Correction Of Kyphosis Research Articles

Comparison of Clinical and Radiological Outcomes after Vertebroplasty and Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures.

Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures. A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage. KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05). Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.

Neural Arch Preservation-Posterior Vertebral Column Resection: 2-Dimensional Operative Video.

This technique is a modification of the posterior vertebral column resection (PVCR) for patients with kyphoscoliosis with vertebral column resection indications (Cobb angle >100° angular and rigid with flexibility <20%-30%). The neural arch (preservation)-PVCR has the biomechanical advantage of maintaining the dural sac and the spinal cord attached within the neural arch and ligamentum flavum (dorsal meningovertebral ligaments are in tension in kyphosis), avoiding spinal cord deviation during the vertebrectomy. Preserving the neural arch did not interfere with corrective maneuvers of the anterior and middle columns and avoided the spinal translation in any anatomic plane. Standard posterior spinal midline approach and insertion of pedicle screws, a temporary rod is placed on contralateral side to maintain the stability of the spine during neural arch (preservation)-PVCR and to prevent translation of the spine. A costotransversectomy for an anterior approach is performed in the apex level and discectomies of the upper and lower levels. The anterior column reconstruction is made with a structural graft or titanium mesh cage with autograft. The correction is made with compression of the segment of the osteotomy, kyphosis correction with "in situ" rod benders, and Cantilever maneuver for final correction. A multiple rod construction is placed to increase stability. This technique has the potential benefits of decreasing operative time and blood loss, protecting the neural elements from fibrous scars and more posterior fusion for decreasing pseudoarthrosis. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of his/her image.

Height Restoration for Vertebra Plana Using a Mechanical Lamellar Vertebral Body Reduction Device: 2-Dimensional Operative Video.

Compression fractures of thoracolumbar vertebra are the most common vertebral fracture.1 Associated with osteoporosis, the compression can progress until reach vertebra plana and cause a kyphosis.2 The reduction of the fresh fracture and restoration of the height are the purposes of the kyphoplasty.3 We present a modified technique adapted for the treatment of vertebral plana using a mechanical flexible lamellar vertebral body reduction device (Tektona, Spinart).4 We present the case of a 77-year-old woman with back pain after a fall. The radiological investigations show a compressive fracture type AO A1 of T7. After an initial conservative management, the patient presented persistence of the pain with a visual analog scale of 9/10 and progression of the fracture at the 2-week follow-up. On the x-ray, focal kyphosis with vertebra plana was observed. A kyphoplasty for pain management and kyphosis correction was performed. The patient consented to the procedure. A bipedicular approach to the vertebra was performed. The correction of the height was done using 2 mechanical devices. The lamellar device allowed a progressive height restoration of the fracture. On one side, the cannula was used as a support to maintain the correction during the contralateral cementing. The postoperative imaging confirmed a maintained vertebral restoration with kyphosis correction. At 1 year, the patient reported a pain at 1 of 10 on the visual analog scale. In our opinion, this technique is adapted for fresh osteoporotic vertebral compression fractures. Surgical experience in osteoporotic fracture treatment and kyphoplasty is recommended before the management of vertebra plana.

Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients.

Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation.

To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters. Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions. Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO. Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.

Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture

To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures. From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups. All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05). Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Surgical Treatment of Developmental Dysplastic Lumbosacral Spondylolisthesis: Additional Help from an Intervertebral Distraction, Correction, and Reduction Device.

In mid- to high-grade adult dysplastic spondylolisthesis, surgeons are faced with three underlying components: angular, translational, and collapse of the disk. In extremely narrow intervertebral spaces, it is difficult to distract and lift the vertebral bodies by the pedicle screw system alone. In this prospective case control study, we analyzed the efficacy of the latest prototypes (distraction, correction, and reduction [DCR] instrument) with intervertebral application in terms of distraction, correction of segmental kyphosis, and slip reduction. Twelve adult patients (5 male and 7 female patients) were enrolled in this study. The average age was 42 years (range: 17-67 years) and in all cases the maneuver was documented during the surgery. The amount of slip reduction, the lumbosacral angle according to the Spinal Deformity Study Group dysplastic angle (dys-SDGG), and the disk height were measured preoperatively, intraoperatively, 3 months after surgery, and during the latest follow-up (range: 3-44 months). The relative height of the lumbosacral disk was determined in relation to the disk height in L3/L4. Slippage ranged from 17 to 67%. Overall, the average slippage was 45% preoperatively and 4.8% after the reduction maneuver. The average ratio of the disk height was 0.3 preoperatively, 1.0 intraoperatively, and 0.9 at the latest follow-up. Two patients showed significant kyphotic changes, and these patients had an 18- and 21-degree lordotic improvement. From those who had a lumbosacral kyphosis >20 degrees, only one patient did not show any lordotic improvement. All other patients had a significant lordotic improvement. In total, the lumbosacral angle changed from 15 to 23 degrees. The application of an intervertebral distractor with a mobile thigh has a good clinical and radiologic outcome for mid- to high-grade adult dysplastic spondylolisthesis in terms of distraction, kyphosis correction, and reduction of underlying slippage. The described hardware failures and the complications were not related to the DCR device.

‘Armed kyphoplasty’ with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series

BackgroundComplex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we...

Correction of pediatric cervical kyphosis: our experience and systematic-literature review.

Pediatric cervical kyphosis is a distinct entity with diverse etiology (congenital, syndromic, traumatic, metabolic or neoplastic). Surgical correctionin pediatric population is challenging due to their growing spine and low blood volume. To analyse their presentation, surgical techniques and outcome of pediatric cervical kyphosis and systematically review the pertinent literature. Retrospective study. 16 patients aged ≤ 18years who underwent correction for cervical kyphosis between 2009 and 2021. Nurick's grading, mJOA score and Global cobb's angle. Clinical parameters (Nurick grading and mJOA score) were noted from database on admission and on follow-up at 6months. Radiological parameters of assessment included Global Cobb's angle. The C2-C7 Cobb angle was the angle of C2 vertebra lower end plate and C7 vertebra lower end plate. For C1-2 kyphosis, anterior border of C1 and anterior border of C2 angle was taken. Radiographic parameters were studied on CT and radiographs of cervical spine to assess for stability, the degree of deformity correction and fusion status at 6months follow-up. 16 patients with mean age of 14.2 ± 3years (9 syndromic, 4 post-traumatic, 2 metabolic and 1 post-laminectomy). All underwent surgical correction, 6 underwent Antero-posterior spinal fusion, 6 underwent Posterior spinal fusion and 4 underwent Anterior spinal fusion. There was significant clinical improvement postoperatively with-Nurick grade (pre vs. post: 2.8 vs. 1.8, p = 0.004), mJOA score (pre vs. post: 11.3 vs. 14, p = 0.003). There was significant deformity correction of Cobb's angle from 40.7 ± 26.5° to 14.9 ± 10° (p = 0.001). Early complications included intraoperative hemodynamic instability (3) and wound complication (1). Mean follow-up was 76.9 ± 59.3months. Pediatric cervical kyphosis is a debilitating condition which are managed surgically. Approach has to be individualized to the pathology and good results can be achieved. Patients should be screened for syndromic association and followed-up regularly.

Selection of the Optimal Dose of Dexmedetomidine and its Cardiovascular Effects when used as Part of Combined Anesthesia for Surgical Correction of Kyphosis in Dogs

Selection of the Optimal Dose of Dexmedetomidine and its Cardiovascular Effects when used as Part of Combined Anesthesia for Surgical Correction of Kyphosis in Dogs

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.

CLINICO-RADIOLOGICAL OUTCOMES IN SHORT SEGMENT FIXATION INCLUDING FRACTURE LEVEL FOR UNSTABLE THORACOLUMBAR JUNCTION FRACTURES (T10-L2)

Background: Thoracolumbar region being a transition zone is frequently injured during trauma. Treatment aims to achieve stable fixation while preserving mobility, prevent deformity, and improve neurology. Short-segment fixation, with fracture level pedicle screw fixation, is popular for preserving motion. This study assesses the clinico-radiological outcomes for short segment fixation including fracture level for unstable thoracolumbar fractures. Methods: This was an observational study conducted at a tertiary care center from December 2020 to November 2022 after receiving ethical approval among single level burst fractures (AO type A3 &amp; A4) at the thoracolumbar junction. Patients with AO type B and C fractures, osteoporotic burst fractures, lack of surgical consent, and multi-level vertebral fractures were excluded from the study. The study utilized ASIA impairment scale, Visual Analogue Score(VAS), and radiological parameters (Kyphotic angle and Loss of vertebral body height) to assess patients immediately, postoperatively and at 6 weeks, 3 months, and 6 months follow-up. Results: Out of 20 patients,70% of the fractures were AO type A3, while the remaining 30% were type A4. The injury resulted in a 56.25 ± 13.75% loss of vertebral height. The mean kyphotic angle improved significantly from 24.38 ± 3.77 degrees preoperatively to 5.92 ± 1.91 degrees at 6 months post-operatively. The VAS scores showed significant improvement from 7.85 ± 0.67 preoperatively to 0.65 ± 0.81 at 6 months postoperatively. Conclusions: Use of pedicle screw in the fractured vertebra can result in significant improvement in post-operative pain and kyphosis correction utilizing fewer motion segment with satisfactory clinic-radiological outcome.

Posterior Hemivertebrectomy for Correction of Congenital Kyphosis in Adulthood. Case Report and Literature Review

Posterior Hemivertebrectomy for Correction of Congenital Kyphosis in Adulthood. Case Report and Literature Review

Unilateral Pediculectomy and Reduction with Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fracture: A Case Series

This study aimed to evaluate the efficacy of unilateral pediculectomy and reduction with short-segment pedicle screw fixation for thoracolumbar burst fracture. We retrospectively reviewed patients who underwent a unilateral pediculectomy and reduction with short-segment fixation and interbody fusion for thoracolumbar burst fracture. The unilateral pediculectomy created sufficient space to approach the ventral side of the spinal cord for removing bone fragments and insertion of an interbody cage to correct kyphosis. Lumbar lordosis (LL), pelvic incidence (PI) minus LL, and segmental Cobb angle were measured at 3 time points: preoperatively, postoperatively, and final follow-up. Furthermore, sagittal vertical axis (SVA) was measured to assess global sagittal balance at the final follow-up. A total of 10 patients, with a mean age of 39.8±21.0, underwent the surgical procedure. All patients had a thoracolumbar injury classification and severity score > 5. The mean follow-up period was 15.8±13.9months. The mean postoperative LL (46.0±5.8) was significantly higher (P=0.008) than the preoperative measurement (32.8±8.2). The mean postoperative PI minus LL (2.2±8.4) was not significantly lower (P=0.051) than preoperative measurement (15.4±12.6). The mean postoperative segmental Cobb angle (11.4±8.4) was significantly higher (P<0.001) than the preoperative measurement (-11.6±10.9). At the final follow-up, the mean sagittal vertical axiswas 10.0±28.8mm. Unilateral pediculectomy and reduction with short-segment fixation and interbody fusion served as an efficient surgical method for thoracolumbar burst fracture.

Comparison of the effects of core stability and whole-body electromyostimulation exercises on kyphosis angle and core muscle endurance of inactive people with hyper kyphosis: A quasi-experimental pre-post study

ObjectiveRestoring the degree of kyphosis to be consistent with good sagittal alignment of the spine is a key concern. This study aimed to compare the effect of core stability exercises (CSE) versus whole-body electromyostimulation (WB-EMS) and a combined program (PLUS) on kyphosis angle and core muscle endurance in sedentary individuals with hyperkyphosis. DesignA quasi-experimental single group pre-post study. SettingsLaboratory of corrective exercise. Participantsseventy-five untrained men (28.9 ± 5.3 years) with thoracic hyperkyphosis. Main outcome measuresA flexible ruler was used to measure the angle of kyphosis and McGill's test was used to evaluate core stability. ResultsThe results of the post hoc test demonstrated that the kyphosis angle was improved in the WB-EMS and PLUS groups compared to that in the CG (P < 0.05), but no significant difference was observed among the three groups(P > 0.05). In the post-test, core stability was significantly improved in CSE, WB-EMS and PLUS groups compared to that in the CG. ConclusionsThe WB-EMS and PLUS protocols as new training methods seem to be effective in changing posture parameters and correcting postural deformities, including kyphosis. Therefore, these protocols along with other rehabilitation programs can be used to correct kyphosis and improve core muscle endurance.

Patient-reported outcomes 1 and 2years after transforaminal thoracic interbody fusion (TTIF).

Retrospective Cohort Study with prospectively collected data. Transforaminal interbody fusion was initially designed for the lumbar spine. A similar approach was later introduced for the thoracic spine (TTIF). Here we report the surgical technique and the Core Outcome Measures Index (COMI) at 1-year and 2-year follow-ups, as well as the sagittal radiographic kyphosis correction of TTIF, achieved at 1year and the latest follow-up. All TTIF procedures from 2012 to 2020 were included. COMI scores were collected preoperatively and at 1- and 2-year follow-ups. The sagittal angle between the upper and lower endplates at the segment where TTIF was performed was measured on preoperative, 1-year postoperative, and last available radiographs. Seventy-nine TTIF procedures were performed for 64 patients (36% males; mean age 67.5 (SD 15.3) years). COMI score reduced from a mean value of 8.1 (SD 1.4) preoperatively to 4.7 (SD 2.7) at 1-year follow-up and 4.7 (SD 2.7) at 2-year follow-up. The mean correction of segmental kyphosis was 10.8 (SD 7.3, p < 0.0001) degrees at 1-year follow-up and 9.3 (SD 7.0, p < 0.0001) degrees at the final follow-up 3.4 (SD 1.4) years after the operation. Kaplan-Meier analysis for reoperations showed a 5-year survival of 91% (95% CI 0.795-1) for primary TTIF operations and survival of 77% (95% CI 0.651-0.899) for TTIFs performed after earlier fusion operations. TTIF is a feasible procedure in the thoracic spine. Kyphosis correction of approximately 10° was maintained at 1-year and final follow-up. Over 69% at 1-year and 61% at 2-year follow-up achieved MCID for COMI.

Radiographic outcomes following surgical correction for lumbar degenerative kyphosis: the impact of supine pelvic tilt.

Lumbar degenerative kyphosis (LDK), a flexible deformity, is a common form of sagittal imbalance in Asian countries. Assessing a patient's spine prior to surgery by using positional radiographs is becoming more crucial in determining surgical planning to achieve favorable clinical and radiographic outcomes, especially in patients with flexible deformities. This study aims to identify radiographic characteristics of supine pelvic tilt (sPT) and its relation to mechanical failure (MF) following LDK correction. A single-center, single-surgeon retrospective analysis was performed in patients who underwent LDK correction with sacropelvic fixation between January 2014 and May 2019. Patients were grouped into pelvic match and mismatch groups according to the difference between postoperative pelvic tilt (PT) and sPT. Demographic, surgical, and radiographic parameters were compared. Chronological change of PT was assessed by comparing preoperative, supine, immediate postoperative, and final PT. Baseline demographics and sagittal alignments were similar between PT match (n = 25) and mismatch (n = 42) groups (p > 0.05). There was a significant difference in the rate of MF between PT match and mismatch groups (4% vs 31%, p = 0.021). Multivariable analysis demonstrated that after including control variables, PT mismatch was independently associated with the likelihood of MF development (OR 33.42, p = 0.04). sPT reflects postoperative PT changes; therefore, supine imaging may represent a tool that could be used for preoperative decision-making in patients with LDK or possibly those with flexible adult spinal deformity. PT mismatch > 10° or < 0° is a significant risk factor for MF following correction of LDK. Measurement of sPT would aid surgeons in optimal preoperative planning and in minimizing catastrophic MF following deformity correction surgery.

Catastrophic Complications Following Spinal Deformity Surgery in a Patient with Myotonic Dystrophy

Myotonic dystrophy (MD) is a genetic disorder that causes progressive muscle weakness and atrophy, often leading to spinal deformities and decreased quality of life. While the surgical correction of spinal deformities is not absolutely contraindicated in MD patients, a comprehensive pre-anesthetic evaluation is crucial, particularly considering cardiovascular and respiratory health. We present a case of a 50-year-old woman with MD who underwent spinal deformity surgery to correct kyphosis and alleviate severe back pain. Despite the absence of significant events during surgery and preoperative risk factors, the patient experienced postoperative respiratory failure, hypotension, aggravated weakness, and mental deterioration in the intensive care unit. The patient received long-term ventilator support during hospitalization for respiratory muscle weakness. She demonstrated significant improvements in strength, mobility, and respiratory function with multidisciplinary support and rehabilitation, achieving functional independence within 6 months postoperatively. The authors discuss the possible etiological mechanisms underlying these complications and highlight the need for preoperative evaluations and multidisciplinary care for patients with MD.

Restoring vertebral height in the treatment of multilevel vertebral compression fractures with vertebroplasty

BackgroundOsteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated.ResultsSixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores.ConclusionsVP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures.

A novel uniplanar clamp-hinge correction system for vertebral column resection of severe angular kyphosis: an experimental study using a sawbone model.

To introduce a novel uniplanar clamp-hinge (Uni-CH) correction system designed for vertebral column resection (VCR) of severe angular kyphosis and test its efficacy using a sawbone simulating model. The Uni-CH was introduced and its functionality was demonstrated on a sawbone model simulating severe angular kyphosis. An 83° thoracolumbar angular kyphosis with the apex at T11 was simulated in the sawbone spine model. The deformity was then corrected using the Uni-CH to identify the optimal hinge position for VCR reduction of severe angular kyphosis. The thoracolumbar angular kyphosis, initially measuring a mean of 82.7 ± 0.5°, was corrected to 0°, achieving a 100% correction rate. The optimal hinge position was identified to be at the level of the posterior vertebral body wall (PVBW), which allowed for the maintenance of the spinal cord with a slight shortening of 3%. In contrast, hinge positions located more posteriorly to the PVBW resulted in a greater 42% lengthening of the spinal cord, while positions located more anteriorly led to a greater 27% shortening of the spinal cord. The Uni-CH proves its efficacy in providing consistent stability to the spinal segments and acts as an adjustable and controllable hinge for VCR correction of severe angular kyphosis in the sawbone model. Placing the hinge pivot at the level of the PVBW preserves the spinal cord, preventing excessive shortening or lengthening during VCR reduction of severe angular kyphosis.