Thoracic Lordosis Research Articles

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations.

Background:Scoliosis is the most frequent spinal deformity related to Marfan syndrome (MFS). Treatment with a brace is often ineffective, and surgical treatment is very challenging; many instrumentations were used along the years. Our retrospective study has the purpose of identifying the reliability of different devices in three-dimensional correction of the spine deformities in MFS.Materials and Methods:We reviewed retrospectively the records of patients surgically treated, in a single institution between 1999 and 2016, for spinal deformities in MFS. X-rays were reviewed for analyzing the magnitude of the curves in preoperative time (T0), the amount of correction in the immediate after surgery period (T1), and it's stability at follow-up (FU) (T2). The clinical outcomes were also evaluated with the Scoliosis Research Society 24.Results:A total of 21 patients with a mean age at surgery of 16 years met inclusion and exclusion criteria. Four different construct types were identified: hooks with sublaminar wires (G1), hooks and pedicle screws (G2), pedicle screws (G3), and pedicle screws with sublaminar wires (G4). The mean FU time was 8 years. The average major scoliosis curve had a mean value of 63.48° at T0 and was corrected to 28.81° at T2. Furthermore, minor curve, thoracic lordosis, and lumbar kyphosis (when associated to scoliosis) were also corrected. Student t-test showed significative differences (P < 0.05) for all curves between T0–T1 and T0–T2 while between T1 and T2, no differences were found. We also evaluated separately the results of each instrumentation, and G3 obtained the best performances.Conclusions:Our results shows that screws may guarantee a better correction of the deformities.Level of Evidence:III

Spine’s Sagittal Plane Curves’ Coherence with Anthropometric Parameters in Schoolchildren

The aim of this study — to identify how anthropometric measurements are connected with spine sagittal curves inschoolchildren.Anthropometric and sagittal body posture measurements were performed for 405 schoolchildren, age range 10—13years. Such anthropometric measurements as body height, weight, fat mass and fat free mass were assessed. Degreesof thoracic kyphosis and lumbar lordosis as sagittal profile features were evaluated.According to the data analysis could be concluded, that coherence between anthropometric parameters and spine’ssagittal profile differs according to gender. The number of statistically significant connections between these twoparameters’ groups was greater in boys. Anthropometric measurements had greater coherence with thoracic kyphosisin comparison with lumbar lordosis. Body weight and fat mass were statistically significantly different according tokyphosis and lordosis values in boys, although fat-free body mass had no significant difference with sagittal curves’expression. Body weight, fat mass and fat-free body mass among girls were associated only with thoracic kyphosis.Keywords: thoracic kyphosis, lumbar lordosis, height, weight, fat mass.

Dynamics of Schoolchildren`s Spine Sagittal Curves, Parameters of Cardiovascular System and their Coherence

Objective. We aimed to investigate the peculiarities of cardiovascular system parameters and changes in spine sagittal curves with age in schoolchildren and also possible interrelation between parameters in those two systems. Material and methods. 124 schoolchildren (aged 7—18 years) were divided into three groups according to their age. For evaluation of cardiovascular system the bicycle ergometry test with modified Bruce protocol was performed and computerized functional test analysis system “Kaunas — Load” was used. Load, arterial blood pressure, ECG in 12 standard derivations were synchronously recorded at every step. Evaluation of spine sagittal plane was performed using flexible ruler-cirtometer. Angular values of thoracic kyphosis and lumbar lordosis were measured. Results. Parameters of sagittal spine had few differences according to gender and age. Changes in sagittal plane curves with age were greater in boys than in girls. In the group of boys the expression of both sagittal curves had decreasing tendencies with age. Changes in girls’ sagittal curves were inconsistent with age. However, we found many significant differences in the parameters of cardiovascular system’s depending on gender and age. Different correlations between spinal sagittal curves and cardiovascular parameters according to gender and age could beassociated with different state in musculoskeletal system and development, different physical activity level and manyother factors, which vary among girls and boys and also changes with age. Conclusions. There was no significant difference of lumbar lordosis according to gender in all age groups. The thoracic kyphosis had significant different expression only among boys and girls in 7—10 years age group. We found significant difference of such cardiovascular system parameters as index of health, maximal power, pressure rate index, half recovery period of heart rate and change of double product according to gender. Thoracic kyphosis had more correlations with cardiovascular system parameters than lumbar lordosis. Blood pressure reactions had more correlations with spine sagittal curves in older girls and younger boys.Keywords: sagittal spine curves, cardiovascular system, lumbar lordosis, thoracic kyphosis.

Spinal manifestations in 12 patients with musculocontractural Ehlers-Danlos syndrome caused by CHST14/D4ST1 deficiency (mcEDS-CHST14).

Musculocontractural Ehlers-Danlos syndrome caused by mutations in CHST14 (mcEDS-CHST14) is a recently delineated disorder, characterized by craniofacial, skeletal, visceral, and ocular malformations; and progressive cutaneous, skeletal, vascular, and visceral fragility-related manifestations. Spinal lesions, though one of the most serious complications, have not been investigated systematically. In this study, we report detailed and comprehensive information about spinal lesions of 12 patients with a mean age at the first visit of 13.4 years. Eight patients (66.7%) had scoliosis with a Cobb angle ≥10°, including one with severe scoliosis with a Cobb angle ≥45°. Five patients (41.7%) had kyphosis at the thoracolumbar junction with a kyphotic angle ≥20°. Three patients (25%) developed severe thoracolumbar kyphosis with a kyphotic angle ≥50° accompanied by thoracic lordosis with a wedge-like vertebral deformity and anterior vertebral osteophyte at the thoracolumbar junction, and two of them underwent surgical correction: complicated by fistula formation in one and performed safely and effectively through two-staged operation in the other. Six patients (50.0%) had cervical kyphosis, all of whom except one had kyphosis ≥20° at the thoracolumbar level. Two patients (16.7%) had atlantoaxial subluxation, and 10 patients (83.3%) had cervical vertebral malformations. Patients with mcEDS-CHST14 are susceptible to develop scoliosis, thoracolumbar kyphosis, and cervical kyphosis; and are recommended to have regular surveillance including total spine radiology. The present findings also suggest the critical role of dermatan sulfate in the development and maintenance of the spine.

A case of tetrophthalmia with unilateral synophthalmia in an unborn fetus of blue shark &lt;i&gt;Prionace glauca&lt;/i&gt; (Carcharhiniformes, Carcharhinidae)

This study describes and classifies a case of multiple malformations in an unborn blue shark Prionace glauca fetus, which was extracted from a gravid female captured during a research campaign addressed to the biological study of sharks in northern and central Chile. The analyzed specimen shows tetrophthalmia with unilateral synophthalmia, anomaly characterized by the existence of 4 ocular globes, two of which are partially fused. In addition, the axial skeleton of the fetus shows thoracic lordosis and helical torsion in the abdominal-caudal portion. This is the first world report of tetrophthalmia with unilateral synophthalmia in chondrichthyans.

FEATURES OF IMAGING FINDINGS IN CHILDREN WITH CONGENITAL THORACIC SPINE DEFORMITY ON THE BACKGROUND OF MALSEGMENTATION OF VERTEBRAE LATERAL SURFACE

Purpose — to study alterations in the bony structures in cases of congenital deformity of the thoracic spine combined with malsegmentation of lateral surfaces of vertebrae due to pathological processes during growth period of childern and to find correlation with above alterations.Material and Methods. The study included 30 patients with congenital deformity of thoracic spine combined with malsegmentation of lateral surfaces of vertebrae. age of patients ranged from 3 to 10 years (mean of 7 years). gender distribution — 19 female and 11 male patients. all patients underwent imaging examination including spine roentgenography in two standard views in prone position as well as computer tomography.Results. Magnitude of deformity scoliotic curve was 67° (45–88°) and of pathological thoracic lordosis — 23° (18–27°). Mean number of block vertebral motion segments included into the main deformity curve was 6 (3–8). Mean distance between the outline of lateral vertebral surface and lateral outline of projection of curve root of apical vertebra on convex side of deformity (aB) was 6 mm (4–10 mm). correlation analysis demonstrated that aB distance mostly depended on the number of vertebral motion segments included into the block along non-segmental area: pearson coefficient 0.67. Based on cT scans the authors observed no rotation component of bodies’ deformity along the non-segmental area.Conclusion. Children with congenital thoracic spine deformity along with malsegmentation of lateral surfaces of vertebrae feature pathological lordosis in affected zone. alterations in the bony structures result from asymmetric growth of one half of the vertebral body at the level of non-segmentation. asymmetry severity has a strong correlation dependency from the number of vertebral bodies included in the block along the non-segmental area.

Characteristics of the rigid spine syndrome due to SEPN-1 myopathy. A long-term follow-up series of 21 patients

SEPN-1 related myopathy is a recessive autosomal disorder caused by SEPN1 gene mutations. Patients present homogeneous clinical features, in particular a striking cervico-axial hypotonia and a weakness associated with poor head control. A progressive spinal stiffness and severe restrictive respiratory insufficiency with diaphragmatic failure is observed in the course of the first or second decade. They are described as a “rigid spine syndrome” (RSMD1). The aim of this study was to describe the course of the spinal deformity and the clinical and respiratory complications. We reviewed retrospectively the medical charts of 21 patients with mutations in the SEPN1 gene. Genetic, clinical, radiological (X-rays) and respiratory studies (spirometry) were reviewed and analyzed. Mean age at last follow-up was 23 years (4–55). All patients except one, showed poor weight and height for their age, with a mean body mass index of 13.3 kg/m 2 (8–25). Mechanical ventilation was required in 19 patients (age range 4–15), usually only nocturnally, but in three cases a tracheostomy was performed. Four patients lost walking at a mean age of 28 (12–44). Clinical and radiological examinations were available for 15. Cervical spine stiffness was present in 65% of patients (mean chin–sternum distance in maximal cervical flexion of 7 cm). Scoliosis was observed in 12 (7 spinal translation; 6 pelvic obliquity). Clinically, a thoracic lordosis was observed in 87% of patients, and X-ray showed a flat thoracic spine. Management of the spinal deformity was focused mainly in axial stretching and antilordotic bracing. Two cases developed a severe progressive scoliosis before puberty. Spinal surgery was performed in 15 patients. SEPN1-related myopathy should be suspected in children developing a characteristic stiff and lordotic thoracic spinal deformity associated with a cervical rigidity. Due to constant respiratory complications, these patients require specialized multidisciplinary management.

The natural history of spinal deformity in patients with Coffin-Lowry syndrome

PurposeLittle is known about the natural history of spinal deformities in Coffin-Lowry syndrome (CLS). Our goal was to evaluate the spinal deformity progression and clinical impact.MethodsIn this institutional review board-approved study, we performed a multinational retrospective review of six male CLS patients, aged 13 to 22 years at final follow-up, for a mean of 7.25 years (3 to 13).ResultsAll showed delayed skeletal maturity. Three had calcifications of their lower cervical ligamentum flavum, all experienced neural axis abnormalities, including lower extremity weakness, numbness and tingling and in one, quadriparesis. Only two were ambulatory at final follow-up.All had significant spinal abnormalities, including severe progressive thoracic lordosis, thoracolumbar kyphosis and scoliosis. All had undergone spinal fusion or were being evaluated for surgery.ConclusionCLS is a rare X-linked mutation in the RSK2 gene, affecting between 1/50 000 to 100 000 people. There are two reports in the literature of patients with calcifications of their ligamentum flavum. Both had neural axis abnormalities and one had acute onset quadriplegia. Analysis of their ligamentum flavum found abundant central calcifications. Despite our small cohort we found 50% had calcifications and 100% had neurologic consequences associated with those calcifications. There was a 100% rate of deformity progression.They all exhibited delay in skeletal maturity, which mandates longer follow-up and has implications for surgical planning.From our cohort and literature review, the natural history of CLS supports frequent patient evaluation and a lower threshold for correction of spinal deformities. Aiming to avoid spinal cord compression and improve or avoid neurological deterioration.Level of EvidenceIV - retrospective study

Posterior Vertebral Column Resection (PVCR) for Congenital Thoracic Lordoscoliosis in children under age of 10 with minimum 5 years follow-up

Congenital thoracic lordosis or lordoscoliosis are rare deformities which causes severe cardiopulmonary problems in early ages. PVCR is effective in restoring thoracal kyphosis in treatment of these rare deformities and avoids morbidity of combined surgeries.

Critical Airway Stenosis in an Adolescent Male With Pompe Disease and Thoracic Lordosis

An adolescent male with late-onset Pompe disease (glycogen storage disease type II) presented with a history of restrictive airway disease and a near-cardiorespiratory arrest during anesthesia for a liver biopsy initially thought to be due to bronchospasm. During a subsequent posterior spinal fusion procedure, he suffered cardiorespiratory arrest resulting in the procedure being aborted. Bronchoscopy performed shortly after resuscitation revealed an undiagnosed narrowing of the distal trachea and bronchi. This is the first description of a patient with late-onset Pompe disease with undiagnosed critical tracheal stenosis due to the progression of thoracic lordosis, which was ultimately relieved by posterior spinal fusion.

ANTERIOR INSTRUMENTATION IN SURGERY FOR LUMBAR AND THORACOLUMBAR IDIOPATHIC SCOLIOSIS

Objective. To analyze the long-term results of surgical correction of idiopathic scoliosis in the lumbar and thoracolumbar spine with anterior instrumentation. Material and Methods . A total of 24 patients (mean age - 18.2 years, male/female ratio - 3/21) were operated on using anterior two-rod instrumentation system. The mean operating time was 170 minutes, and the mean blood loss - 374 ml. The average postoperative follow-up period was 50 months. Results . The primary curve was reduced from 48.7° to 14.8°o (69.6 %). Postoperative progression was 6.4°. Thoracic counter-curve underwent self-correction from 27.7° to 14.7°, postoperative progression was 3.0°. The thoracic kyphosis and lumbar lordosis remained within the normal ranges. Rotation of the apical vertebra before the operation was 27.8 %, immediately after the intervention - 17.5 %, at the end of the follow-up period - 17.1 %. Coronal imbalance before surgery was 24.7 mm, immediately after the intervention - 27.5 mm, at the end of the follow-up period - 7.1 mm. The patients’ self-evaluation of treatment outcomes was carried out using the Russian version of the SRS-24 questionnaire. At the first follow-up visit, patients reported expectedly lower postoperative function score and gave middle scores for the remaining domains. Later, there was a positive dynamics in all assessed parameters, most pronounced in pain syndrome, function and overall activity after surgery. Conclusion . Correction of idiopathic scoliosis of lumbar and thoracolumbar localization using anterior instrumentation is a highly effective method of treatment, which in most cases gives a stable positive result. However, the development of pronounced trunk imbalance in some patients requires the continuation of studies in order to optimize the technique for determining the optimal extent of the instrumented fusion.

Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study.

The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands. 35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported. The age of the cohort was 16years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p=0.002 and 4°, p<0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8°±7°, p<0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16°±4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r=0.62). Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases.

Effects of vertebral-body-sparing proton craniospinal irradiation on the spine of young pediatric patients with medulloblastoma

PurposeTo investigate the long-term effects of vertebral-body-sparing proton craniospinal irradiation (CSI) on the spine of young patients with medulloblastoma. Methods and materialsSix children between the ages of 3 and 5 years with medulloblastoma were treated with vertebral-body-sparing proton CSI after maximal safe resection. Radiation therapy was delivered in the supine position with posterior beams targeting the craniospinal axis, and the proton beam was stopped anterior to the thecal sac. Patients were treated with a dose of either 23.4 Gy or 36 Gy to the craniospinal axis followed by a boost to the posterior fossa and any metastatic lesions. Chemotherapy varied by protocol. Radiographic effects on the spine were evaluated with serial imaging, either with magnetic resonance imaging scans or plain film using Cobb angle calculations, the presence of thoracic lordosis, lumbar vertebral body-to-disc height ratios, and anterior-posterior height ratios. Clinical outcomes were evaluated by patient/family interview and medical chart review. ResultsOverall survival and disease free survival were 83% (5/6) at follow-up. Median clinical and radiographic follow-up were 13.6 years and 12.3 years, respectively. Two patients were clinically diagnosed with scoliosis and treated conservatively. At the time of follow-up, no patients had experienced chronic back pain or required spine surgery. No patients were identified to have thoracic lordosis. Diminished growth of the posterior portions of vertebral bodies was identified in all patients, with an average posterior to anterior ratio of 0.88, which was accompanied by compensatory hypertrophy of the posterior intervertebral discs. ConclusionVertebral-body-sparing CSI with proton beam did not appear to cause increased severe spinal abnormalities in patients treated at our institution. This approach could be considered in future clinical trials in an effort to reduce toxicity and the risk of secondary malignancy and to improve adult height.

Adolescent idiopathic scoliosis with Lenke type V and VI curves: possibilities of modern segmental instrumentation

To analyze long-term results of surgical correction and postoperative quality of life in patients with Lenke type V and VI deformities of the spine. Material and Methods. The treatment results of 61 patients (average age 15 years) with Lenke type V–VI spinal deformities and mean follow-up period of 3.3 years were analyzed. The average length of anterior fusion was 12.7 segments. The average length of the primary curve instrumented with pedicle screws was 4.9 segments. Results . The primary curve was 56.6°, after surgical intervention it was reduced to 15.1° (73.3 % correction). Postoperative progression within 3.3 years was 2.1°. Thoracic countercurve was 40.6°, after surgery it was corrected to 15.0° (63.0 % correction). At the final follow-up examination, the thoracic curve was 17.3° (progression 2.3°). Thoracic kyphosis and lumbar lordosis were within the normal ranges. The frontal imbalance was 22.1 mm before surgery and 12.2 mm at the final follow-up examination. The SRS-24 questionnaire data showed a significant score increase in all seven domains. Conclusion . Transpedicular fixation allows achieving a high degree of Lenke type V–VI spinal deformity correction with a stable result and significant improvement in the quality of life of patients.

The Development of a Representative Porcine Early-Onset Scoliosis Model With a Standalone Posterior Spinal Tether

Study DesignIn vivo analysis in a porcine model. ObjectivesTo develop a porcine experimental scoliosis model representative of early-onset scoliosis (EOS) with the use of a radiopaque ultra-high molecular weight polyethylene (UHMWPE) posterior spinal tether. Summary of Background DataLarge animal experimental scoliosis models with substantial growth potential are needed to test new fusionless scoliosis correction techniques. Previously described scoliosis models involve rib procedures, which violate the thoracic cage and affect subsequent corrective procedures. Models omitting these rib procedures have experienced difficulties in producing persistent three-dimensional structural deformities representative of EOS. MethodsScoliosis was induced in 14 immature pigs using an asymmetric posterior radiopaque UHMWPE spinal tether fixated to an offset device at lumbar and thoracic levels. Radiographs were taken at 2-week intervals, and frontal and sagittal Cobb angles were measured. A tether release was performed at the 10-week follow-up, and the animals were observed for another 10 weeks. ResultsFour animals had complications (infections and/or screw breakout) and were excluded from the study. Eight animals developed progressive curves with a mean frontal Cobb angle of 62°. A thoracic lordosis (34°) and a thoracolumbar kyphosis (22°) formed. CT analysis, acquired prior to tether release, showed a mean vertebral rotation of 37° at the apex with a mean vertebral wedge angle of 10°. After tether release, the frontal Cobb angles decreased to 46° at the 20-week follow-up. Sagittal curvature was not substantially affected after tether release. ConclusionsWe describe a large animal scoliosis model, which exhibits a substantial deformity in three planes without the use of rib procedures additional to a posterior spinal tether. The created deformities showed persistence after tether release. With the management of infection and enhancement of instrumentation stability, the creation of a valid model for testing new devices in fusionless scoliosis surgery seems feasible. Level of EvidenceLevel V.

The Thoracic Lordosis Correction Improves Sacral Slope and Walking Ability in Neuromuscular Scoliosis.

Retrospective study. To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.

Myelokyphectomy in Spina Bifida: The Modified Fackler or Sagittal Shilla Technique

Severe focal kyphosis occurs in approximately 5–10% of infants with myelomeningocele with the apex of the curve centered around the second lumbar vertebra. The kyphosis is fixed in nature and is usually associated with a compensatory thoracic lordosis proximally. Indications for surgery include an impaired sitting balance, recurrent skin ulcerations, respiratory depression, and pain. The modified Fackler or sagittal Shilla technique is used to solve these problems in a child of 9 years of age or younger. It combines aspects of both the Shilla technique described by McCarthy and the originally described Fackler technique for myelokyphosis. The specific steps to performing this procedure include (1) exposure of the midthoracic spine to pelvis with dissection around the gibbus, (2) pedicle screw instrumentation at the 2 vertebrae to be joined, (3) Luque wire instrumentation, (4) removal of vertebral bodies, (5) presacral rod insertion through the sacral foramina, (6) cantilevering and fixation of the rods to the pedicle screws, (7) tensioning the rods to the Luque wires, (8) grafting to create a limited apical fusion, and (9) tension-free wound closure. This procedure is associated with good long-term outcomes including an increased and sustained curve correction, decreased overall surgeries, and height gain.

Respiratory Arrest in a Patient with severe Cervical Dystrophic Kyphosis Secondary to Neurofibromatosis Type 1: A Case Report

Background: Cases of severe cervical kyphosis due to neurofibromatosis type 1 (NF1) and requiring tracheal intubation are rare. Dystrophic-type NF1 needs a combination of anterior and posterior spinal fusion, and use of sublaminar tape with rods appears reasonable and safe for posterior corrective spinal surgery in patients with this pathology. Case presentation: A 61-year-old woman with severe cervical kyphosis of 139 presented with sudden respiratory arrest before planned spinal surgery. Two-stage posterior and anterior corrective instrumented fusion using multiple segmental sublaminar tape and rods was performed under spinal cord monitoring. Cervical kyphosis was corrected from 104° to 83° and upper thoracic lordosis was corrected from 70° to 37°. Finally, she underwent additional posterior C1-C2 fusion with transarticular screwing for postoperative atlantoaxial subluxation. Solid bone fusion was demonstrated on 2-year follow-up Computed tomography, correction was maintained for 4 years after first surgery, and respiratory function was improved. Conclusion: Rib cage hypoplasia with upper thoracic lordosis secondary to severe cervical kyphosis can lead to acute-on-chronic respiratory failure. Planned corrective posterior spinal fusion with sublaminar tape, followed by anterior spinal fusion with a fibular strut bone resulted in successful solid bone fusion and improvement of respiratory function.

Retraction note: Comparison of the sagittal profiles among thoracic idiopathic scoliosis patients with different Cobb angles and growth potentials.

Previous studies have demonstrated that pelvic incidence and sacral slope are significantly greater in idiopathic scoliosis patients compared with normal adolescents. However, whether these sagittal parameters are related to the progression of scoliosis remain unknown. The present was designed to determine the differences in the sagittal profiles among thoracic idiopathic scoliosis patients with different potentials for curve progression. Ninety-seven outpatient idiopathic scoliosis patients enrolled from June 2008 to June 2011 were divided to three groups according to different Cobb angles and growth potentials: (1) non-progression of thoracic curve group, Risser sign of 5 and Cobb’s angle < 40°; (2) moderate progression of thoracic curve group, Risser sign of 5 and Cobb’s angle ≥ 40°; and (3) severe progression of thoracic curve group, Risser sign ≤ 3 and Cobb’s angle ≥ 40°. All patients underwent whole spinal anteroposterior and lateral X-ray in standing position, and the sagittal parameters were measured, including thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt. The average thoracic scoliosis Cobb’s angle in the non-progression group was significantly less than that in the moderate progression group (P < 0.01) and severe progression group (P < 0.01), but there was no statistical difference in the average thoracic scoliosis Cobb’s angle between the severe progression group and moderate progression group. The average thoracic kyphosis angle in the severe progression group (9° ± 4°) was significantly smaller than that in the non-progression group (18° ± 6°, P < 0.01) and moderate progression group (14° ± 5°, P < 0.05). No statistical differences were present in the average lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt among the three groups. Thoracic hypokyphosis is strongly related with the curve progression in thoracic idiopathic scoliosis patients, but not pelvic sagittal profiles.

Corrective surgery for Parkinson's disease (PD) deformity following Deep Brain Stimulation (DBS) - Is DBS a last resort?

Spinal deformity related to Parkinson’s disease (PD) is severe. Due to reported high complication rate, some authors reported that PD deformity with no neurological symptoms should not undergo surgery and also reported deep brain stimulation (DBS) should be considered instead of corrective surgery for their postural disorders. However, almost of previous reports did not consider spino-pelvic parameters. If spino-pelvic harmonization is achieved even in PD deformity surgery, there is a possibility of obtaining much better surgical results. We analyzed the surgical results of PD deformity surgery focused in spino-pelvic parameters and we here report minimum two years follow up of PD deformity surgery. Patients and methods Six patients with Parkinson’s deformity following DBS underwent corrective surgery were enrolled this study. Mean age at surgery was 67.8 y.o. and there were 3 men and 3 women. Pelvic incidence, Pelvic tilt, SVA, lumbar lordosis, thoracic lordosis, JOA score were analyzed pre-, and post-surgery. Results