Aims. The surgical treatment of tuberculosis (TB) of the spine consists
of debridement and reconstruction of the anterior column. Loss of
correction is the most significant challenge. Our aim was to report
the outcome of single-stage posterior surgery using bone allografts
in the management of this condition. Patients and Methods. The study involved 24 patients with thoracolumbar TB who underwent
single-stage posterior spinal surgery with a cortical bone allograft
for anterior column reconstruction and posterior instrumentation
between 2008 and 2015. A unilateral approach was used for 21 patients
with active TB, and a bilateral approach with decompression and closing-opening
wedge osteotomy was used for three patients with healed TB. Results. A median of 1.25 vertebrae were removed (interquartile range
(IQR) 1 to 1.75) and the median number of levels that were instrumented
was five (IQR 3 to 6). The median operating time was 280 minutes
(IQR 230 to 315) and the median blood loss was 700 ml (IQR 350 to
900). The median postoperative kyphosis was 8.5° (IQR 0° to 15°)
with a mean correction of the kyphosis of 71.6%. Good neurological
recovery occurred, with only two patients (8%) requiring assistance
to walk at a mean follow-up of 24 months (9 to 50), at which time
there was a mean improvement in disability, as assessed by the Oswestry
Disability Index, of 83% (90% to 72%). Conclusion. The
Aims. To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by
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
Aims. Whether a combined anteroposterior fusion or a
This review of the literature presents the current understanding of Scheuermann’s kyphosis and investigates the controversies concerning conservative and surgical treatment. There is considerable debate regarding the pathogenesis, natural history and treatment of this condition. A benign prognosis with settling of symptoms and stabilisation of the deformity at skeletal maturity is expected in most patients. Observation and programmes of exercise are appropriate for mild, flexible, non-progressive deformities. Bracing is indicated for a moderate deformity which spans several levels and retains flexibility in motivated patients who have significant remaining spinal growth. The loss of some correction after the completion of bracing with recurrent anterior vertebral wedging has been reported in approximately one-third of patients. Surgical correction with instrumented spinal fusion is indicated for a severe kyphosis which carries a risk of progression beyond the end of growth causing cosmetic deformity, back pain and neurological complications. There is no consensus on the effectiveness of different techniques and types of instrumentation. Techniques include
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
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
Tumours of the sacrum are difficult to manage. The sacrum provides the structural connection between the torso and lower half of the body and is subject to both axial and rotational forces. Thus, tumours or their treatment can compromise the stability of the spinopelvic junction. Additionally, nerves responsible for lower limb motor groups as well as bowel, bladder, and sexual function traverse or abut the sacrum. Preservation or sacrifice of these nerves in the treatment of sacral tumours has profound implications on the function and quality of life of the patient. This annotation will discuss current treatment protocols for sacral tumours. Cite this article:
The February 2023 Trauma Roundup360 looks at: Masquelet versus bone transport in infected nonunion of tibia; Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multicentre randomized clinical trial; Is the T-shaped acetabular fracture really a “T”?; What causes cut-out of proximal femur nail anti-rotation device in intertrochanteric fractures?; Is the common femoral artery at risk with percutaneous fragility pelvis fixation?; Anterior pelvic ring pattern predicts displacement in lateral compression fractures; Differences in age-related characteristics among elderly patients with hip fractures.
Introduction:. Circumferential arthrodesis of the spine may be achieved by
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
To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS). We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence.Aims
Methods
Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal deformity surgery in a National Health Service. Descriptive study of prospectively collected data. Clinical data of all patients undergoing surgery for spinal deformity between 2005 and 2018 was collected, compared to the demographics of the national population, and analyzed by underlying aetiology.Aims
Methods
Adolescent idiopathic scoliosis (AIS) is a complex
3D deformity of the spine. Its prevalence is between 2% and 3% in the
general population, with almost 10% of patients requiring some form
of treatment and up to 0.1% undergoing surgery. The cosmetic aspect
of the deformity is the biggest concern to the patient and is often
accompanied by psychosocial distress. In addition, severe curves
can cause cardiopulmonary distress. With proven benefits from surgery,
the aims of treatment are to improve the cosmetic and functional
outcomes. Obtaining correction in the coronal plane is not the only
important endpoint anymore. With better understanding of spinal
biomechanics and the long-term effects of multiplanar imbalance,
we now know that sagittal balance is equally, if not more, important.
Better correction of deformities has also been facilitated by an
improvement in the design of implants and a better understanding
of metallurgy. Understanding the unique character of each deformity
is important. In addition, using the most appropriate implant and
applying all the principles of correction in a bespoke manner is important
to achieve optimum correction. In this article, we review the current concepts in AIS surgery. Cite this article:
The aim of this study was to report a retrospective, consecutive
series of patients with adolescent idiopathic scoliosis (AIS) who
were treated with posterior minimally invasive surgery (MIS) with
a mean follow-up of two years ( We prospectively collected the data of 70 consecutive patients
with AIS treated with MIS using three incisions and a muscle-splitting
approach by a single surgeon between June 2013 and February 2016
and these were retrospectively reviewed. There were eight male and
62 female patients with a mean age of 15 years (Aims
Patients and Methods
We report the results of vertebral column resection
(VCR) for paediatric patients with spinal deformity. A total of
49 VCRs in paediatric patients from four university hospitals between
2005 and 2009 with a minimum two-year follow-up were retrospectively
identified. After excluding single hemivertebral resections (n =
25) and VCRs performed for patients with myelomeningocele (n = 6),
as well as spondylectomies performed for tumour (n = 4), there were
14 patients who had undergone full VCR at a mean age of 12.3 years
(6.5 to 17.9). The aetiology was congenital scoliosis in five, neuromuscular
scoliosis in three, congenital kyphosis in two, global kyphosis
in two, adolescent idiopathic scoliosis in one and secondary scoliosis
in one. A total of seven anteroposterior and seven posterolateral approaches
were used. The mean major curve deformity was 86° (67° to 120°) pre-operatively
and 37° (17° to 80°) at the two-year follow-up; correction was a
mean of 54% (18% to 86%) in the anteroposterior and 60% (41% to
70%) in the posterolateral group at the two-year follow-up (p =
0.53). The mean Scoliosis Research Society-24 total scores were
100 (92 to 108) for the anteroposterior and 102 (95 to 105) for
the posterolateral group. There was one paraparesis in the anteroposterior
group necessitating urgent re-decompression, with a full recovery. Patients undergoing VCR are highly satisfied after a successful
procedure.
We report the incidence of and risk factors for
complications after scoliosis surgery in patients with Duchenne muscular
dystrophy (DMD) and compare them with those of other neuromuscular
conditions. We identified 110 (64 males, 46 females) consecutive patients
with a neuromuscular disorder who underwent correction of the scoliosis
at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up.
We recorded demographic and peri-operative data, including complications
and re-operations. There were 60 patients with cerebral palsy (54.5%) and 26 with
DMD (23.6%). The overall complication rate was 22% (24 patients),
the most common of which were deep wound infection (9, 8.1%), gastrointestinal
complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication
rate was higher in patients with DMD (10/26, 38.5%) than in those
with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All
hepatotoxicity occurred in patients with DMD (p = 0.003), who also
had an increased rate of deep wound infection (19% In our series, correction of a neuromuscular scoliosis had an
acceptable rate of complications: patients with DMD had an increased
overall rate compared with those with other neuromuscular conditions.
These included deep wound infection and hepatotoxicity. Hepatotoxicity
was unique to DMD patients, and we recommend peri-operative vigilance
after correction of a scoliosis in this group. Cite this article: