the first and second branchial arches.

Purpose of the study: The aim of the present study was to determine the prevalence of Goldenhar related conditions in patients with congenital deformities of the spine and to describe the types of vertebral abnormalities and the necessity for treatment.

Material-Methods: We performed a retrospective study of 668 consecutive patients with congenital deformities of the spine. The medical records and spinal radiographs were reviewed and patients with a Goldenhar associated condition were identified. The vertebral anomalies causing the spine deformity were detected on antero-posterior and lateral spine radiographs. The type and site of the craniofacial abnormalities, as well as other musculoskeletal deformities and systemic anomalies were recorded.

Results: Fourteen patients had Goldenhar associated conditions (7 males and 7 females). A thoracic scoliosis was the most common type of deformity occurring in ten patients (71.5%). Eight of these patients had an isolated hemivertebra and the remaining two had a unilateral unsegmented bar with contralateral hemivertebra at the same level. There was only one patient with a lumbar scoliosis and this was due to a hemivertebra. The side of the vertebral anomaly correlated with that of the hemifacial microsomia in five of the eleven patients who had a scoliosis or kyphoscoliosis. A thoracolumbar kyphosis occurred in four patients; two had posterior hemivertebrae, one had wedge vertebrae, and the remaining patient had an anterior unsegmented bar. A thoracolum-bar kyphoscoliosis occurred in only one patient and was due to a posterolateral quadrant vertebra. Klippel-Feil syndrome occurred in six patients (42.8%).

Eight patients (57%) underwent surgical treatment at a mean age of 9.8 years (range: 2.9–19). Four patients had a combined anterior-posterior spine arthrodesis. The remaining four patients had a posterior spinal arthrodesis.

Conclusions. The prevalence of Goldenhar associated conditions in patients with congenital deformities of the spine was 2%. Failures of vertebral segmentation were the most frequent abnormality in the cervical spine, whereas failures of vertebral formation most commonly occurred in the thoracic or thoracolumbar spine.

Objective: Surgical correction of late-onset idiopathic scoliosis (AIS) has been shown to be effective in obtaining correction in the frontal and sagittal planes, but is of questionable benefit in reducing the rib hump in the transverse plane The purpose of this study was to assess the effects of double rod and pedicle screw (AO USS) instrumentation on transverse plane asymmetry (on the convex and concave side of the scoliosis) in a single thoracic curve type (King III).

Design: A consecutive, prospectively studied cohort treated by a single surgeon with either a single-stage or two-stage procedure.

Subjects: Sixty-five patients with a King III adolescent idiopathic scoliosis were studied. There were 53 females and 12 males whose mean age at surgery was 14.5 years (range 11.1 to 17.9). A single-stage posterior fusion with instrumentation was performed in 46 patients whose mean Cobb angle at surgery was 56° (range 35 to 84). A two-stage procedure with thoracotomy and anterior spine release by multiple disc excisions (mean 6 levels) combined with internal costoplasty (mean 6 ribs), followed one week later by posterior spinal fusion with instrumentation, was performed in 15 patients whose mean Cobb angle was 78° (range 40 to 92).

Outcome measures: All patients were assessed both radiographically and by Integrated Shape Imaging System (ISIS) surface topography pre-operatively, postoperatively (mean of 14 weeks) and at follow-up visits for a mean 2.7 years (range 1.5–6.1).

Results: There were no non-unions or instrument failures in either group.

Single-stage group: Post-operative improvement in the Cobb angle was a mean 54% with a mean 2° loss in correction at final follow-up. ISIS showed the angle of rib hump elevation (convexity side) was improved by a mean of 2.1° and the angle of rib depression (concavity side) was unchanged. At final follow-up the angle of rib hump elevation had recurred by a mean of 3.6° beyond the original pre-operative value. The angle of rib depression remained unchanged.

Two-stage group: Post-operative improvement in the Cobb angle was a mean 64% with a mean 1° loss in correction at final follow-up. ISIS showed the angle of rib hump elevation (convexity side) was improved by a mean of 6.2° and the angle of rib depression (concavity side) was improved by a mean of 3.5°, producing a more balanced transverse plane. At final follow-up the angle of rib hump elevation only recurred by a mean 2.2°. This was compensated by a further improvement in the angle of rib depression by a mean of 2.5°, producing a further correction to balance the transverse plane.

Conclusions: Single-stage surgery is not effective in improving the transverse plane deformity. Two-stage surgery improves the transverse plane deformity on both the convexity and concavity producing a more balanced spine with further improvement due to an improvement of the rib depression (concave side) during follow-up (growth).