Aims

To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach.

Aims. We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis. . Methods. No patient underwent spinal decompression or instrumentation placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative blood loss 200 ml (150 to 340). There was one wound infection treated with antibiotics but no other complication. Radiological assessment included standing posteroanterior and lateral, Ferguson and lateral flexion/extension views, as well as CT scans. . Results. A solid posterolateral fusion was confirmed in all patients at mean latest follow-up of 4.7 years (3.4 to 9.8) beyond skeletal maturity into early adult life. Fusion of the isthmic lesion was documented in nine patients bilaterally and eight patients unilaterally. The poor fusion rate across the spondylolysis has not affected the excellent functional results of the procedure, which in our series depended on achieving a stable lumbosacral junction. . Conclusion. Quality of life assessment demonstrated significant improvement in all functional scores and high patient satisfaction with 28 patients returning to previous sports activities at an elite competitive level. Take home message: Posterolateral arthrodesis in situ with autologous iliac crest bone without instrumentation has achieved a solid fusion between the L5 transverse processes and the sacral ala in patients with grade I to II isthmic lumbosacral spondylolisthesis and this has produced excellent clinical outcomes and high patient satisfaction. Cite this article: Bone Joint J 2016;98-B:88–96

We describe 13 patients with cerebral palsy and lordoscoliosis/hyperlordosis of the lumbar spine who underwent a posterior spinal fusion at a mean age of 14.5 years (10.8 to 17.4) to improve sitting posture and relieve pain. The mean follow-up was 3.3 years (2.2 to 6.2). The mean pre-operative lumbar lordosis was 108. °. (80 to 150. °. ) and was corrected to 62. °. (43. °.  to 85. °. ); the mean thoracic kyphosis from 17. °. (-23. °. to 35. °. ) to 47. °. (25. °. to 65. °. ); the mean scoliosis from 82. °. (0. °. to 125. °. ) to 22. °. (0. °. to 40. °. ); the mean pelvic obliquity from 21. °. (0. °. to 38. °. ) to 3. °. (0. °. to 15. °. ); the mean sacral slope from 79. °. (54. °. to 90. °. ) to 50. °. (31. °. to 66. °. ). The mean pre-operative coronal imbalance was 5 cm (0 cm to 8.9 cm) and was corrected to 0.6 cm (0 to 3.2). The mean sagittal imbalance of -8 cm (-16 cm to 7.8 cm) was corrected to -1.6 cm (-4 cm to 2.5 cm). The mean operating time was 250 minutes (180 to 360 minutes) and intra-operative blood loss 0.8 of estimated blood volume (0.3 to 2 estimated blood volume). The mean intensive care and hospital stay were 3.5 days (2 to 8) and 14.5 days (10 to 27), respectively. Three patients lost a significant amount of blood intra-operatively and subsequently developed chest or urinary infections and superior mesenteric artery syndrome. An increased pre-operative lumbar lordosis and sacral slope were associated with increased peri-operative morbidity: scoliosis and pelvic obliquity were not. A reduced lumbar lordosis and increased thoracic kyphosis correlated with better global sagittal balance at follow-up. All patients and their parents reported excellent surgical outcomes. Lordoscoliosis and hyperlordosis are associated with significant morbidity in quadriplegic patients. They are rare deformities and their treatment is challenging. Sagittal imbalance is the major component: it can be corrected by posterior fusion of the spine with excellent functional results. Cite this article: Bone Joint J 2014;96-B:800–6

Aim:. To present 11 patients with quadriplegia who developed severe lordoscoliosis or hyperlordosis. This is a rare deformity in children with CP, treatment is challenging and there are less than 20 patients ever reported. Method:. All patients underwent posterior spinal arthrodesis at mean age 14.6 years with mean follow-up 3.5 years. We measured all radiographic parameters including coronal and sagittal balance and sacral slope before and after surgery. Results:. Mean preoperative lumbar lordosis was 107°. This corrected to mean 63° at follow-up. Mean preoperative thoracic kyphosis was 13°. This improved to mean 47° at follow-up. Mean preoperative scoliosis was 80°. This corrected to mean 22o at follow up. Mean preoperative pelvic obliquity was 22°. This corrected to mean 4° at follow-up. Mean preoperative sacral slope was 80o. This corrected to mean 51o at follow-up. Mean preoperative coronal imbalance was 5.2 cm. This corrected to mean 0.6 cm at follow-up. Mean preoperative sagittal imbalance was 8 cm. This corrected to mean 1.6 cm at follow-up. Mean surgical time was 260 minutes. Mean intra-operative blood loss was 0.82 EBV. Mean stay in ICU was 3.6 and in hospital 15.2 days. Complications included 3 patients with severe blood loss (1.3–2 EBV), one patient with chest and one chest and urinary infection, and a patient with superior mesenteric artery syndrome. Increased preoperative lumbar lordosis and sacral slope correlated with surgical and postoperative morbidity. In contrast, there was no correlation between preoperative scoliosis or pelvic obliquity and surgical morbidity. Reduced lumbar lordosis and increased thoracic kyphosis correlated with better global sagittal balance at follow-up. Greater surgical time and blood loss correlated with increased postoperative morbidity. All 11 patients and their parents reported excellent feedback on the outcome of surgery with major improvement in physical appearance, sitting balance and relief of severe preoperative back pain. Discussion:. Lordoscoliosis and hyperlordosis are associated with significant morbidity in patients with quadriplegia. The sagittal imbalance is the major component of the deformity and this can be corrected satisfactorily through a posterior spinal arthrodesis which produced excellent functional results and increased patients'/caretakers' satisfaction. Conflict Of Interest Statement: No conflict of interest

Introduction. Internal transpedicular fixation for the treatment of scoliosis develops quite fast and is widely used in clinical practice. The purpose of the study was to assess the efficacy of internal transpedicular fixation in treatment of patients with scoliosis. Material and methods. The system of internal transpedicular fixation (Vertebra Stabilization System Ø 5.5-6.35, OIM, Turkey) was employed for treatment of 50 patients with scoliosis of various severity. There was 83% of female patients aged from 15 to 23 years. Clinical and radiological methods were used for assessment of treatment results. Results. An angle of scoliotic deformity measured 40-60° in 20 cases, 60-100° in 21 patients, and more than 100° in 9 cases. Two-staged procedure was produced for two patients, and one-staged intervention for 33 cases. The length of in-patient treatment was five days. The patients could sit on the bed on the next day after the surgery, walk after 3 days, and were discharged from the hospital after 5 days for the follow-up. The deformity was corrected by 95-100% in the group of patients with scoliosis of 40-60°. The deformity was corrected by 85-90% in the group of patients with scoliosis of 60-100°. One-staged procedure allowed for 70-75% correction in patients with scoliosis more than 100°. Discussion and conclusion. The results of treatment showed no loss of correction at one-year follow-up. Patient aged more than 20 showed changing the deformity angle by 2-5° due to degenerative changes of the spine. No complications associated with inflammation of soft tissues, broken metal constructs were observed in this cohort of patients. Long-term follow-ups were evaluated from one to two years. All the patients were satisfied with their cosmetic and functional result

We reviewed 75 patients (57 men and 18 women), who had undergone tension-band laminoplasty for cervical spondylotic myelopathy (42 patients) or compression myelopathy due to ossification of the posterior longitudinal ligament (33 patients) and had been followed for more than ten years. Clinical and functional results were estimated using the Japanese Orthopaedic Association score. The rate of recovery and the level of postoperative axial neck pain were also recorded. The pre- and post-operative alignment of the cervical spine (Ishihara curve index indicating lordosis of the cervical spine) and the range of movement (ROM) of the cervical spine were also measured. The mean rate of recovery of the Japanese Orthopaedic Association score at final follow-up was 52.1% (. sd. 24.6) and significant axial pain was reported by 19 patients (25.3%). Axial pain was reported more frequently in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p = 0.027). A kyphotic deformity was not seen post-operatively in any patient. The mean ROM decreased post-operatively from 32.8° (. sd. 12.3) to 16.2° (. sd. 12.3) (p < 0.001). The mean ROM ratio was 46.9% (. sd. 28.1) for all the patients. The mean ROM ratio was lower in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p < 0.001). Compared to those with cervical spondylotic myelopathy, patients with ossification of the posterior longitudinal ligament had less ROM and more post-operative axial neck pain

Aims

We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture.

Aims

The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function.