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Background Context: Many different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior and posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion, was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis.Purpose: We aimed to compare the clinical results of APSF and APVCR for severe and rigid scoliosis.Study Design: This is a retrospective, one-center, institutional review board-approved study.Patient Sample: A total of 48 patients with severe and rigid scoliosis treated by APSF or APVCR were enrolled.Outcome Measures: Comparisons between groups were made regarding the following variables: age at surgery, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, follow-up duration, different radiological parameters, complication rate, and Scoliosis Research Society (SRS)-22 scores.Methods: According to the operating technique, 48 patients with severe and rigid scoliosis were divided into two groups. In the first group, 26 patients were treated by APSF. In the second group, 22 patients were treated by APVCR. All patients had a minimum 2-year follow-up. The radiographic parameters as well as anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, complication rate, and demographic data were analyzed.Results: There was no significant difference in age, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, and follow-up between the two groups. The APVCR group had longer operation and hospitalization time, and more blood loss. There was no significant difference in the preoperative main curve between the two groups, but the APVCR group had smaller main curve at postoperation and final follow-up, and higher correction rate at immediate postoperation and final follow-up. There was no significant difference in the preoperative, postoperative, and final follow-up thoracic kyphosis, and coronal and sagittal balance between the two groups. There was no significant difference in complication rate between the two groups. Analysis of the preoperative SRS-22 questionnaire revealed no difference between the two groups. At final follow-up, APSF and APVCR groups had similar scores in the function, pain, self-image, mental health, and satisfaction with the treatment domains.Conclusions: Compared with APSF, treating severe and rigid scoliosis by APVCR means longer operation and hospitalization time, and more blood loss, but it allows better correction rate of main curve. Furthermore, SRS-22 questionnaire improvement scores were similar for both correction methods. [ABSTRACT FROM AUTHOR]

Abstract: Background context: To date, there are no clinical series documenting the treatment of severe and rigid scoliosis in patients with low body weight. To optimize curve correction and minimize the risk of complications, we performed a two-stage vertebral column resection (VCR) with posterior pedicle screw instrumentation to treat patients with severe and rigid scoliosis and low body weight. Purpose: The purposes of this study were to report the results of a two-staged VCR for patients with severe and rigid scoliosis and low body weight. Study design: This was a prospective, longitudinal, and descriptive study with a minimum follow-up of 2 years. Patient sample: Sixteen patients (nine women and seven men) with severe and rigid scoliosis and low body weight from the department of orthopedics, West China hospital, Sichuan University. Outcome measures: Clinical analysis included rib hump and lumbar hump. Radiographic analysis consisted of Cobb angle measurements of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis. All measurements were taken before surgery, after surgery, and in the final follow-up period. Methods: For evaluation of surgical effectiveness, comparative analysis of rib hump, lumbar hump, Cobb angle of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis before operation, after operation, and at the most recent follow-up was done. Results: The body weight of patients averaged 33.8 kg (range 27–40 kg). Mean operating time was 580.3 minutes, with a blood loss of 1,581.3 mL. The correction rates of rib hump and lumbar hump were 77% and 85%. Preoperative major curves ranged from 90° to 130° Cobb angle. Coronal plane correction of the major curve averaged 70.7%, with an average loss of correction of 1.8%. The apical vertebral translation of the major curve was corrected by 73.2%. The preoperative coronal imbalance of 0.6 cm (range 0–1.4 cm) was improved to 0.5 cm (range 0–1.4 cm) at the most recent follow-up. The preoperative sagittal imbalance of 0.9 cm (range −3.1 to 4.6 cm) was improved to 0.8 cm (range −1.0 to 3.0 cm) at the most recent follow-up. The preoperative thoracic kyphosis of 50.1° (range 6°–86°) was corrected to 28.9°±7.7° (range 18°–42°) at the most recent follow-up. The preoperative lumbar lordosis of −57.9° (range −85° to −32°) was corrected to −49.0° (range −62° to −40°) at the most recent follow-up. Complications were encountered in two patients. One patient required ventilator support for 12 hours after anterior surgery. Malposition of one pedicle screw was found in one patient. There were no neurologic complications or any deep wound infections. No complication of instrumentation was found at final follow-up. Conclusions: The use of two-stage VCR for patients with severe and rigid scoliosis and low body weight can achieve a good correction of scoliosis without serious complications. [Copyright &y& Elsevier]

Cage subsidence after lumbar fusion can lead to many adverse outcomes. Low bone mineral density (BMD) is a widely recognized risk factor for cage subsidence. Conventional methods can predict and evaluate BMD, but there are many shortcomings. Recently, MRI-based assessment of bone quality in specific parts of the vertebral body has been proposed, including scores for vertebral bone quality (VBQ) and endplate bone quality (EBQ). However, the predictive accuracy of the two scoring systems for cage subsidence after transforaminal lumbar interbody fusion (TLIF) remains unknown. Therefore, we investigated MRI-based VBQ and EBQ scores for assessing bone quality and compared their predictive value for cage subsidence after TLIF. To compare the predictive value between MRI-based VBQ and EBQ scores for cage subsidence after TLIF. A retrospective case-control study. Patients with degenerative lumbar diseases underwent single-level TLIF at our medical center between 2014 and 2020, all of whom had preoperative MRIs available. Cage subsidence, disc height, VBQ score, EBQ score, upper and lower vertebral body bone quality (UL-VBQ) score. Data were retrospectively examined for a consecutive sample of 346 patients who underwent TLIF at our medical center between 2014 and 2020. Patients who subsequently experienced cage subsidence or not were matched to each other based on propensity scoring, and the two matched groups (52 patients each) were compared using conditional logistic regression to investigate the association between the potential radiographic factors and cage subsidence. Scores for VBQ and EBQ were assessed for their ability to predict cage subsidence in the matched patients based on the area under the receiver operative characteristic curve (AUC). Among matched patients, those who suffered cage subsidence had significantly higher VBQ score (3.7 vs 3.1, p<.001) and EBQ score (5.0 vs 4.3, p<.001), and regression linked greater risk of subsidence to higher VBQ score (OR 4.557, 95% CI 1.076–19.291, p=.039) and higher EBQ score (OR 5.396, 95% CI 1.158–25.146, p=.032). A cut-off VBQ score of 3.4 predicted the cage subsidence among matched patients with an AUC of 0.799, sensitivity of 84.6%, and specificity of 69.2%. A cut-off EBQ score of 4.7 predicted subsidence with an AUC of 0.829, sensitivity of 76.9%, and specificity of 82.7%. Higher VBQ and EBQ scores are associated with a greater risk of cage subsidence following TLIF, and EBQ may perform better because of greater specificity. [ABSTRACT FROM AUTHOR]

Background Context: Minimally invasive lateral lumbar intervertebral fusion (LLIF) procedure has been reported as a feasible alternative to the traditional anterior approach for patients with lumbar tuberculosis. However, there is still no study in the existing literature comparing LLIF to traditional surgeries in the treatment of such patients.Purpose: To evaluate the clinical, radiological, and functional outcomes of LLIF versus the traditional anterior approach for treating localized lumbar tuberculosis.Study Design: Retrospective case-control study.Patient Sample: A total of 60 patients with single-level localized lumbar tuberculosis.Outcome Measures: The outcome parameters included incision length, operation time, blood loss, complications, segmental lordosis, fusion status, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), and Oswestry Disability Index (ODI).Methods: We matched 20 patients treated by LLIF with 40 patients undergoing traditional anterior surgery (ratio, 1:2) by age, sex, lesion level, and radiographic features. The LLIF group consisted of 12 men and eight women with a mean age of 42.2±11.1 years, while the traditional group consisted of 22 men and 18 women with a mean age of 40.0±14.5 years. Both the demographics and radiographic data were reviewed. Pre- and postoperative segmental lordosis Cobb angle was measured on lateral X-ray films, while fusion status was assessed on computed tomography scans. The VAS and ODI were used to evaluate functional outcomes.Results: The average follow-up was 24 months in the LLIF group and 39 months in the traditional group. Incision length, operation time, and blood loss were significantly less in the LLIF group than in the traditional group. A similar improvement in segmental lordosis after operation was found in both groups. There was no significant difference between the two groups in neurological recovery, blood infection markers (ESR, CRP), functional outcome, or fusion rate, except for the postoperative VAS score, which was significantly lower in the LLIF group than in the traditional group (2.7±1.0 vs. 3.6±1.0, p=.003). Four patients in the traditional group received a transfusion and 4 patients had a superficial wound infection, while no patient in the LLIF group received a transfusion or experienced any infection; however, the difference between the two groups was not statistically significant (p=.291).Conclusions: Both LLIF and traditional anterior surgery are sufficient for treating patients with localized lumbar tuberculosis, but the LLIF approach results in significantly shorter operation time and less blood loss. [ABSTRACT FROM AUTHOR]

Cage subsidence following transforaminal lumbar interbody fusion (TLIF) has closely correlated with poor vertebral bone quality. Studies have shown better predictive value for cage subsidence by measuring bone density at specific site. However, few studies have been performed to examine the relationship between site-specific MRI bone assessment and cage subsidence in patients who have undergone lumbar interbody fusion. The association between MRI-based assessment of endplate bone quality and cage subsidence after TLIF remains unclear. To study the predictive value of MRI-based endplate bone quality (EBQ) score for cage subsidence following TLIF, using QCT bone densitometry as a reference standard. A retrospective study. A total of 280 adult patients undergoing single-segment TLIF for degenerative lumbar spine disease from 2010 to 2020 at our institution who had preoperative T1-weighted MRIs. Cage subsidence, disc height, endplate bone quality (EBQ) score, bone mineral density, fusion rate. The retrospective study reviewed patients who underwent TLIF at one institution between March 2010 and October 2020. Cage subsidence was measured with postoperative lumbar X-rays based on the cage protrusion through into the superior or inferior end plate or both by more than 2 mm. The EBQ score was measured from preoperative T1-weighted MRI in accordance with the previously reported method. Cage subsidence was observed in 42 of the 280 patients. Bone densitometry with quantitative computed tomography was visibly reduced in the subsidence group. The mean EBQ scores of the lumbar endplate bone was 4.3±0.9 in nonsubsidence and 5.0±0.6 in subsidence. On multivariate logistic regression, the difference between the two groups was remarkable. Risk of cage subsidence increases significantly with higher EBQ scores (odds ratio [OR]=2.063, 95% confidence interval [CI] 1.365–3.120, p=.001) and was an independent factor in predicting subsidence after TLIF. On receiver operating characteristic curve, the AUC for the EBQ score was 0.820 (95% confidence interval [CI]: 0.755–0.844) and the most suitable threshold for the EBQ score was 4.730 (sensitivity: 76.2%, specificity: 83.2%). Higher EBQ scores measured on preoperative MRI correlated significantly with cage subsidence following TLIF. Performing EBQ assessment prior to TLIF may be a valid method of predicting the risk of postoperative subsidence. [ABSTRACT FROM AUTHOR]

Background Context: Atlantoaxial fixation with C1 lateral mass-C2 translaminar bicortical (C1LM-C2TB) screws has been reported to afford good stability with the least risk of injury to vertebral artery. However, no comparative in vitro studies have been conducted to evaluate the biomechanical stability of this method.Purpose: This study aimed to compare in vitro biomechanics of fixation with C1LM-C2TB with fixation with C1 lateral mass-C2 translaminar unicortical screws (C1LM-C2TU) and with C1 lateral mass-C2 pedicle screws (C1LM-C2PS).Study Design: This is an in vitro biomechanical study.Methods: Fifteen fresh-frozen human cadaveric cervical spines (C1-C3) were tested after destabilization by transverse-alar-apical ligament disruption. Instrumentation was performed with three fixation constructs: C1LM-C2PS, C1LM-C2TU, and C1LM-C2TB. Flexion, extension, lateral bending, and axial rotation were tested. Range of motion and neutral zone pre-fatigue and post-fatigue values were measured.Results: No significant differences were observed in flexion-extension among the three groups. However, C1LM-C2TB fixation was superior to C1LM-C2TU fixation in lateral bending and axial rotation.Conclusion: C2 translaminar bicortical screws are biomechanically superior to C2TU screws for fixation of the atlantoaxial complex, and it is equivalent to C2PS fixation. C2 translaminar bicortical screws or C2PS should be preferred over C2TU screws. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Isolated tuberculosis (TB) of posterior elements of the cervical spine is extremely rare. Only few cases are reported in literature, but none describe isolated spinous process and laminae involvement without TB in any other part of the body. Purpose: To report a case of isolated TB involvement of the spinous process and right laminae of C2 combined with atlantoaxial luxation. Study design: A case report of isolated spinous process and right laminae TB of C2 combined with atlantoaxial luxation. Patient sample: A 20-year-old male farmer complained about a 2-month history of aggravating neck pain, a 1-month history of a slowly growing lump at the back of the neck, and numbness and weakness of the right arm that had gradually progressed to involve all the limbs for 2 weeks before presentation. Outcome measures: X-ray and computed tomography of cervical spine and Frankel grading of neural function are included to evaluate the therapeutic efficiency. Methods: Computed tomography scans showed flake-like bony destruction located in the spinous process and at the right laminae of C2. Magnetic resonance imaging (MRI) showed a large swelling posterior to C2 and atlantoaxial luxation-induced distinct compression of the spinal cord. The patient underwent 2 weeks of skull traction and quadruple anti-TB treatment before surgery. Results: The patient underwent surgical treatment that included posterior radical debridement, decompression, internal fixation with a screw-rod system from C1 to C4, autologous bone grafting, and fusion. The patient gained normal neural function and returned to work 1 year after surgery. Conclusions: Tuberculosis of the posterior elements of the upper cervical spine is very rare and potentially dangerous. Computed tomography and MRI are very useful and important for correct diagnosis. Prompt medical and surgical treatment may avert potential catastrophic event in these cases. [Copyright &y& Elsevier]

Background Context: Posterior hemivertebra resection with short fusion has gradually become the mainstream treatment for the congenital scoliosis due to single fully segmented hemivertebra. A kind of unexpected emerging S-shaped scoliosis was found secondary to this surgery, and that has not been reported yet.Purpose: The aim of the present study was to analyze the possible pathogenesis, clinical feature, and treatment of the emerging S-shaped scoliosis after posterior hemivertebra resection and short fusion.Study Design: This study is a retrospective case series.Patient Sample: A total of 128 patients participated.Outcome Measures: Preoperative and postoperative whole spine radiographs were used to measure the Cobb angle of main curve, compensatory curve, and emerging curves. And the hemivertebra location, the fused segment, the apical and ending vertebrae of postoperative-emerging curve (and preoperative compensatory curves) were assessed.Methods: Both the demographics and radiographic data were reviewed. Postoperative-emerging scoliosis was defined as the curve with an increasing angle of 20° and an apical vertebra locating at least two levels away from fusion region.Results: Of the 128 patients, 9 (7%) showed postoperative-emerging S-shaped scoliosis. The mean age was 11.4 years old. The mean main curve was 36.1±14.4° preoperatively and been significantly corrected to 6.9±6.1° (p<.001). No significant difference was found in the main curve, kyphosis, coronal balance, or sagittal balance during follow-up. The emerging scoliosis occurred at 3 months (in four patients) or 6 months (in five patients) after initial surgery with an average angle of 42.6±12.9° at last follow-up. All patients underwent bracing or observation when the S-shaped scoliosis was arising, and four patients underwent a revision surgery because of deformity developing.Conclusions: The emerging S-shaped scoliosis was an extraordinary complication that may be developing from the preoperative compensatory scoliosis and usually occurred at 3-6 months after hemivertebra resection. The feature of these curves was similar to the adolescent idiopathic scoliosis (AIS) and brace or revision surgeries were suitable for therapy. [ABSTRACT FROM AUTHOR]

Background Context: Treatment guidelines for severe and rigid syringomyelia-associated scoliosis (SRSMS) are limited. Typically, surgeons apply practice guidelines for severe and rigid idiopathic scoliosis (SRIS) to treat SRSMS. No study has directly compared the results of surgical treatment between patients with SRSMS and those with SRIS.Purpose: The present study was performed to compare the outcomes of surgical correction of SRSMS and SRIS from clinical and radiographic perspectives.Study Design: This is a retrospective, case-matched, single-center, institutional review board-approved study.Patient Sample: A total of 26 patients with SRSMS or SRIS treated by an anterior and posterior vertebral column resection approach or an internal distraction approach were enrolled.Outcome Measures: The SRSMS and SRIS groups were compared on the following variables: fusion length, screw number, operation time, estimated blood loss, follow-up duration, different radiological parameters (including main thoracic curve, cranial compensatory curve, caudal compensatory curve, thoracic kyphosis, lumbar lordosis, thoracic apical vertebral translation, coronal balance, and sagittal vertical axis), Scoliosis Research Society (SRS)-22 scores, and complication rate.Methods: Thirteen patients with SRSMS were matched with patients with SRIS on curve magnitude, the flexibility of the main curve, surgical procedure, age, and gender. All patients had a minimum of 2 years of follow-up. The radiographic parameters and demographic data from patients were evaluated before surgery, immediately after surgery, and at the latest follow-up.Results: The case matches were relatively ideal except one pair with the main curve in the opposite direction. There was no significant difference in fusion length, screw number, operation time, estimated blood loss, or follow-up duration between the two groups. No significant differences were found between the two groups in the main curve or caudal compensatory curve before surgery, immediately after the operation, or at the final follow-up. The correction of thoracic apical vertebral translation in the SRIS group was better than that in the SRSMS group. The SRSMS group had a larger preoperative, postoperative, and final follow-up cranial compensatory curve and a lower correction rate than did the SRIS group. There was no significant difference in preoperative coronal balance between the two groups. After surgery, the coronal balance in the SRSMS and SRIS groups averaged 24.4±13.2 mm and 12.1±7.9 mm, respectively, which was significantly different (p=.04). At the most recent follow-up, the coronal balance in the SRSMS group improved to 14.8±12.6 mm, and it was 11.8±8.6 mm in the SRIS group. No significant difference was found between the two groups (p=.56). There was no significant difference in thoracic kyphosis, lumbar lordosis, or sagittal vertical axis before surgery, immediately after the operation, or at the final follow-up. Before surgery and at the final follow-up, the two groups had similar scores on function, pain, self-image, mental health, and satisfaction. There was no significant difference in complication rates between the two groups.Conclusions: Typically, surgical correction outcomes are similar in patients with SRSMS and SRIS. Patients with SRIS tended to have a smaller cranial compensatory curve and better correction of the cranial compensatory curve and thoracic apical vertebral translation. Patients with SRSMS tended to have a higher proportion and greater amount of postoperative coronal imbalance, which may be improved during follow-up. [ABSTRACT FROM AUTHOR]

Background Context: The efficacy of one-stage posterior pedicle screw instrument used in the treatment of non-dystrophic scoliosis in neurofibromatosis type I (NF-1) is unknown. Also, there is no study that has directly compared the results of spinal deformity correction between non-dystrophic scoliosis in NF-1 and adolescent idiopathic scoliosis (AIS).Purpose: The objectives of this study were to study the efficacy of a one-stage posterior pedicle screw instrument used in the treatment of non-dystrophic scoliosis in NF-1 and to compare non-dystrophic scoliosis in NF-1 with matched AIS to illustrate the differences.Study Design: This is a retrospective case control study.Patient Sample: Fifteen patients with non-dystrophic scoliosis in NF-1 and 15 patients with AIS underwent a one-stage posterior surgery with the pedicle screw system.Outcome Measures: Preoperative and postoperative whole-spine radiographs were used to determine coronal and sagittal Cobb angles. Also, the distance between the C7 plumb line and the center sacral vertical line and the sagittal vertebral axis was measured to assess spinal balance. The Scoliosis Research Society (SRS)-22 questionnaire was used to evaluate functional outcomes.Methods: We matched 15 patients with non-dystrophic scoliosis in NF-1 with patients with AIS (ratio, 1:1) for age, sex, and degree of major deformity. The overall mean age was 13.4±2.0 and 14.0±2.1 years, respectively. The NF-1 group consisted of 10 boys and 5 girls, and the AIS group consisted of 9 boys and 6 girls. The mean follow-up was 37.6±3.9 and 33.5±5.0 months, respectively. The AIS group underwent end vertebra (EV) or EV+1 fusion. The NF-1 group underwent EV+1, 2, or 3 fusion. Both coronal and sagittal Cobb angles, trunk balance, operative time, blood loss, fusion levels, length of stay, and scores on the SRS-22 questionnaire were compared between the two groups. The study was supported by the National Natural Science Foundation of China (Grant No. 81401760). There were no study-specific conflict of interest-associated biases.Results: The preoperative main curve magnitude was similar between the two groups; however, the flexibility of the NF-1 group tended to be less than that of the AIS group. The rate of correction of the main curve obtained surgically (79.8% compared with 81.1%) was similar in the NF-1 and AIS groups. There were no significant differences in the loss of correction between the two groups (p>.05). Also, there were no significant differences between the groups in operative time, blood loss, fusion levels, screw number, length of stay, trunk balance, and scores on the SRS-22. There were no serious complications related to surgery in both groups.Conclusions: Despite the differences in preoperative flexibilities and fusion strategies, non-dystrophic scoliosis in NF-1 can be treated with a satisfied correction rate and progression rate similar to comparable AIS by using the one-stage posterior pedicle screw technique. Dural ectasia or thin pedicles in non-dystrophic scoliosis could make pedicle screw placement challenging. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Posterior laminectomy is an effective spinal surgical procedure. The adhesion of postoperative scar tissue to surgically exposed dura and, occasionally, to nerve roots can cause failed back surgery syndrome. The establishment of a barrier between scar tissue and dura that is made of hard material may prevent scar adhesions. Purpose: To evaluate the efficacy of a novel biodegradable multi-amino acid copolymer/nanohydroxyapatite composite artificial lamina. Methods: A cervical laminectomy animal model in goats was used, and the animals were randomly divided into three groups. In the test group, cervical 4 was removed by laminectomy and the artificial lamina was inserted (n=12). In the control group, the incision was closed directly without implantation (n=9). The goats in the normal group did not undergo any procedure or treatment. Copolymer efficiency was tested by using X-ray, computed tomography scanning, magnetic resonance imaging, scanning electronic microscope, and histologic and biomechanical measurements 4, 12, and 24 weeks postoperation. Results: No shifting of the artificial lamina or dural adhesion pressure was observed. New cervical natural bone formed in the defect and the bony spinal canal was rebuilt. In the control group, fibrous scar tissue filled the defect and exerted pressure on the dura. No paralysis was observed, and gait was normal in all test and control goats. Conclusions: Artificial lamina can prevent the epidural adhesions surrounding the defect and promote effectively bone tissue repair and new bone formation. [Copyright &y& Elsevier]