Segmental Pedicle Screw Instrumentation Research Articles

Midterm Outcomes of Multimodal Approach to Treating Severe Scoliosis in Patients With Osteogenesis Imperfecta.

The surgical management of severe scoliosis in patients with osteogenesis imperfecta (OI) is challenging because of curve rigidity, small stature, and inherent bone fragility. This study evaluated the midterm outcomes of our multimodal approach to address these issues, integrating perioperative bisphosphonate therapy, preoperative/intraoperative traction, various osteotomies, segmental pedicle screw instrumentation with cement augmentation, and bone morphogenetic protein-2 application. A single-center retrospective review of 30 patients (average age 14.1 ± 2.2 years; 18 were female) diagnosed with OI and scoliosis was conducted. These patients underwent posterior spinal fusion between 2008 and 2020 and completed a minimum follow-up of 2 years. We measured radiographic parameters at each visit and reviewed the incidence of complications. A mixed-effects model was used to evaluate changes in radiographic parameters from preoperative measurements to the first and latest follow-ups. The patient cohort consisted of 2 individuals with type I OI, 20 with type III, 6 with type IV, and 2 with other types (types V and VIII). Surgical intervention led to a notable improvement in the major curve magnitude from 76° to 36°, with no notable correction loss. In addition, the minor curve, apical vertical translation, lowest instrumented vertebra tilt, and pelvic obliquity were also improved. In the sagittal plane, thoracic kyphosis and lumbar lordosis remained unchanged while thoracolumbar kyphosis markedly improved. Two patients experienced proximal junctional kyphosis with screw pullout, one of whom required revision surgery. One patient developed a superficial infection that was successfully treated with oral antibiotics. No instances of neurologic deficits or cement extravasation were observed. This study demonstrated the effectiveness and safety of our multimodal approach to treating scoliosis in patients with OI, achieving a 53% major curve correction with minimal complications over 2-year follow-up. These findings provide notable insights into managing scoliosis in this population. Level IV (case series).

Pulmonary Function at Minimum 10 Years After Segmental Pedicle Screw Instrumentation for Thoracic Adolescent Idiopathic Scoliosis.

A prospective multi-center cohort study. This study evaluates the 10-year pulmonary function outcomes for patients with structural thoracic adolescent idiopathic scoliosis (Lenke curve types 1-4, 6) after segmental pedicle screw instrumentation. Adolescent idiopathic scoliosis with thoracic curves is associated with reduced pulmonary function preoperatively. It remains unclear how much pulmonary improvement can be obtained using pedicle screw instrumentation at long-term follow-up. Out of 64 consecutively surgically treated patients with thoracic AIS (Lenke 1-4, 6) using pedicle screw instrumentation, 50 (mean age at final FU 14.7 ± 1.9, 44 females) participated in a prospective 10-year follow-up study. They were evaluated using clinical examination, spinal radiographs, and spirometry preoperatively and at 10-year follow-up. The preoperative percentage predicted values were adjusted for the height loss caused by the scoliosis according to curve size. Preoperatively 49% (20/41) had forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) below 80% of the predicted normal values representing pulmonary function impairment. Major curve correction averaged 76% (SD 9%). FVC improved from preoperative 3.29 L (SD 0.78L) to 3.87 L (0.79L) at 10-year follow-up (P<0.001). This improvement averaged 510mL (SD 560mL) in patients having both preoperative and 10-year follow-up measurements available. The percentage predicted values for FVC showed an improvement from 83% preoperatively to 86% at 10-year follow-up (P=0.048). At 10-year follow-up 38% (19/50) of the patients had FVC or FEV1 below 80% of the predicted values. FVC improved by a mean of 510ml from preoperative to 10-year follow-up in patients undergoing pedicle screw instrumentation for thoracic AIS. Despite 76% scoliosis correction and significant improvement of absolute lung volume values, more than one-third of these surgically treated otherwise healthy young adults fulfilled the criteria for pulmonary function impairment at 10-year follow-up. II.

Posterior instrumented correction and fusion of adolescent idiopathic scoliosis

Balanced frontal curve correction with horizontal shoulder levels, restoration of sagittal plane and vertebral derotation with afusion length as short as possible. Curves larger than 40-50° Cobb angle; furthermore age, location, degree of rotation, and sagittal plane deviation have to be considered. Posteriorly, segmental pedicle screw instrumentation with ahigh screw density (80%) and both titanium alloy and cobalt chrome rods. Freehand screw placement under consideration of both natural and deformity-induced pedicle morphology. Correction via reduction screws or instruments. Combined correction technique with rod rotation, segmental screw approximation to the generally concave rod and segmental correction of vertebral translation. Moderate concave distraction and convex compression. If needed, final in situ bending of the rods. Schwab typeI osteotomies; in rigid curves typeII osteotomies. Fusion with local bone, allogenic bone and/or bone substitutes (i.e.,tricalcium phosphate). Intraoperative placement of athoracic epidural catheter for postoperative pain control. Neurological monitoring throughout the procedure. Mobilization on postoperative day1 with focus on pain management and nutrition. Return to school after 4weeks. Physiotherapy after 3months, cycling after 3-6months, and full sport activities after 1year. Frontal curve correction of 60-80%, sufficient sagittal plane correction. Correction of rib hump 40%. Patient satisfaction is high at 95% and long-term revision rates of < 10%.

Health-related quality of life after segmental pedicle screw instrumentation: a matched comparison of patients with neuromuscular and adolescent idiopathic scoliosis

Progressive neuromuscular scoliosis (NMS) often requires a long instrumented spinal fusion to improve health-related quality of life (HRQoL) and sitting balance. Segmental pedicle screw instrumentation improves HRQoL in patients with adolescent idiopathic scoliosis (AIS), but data on NMS is limited. We aimed to assess the impact of spinal fusion on HRQoL in NMS patients. We conducted a retrospective case-control study with prospective data collection of NMS patients undergoing posterior spinal fusion at a tertiary level hospital in 2009-2021. 2 controls with AIS matched for sex and age were selected for each NMS patient. The Scoliosis Research Society-24 (SRS-24) questionnaire was utilized for pre- and postoperative HRQoL assessment. Follow-up time was a minimum of 2 years. 60 NMS and 120 AIS patients were included in the analysis, and the mean age (SD) at operation was 14.6 (2.7) in NMS and 15.7 (2.5) in AIS groups. Total SRS score and all domains showed a significant improvement in NMS patients (p < 0.05). Total SRS score improved more (p < 0.001), while pain score improved less (p = 0.04) in NMS (change [95% CI], 0.31 [0.05-0.58] and 0.55 [0.27-0.81]) compared with AIS (0.01 [-0.10 to 0.12] and 0.88 [0.74-1.03]). Postoperative self-image was significantly better in NMS than in AIS at 2-year follow up (p = 0.01). Pelvic instrumentation reduced improvements in the SRS domains. HRQoL in NMS patients improved significantly after spinal fusion, and these benefits are comparable to those of AIS patients.

Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis.

Comparative cohort study. The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. The mean major curve was 57° preoperatively and 15° at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up ( P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above ( P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total score s than those surgically treated at 10-year follow-ups ( P < 0.001). Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.

Perioperative Risk Factors for Bleeding in Adolescents Undergoing Pedicle Screw Instrumentation for Scoliosis.

Progressive scoliosis eventually leads to extensive spinal fusion surgery, which carries a risk for significant bleeding. Neuromuscular scoliosis (NMS) patients have an additional inherent risk of major perioperative bleeding. The purpose of our research was to investigate the risk factors for measured (intraoperative, drain output) and hidden blood loss related to pedicle screw instrumentation in adolescents, divided into adolescent idiopathic scoliosis (AIS) and NMS patient groups. A retrospective cohort study with prospectively collected data of consecutive AIS and NMS patients undergoing segmental pedicle screw instrumentation at a tertiary level hospital between 2009 and 2021 was conducted. In total, 199 AIS (mean age 15.8 years, 143 females) and 81 NMS patients (mean age 15.2 years, 37 females) were included in the analysis. In both groups, levels fused, increased operative time, and smaller or larger size of erythrocytes were associated with perioperative blood loss (p < 0.05 for all correlations). In AIS, male sex (p < 0.001) and the number of osteotomies correlated with more drain output. In NMS, levels fused correlated with drain output, p = 0.00180. In AIS, patients' lower preoperative MCV levels (p = 0.0391) and longer operation times, p = 0.0038, resulted into more hidden blood loss, but we did not find any significant risk factors for hidden blood loss in NMS patients.

A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis

BackgroundProgressive scoliosis in neuromuscular patients often requires a long instrumented spinal fusion. Previous studies have shown larger intraoperative blood loss in these patients than those with adolescent idiopathic scoliosis (AIS), but the total blood loss composed of visible and hidden blood loss has not been described in this patient population. The aim of our study was to investigate the bleeding characteristics and hidden blood loss related to spinal fusion in neuromuscular scoliosis (NMS) as compared to AIS patients. MethodsA retrospective cohort study with prospective data collection of NMS patients undergoing segmental pedicle screw instrumentation at a university hospital between 2009 and 2021. A comprehensive statistical analysis was performed regarding intra- and postoperative blood loss compared to patient characteristics such as age and diagnosis. Hidden blood loss was estimated and compared to the total blood loss. We standardized amount of bleeding with patient weight and fusion level for further analysis. Consecutive AIS patients served as a control population. Eighty-one consecutive patients with NMS (mean age 15.2 years, 37 females) were included and their bleeding characters were compared with 199 AIS patients (mean age 15.8 years, 143 females). The primary outcome was total blood loss including intraoperative, 24-hour drain output and hidden blood loss. Secondary outcome measures included requirement for blood transfusion. ResultsNeuromuscular patients had a significantly larger total blood loss with mean values of 1914 mL in the NMS and 1357 mL in the AIS groups, respectively (p<0.001). The hidden blood loss was also significantly larger in NMS than in AIS group (566 ± 533 mL vs. 398 ±411 mL, p=0.0332). Neuromuscular scoliosis was also associated with significantly greater weight and levels of fused adjusted intraoperative bleeding (1.79 ml/kg/fused level in NMS vs. 0.87 ml/kg/fused level in AIS vs. p< 0.0001) and hidden blood loss (1.00 ml/kg/levels fused vs. 0.65 ml/kg/fused levels, p=0.053). NMS diagnosis was also a risk factor for greater hidden blood loss in multivariable analysis (p=0.0011). 24-hour drain output was similar in the NMS and AIS groups. Male gender was a risk factor for greater hidden blood loss in the NMS group (p=0.0429). Fifty-nine (73%) NMS and 27 (14%) AIS patients received allogenic red blood cell infusions perioperatively (p<0.001). ConclusionsHidden blood loss constitutes one-third of total blood loss in children undergoing segmental pedicle screw instrumentation for neuromuscular scoliosis. Hidden blood loss is significantly greater in the neuromuscular as compared with idiopathic scoliosis. Hidden blood loss should be considered in the perioperative management of NMS.

Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial.

The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. Leaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain.Cite this article: Bone Joint J2022;104-B(9):1067-1072.

Back pain and quality of life 10 years after segmental pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS). Comparison to age and gender matched untreated AIS patients and healthy controls

Back pain and quality of life 10 years after segmental pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS). Comparison to age and gender matched untreated AIS patients and healthy controls

Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5.

Intraoperative traction has shown improved curve correction in neuromuscular scoliosis surgery. It is found to be superior to anterior release in terms of correction of both main curve and pelvic obliquity. No previous study has examined the effect of intraoperative traction in patients without pelvic fixation. This retrospective study included 40 non-ambulatory (GMFCS 4 or above) patients with neuromuscular scoliosis undergoing surgery with bilateral segmental pedicle screw instrumentation to L5. Twenty-two consecutive patients had intraoperative Gardner-Wells tongs and skin traction (traction group), while the remaining did not (non-traction group). Inclusion criteria were minimum 2-year follow-up, complete medical records and radiographs. Main curve (MC), pelvic obliquity (POB), T1 tilt, kyphosis, rotation, coronal and sagittal balance and preoperative bending radiographs were measured and analyzed in all patients. Both groups demonstrated roughly 60% MC correction. Preoperative MC was larger in the traction group [97° (49-126) vs. 83° (40-134); P = 0.03]. The measured correction index was almost twice as large in the traction group (1.9 vs. 1.1; P = 0.001). Mean [IQR] 2-year POB was 14° [7-40] in the traction group compared to 16° [4-60] in the non-traction group (P = 0.59). Eleven patients (50%) in the traction group compared to only four (22%) in the non-traction group had a POB within 10° at 2-year follow up (RR: 2.1; 95% CI 0.8-5.2). We found no difference in kyphosis or remaining radiographic parameters. No traction-related complications were recorded. In patients with neuromuscular scoliosis undergoing instrumented fusion to the L5, we found that intraoperative traction increased the degree of MC correction and patients were more likely to achieve POB below 10° without any effects on sagittal parameters or without any detectable significant reduction on rotation.

UNSTABLE LUMBAR FRACTURE-DISLOCATION TREATED BY LONG SEGMENT POSTERIOR PEDICLE SCREW INSTRUMENTATION

Background: Among all the thoracolumbar fractures, 50-60% affects the thoracolumbar transitional zone, and 51% AO Type C Fractures has a neurological deficit. We experienced treating a case of unstable lumbar fracture-dislocation treated with long segment pedicle screw instrumentation.Case: A 26-year-old man came to the ER after his back hit by a canopy while working 2 hours before admission. The motoric function was diminished from the L2-S1 level and hypoesthesia at the T12 level. Plain X-Ray showed Fracture-Dislocation Lumbar Vertebral 1-2 Denis Classification Flexion Rotation (AO Type C) ASIA A. The patient underwent reduction, decompression, and long-segment posterior pedicle screw instrumentation.Discussion: The surgery’s primary purpose is to restore alignment and stability to improve the patient’s quality of life by enabling daily activity in a wheelchair without significant pain. Short segment or long segment pedicle screw instrumentation remains a debate. In this case report, we apply long segment pedicle screw instrumentation for lumbar vertebral fracture-dislocation.Conclusion: Thoracolumbar fracture and dislocation fixation aim to restore alignment and stability, to reduce kyphotic deformity, and to decompress the spinal canal. The long segment pedicle screw instrumentation can resist the deforming force of thoracolumbar fractures and dislocations that will inevitably collapse into further kyphosis, resulting in a better outcome.

Idiopathic Scoliosis in Children and Adolescents: Emerging Techniques in Surgical Treatment

Idiopathic scoliosis is the most common spinal disorder in the pediatric population. The goals of treatment for pediatric idiopathic scoliosis are to correct deformity, prevent curve progression, restore trunk symmetry and balance, and minimize pain and morbidity. Surgical treatment has advanced significantly, from the advent of segmental pedicle screw instrumentation several decades ago to the recent development of robotic-assisted surgery and growth-modulating fusionless surgery. The objective of the present study was to review the reported data on emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. The PubMed and Google Scholar electronic databases were used to identify studies that had examined new emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents. Major developments in the surgical techniques for pediatric idiopathic scoliosis have included robotic-assisted pedicle screw placement, vertebral body stapling, vertebral body tethering, magnetically controlled growing rods, ApiFix (not currently approved for use in the United States by the Food and Drug Administration), and sublaminar polyester bands. Such growth-modulating fusionless surgical techniques have received increasing attention in recent years, especially for the younger pediatric scoliosis population with significant growth potential remaining. Various emerging techniques in the surgical treatment of idiopathic scoliosis in children and adolescents have demonstrated promising results in the reported data thus far. However, longer term prospective studies with larger cohorts are necessary to better evaluate their safety and efficacy.

Comparison of Circular and Sagittal Reinforced Rod Options on Sagittal Balance Restoration in Adolescents Undergoing Pedicle Screw Instrumentation for Idiopathic Scoliosis

Pedicle screw instrumentation is widely used for spinal deformity correction and fusion in adolescents for idiopathic scoliosis. The goal is to achieve and sustain good alignment in all 3 planes. We compared 2 different cobalt-chromium (CoCr) rod designs with different stiffnesses with regard to the restoration of coronal and sagittal balance in adolescents operated on for idiopathic scoliosis. A prospective comparative study was made of 90 consecutive adolescents, mean age (standard deviation) 15.6 years (2.1 years), with idiopathic scoliosis who underwent posterior spinal fusion by the use of bilateral segmental pedicle screw instrumentation (PSI) with 6.0 Co-Cr rods. Fifty-four adolescents (43 girls) were operated on by the use of circular rods and 36 (27 girls) by the use of sagittal reinforced rods, with a 2-year follow-up. Preoperative major coronal curves were similar and at 2 years: 11° (5.0) and 17° (7.2) with correction percentages of 78% (10) and 69% (12) in the circular and reinforced rod groups (P < 0.01). Thoracic kyphosis at 2 years measured 16° (7) and 21° (6) in the circular and reinforced rod groups (P < 0.01). The number of patients with hypokyphosis was lower in the reinforced rod group at 2 years (P= 0.02). In the reinforced rod group, there was a negative correlation between coronal correction and thoracic kyphosis (r=-0.52, P < 0.01). Both circular and sagittal reinforced 6.0-mm CoCr rods provide adequate coronal correction for adolescents with idiopathic scoliosis. The use of sagittal reinforced rods provided better thoracic kyphosis restoration and a lower risk for postoperative hypokyphosis.

Segmental Pedicle Screw Instrumentation and Fusion Only to L5 in the Surgical Treatment of Flaccid Neuromuscular Scoliosis.

A retrospective cohort study was performed. The purpose of this study was to determine the efficacy and safety of stopping segmental pedicle screw instrumentation constructs at L5 in the treatment of neuromuscular scoliosis. Duchenne muscular dystrophy and spinal muscular atrophy are flaccid neuromuscular disorders in which gradual deterioration is the hallmark and have a lot of characteristics in common despite differences in etiology. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of flaccid neuromuscular scoliosis and recommended to correct pelvic obliquity. However, the caudal extent of instrumentation and fusion in the surgical treatment of flaccid neuromuscular scoliosis has remained a matter of considerable debate and there have been few studies on the use of segmental pedicle screw instrumentation for flaccid neuromuscular scoliosis. From 2005 to 2007, a total of 27 consecutive patients with neuromuscular disorders (20 Duchenne muscular dystrophy and 7 spinal muscular atrophy), aged 11 to 17 years, underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. Minimum 2-year follow-up was required for inclusion in this study. Twenty patients were enrolled in this study. No patient was lost to follow-up. All patients had L5 tilt of less than 15° and a coronal curve with apex L2 or higher preoperatively. Preoperative coronal curve averaged 70° (range: 51°-88°), with a postoperative mean of 15° (range: 5°-25°) and 17° (range: 6°-27°) at the last follow-up. The pelvic obliquity improved from 15° (range: 9°-25°) preoperatively to 5° (range: 3°-8°) postoperatively and 6° (range: 3°-8°) at the last follow-up. The L5 tilt improved from 9° (range: 2°-14°) preoperatively to 2° (range: 0°-4°) postoperatively and 2° (range: 0°-5°) at the last follow-up. Physiologic sagittal plane alignment was recreated after surgery and maintained long-term. There was no significant loss of correction of coronal curve and pelvic obliquity. There was no major complication. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with flaccid neuromuscular scoliosis with apex L2 or higher and minimal L5 tilt of less than 15°. Segmental pedicle screw instrumentation ending at L5 offered the ability to correct spinal deformity and pelvic obliquity initially, intermediate and even long-term, with no major complications. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of flaccid neuromuscular scoliosis. N/A.

Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &amp;gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.&lt;/p&gt;

Nonunion of Traumatic Lumbar Fracture: Case Report

Nonunion of flexion-distraction thoracolumbar fractures has few been described previously. The case report discussed a case of nonunion of traumatic lumbar fracture. A 30-year-old man suffered a traumatic L1-2 flexion-distraction fracture and no paraplegia. After complete bed rest 2 months, then hyperextension thoracolumbar cast 3 months, he still felt back pain when out-of-bed activity. X-ray images demonstrated the fracture was not united. At last, the patient underwent open reduction of the fracture nonunion and L1-2 posterior fusion using short segmental pedicle screw instrumentation with autogenous iliac crest graft. The patient gained an excellent functional restoration at 5 months after operation. This suggests that the disease entity may require surgical treatment as early as possible. Spinal fusion combined instrumentation fixation and bone graft may be the best treatment.

Comparison of Shoulder Balance between Rod Derotation and Rod Derotation with Direct Vertebral Rotation in Double Thoracic Adolescent Idiopathic Scoliosis

Introduction There is no report on the effect of DVR on the shoulder balance using segmental pedicle screw instrumentation in the treatment of double thoracic adolescent idiopathic scoliosis (AIS) with minimum 5-year follow-up. This study is to evaluate the shoulder balance resulting from the correction of double thoracic AIS comparing rod derotation (RD) with direct vertebral rotation (DVR) and RD only following pedicle screw instrumentations. Materials and Methods Double thoracic AIS patients ( n = 57) were treated by fusing both thoracic curves with RD and DVR ( n = 35), or RD ( n = 22) methods and retrospectively studied with a minimum 5 years follow-up. Results In the RD with DVR group, the preoperative PT curve of 40.2 degrees improved to 17.9 degrees postoperatively and 19.9 degrees at last follow-up. In the RD group, the preoperative PT curve of 37.5 degrees improved to 22.4 degrees postoperatively and 23.2 degrees at last follow-up. In the RD with DVR group, the preoperative DT curve of 56.6 degrees improved to 16.1 degrees postoperatively and 16.7 degrees at last follow-up. In the RD group, the preoperative DT curve of 50.6 degrees improved to 17.8 degrees postoperatively and 18.2 degrees at last follow-up. In the RD with DVR group, the average preoperative SHD of 16.3 mm was improved to 7.2 mm postoperatively and was 7.0 mm at last follow-up. In the RD group, the average preoperative SHD of 15.1 mm was changed to 7.5 mm postoperatively and was 7.3 mm at last follow-up. Conclusion Shoulder balance was not significantly improved even with additional correction method of DVR using segmental pedicle screw instrumentation in double thoracic AIS. The PT curve was rigid and corrected less in both groups. Therefore, less correction of the DT curve effectively achieves better shoulder balance.

Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation.

Background:Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury.Materials and Methods:A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly.Results:Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup.Conclusion:Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

How to improve shoulder balance in the surgical correction of double thoracic adolescent idiopathic scoliosis.

A retrospective comparative study. To evaluate the shoulder balance resulting from the correction of double thoracic adolescent idiopathic scoliosis (AIS) comparing rod derotation (RD) with direct vertebral rotation (DVR) and RD only after pedicle screw instrumentations. This is the first report on the effect of DVR on the shoulder balance using segmental pedicle screw instrumentation in the treatment of double thoracic AIS with minimum 5-year follow-up. Patients with double thoracic AIS (n = 57) were treated by fusing both thoracic curves with RD and DVR (n=35), or RD (n=22) methods and retrospectively studied with a minimum 5 years of follow-up. In the RD with DVR group, the preoperative proximal thoracic curve of 40.2° improved to 17.9° postoperatively and 19.9° at the last follow-up. In the RD group, the preoperative proximal thoracic curve of 37.5° improved to 22.4° postoperatively and 23.2° at the last follow-up. In the RD with DVR group, the preoperative distal thoracic curve of 56.6° improved to 16.1° postoperatively and 16.7° at the last follow-up. In the RD group, the preoperative distal thoracic curve of 50.6° improved to 17.8° postoperatively and 18.2° at the last follow-up. In the RD with DVR group, the average preoperative shoulder height difference of 16.3 mm had improved to 7.2 mm postoperatively and was 7.0 mm at the last follow-up. In the RD group, the average preoperative shoulder height difference of 15.1 mm had changed to 7.5 mm postoperatively and was 7.3 mm at the last follow-up. Shoulder balance had not significantly improved even with additional correction method of DVR using segmental pedicle screw instrumentation in double thoracic AIS. The proximal thoracic curve was rigid and corrected less in both groups. Therefore, less correction of the distal thoracic curve effectively achieves better shoulder balance. 3.

Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.