We reviewed 212 consecutive patients with adolescent idiopathic scoliosis who underwent posterior spinal arthrodesis using all pedicle screw instrumentation in terms of clinical, radiological and Scoliosis Research Society (SRS)-22 outcomes. In Group 1 (51 patients), the correction was performed over two rods using bilateral segmental pedicle screws. In Group 2 (161 patients), the correction was performed over one rod using unilateral segmental pedicle screws with the second ^{rod providing stability of the construct through two-level screw fixation at proximal and distal ends. The mean age at surgery was 14.8 years in both groups. Comparison between groups showed no significant differences with regard to age and Risser grade at surgery, pre- and post-operative scoliosis angle, coronal Cobb correction, length of hospital stay and SRS scores. Correction of upper thoracic curves was significantly better in Group 1 (p = 0.02). Increased surgical time and intra-operative blood loss was recorded in Group 1 (p < 0.001 and p = 0.04, respectively). The implant cost was reduced by mean 35% in Group 2 due to the lesser number of pedicle screws.}

Unilateral and bilateral pedicle screw techniques have both achieved excellent deformity correction in adolescent patients with idiopathic scoliosis, which was maintained at two-year follow-up. This has been associated with high patient satisfaction and low complication rates.

We present data relating to the Bryan disc arthroplasty for the treatment of cervical spondylosis in 46 patients.

Patients with either radiculopathy or myelopathy had a cervical discectomy followed by implantation of a cervical disc prosthesis. Patients were reviewed at six weeks, six months and one year and assessment included three outcome measures, a visual analogue scale (VAS), the short form 36 (SF-36) and the neck disability index (NDI). The results were categorised according to a modification of Odom’s criteria. Radiological evaluation, by an independent radiologist, sought evidence of movement, stability and subsidence of the prosthesis.

A highly significant difference was found for all three outcome measurements, comparing the pre-operative with the post-operative values: VAS (Z = 6.42, p < 0.0001), SF-36 (mental component) (Z = −5.02, p < 0.0001), SF-36 (physical component) (Z = −5.00, p < 0.0001) and NDI (Z = 7.03, p < 0.0001). The Bryan cervical disc prosthesis seems reliable and safe in the treatment of patients with cervical spondylosis.

Aims. The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. Methods. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. Results. This investigation included 739,474 spinal surgeries and 739,215 hospitalizations in Japan. There was an average annual increase of 4.6% in the number of spinal surgeries. Scheduled hospitalizations increased by 3.7% per year while unscheduled hospitalizations increased by 11.8% per year. In-hours surgeries increased by 4.5% per year while after-hours surgeries increased by 9.9% per year. Complication rates and costs increased for both after-hours surgery and unscheduled hospitalizations, in comparison to their respective counterparts of in-hours surgery and scheduled hospitalizations. Conclusion. This study provides important insights for those interested in improving spine care in an ageing society. The swift surge in after-hours spinal surgeries and unscheduled hospitalizations highlights that the medical needs of an increasing number of patients due to an ageing society are outpacing the capacity of existing medical resources. Cite this article: Bone Jt Open 2024;5(8):662–670

Objectives. Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. Methods. Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher’s exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. Results. In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p < 0.05, Fisher’s exact test) increased the fusion rate at six and 12 months for certain high-risk subjects who had at least one clinical risk factor of being elderly, a nicotine user, osteoporotic, or diabetic; and for those with at least one clinical risk factor and who received at least a two- or three-level arthrodesis. Conclusion. Adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis. Cite this article: D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124–130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1

Aims. Clinical and radiological data were reviewed for all patients with mucopolysaccharidoses (MPS) with thoracolumbar kyphosis managed non-operatively or operatively in our institution. Methods. In all 16 patients were included (eight female: eight male; 50% male), of whom nine had Hurler, five Morquio and two Hunter syndrome. Six patients were treated non-operatively (mean age at presentation of 6.3 years; 0.4 to 12.9); mean kyphotic progression +1.5. o. /year; mean follow-up of 3.1 years (1 to 5.1) and ten patients operatively (mean age at presentation of 4.7 years; 0.9 to 14.4); mean kyphotic progression 10.8. o. /year; mean follow-up of 8.2 years; 4.8 to 11.8) by circumferential arthrodesis with posterior instrumentation in patients with flexible deformities (n = 6). Results. In the surgical group (mean age at surgery of 6.6 years; 2.4 to 16.8); mean post-operative follow-up of 6.3 years (3.5 to 10.3), mean pre-operative thoracolumbar kyphosis of 74.3. o. (42. o. to 110. o. ) was corrected to mean of 28.6. o. (0. o. to 65. o. ) post-operatively, relating to a mean deformity correction of 66.9% (31% to 100%). Surgical complications included a deep wound infection treated by early debridement, apical non-union treated by posterior re-grafting, and stable adjacent segment spondylolisthesis managed non-operatively. Thoracolumbar kyphosis > +38. o. at initial presentation was identified as predicting progressively severe deformity with 90% sensitivity and 83% specificity. Discussion. This study demonstrates that severe thoracolumbar kyphosis in patients with MPS can be effectively treated by circumferential arthrodesis. Severity of kyphosis at initial presentation may predict progression of thoracolumbar deformity. Patients with MPS may be particularly susceptible to post-operative complications due to the underlying connective tissue disorder and inherent immunological compromise. Take home message: Clinical and radiological data were reviewed for all patients with mucopolysaccharidoses with thoracolumbar kyphosis managed non-operatively or operatively in our institution. Cite this article: Bone Joint J 2016;98-B:229–37

Purpose of the study. To investigate the efficacy of pedicle screw instrumentation in correcting thoracolumbar/lumbar idiopathic scoliosis in adolescent patients. Summary of Background Data. Thoracolumbar/lumbar scoliosis has been traditionally treated through an anterior approach and instrumented arthrodesis with the aim to include in the fusion the Cobb-to-Cobb levels and preserve distal mobile spinal segments. Posterior instrumentation has been extensively used for thoracic or thoracic and lumbar scoliosis. In the advent of all-pedicle screw constructs there is debate on whether thoracolumbar/lumbar scoliosis is best treated through an anterior or a posterior instrumented arthrodesis. Methods. We reviewed the medical notes and radiographs of 19 consecutive adolescent patients with Lenke 5C idiopathic scoliosis (17 female-2 male, prospectively collected single surgeon's series). We measured the scoliosis, thoracic kyphosis and lumbar lordosis angles, apical vertebral rotation (AVR) and translation (AVT), trunk shift (TS), as well as the lower instrumented vertebra angle (LIVA) both pre-and post-operatively and at minimum 2-year follow-up. SRS 22 data was available for all patients. Results. All patients underwent posterior spinal arthrodesis of the primary thoracolumbar/lumbar curve using all-pedicle screw constructs. Mean age at surgery was 15.1 years. We identified 3 separate groups: Group 1 (9 patients) had a fusion to include the preoperative Cobb-to-Cobb levels of the curve; in Group 2 (8 patients) the fusion extended 1-2 levels distal (all patients) +/− proximal (4 patients) to the end Cobb vertebrae; in Group 3 (2 patients) the fusion extended to one level proximal to the lower end Cobb vertebra. Eight patients had compensatory thoracic curves. Mean Cobb angle before surgery was 60.3° (range: 43-91°). This was corrected by 79% to mean 13° (p<0.001) with no patient losing >2° correction at follow-up. Mean preoperative Cobb levels of the thoracolumbar/lumbar curve were 6.3; mean levels of instrumented fusion were 7 (mean extent of fusion: preoperative Cobb angle + 0.7 levels). Mean preoperative thoracic kyphosis was 34.7° and lumbar lordosis 45.3°. Mean postoperative thoracic kyphosis was 36.6° and lumbar lordosis 43°. Mean theatre time was 3.8 hours, hospital stay 7.5 days and intraoperative blood loss 0.26 blood volumes. There were no neurological complications other than one temporary brachial plexus neuropraxia (recovered before patient discharge from hospital), no wound infections or detected non-union at follow-up. Mean preoperative SRS 22 score was 3.7; this was improved to 4.5 at 2-year follow-up (p=0.01). Pain and self-image demonstrated significant improvement (p=0.02, p=0.001 respectively) with mean satisfaction rate 4.8. Comparison between Groups 1 and 2 showed similar age at surgery but higher preoperative scoliosis in Group 2 (Group 1: 54°/Group 2: 65°, p=0.05). Preoperative AVR, TS and LIVA were similar between the 2 groups (p>0.05). Preoperative AVT was significantly higher in Group 2 (Group 1: 3.3 cm/Group 2: 5 cm, p=0.01). Conclusion. Pedicle screw instrumentation can achieve excellent correction of Lenke 5C idiopathic scoliosis which is maintained at follow-up. This is associated with high patient satisfaction and low complication rates. Greater preoperative AVT and scoliosis angle predicted the need for longer fusion both distally and proximally beyond the end vertebra of the preoperative Cobb angle

Aim:. To determine radiographic variables that predict the need for distal extension of the fusion beyond Cobb-to-Cobb levels in treating thoracolumbar/lumbar (TL/L) scoliosis (Lenke 5) in adolescent patients. Method:. We reviewed the medical notes and radiographs of the senior author's consecutive series of 53 adolescent patients with TL/L scoliosis treated by posterior instrumented spinal arthrodesis using an all-pedicle screw construct. Our patients were categorised into 2 groups: patients with instrumented fusion between Cobb-to-Cobb levels of the TL/L curve (Group 1), and patients that required distal extension beyond the caudal Cobb level (Group 2). Pearson correlation and binary logistic regression analyses (significance p<0.05) were performed to identify variables that predict the need for distal extension. Results:. Groups 1 and 2 comprised 36 and 17 patients, respectively. The following preoperative parameters significantly correlated with distal extension of the fusion: TL/L scoliosis angle (TL/L), TL/L supine maximum lateral bending angle, TL/L apical vertebral translation (AVT), TL/L flexibility index (FI), lowest instrumented vertebra angle (LIVA), and compensatory thoracic scoliosis angle (TH). Binary logistic regression analysis optimised a predictive equation incorporating TL/L, AVT, FI, LIVA, and TH parameters that provides an 81% accuracy in predicting the need for Cobb-to-Cobb fusion or distal extension. There was no difference in demographic data or SRS-22 scores between the 2 groups. Discussion:. Regression analysis of preoperative radiographic variables can accurately predict the need for distal extension of the fusion beyond the preoperative Cobb-to-Cobb levels during posterior spinal arthrodesis in patients with adolescent idiopathic thoracolumbar/lumbar scoliosis. Conflict Of Interest Statement: No conflict of interest

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

Purpose of the study. We report septic shock as postoperative complication following an instrumented posterior spinal arthrodesis on a patient with multiple body piercings. The management of this potentially catastrophic complication and outcome of treatment is been discussed. Summary of Background Data. Body piercing has become increasingly more common due to change in culture or as a fashion statement. This has been associated with local or generalized ill effects including tissue injury, skin and systemic infections, and septic shock. There is no clear guideline pathway regarding removal and reinsertion of body piercings in patients who undergo major surgery. Complications following Orthopaedic or Spinal procedures associated with body piercing have not been reported. Methods. We reviewed the medical notes and radiographs of an adolescent patient with severe Scheuermann's kyphosis and multiple body piercings who underwent an uneventful posterior spinal arthrodesis with pedicle hook/screw/rod instrumentation and autologous iliac crest bone graft and developed septic shock. Results. Septic shock developed on postoperative day 2 after reinsertion of all piercings following patient's request. The patient became systemically very unwell and required intensive medical management, as well as a total course of antibiotics of 3 months. The piercings remained in situ. She did not develop a wound infection despite the presence of bacteraemia (coagulase-negative Staphylococci/Streptococci warneri) and spinal instrumentation. The patient had no new piercings subsequent to her deformity procedure. Two and a half years after spinal surgery she reported no medical problems, had a balanced spine with no loss of kyphosis correction and no evidence of nonunion or recurrence of deformity. Conclusion. The development of septic shock as a result of piercing reinsertion in the postoperative period has not been previously reported. This is an important consideration to prevent potentially life-threatening complications following major spinal surgery. Despite the wide array of complications associated to body art there are no clear guidelines for body piercing. There is growing public awareness and several countries are laying regulations which have not yet been internationally standardized. A clear practice guideline in the perioperative management of piercings is needed as the incidence of body piercing and associated complications is rising. There is need for surgeons to be aware of the hazards of body piercing and its implications. We propose that multiple piercings should not be reinserted after major surgery and appropriate counseling should be provided to the patients as part of the consent process

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

Aims

To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.

Aims

The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques.

Purpose of the study. Two patients with very severe thoracolumbar Scheuermann's kyphosis who developed spontaneous bony fusion across the apex of the deformity are presented and their treatment, as well as surgical outcome is discussed. Summary of Background Data. Considerable debate exists regarding the pathogenesis, natural history and treatment of Scheuermann's kyphosis. Surgical correction is indicated in the presence of severe kyphosis which carries the risk of neurological complications, persistent back pain and significant cosmetic deformity. Methods. We reviewed the medical notes and radiographs of 2 adolescent patients with severe thoracolumbar Scheuermann's kyphosis who developed spontaneous posterior and anteroposterior fusion across the apex of the deformity. Results. Patient 1. A male patient aged 17 years and 11 months underwent kyphosis correction when the deformity measured 115o and only corrected to 100o on supine hyperextension radiograph against the bolster; he had a small associated scoliosis. The surgery involved a combined single-stage anterior and posterior spinal arthrodesis T4-L3 with the use of posterior pedicle hook/screw/rod instrumentation and autologous rib graft. The anterior longitudinal ligament was ossified from T10 to L1 with bridging osteophytes extending circumferentially from T11 to T12 at the apex of kyphosis and displacing the major vessels anteriorly. The intervertebral discs from T9 to T12 were very stenotic and immobile. The osteophytes were excised both on the convexity and concavity of the associated thoracolumbar scoliosis. The anterior longitudinal ligament was released and complete discectomies back to the posterior longitudinal ligament were performed from T7 to L1. During the posterior exposure, the spine was found to be spontaneously fused across the apex of the kyphosis from T9 to L1. There were no congenital vertebral anomalies. Extensive posterior apical closing wedge osteotomies were performed from T7 to T12. The fused facets and ossified ligamentum flavum were excised and the spine was mobilised at completion of the anterior and posterior osteotomies. The kyphosis was corrected using a cantilever maneuver from proximal to distal under spinal cord monitoring. Excellent correction to 58o was achieved and maintained at follow-up. Autologous rib graft was used to enhance a solid bony fusion. Patient 2. A female patient aged 18 years and one month underwent kyphosis correction when the deformity measured 115o and only corrected to 86o on supine hyperextension radiograph against the bolster; she had a small thoracolumbar scoliosis. The surgery involved a single-stage posterior spinal arthrodesis T2-L4 with the use of posterior pedicle hook/screw/rod instrumentation and autologous iliac crest bone. The spine was spontaneously fused across the apex of kyphosis from T9 to L1. There were no congenital vertebral anomalies. Extensive posterior apical closing wedge osteotomies were performed from T6 to T12. The fused facets and ossified ligamentum flavum were excised and the spine was mobilised at completion of the osteotomies. The kyphosis was corrected using a cantilever maneuver from proximal to distal under spinal cord monitoring. Excellent correction to 60o was achieved and maintained at follow-up. Autologous iliac crest graft was used to achieve a solid bony fusion. In both patients the preoperative MRI assessed the intraspinal structures but failed to diagnose the solid fusion across the posterior bony elements at the apex of kyphosis. A CT scan with 3D reconstruction would have illustrated the bony anatomy across the kyphosis giving valuable information to assist surgical planning. This is recommended in the presence of rigid thoracolumbar Scheuermann's kyphosis which does not correct in hyperextension, especially if the plain radiograph shows anterior bridging osteophytes. Conclusion. Spontaneous posterior or anteroposterior fusion can occur across the apex of severe thoracolumbar Scheuermann's kyphosis; this should be taken into account when surgical correction is anticipated. The bony ankylosis may represent the natural history of an extreme deformity as an attempt of the spine to auto-stabilise. A combination of factors including a rigid deformity, which limits significantly active movement of the spine, as well as anterior vertebral body wedging with severe adjacent disc stenosis which induces bridging osteophyte formation may result in the development of spontaneous fusion across the apex of the kyphosis either posteriorly or anteroposteriorly. In the presence of an isolated posterior fusion, segmental posterior closing wedge osteotomies with complete excision of the ossified ligamentum flavum and fused facets should mobilise the thoracolumbar spine and allow for kyphosis correction. An additional anterior spinal release including complete discectomies, resection of the anterior longitudinal ligament and osteophytes is required if the bony fusion extends anteroposteriorly. Patients with Scheuermann's kyphosis should be ideally treated at an earlier stage and with a lesser degree of deformity so that this ossification process is prevented

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

Aim:. Our aim was to report the rate and risk factors for post-operative complications in Duchenne Muscular Dystrophy (DMD) patients undergoing spinal arthrodesis for scoliosis, with a comparison to neuromuscular scoliosis of other aetiology. Methods:. From a prospective single surgeon spinal deformity database, we identified all patients with neuromuscular disorders who underwent surgical correction for progressive scoliosis. We recorded demographic and peri-operative data, including complications and subsequent procedures. The rate and risk factors for complications was determined, with a sub-analysis of the DMD group to determine any peri-operative factors predictive of overall complication rates. Results:. There were 98 patients, 59 (60%) were male with mean age at surgery 14 yrs (7–19 yrs). Forty-eight patients had cerebral palsy (n=48, 49%) and 26 DMD (27%). The overall complication rate was 18.4% (n=18), with deep wound infection (DWI; n=9, 9.2%) and acute liver injury (ALI; n=4, 4.0%) most frequent. The complication rate was significantly higher in DMD patients (35%) compared to other neuromuscular disorders (13%; p=0.013). All ALIs occurred in DMD patients (p=0.004), with an increased DWI rate (19% vs 6%; p=0.053). On subanalysis, no peri-operative factors correlated with overall complication rate or DWI rate. Increased intraoperative blood loss was the only factor associated with ALI (p=0.036). Discussion:. Scoliosis correction has an acceptable complication rate in patients with neuromuscular diagnoses. DMD patients have an increased complication rate when compared to other neuromuscular disorders. ALI in our series was unique to DMD patients and we would recommend peri-operative vigilance for hepatotoxicity in these patients. Conflict Of Interest Statement: No conflict of interest

Background. For bone grafting procedures, the use of autologous bone is considered the gold standard, as it is has a better healing capacity compared to other alternatives as allograft and synthetic bone substitutes. However, as there are several drawbacks related to autografting (infection, nerve- or vascular damage, chronic pain problems, abdominal herniation), there has been a targeted effort to improve the healing capacities of synthetic bone substitutes. Aim. To evaluate the performance of a carbonated osteoionductive hydroxyapatite (CHA) scaffold of clinical relevant size (Ø=15mm, H=50mm) in a sheep model of multi level posterolateral intertransverse lumbar spine fusion after activation with autologous bone marrow nuclear cells (BMNC) in a flow perfusion bioreactor. Method. Two groups were included in the study, autograft (n=6) and CHA scaffold (n=6) CHA. A paired design was used between and within the groups as lumbar posterolateral arthrodesis was performed in sheep on two levels (L2-L3, L5-L6) +/− BMNC, respectively. Before implantation, the CHA scaffold was cultured in a flow perfusion bioreactor system with BMNC for 21 days, and the autograft group was supplemented with isolated BMNC during the procedure. Micro tomography was used to evaluate fusion rate and the microarchitectural properties of the explants after an observation period of four months. Results. In the autograft group, the healing rate was 83.3% irrespective of the presence BMNC, and in the CHA group, 66.7% fused in the presence of BMNC, and 33.3% without. The microarchitectural data suggested the autograft group to be superior to the CHA scaffold regarding mechanical properties, however porosity decreased significantly (p=0.001) in the CHA scaffold group suggesting deposition of mineralized bone matrix. Conclusion. Based on the fusion rate and micro architectural properties, we consider the CHA scaffold fully capable of new bone formation, and that the presence of BMNC has a positive effect on the fusion rate in a challenging model of bone healing

Aims

Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis.

The “Wallis” implant is indicated to stabilize symptomatic degenerative lumbar spine segments, relieving low back pain related to instability and thus delaying the need for irreversible, more invasive surgical management. The purpose of this study was to provide the first objective clinical evaluation of the “Wallis” lumbar dynamic stabilisation system. An independent prospective observational study was carried out utlising SF-36, Oswestry Disability Index (ODI) and visual analogue pain scores (VAS). Surgical pathologies in which this technique was used, the intra-operative and post-operative complications and length of post-op stay were recorded. 102 patients underwent Wallis insertion between June 2007- May 2009, Median age 51.5 (range 28-108). 94% of patients completed questionnaires and were followed up at 3, 6 and 12 month time points. ODI scores decreased from pre-op 39 to 27 at twelve months (p<.0016). VAS back pain scores decreased 59 to 36 (p<0.0001). Leg scores decreased 50 to 39 (p<0.0002). SF 36 scores improved significantly, physical functioning 46 to 59, physical health 30 to 54 and social functioning 47 to 68. 50% of patients believed their health to be better 12 months post-op. Pre-operatively 28% of patients were employed and working with 26% off work due to back problems. This rate increased steadily with 42% employed at 12 months. Two implants were removed, one due to non-benefit with subsequent arthrodesis and one due to infection. One superficial wound infection occurred. The Wallis dynamic stabilization system provides a superficial and easily reversible surgical procedure with a lower complication rate than conventional athrodesis. Used in patients with painful degenerative lumbar conditions their quality of life objectively approached values of the age- and gender-matched general population

Introduction. Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion, have a deleterious effect on pulmonary function for up to 5 years after surgical treatment of adolescent idiopathic scoliosis. We aimed to compare two groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T). We focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis. Methods. We compared 40 consecutive adolescent patients surgically treated between 1998 and 2001 by PSF+T with a similar cohort of 40 adolescents treated in the same period by PSF. Inclusion criteria were pedicle screw instrumentation alone and a minimum 5 years of follow-up. A radiographic analysis and a chart review were done, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire, and the Lenke classification system. A radiographic rib-hump (RH) assessment was also undertaken. Results. The entire series was reviewed at an average clinical follow-up of 8·3 years. The two groups did not differ significantly in terms of sex, age (PSF+T 16·3 years vs PSF 15·2 years), Lenke curve type classification, and preoperative Cobb main thoracic (MT) curve magnitude (66° vs 63°); however, final MT percentage correction (53·03% vs 51·35%; p<0·03), RH absolute correction (–2·1 cm vs –1·05; p<0·01), and RH overall percentage correction (55·4% vs 35·4%; p<0·0001) were greater in the PSF+T group than in the PSF group. We recorded no statistical differences between the two groups in PFTs both preoperatively and at last follow-up. Nevertheless, comparing preoperative with final PFTs within each group, only in the PSF group was both forced vital capacity and forced expiratory volume in 1 s significantly improved at final evaluation. At last follow-up visit, the SRS-30 scores did not differ significantly between the two groups (total score 4·1 vs 4·3). Conclusions. Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in patients with adolescent idiopathic scoliosis treated by posterior spinal fusion alone with pedicle screws instrumentation, as already shown in previous reports. A trend towards better coronal plane correction and rib-hump improvement was recorded, although this improvement was not clearly reported in a self-assessment disease-specific questionnaire

Objectives

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine.