Kyphotic Deformity Research Articles

Efficacy and safety of short segment pedicle screw fixation in patients with neurologically intact burst fractures of the lower thoracic and lumbar spine: a meta-analysis of studies published over the last 20 years

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group.Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method.Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %.Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Percutaneous kyphoplasty combined with pediculoplasty (PKCPP) augments and internally fixates the severe osteoporotic vertebral fractures: a retrospective comparative study.

Vertebral augmentation (VA) has emerged as a satisfactory and minimally invasive surgical approach for severe osteoporotic vertebral fractures (OVFs). However, treating severe OVFs with advanced collapse, burst morphology with MC injury, posterior wall retropulsion, high degree of osseous fragmentation, pediculo-somatic junction fracture, and large vacuum cleft presents significant challenges. This study aimed to evaluate the effectiveness of percutaneous kyphoplasty combined with pediculoplasty (PKCPP) in reducing refracture, preventing further collapse and bone cement displacement, reconstructing vertebral body (VB) stability, and providing internal fixation of the anterior column (AC), middle column (MC), and the bilateral pedicles. The current study was designed as a retrospective review of clinical and radiologic parameters. From July 2018 to September 2021, ninety-six patients with severe OVFs and without neurological deficit were treated either with simple percutaneous kyphoplasty (simple PKP group, n = 54) or with percutaneous kyphoplasty combined with pediculoplasty (PKCPP group, n = 42). All patients were followed up for at least 1year, and clinical and radiological outcomes were assessed. Surgery duration and bone cement volume were compared between the two groups, as well as analgesic dosage and hospital stay. Anterior wall height (AWH), posterior wall height (PWH), and Cobb angle (CA) were measured and analyzed before and after surgery. The simple PKP group had significantly shorter surgery duration and lower bone cement volume compared to the PKCPP group (P < 0.05). Conversely, the simple PKP group had significantly higher analgesic dosage and longer hospital stay than the PKCPP group (P < 0.05). Both groups showed significant improvements in AWH, PWH, and CA after surgery (P < 0.05). At the final follow-up, the PWH in the simple PKP group was significantly lower than the preoperative measurement (P < 0.05), and the difference in PWH between the two groups was statistically significant (P > 0.05). Moreover, both groups demonstrated a significant reduction in CA after surgery, with the PKCPP group showing a greater reduction compared to the simple PKP group throughout the postoperative period to the final follow-up (P < 0.05). VAS and ODI scores significantly decreased in both groups after surgery (P < 0.05), with no significant difference between the groups at the final follow-up (P > 0.05). However, the PKCPP group achieved better VAS scores than the simple PKP group at postoperative 1day, 1month, and 3months (P < 0.05), and the ODI in the PKCPP group was lower than the simple PKP group at 1month after surgery (P < 0.05). Furthermore, the overall complication rate in the PKCPP group was significantly lower than that in the simple PKP group (P < 0.05). If performed by appropriately trained surgeons, both PKP and PKCPP are safe and effective treatments for patients with severe OVFs. However, PKCPP offers additional benefits in the setting of bothersome fractures, including rapid pain relief, improved spinal stability, satisfactory restoration of vertebral body height, and better correction of kyphotic deformity. These promising results have been tested in a single center but require further confirmation in multiple centers.

Safety and efficacy of short percutaneous fixation in AO3 and AO4 lumbar fractures: a single-centre experience of 35 cases.

Spinal fractures with subsequent bone fragment dislocation are among the injuries most feared by patients and physicians. The surgical strategy is tailored to the individual patient's characteristics and often consists of pedicle instrumentation with rod-screw systems. Short instrumentation has been associated with worse spinal correction and increased complications. However, recent studies have suggested similar results in terms of kyphosis correction and the maintenance of sagittal alignment compared to longer instrumentation. This single-center retrospective study was conducted between January 2018 and April 2021. We included 35 single lumbar burst fractures AO Spine grade A3 or A4 with evidence of intra-canal fragments. Patients underwent minimally invasive percutaneous posterior lumbar instrumentation with pedicle screws. Patients received short segmental fixation involving only one level above and below the fractured vertebra. An immediate postoperative computed tomography (CT) scan demonstrated a significant reduction in vertebral kyphotic deformation (11.7° ± 1.6 vs 16.7° ± 5, p<0.001) and sagittal Cobb angle (9.8° ± 1.3 vs 11.7° ± 1.5, p < 0.001). The correction was slightly reduced but remained significant at 12 months for both kyphotic (12.3° ± 1.4, p = 0.03) and sagittal Cobb (10.3° ± 0.9, p = 0.04). Upper lumbar vertebrae showed even larger correction indices compared to lower lumbar segments. No implant failure or screws pullout was seen at the last follow-up. Short spinal fixation is a safe and effective treatment of complete and incomplete burst fractures with posterior bone fragment dislocation. All included patients fared well and achieved good kyphotic correction with no perioperative or long-term complications.

Survey of spinal tuberculosis in Basrah

Background. Tuberculous spondylitis (TS) or spinal tuberculosis is secondary either to pulmonary or intestinal tuberculosis and may be the initial manifestation of tuberculosis (TB). Spinal TB also called Pott’s disease is by definition, an advanced severe disease, requiring accurate evaluation and aggressive systemic therapy. Objective. This study was conducted to demonstrate the prevalence and clinical, laboratory, and management characteristics of patients with spinal tuberculosis in Basrah governorate. Methods. A cross-sectional descriptive retrospective and prospective study was conducted during the period of March 2020 to December 2021. All cases either registered at the tuberculous center / Basrah Health Director were viewed by phone calling or recall or newly diagnosed with spinal tuberculous which attended to Basrah Teaching Hospital. Those patients were followed after diagnosis and treatment initiation for any clinical improvement, worsening or no improvement after diagnosis. Results. Among 51 enrolled patients with spinal tuberculosis in this study, the age distribution was 20-39 years old 23 (45.09%). Most of the patients were males (32) with rates 62.74%. The most common site of vertebral involvement is dorsal segment 29 (56.86%). The most common presenting complaints were: back pain in 49 patients (96.07%). Regarding the examination findings, 2(13.33%) with deformity either kyphotic or gibbous deformity. Most of the examined patients had a power grade 1-3/5 (93.33%) in the lower limbs. Out of the 4 cases of cervical tuberculosis, all of them had been managed conservatively, while 6 out of 16 cases (37.5%) diagnosed with lumber lesions were managed conservatively, and 10 cases (62.5%) were managed surgically. Conclusion. The prevalence and characteristics of patients with spinal TB follow the global trend, although some differences were recorded, but it was not that significant. The surgical approach is still superior to the conservative one in the improvement of neurological deficits.

K-Line Tilt May Influence the Short-Term Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy.

A retrospective study. To explore the relationship between K-line tilt and short-term surgical outcomes following laminoplasty in patients with multilevel degenerative cervical myelopathy (DCM), and to evaluate the potential of K-line tilt as a reliable preoperative predictor. A retrospective analysis was performed for 125 consecutive patients who underwent laminoplasty for multilevel DCM. The radiographic parameters utilized in this study encompassed T1 slope (T1S), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope minus C2-C7 lordosis (T1S-CL), C2-C7 range of motion (ROM), and K-line tilt. The neurological recovery was evaluated using the Japanese Orthopaedic Association (JOA) score. Pearson correlation coefficients were calculated to assess the relationship between K-line tilt and other classical cervical parameters. Logistic regression analysis was employed to examine the association between K-line tilt and surgical outcomes. Of the 125 patients, 89 were men. The mean age of the patients was 61.74 ± 11.31 years. The results indicated a correlation between the K-line tilt and the cSVA (r = 0.628, P < 0.001), T1S (r = 0.259, P = 0.004), and T1S-CL (r = 0.307, P < 0.001). The K-line tilt showed an association with the failure of the JOA recovery rate (RR) to reach the minimal clinically important difference (MCID) and the occurrence of postoperative kyphotic deformity. We identified cutoff values for the K-line tilt which predict the failure of the JOA RR to reach the MCID and postoperative kyphotic deformity as 10.13° and 9.93°, respectively. The K-line tilt is an independent preoperative risk factor associated with both the failure of the JOA RR to reach the MCID and the occurrence of postoperative kyphotic deformity in patients with multilevel DCM after laminoplasty.

Application of neurophysiological studies for diagnosis and justification of neurosurgical treatment of kyphotic deformity due to the congenital anomaly of the spine

The results of a comprehensive clinical, radiological and neurophysiological study were analyzed in patients with kyphotic deformity of the thoracic and lumbar spine due to a congenital anomaly of vertebral development in the dynamics of surgical treatment. It has been established that congenital kyphotic spinal deformity is accompanied by vertebromedullary conflict with a high risk of the occurrence and/or worsening of spinal neurological disorders. The study of the data obtained made it possible to evaluate deformation lesions of the spine from the standpoint of qualitative and quantitative severity of pathological changes in the conduction function in the system of nervous tracts of the spinal cord, which was an objective argument in justifying the indications for surgical correction and its methodological implementation, as well as an important neurophysiological criterion for subsequent dynamic monitoring of clinical conditions of a patient.It was found that the surgical treatment allowed us to improve and subsequently stabilize the functional state of the spinal cord as a consequence of the achieved significant correction of congenital kyphotic spinal deformity.

Surgical Treatment Strategies for Ankylosing Spondylitis with “Folded Man” Deformity: A Single-Center Retrospective Case Series Study

Ankylosing spondylitis (AS) combined with severe kyphotic deformity can cause the trunk to collapse, pressing tightly against the front of the thighs and forming a "folded man" deformity. The purpose of this article is to evaluate the effectiveness and safety of a treatment strategy for correcting the "folded man" deformity. A retrospective study was conducted to analyze 12 AS patients with "folded man" deformity treated at our hospital with staged kyphosis correction in the lateral position, followed by total hip arthroplasty, from May 2018 to July 2021. Global kyphosis (GK), thoracic kyphosis, lumbar lordosis, sagittal vertical axis, chin-brow vertical angle, and Scoliosis Research Society-22 Patient Questionnaire scores were compared preoperation and postoperation. Surgical duration, positioning time, blood loss, and complications were also recorded and analyzed. All patients demonstrated a correction of the "folded man" deformity, achieving sagittal balance and horizontal gaze with mild complications. Postoperatively, there were significant improvements in spinal sagittal parameters (GK, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis) and chin-brow vertical angle compared to preoperative values (P < 0.05). The preoperative GK of 139.6 ± 9.1° was corrected to 55.3 ± 5.7° postoperatively, with a mean correction of 84.3°. The standardized treatment strategy involving staged correction of spinal kyphosis in a lateral position, followed by subsequent total hip arthroplasty, offers a safe and effective solution for managing AS with "folded man" deformity.

Surgical management of congenital cervical spondylolytic spondylolisthesis: illustrative case.

Congenital cervical spondylolytic spondylolisthesis is a rare and complex disorder of the cervical spine. Surgical treatment is reserved for those symptomatic patients who do not improve with conservative management. A 34-year-old man presented with bilateral C7 radiculopathy for the past 6 months. Magnetic resonance imaging of the cervical spine revealed grade II C6-7 spondylolisthesis. Computed tomography showed the presence of spondyloarthritis, bilateral pedicle dysplasia, bilateral isthmic defect, and spinous process schisis. Dynamic radiographs showed no signs of vertebral instability. Dynamic magnetic resonance imaging showed kinking of the spinal cord over the fulcrum of C6-7 kyphosis during flexion, with no signs of myelopathy. The patient underwent C6-7 anterior fusion surgery. His symptoms improved postoperatively, with a 2-month computed tomography scan showing initial bony bridging. The absence of evident instability on radiography does not always correspond to the absence of actual functional compression of neurological structures. Spinal misalignment, muscle dysfunction, and kyphotic deformity with kinking of the spinal cord and stretching of the nerve roots may also contribute to the development of symptoms. In this setting, dynamic magnetic resonance imaging can be extremely useful. Single-level anterior fusion surgery without posterior fixation can achieve solid fusion and improve the clinical conditions of patients. https://thejns.org/doi/10.3171/CASE24174.

Comparative analysis of surgical treatment results for osteoporotic burst fractures of thoracolumbar vertebral bodies

Introduction Surgical methods for osteoporotic burst vertebral body fracture repair have their advantages and shortcomings. The use of circumferential stabilization and corrective vertebrotomies in elderly patients is highly invasive and carries great surgical risk. On the other hand, minimally invasive methods lead to recurrence of the deformity. Thus, in the treatment of patients with such pathology, it is necessary to choose a surgical method that allows achieving optimal results.Purpose of the work was to compare the results of surgical treatment for osteoporotic burst fractures in thoracolumbar vertebral bodies using the developed method and methods of circular and hybrid stabilization based on clinical and radiological criteria.Materials and methods The study was retrospective. Three groups of patients were formed according to the type of surgical intervention. Inclusion criteria were patients with primary osteoporosis who did not receive osteotropic therapy before surgery, with osteoporotic fractures (type OF3 and OF4) of the vertebral bodies of the thoracolumbar location (Th10–L2). The follow-up period was 12 months. The following criteria were assessed: the amount of kyphosis correction (according to the Cobb method), the amount of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period; sagittal balance of the torso (Barrey index), subjective evaluation of the patient’s condition (VAS). Quality of life assessment was not performed.Results There were no statistically significant differences in the dynamics of sagittal balance during the follow-up period between the groups (p &gt; 0.99). There was no difference between groups in clinical outcomes (VAS) at follow-up (p &gt; 0.05). A statistically significant difference in the magnitude of kyphotic deformity and its correction in the specified postoperative periods was revealed between the hybrid fixation groups and the corrective vertebrotomy group. No difference was found with the circular stabilization group.Discussion Due to the high risks of poor outcomes of anterior spinal fusion, in particular, implant subsidence, to avoid anterior spinal fusion, we used a method of focal kyphosis correction and posterior spinal fusion with autologous bone. The method proposed by the authors for the correction of focal kyphotic deformity in the treatment of patients with osteoporotic burst fractures of the vertebral bodies combines satisfactory correction of focal kyphosis with minimal surgical invasiveness, which reduces the risks of complications and poor outcomes. The proposed method may also be combined with hybrid fixation.Conclusion The developed method for focal kyphotic deformity correction in the treatment of osteoporotic burst fractures of vertebral bodies provides satisfactory correction of focal kyphosis, reduces the risks of complications and poor outcomes in comparison with circular and hybrid stabilization.

Posterior Spinal Fusion for Severe Kyphosis in a Child with Gaucher Disease: A Case Report and Review of the Literature

Background: Skeleton involvement is one of the most significant aspects of Gaucher disease (GD). However, the treatment for spinal involvement in GD among patients undergoing enzyme replacement therapy (ERT) is poorly characterized. We present a case of progressive kyphotic spinal deformity in a young child caused by vertebral involvement, which was managed by posterior spinal fusion without anterior spinal release under ERT. Case presentation: This is a retrospective study. A 10-year-old boy presenting with progression kyphosis (thoracic kyphotic angle of 113°) associated with type-IIIb GD had undergone posterior spinal fusion with segmental pedicle screw fixation (from T6-L3) and Ponte osteotomy. The patient went back to school without further brace protection. Proximal junctional kyphosis (PJK) was observed at 4 months postoperatively. Revision surgery was performed to prevent neurological impairment. Additional posterior spinal fusion from T2–T6 and decompressive laminectomy were performed during the revision surgery. A 2-year follow-up showed no recurrence of PJK and solid fusion was achieved in the patient under ERT and brace protection. Conclusions: Posterior spinal fusion without anterior spinal release is a good treatment option for severe spinal deformity in patients with GD. However, the fusion level and reinforced fixation require careful consideration. Revision surgery and brace protection is needed as long as PJK is observed.

Atypical Variants of Spinal Dysraphism: A Case Series

Abstract The aim of this study is to present and discuss atypical instances of spina bifida (SB) within a Nigerian paediatric cohort, highlighting their distinctive clinicoradiological features. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This case series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Amongst these, four cases exhibited segmental spinal dysgenesis (SSD; one thoracolumbar, one lumbar, and two sacral). Each of these cases demonstrated diverse associated musculoskeletal, cutaneous, and perineal anomalies, accompanied by varying degrees of neurological dysfunction. Other cases included lipomyelomeningocele (LMMC), human tail (HT), membranous meningocele, and myeloschisis (MSS). Autonomic dysfunction was a common feature in all of the cases, whilst two of the patients presented with congenital kyphotic spinal deformity. Lower limb anomalies varied, including congenital talipes equinovarus deformity, pes planus, congenital calcaneovagus deformity, rocker bottom feet, clinodactyly, and tetrapolydactyly. Remarkably, none of the patients exhibited clinical features indicative of hydrocephalus. SSD, LMMC, HT, membranous meningocele, and MSS represent atypical forms of SB in the Nigerian paediatric population. Early neuroimaging of patients with suspected spinal dysraphism is crucial, as it may reveal a spectrum of diverse vertebral anomalies associated with this neurological condition within the African population.

Kyphoscoliotic spinal deformities associated with high risk of developing neurological deficits. Literature review

This is a literature review on kyphoscoliotic deformities with a high risk of severe primary neurological deficit. The review is integrative in nature and was conducted using medical literature databases and search resources such as PubMed, Google Scholar, and eLibrary. The following aspects are covered: the etiology and pathogenesis of neurological deficits caused by the natural progression of deformities, the main principles, and directions of surgical treatment for neurologically complicated spinal deformities. The scientific literature describes the primary mechanisms of neurological deficit development: mechanical compression and traction of the spinal cord, as well as impaired circulation at the apex of the deformity. Surgical methods for treating neurologically complicated kyphotic and scoliotic deformities have evolved with advancements in spinal instrumentation and approaches. In the first half of the 20th century, various spinal canal decompression methods were described, including laminectomy, costotransversectomy, spinal cord mobilization, and spinal canal remodeling. In the second half of the 20th century, the development and active use of spinal instrumentation (sublaminar hooks, pedicle screws) enabled simultaneous decompression, fixation, stabilization, and correction of spinal deformities. Combining different stabilization and deformity correction methods with concurrent spinal canal decompression creates the conditions for restoring spinal cord function, leading to a regression of neurological deficits and preventing severe patient disability.

Percutaneous unilateral vertebro-stentoplasty for painful osteoporotic compression fracture of lumbar vertebra

Osteoporosis is one of the common diseases in the elderly population which can cause compression fracture of the vertebral body due to loss of microarchitecture, loss of density, and deterioration of bone tissue leading to chronic pain, kyphotic deformity of the vertebra, and neurological complications. We report the case of a 68-year-old female, who presented to us with severe midback region pain for one year, which was increased over two months along with numbness in the right leg and difficulty in walking. The radiological investigation and magnetic resonance imaging spine revealed chronic compression fracture with the reduction in height of the L1 vertebra, which is seen with anterior wedging. The patient underwent vertebro-stentoplasty (VS) with bone cement, polymethyl-methacrylate. The patient was discharged well on third day of surgery. The VS for compression fracture of the lumbar vertebra demonstrated better results with improvement in pain and radiological finding in our patient.

Endoscopic decompression of severe post-tuberculosis kyphosis related ossification of the ligamentum flavum: case report and literature review.

Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS). A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures. The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage. In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.

Risk predictive score and cord morphology classification for intraoperative neuromonitoring alerts in kyphosis surgery

BACKGROUNDIntraoperative neuromonitoring (IONM) alert is one of the worrying events of kyphosis corrective surgery, which can result in a postoperative neurological deficit. To our knowledge, there is no risk prediction score to predict such events in patients undergoing kyphosis surgery. PURPOSETo develop a new preoperative MRI-based cord morphology classification (CMC) and risk prediction score for predicting IONM alerts in patients with kyphotic deformity. STUDY DESIGNRetrospective analysis of prospectively collected data. PATIENT SAMPLEAbout 114 patients undergoing surgical correction for kyphotic deformity. OUTCOME MEASURESIntraoperative neuromonitoring alerts and postoperative neurological status using AIS grading. METHODSKyphotic deformity patients undergoing posterior spinal fusion were retrospectively reviewed. Based on the morphology of the spinal cord and surrounding CSF in MRI, there are 5 types of cord. Type 1 (normal cord): circular cord with surrounding visible CSF between the cord and the apex, Type 2 (flattened cord): cord with <50% distortion at the apex with obliteration of the anterior CSF; Type 3 (deformed cord): cord with >50% distortion at the apex with complete obliteration of the surrounding CSF; Type 4 (stretched cord): the cord is stretched and atrophied over the apex of the curve. Type 5 (translated cord): horizontal translation of the cord at the apex with buckling collapse of the vertebral column. Preoperative radiographs were used to measure the preoperative sagittal cobbs angle, sagittal deformity angular ratio (S-DAR), sagittal vertical axis (SVA), apex of the curve, and type of kyphosis. Clinical data like the duration of symptoms, clinical signs of myelopathy, neurological status (AIS grade), grade of myelopathy using the mJOA score, and type of osteotomy were documented. Multivariate logistic regression was used to determine the risk factors for IONM alerts and the risk prediction score was developed which was validated with new cohort of 30 patients. RESULTSA total of 114 patients met the inclusion criteria. IONM alerts were documented in 33 patients (28.9%), with full recovery of the signal in 25 patients and a postoperative deficit in 8 patients. Rate of IONM alerts was significantly higher in Type 5 (66%), followed by Type 4 (50%), Type 3 (21.1%), Type 2 (11.1%), and Type 1 (11.1%) (p-value<.001). Based on multiple logistic regression, 7 factors, namely preoperative neurological status, mJOA score≤6, presence of signs of myelopathy, apex of the curve above T5, preoperative sagittal cobbs, S-DAR, and MRI-based CMC, were identified as risk predictors. The value for the risk factors varies from 0 to 4, and the maximum total risk score was 13. The cut-off value of 6 had good sensitivity (84.9%) and specificity (77.8%) indicating a high risk for IONM alerts. The AUC of the predictive model was 0.92, indicating excellent discriminative ability. CONCLUSIONWe developed and validated a risk predictive score that identifies patients at risk of IONM alerts during kyphosis surgery. Identification of such high-risk patients (risk score≥6) helps in proper evaluation and preoperative counselling and helps in providing a proper evidence-based reference for treatment strategies.

Effective method of pedicle screw fixation in patients with neurologically intact thoracolumbar burst fractures: a systematic review of studies published over the last 20 years

ObjectiveTo conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches. MethodsWe conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months. ResultsA total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF. ConclusionsShort-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes.

The effectiveness of a low implant density in Scheurmann kyphosis in correcting the lumbar lordosis -pelvic incidence mismatch

Purpose To evaluate the effectiveness of using a low implant density in surgical treatment of Scheurmann Kyphosis (SK) in correcting the lumbar lordosis (LL)- Pelvic incidence (PI) mismatch. Methods Patients that were surgically treated for SK by a low screw density with multiple Ponte osteotomies at two institutions from January 2021 to January 2022 were identified and included in the study. Preoperative/postoperative/1- and 2-year follow-up measurements were analyzed from full-spine standing radiographs. Results Thirty patients were enrolled in our study, mean age 20.5 (13–37) years, mean preoperative kyphosis was 85.9 (75–108), a mean preoperative lumbar lordosis-pelvic LL-PI mismatch was 25.9 (23–28). The maximum kyphosis was corrected to 46.2 (37–63) and the LL-PI mismatch was reduced to 7.7. The correction was maintained at 1- and 2-years follow-up with no statistical change in the sagittal angles. Conclusion Surgical correction of SK using low-density implants and multiple Ponte osteotomies is an effective method of correcting the kyphotic deformity and reducing the LL-PI mismatch to normal physiological values.

The Role of Spinal Cord Compression in Predicting Intraoperative Neurophysiological Monitoring Events in Patients With Kyphotic Deformity: A Magnetic Resonance Imaging-Based Study.

To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with kyphotic deformity. Patients with kyphotic deformity who underwent surgical correction of cervicothoracic, thoracic, or thoracolumbar kyphosis in our center from July 2005 to December 2020 were recruited. We proposed a classification system to describe the morphology of the spinal cord on T2-weighted sagittal magnetic resonance imaging: type A, circular/symmetric cord with visible cerebrospinal fluid (CSF) between the cord and vertebral body; type B, circular/oval/symmetric cord with no visible CSF between the cord and vertebral body; type C, spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the cord and vertebral body. Furthermore, based on type C, the spinal cord compression ratio (CR) < 50% was defined as the subtype C-, while the spinal cord CR ≥ 50% was defined as the subtype C+. IONM event was documented, and a comparative analysis was made to evaluate the prevalence of IONM events among patients with diverse spinal cord types. A total of 294 patients were reviewed, including 73 in type A; 153 in type B; 53 in subtype C- and 15 in subtype C+. Lower extremity transcranial motor-evoked potentials and/or somatosensory evoked potentials were lost intraoperatively in 41 cases (13.9%), among which 4 patients with type C showed no return of spinal cord monitoring data. The 14 subtype C+ patients (93.3%) had IONM events. Univariate logistic regression analysis showed that patients with a type C spinal cord (subtype C-: odds ratio [OR], 10.390; 95% confidence interval [CI], 2.215-48.735; p = 0.003; subtype C+, OR, 497.000; 95% CI, 42.126- 5,863.611; p < 0.001) are at significantly higher risk of a positive IONM event during deformity correction compared to those with a type A. In further multiple logistic regression analysis, the spinal cord classification (OR, 5.371; 95% CI, 2.966-9.727; p < 0.001) was confirmed as an independent risk factor for IONM events. We presented a new spinal cord classification system based on the relative position of the spinal cord and vertebrae to predict the risk of IONM events in patients with kyphotic deformity. In patients with type C spinal cord, especially those in C+ cases, it is essential to be aware of potential IONM events, and adopt standard operating procedures to facilitate neurological recovery.

Morphological features of lower lumbar degenerative kyphosis.

Kyphosis in the lower lumbar spine (L4-S1) significantly affects sagittal alignment. However, the characteristics of the spinopelvic parameters and compensatory mechanisms in patients with lower lumbar degenerative kyphosis (LLDK) have not been described in detail. The objective of this retrospective study was to analyze the morphological characteristics in patients with sagittal imbalance due to LLDK. In this retrospective study, we reviewed the clinical records of consecutive patients who underwent corrective surgery for adult spinal deformity (ASD) at a single institution. We defined LLDK as (i) kyphotic deformity in lower lumbar spine (L4-S1) or (ii) inappropriate distribution of lordosis (lordosis distribution index < 40%) in the lower lumbar spine. Global spine parameters of ASD patients and MRI findings were compared between those with LLDK (LLDK group) and without LLDK (control group). A total of 95 patients were enrolled in this study, of which the LLDK group included 14 patients (14.7%). Compared to the control, LLDK presented significantly higher pelvic incidence (62.1° vs 52.6°) and pelvic tilt (40.0° vs 33.4°), larger lordosis at the thoracolumbar junction (12.0° vs -19.6°), and smaller thoracic kyphosis (9.3° vs 26.0°). In LLDK, there was significantly less disc degeneration at L2/3 and L3/4. LLDK patients had high pelvic incidence, large pelvic tilt, and a long compensatory curve at the thoracolumbar junction and thoracic spine region.

P.148 Consult and kyphoplasty delay impacts on geriatric vertebral compression fracture outcomes

Background: Vertebral compression fractures (VCF) lead to both considerable morbidity and increased mortality. Kyphoplasty, a minimally invasive surgery, treats VCFs providing significant pain relief, preserving vertebral height, and reducing spinal deformity. Methods: A retrospective cohort study at Hamilton Health Sciences (HHS) was conducted on elderly patients (60 years or older) who underwent kyphoplasty at between 2012 and 2022. The patients had prior hospital admissions under non-spine-related specialties at HHS within two years before their surgery. Primary outcomes were the progression of vertebral height loss and focal kyphotic deformity. Results: The study included 119 patients (52.1% female, mean age 70.71 years). A significant increase in vertebral height loss was observed from diagnosis to pre-kyphoplasty (0.32% change, p &lt; 0.0001) and from diagnosis to post-kyphoplasty (0.24% change, p = 0.015). However, there were no significant correlations between delay times and changes in vertebral height or focal kyphotic deformity. Conclusions: Delays in neurosurgical consultation and kyphoplasty did not significantly affect radiographic outcomes in elderly patients with VCF despite the progression of vertebral height loss. This suggests that while timely patient care is essential, delayed treatment may not adversely affect key radiographic metrics in elderly VCF patients.