Introduction:

Scheuermann's kyphosis is a fixed round back deformity characterised by wedged vertebrae seen on radiograph. It is known patients presented with a negative sagittal balance before operation. Few studies investigated the outcome after operation, especially the change in the lumbar hyperlordosis.

Introduction: Scheuermann’s disease is defined as thoracic kyphosis greater than 45° with greater than 5° of anterior wedging in 3 consecutive vertebrae. We describe a new technique for the surgical treatment of thoracic kyphosis due to Scheuermann’s disease. Eleven patients were treated in our series.

Results: The average preoperative kyphotic angle was 83.3 degrees (58 – 94 degrees). Multiple posterior closing wedge osteotomy was performed and four rods (two proximal and two distal) were contoured and fixed to pedicle screws and the deformity reduced by the cantilever technique.

The average postoperative kyphotic angle was 41.1 degrees (range 25–54 degrees) giving an average correction of 42.2 degrees per patient. The average postop lumbar angle was 51.8 degrees (range 20–70 degrees). The average follow up time was 25.3 months (range 6–60 months). At follow up the kyphotic angle was found to be 42.8 degrees average (range 24–55 degrees) and the lumbar angle was 57.6 degrees average (range 42–70 degrees). This technique is superior as it avoids sudden stretching of the anterior vasculature and possible rupture of the anterior longitudinal ligament (ALL) and provides correction at multiple levels, avoiding build-up of stress at any single level.

Conclusion: We find this technique simple and effective in reducing curves of high magnitude and the reduction was maintained in the long term. Our complication rate was comparable to that quoted in literature.

Ossification of the posterior longitudinal ligament (OPLL) is a condition found predominantly in the oriental population and is rarely seen in non orientals. OPLL can present with cervical canal stenosis and myelopathy (including central cord syndrome), often following minor trauma. Co-existence of OPLL with diffuse idiopathic skeletal hyperostosis (DISH) is a rare condition and very few reports of such patients exist in literature. Here we report the case of a Caucasian with co-existing DISH and OPLL, presenting with acute central cord syndrome associated with fracture of the ossification. A 64 year old Caucasian farmer was transferred to our spinal unit with weakness in the right upper limb following a road traffic accident. On examination he had hyperaesthesia in both upper limbs and motor power of grade 4 in the right upper limb with a distal motor power of grade 3 in the hand. There was no motor deficit in the left upper limb or lower limbs. Radiographs revealed an ossification of the posterior longitudinal ligament with a break at C2 and C3 levels. He also had exuberant soft tissue ossification in the cervical and thoracic spines, suggestive of diffuse idiopathic skeletal hyperostosis (DISH). He recovered completely in 6 weeks with non operative treatment. Fracture of the posterior longitudinal ligament has not been widely reported, although it is possibly more prevalent than is recognised. We report this case in order to highlight the importance of recognising this condition in non oriental populations and to demonstrate that non operative treatment has a good prognosis.

The use of blood transfusion in elective spinal surgery still remains a topic of debate in spite of several guidelines on transfusion in orthopaedic surgery. We report on a study done to look at the transfusion practice in 64 patients who underwent scoliosis correction surgery in our institution. There were 16 males and 48 females, with an average age of 19.8 years (range 3–70 years). There were 50 patients with idiopathic scoliosis, seven with degenerative scoliosis, five with neuromuscular scoliosis, and one each of congenital and neurologic scolioses. 31 of the patients underwent posterior correction and 13 patients underwent anterior surgery and 11 patients underwent posterior surgery with costoplasty and 5 patients underwent front and back surgery while 4 patients had front and back surgery with costoplasty. 10 patients underwent iliac crest bone grafting. The mean preop haemoglobin was 13.1 g % (range11.3–16.2 g %) and the mean postop haemoglobin was 8.9 g % (5–14.9 g %). The average amount of intraoperative fluids infused was 4100 ml (range: 300–11000 ml). The mean blood loss was 803.3 ml (range: 300–1800 ml). Sixteen patients were transfused in all requiring 32 units of blood, with an average of 2 units per patient. The average duration of hospital stay was 10.1 days (5–45 days). The mean blood loss through drains was 396 ml (10–2000 ml).

Scheuermann’s disease is defined as thoracic kyphosis greater than 45° with greater than 5° of anterior wedging in 3 consecutive vertebrae. We describe a new technique for the surgical treatment of thoracic kyphosis. Eleven patients were treated in our series. The average preoperative kyphotic angle was 83.3 degrees (58–94 degrees). Multiple posterior closing wedge osteotomy was performed and four rods (two proximal and two distal) were contoured and fixed to pedicle screws and the deformity reduced by the cantilever technique. The average postoperative kyphotic angle was 41.1 degrees (range 25–54 degrees) giving an average correction of 42.2 degrees per patient. The average postop lumbar angle was 51.8 degrees (range 20–70 degrees). The average follow up time was 25.3 months (range 6–60 months). At follow up the kyphotic angle was found to be 42.8 degrees average (range 24–55 degrees) and the lumbar angle was 57.6 degrees average (range 42–70 degrees). We find this technique simple and effective in reducing curves of high magnitude and the curve was maintained in the long term. Our complication rate was comparable to that quoted in literature. This technique is superior as it avoids sudden stretching of the anterior vasculature and possible rupture of the anterior longitudinal ligament (ALL) and provides correction at multiple levels, avoiding build-up of stress at any single level.

This study was done to determine the effectiveness of percutaneous autologous bone marrow injection in fracture healing and to determine if centrifuged bone marrow is more effective in bone healing as compared to uncentrifuged marrow.

This is a randomized interventional trial of 106 patients who had bone marrow injection. The study was done in 2 parts. In the first part, 51 patients were divided into three groups – a) Fresh fractures,(within 6 weeks of injury) b) Delayed union – (8 to 12 weeks after injury) c) Non union – more than 16 weeks after injury. All patients in the first part of the study underwent percutaneous autologous bone marrow injection and were followed up at 6,8,10 and 12 weeks and every 4th week thereafter. Forty seven out of 51 patients united. The second part of the study was done to compare centrifuged and uncentrifuged bone marrow injections. Fifty five patients having either tibial or femoral fractures were divided into two groups, centrifuged and uncentri-fuged and appropriate marrow injection was done. All patients were followed up every 6 weeks till 36 weeks. 48 patients out of 55 united. Equal number of patients united in the centrifuged and uncentrifuged group.

We conclude that percutaneous autologous bone marrow injection is a simple and effective tool which can be used for fracture healing and centrifugation of bone marrow yields no added advantage in bone healing.