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• This study investigated the risk factor for kyphotic deformity development after CLP in patients with CSM. • Greater cervical kyphosis during flexion (fC2–C7 angle) was the best predictive factor for kyphotic deformity development. • Whereas, greater gap range of motion (gROM) had the highest ability to estimate marked loss of cervical lordosis. • Clinically, patients with an fC2–C7 angle ≤-25° along with gROM ≥30° are at a high risk of developing kyphotic deformity. Kyphotic deformity following the loss of cervical lordosis can lead to unfavourable neurological recovery after cervical laminoplasty (CLP); therefore, it is essential to identify its risk factors. Recent studies have demonstrated that the dynamic parameters of the cervical spine, based on baseline flexion/extension radiographs, are highly useful to estimate the loss of cervical lordosis after CLP. However, it remains unclear whether such dynamic parameters can predict kyphotic deformity development after CLP. Hence, the present study aimed to investigate whether the dynamic parameters could predict kyphotic deformity in patients with cervical spondylotic myelopathy (CSM) after CLP. This retrospective study included 165 patients, consisting of 10 and 155 patients with and without cervical kyphosis of C2–C7 angle ≤ -10° at the final follow-up period, respectively. Among the static and dynamic parameters of the cervical spine, greater cervical kyphosis during flexion (fC2–C7 angle) demonstrated the best discrimination between these two cohorts, with an optimal cutoff value of −27.5°. Meanwhile, greater gap range of motion (gROM = flexion ROM – extension ROM) had the highest ability to predict a loss of ≥ 10° in C2–C7 angle after CLP, with an optimal cutoff value of 28.5°. This study suggests that in patients with CSM, fC2–C7 angle ≤ -25° on baseline radiographs is a potential risk for kyphotic deformity after CLP. In clinical practice, the patients with this criterion (fC2–C7 angle ≤ -25°) along with gROM ≥ 30° are at high risk of developing significant kyphotic deformity after CLP. [ABSTRACT FROM AUTHOR]

Cervical laminoplasty is a common approach for the treatment of multilevel cervical spondylotic myelopathy (CSM). Postoperative loss of cervical lordosis (LCL) was associated with lower extension motion of the cervical spine before laminoplasty. To analyze the possible causes of preoperative cervical extension capacity affecting LCL after laminoplasty by evaluating the changes in cervical lordosis (CL) at different stages. Retrospective study. Seventy-two patients undergoing laminoplasty due to multilevel CSM. Radiographic parameters included CL, extension CL (eCL), flexion CL (fCL), range of motion (ROM), extension ROM (eROM), flexion ROM (fROM) and LCL. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) and neck disability index (NDI) score. The data were recorded before surgery and at 3- and 24-month follow-up. All patients completed a cervical extension test preoperatively. A receiver operating characteristic (ROC) curve of eROM was constructed to discriminate the patients with and without postoperative kyphotic deformity. According to the optimal cut-off value of eROM, the patients were divided into two groups: extension group (eROM≥9.3°) and control group (eROM<9.3°). The radiographic outcomes demonstrated no significant differences in CL, eCL, fCL and ROM between the two groups. Both eROM and fROM were significantly different in the two groups. There was a significant change in CL in the extension group at 3-month follow-up and in the control group at 24-month follow-up. The extension group exhibited significantly lower LCL compared with the control group at follow-up. No significant difference between the two groups was noted in the JOA recovery rate, while the NDI score was significantly different at 24-month follow-up. The positivity ratio of the extension test was significantly greater in the extension group than that in the control group. eROM in patients with favorable preoperative cervical extension capacity (eROM≥9.3°) consisted of the actual extension capacity and compensatory flexion. The cervical alignment would be spontaneously restored to its initial lordosis in the short term after laminoplasty. These patients had no substantial LCL at 24-month follow-up and would be good candidates for laminoplasty. [ABSTRACT FROM AUTHOR]

Correction of kyphotic deformities of the spine is a common problem faced by spine surgeons. Unfortunately, there are no clear published guidelines available regarding the extent of spinal fusion required to achieve and maintain lasting deformity correction. We aim to share a set of novel radiographic parameters ("the Circle") that can be used as a guideline for determining the extent of fusion required in surgical correction of spinal kyphotic deformity. A Google forms survey was distributed among spine surgeons and trainees to evaluate differences in recommended extent of posterior-approach fusions for cervical spinal kyphotic deformities before and after introduction to the Circle. Extent of fusion before and after use of the Circle were qualitatively and quantitatively analyzed. Data were anonymized and stored in a secure database. Twenty-seven neurosurgical attendings (n = 14), residents (n = 9), and fellows (n = 3) responded to the survey. Variance between predicted upper and lower instrumented vertebrae, and length of construct, was statistically significantly decreased after application of the Circle in almost all cases. Respondents rated the ease of use of the Circle an average of 4.2 out of 5 (5 = the most ease). The majority of participants (92 [6%]; n = 25 of 27) stated that they would or would likely use the Circle as a radiographic tool in the surgical planning for correction of cervical spinal kyphotic deformities in the future. The Circle is a novel set of radiographic parameters that may be used to educate and guide surgical plans and extent of fusion when aiming to correct spinal kyphotic deformities. [ABSTRACT FROM AUTHOR]

Axial compressive/flexion moderate forces on the anterior spinal elements may cause vertebral compression fractures (VCF), compromising the anterior column of the spine, reducing vertebral body height and leading to characteristic wedge-shaped deformity. 60% to 75% of VCFs are located in the thoracolumbar junction (T12 - L2) due to mechanical forces upon the transition from the relatively fixed thoracic to the relatively mobile lumbar spine. Compression force spinal fractures vary in literature according to the classification system in use, resulting in controversial treatment options. Type A fracture patterns of AO classification are eligible for non-operative treatment provided the posterior complex is intact and there are no neurologic complications. That includes both simple compressive and burst fractures. The aim of this study is to investigate the long-term consequences of non-operative treated compressive thoracolumbar fractures regarding posttraumatic deformity, chronic back pain, and functional status. A retrospective study of 75 patients with stable (compressive and burst type A AO) spinal fractures of the thoracolumbar spine (T12-L2) without neurological symptoms and treated non-operatively was conducted. Post traumatic regional kyphosis, Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to evaluate deformity progression, pain and alteration of the quality of life during follow up. There was no significant correlation between magnitude of posttraumatic regional kyphosis, sex, pain score and disability index. Statistically significant correlation between patients age and disability index was revealed. [ABSTRACT FROM AUTHOR]

• Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP). • The recognition of the risk factor is essential for proper patient selection to achieve successful surgical outcomes. • Flexion range of motion is a useful predictor of kyphotic change after CLP. • For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated. Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP), and several studies have investigated its predictors. In these studies, a kyphotic Cobb angle of 0°–5° between C2 and C7 at a certain postoperative time-point was often used to detect kyphotic deformity. However, studies considering the amount of cervical lordosis loss compared to the preoperative measurement are scarce. This study aimed to elucidate risk factors for kyphotic change after CLP by comparing patients with and without marked loss of cervical lordosis postoperatively. The study population was divided into seven patients with and 92 patients without a loss of >10° of the C2-7 angle during the follow-up period compared to the preoperative measurements [cervical lordosis loss (CLL) group and no CLL (NCLL) group, respectively]; demographic characteristics, surgical information, preoperative radiographic sagittal parameters of the cervical spine, and posterior paravertebral muscle morphology evaluated by magnetic resonance imaging were compared between two groups. A univariate analysis revealed that the CLL group had significantly greater flexion range of motion (fROM) than the NCLL group (43.0° vs. 25.8°, P < 0.001); however, no statistical significance was identified for other parameters. The fROM had a high capacity to discriminate between the CLL and NCLL groups (area under the receiver-operating characteristic curve, 0.880; P < 0.001; 95% confidence interval, 0.589–0.974) with an optimal cutoff point of 37°. This study suggests that greater fROM is a risk factor for the development of kyphotic changes after CLP. For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated. [ABSTRACT FROM AUTHOR]

Spinal cord herniation in the cervical spine is an exceptionally rare occurrence. It is most often cited in association with surgery and almost exclusively with a posterior approach. Herniation with an anterior approach has been reported in 3 cases after multilevel corpectomy, all of which involved herniation through a dural defect sustained during surgery. A 49-year-old man presented to the emergency room with generalized fatigue. He had a previous anterior C5 corpectomy and posterior cervical fusion from C2-T4 performed 17 years prior for a cervical kyphotic deformity that developed after a laminectomy. Magnetic resonance imaging of the cervical spine demonstrated a significant ventral cord herniation into the C5 ventral corpectomy site. The patient underwent a C4-6 vertebral corpectomy with C3-7 anterior reconstruction, fusion, and instrumentation with successful reduction and anatomic realignment of the spinal cord herniation. We present a case of cervical cord herniation that occurred into the ventral corpectomy site without obvious dural defect. We hypothesize that cerebral spinal pulsations over time degraded the corpectomy site and ultimately promoted herniation of the spinal cord. Here, we discuss the successful surgical management of this unique pathology and discuss a relevant review of the literature. [ABSTRACT FROM AUTHOR]

• Early evaluation of Tuberculosis spondylitis is necessary to decide for the appropriate management. • Detailed medical history, meticulous examination, and prompt radiological investigation are important to reach for the right surgical decision. • Early surgical decompression with correction of deformity prevents neurological deterioration and promotes adequate functional recovery. Tuberculosis spondylitis or Pott's disease is the most common destructive form of skeletal tuberculosis. The most commonly affected site is the thoracolumbar vertebra. Once invading the adjacent structures of the vertebrae and intervertebral discs ultimately form an abscess causing spinal cord compression, vertebral collapse, and severe kyphotic deformity. We present the first-ever case done in King Fahd Military Medical Complex in Dhahran, Saudi Arabia, of an 18-year-old male diagnosed with tuberculosis spondylitis who was complaining of progressive upper back pain and lower limb weakness. Emergent anterior decompression with expandable cage, plates, and screws were done. The patient showed a smooth and rapid recovery and was discharged with improved lower limb power and sensations. Pott's disease can lead to progressive neurological deficits in which surgical decompression is indicated. Current surgical practice includes anterior or posterior decompression with or without fusion and/or instrumentation. Surgery with either anterior or posterior decompression should assure complete clearance of the lesion, correcting the kyphotic deformity that prevents disease progression. [ABSTRACT FROM AUTHOR]

• Kyphotic deformity is common and can be associated with considerable morbidity. • Vertebral resection and reconstruction have been shown to preserve neurological function and decrease pain. • Two-stage, combined anterior and posterior approaches are performed to surgically address significant vertebral kyphotic. • The modified lateral extracavitary approach for reconstruction and instrumentation is an alternative to standard approach. Commonly, two stage combined anterior - posterior approaches were performed to treat significant kyphotic deformity, but potentially increase morbidity level. Recently, single - stage posterior approach for anterior column reconstruction have shown sagittal alignment improvement. The objective of this study is to describe a series of kyphotic deformity patients whom were treated using modified lateral extracavitary approach for anterior column reconstruction and posterior instrumentation. Data collected from all kyphotic deformity patients whom treated with modified lateral extracavitary approach between 2016 until 2017 and this research work has been reported in line with the PROCESS criteria. In addition this technique could address kyphotic correction. 7 patients were reported, 4 males and 3 females with local and regional kyphotic more than 40 degrees. Procedures performed mostly on the right side to avoid the aorta with approximately 2 cm of the rib distal to the transverse processes. The average estimated blood loss and length of surgery were 1280 ml and 3.9 h. None of the patient had neurological deficit, and all of them have shown kyphotic improvement. The modified lateral extracavitary approach for anterior column reconstruction and posterior instrumentation is a viable alternative to the standard combined approach. This approach continues to evolve as instrumentation development and possesses significant advantages. [ABSTRACT FROM AUTHOR]

Botulinum toxin (Botox) has long been used therapeutically to treat a variety of diseases, including migraine headaches, cervical spine dystonia, and chronic cervical spine pain, among many others. Although quite useful, Botox has been reported to cause adverse events, some of which may lead to devastating morbidity. An elderly woman presented with severe neck pain after a motor vehicle collision. She underwent Botox administration to the neck extensor muscles, after which she developed severe cervical kyphotic deformity, a complication previously reported only in patients with a history of cervical fusion. In addition, the patient had a pre-existing cervical spine degenerative disc disease with listhesis resulting in cervical kyphotic deformity and loss of cervical lordosis. This case illustrates a potential danger of using Botox in the neck of an elderly patient who may have pre-existing cervical spine instability, underlying cervical musculature weakness, and pre-existing cervical kyphosis. It demonstrates the need to evaluate patients who are predisposed to developing cervical kyphotic deformities before offering them Botox treatment. [ABSTRACT FROM AUTHOR]

Background context Kyphotic deformity associated with vertebral fracture is believed to be a significant risk factor for additional vertebral fractures. However, previously published research is limited. Purpose The purpose of this study was to estimate the biomechanical stresses that kyphotic deformity, with an initial vertebral fracture, place on adjacent vertebrae using three-dimensional finite element (FE) of the spine, head, and ribs. Study design This study is based on the basic science. Methods Total Human Model for Safety, a three-dimensional FE model of the human body, was used and adjusted to represent an elderly osteoporotic woman. The 12th thoracic vertebra (T12), which is a frequent site of osteoporotic vertebral fractures, was transformed to a wedge shape at 0°, 10°, and 20° to create a normal model, a 10° kyphosis model, and a 20° kyphosis model. Additionally, compensated postures were created for the 10° and 20° kyphosis models. Thus, five models were created: (A) a normal model, (B) a 10° kyphosis model, (C) a 20° kyphosis model, (D) a 10° kyphosis model with compensated posture, and (E) a 20° kyphosis model with compensated posture. Compressive principal stresses (CPSs) on T1–L5 in each model were calculated. Results The highest CPS value was 7.78 MPa placed on the anterior part of the T10 vertebra in the 20° kyphosis model. In the 20° kyphosis model, the higher CPS values showed bimodal peaks at T6 and T7 in the midthoracic spine and at T10 and T11 in the two superior adjacent vertebrae. The maximum CPS values in the A, B, C, D, and E models at T10 were 3.12, 6.74, 7.78, 6.61, and 5.78 MPa. At T11, they were 1.70, 4.41, 6.45, 4.07, and 4.79 MPa. Conclusions The existence of an initial vertebral fracture at T12 caused an increase in stress on adjacent vertebrae. Higher CPS values showed bimodal peaks in midthoracic vertebrae and in two superior adjacent vertebrae when T12 was transformed to a wedge shape in the 20° kyphosis model. [ABSTRACT FROM AUTHOR]

Background context A preoperative plan is important to obtain appropriate balance of the sagittal plane in patients with kyphotic deformity. Previous methods to calculate the correction angle are inconvenient and complicated, whereas the method using computer simulations may be very effective and much simpler than existing methods. Purpose To evaluate the efficacy of preoperative measurements using a computer simulation for corrective osteotomy for the surgical treatment of kyphosis caused by ankylosing spondylitis (AS). Study design Retrospective clinical data analysis. Patient sample The sample comprises 18 AS patients with fixed kyphotic deformity who underwent corrective osteotomies at our hospital between October 2007 and January 2010. Outcome measures Thoracic kyphosis, lumbar lordosis, and the sagittal vertical axis (SVA) of the spine were evaluated by preoperative computer simulation and radiologic measurement. Clinical assessments were performed according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form-36 (SF-36), and EuroQol-5 dimension (EQ-5D) before and after the surgery. Methods The coincidence between the preoperative computer simulation and postoperative radiologic parameters was evaluated. We also analyzed the changes derived from each clinical and radiologic measurement before and after the surgery. Results Mean thoracic kyphosis changed from 32.4° to 31.9°, mean lumbar lordosis was corrected from 11.5° to 26.9°, and the SVA was improved from 125.7 to 65.1 mm after surgery (p<.001). The correlation coefficients within groups between the computer simulations and radiologic parameters were 0.9, 0.6, and 0.7, showing significant congruency. Although BASDAI and BASFI did not significantly differ (p=.53 and p=.45, respectively), SF-36 and EQ-5D were significantly increased (p<.05 and p<.001, respectively). Conclusions Comparisons of preoperative simulations and actual surgical outcomes showed significant coincidences; thus, evaluations through computer simulations before surgery are expected to help predict the level of correction possible after surgery and improve surgical planning. [ABSTRACT FROM AUTHOR]

Background context Little is known about the psychological status in patients with ankylosing spondylitis (AS) before and after correction of fixed sagittal imbalance. Purpose The aim of this study was to evaluate the changes in patients' psychological status after surgical correction and the existence of a correlation between psychological state and the angle of correction. Study design A retrospective study was performed to assess radiological and clinical results, and psychological status in patients with AS with fixed kyphotic deformity. Patient sample The sample comprises 24 patients with AS with fixed sagittal imbalance who underwent one-stage corrective osteotomies at our hospital between March 2006 and May 2010. All of the patients included in this study demonstrated an inability to look straight forward because of severe kyphotic deformities. Outcome measure The radiologic analysis included evaluation of thoracic kyphosis, lumbar lordosis, and the sagittal vertical axis (SVA) of the spine. Clinical assessments were performed with Short Form 36 (SF-36), the Bath Ankylosing Spondylitis Function Index (BASFI), and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Patient psychological status was assessed using the Hospital Anxiety and Depression Questionnaire (HADS) and the Health Locus of Control-Form C Questionnaire (HLC-C). Methods Each of the above measurements was recorded before and 1 year after the surgery. The changes derived from each measurement before and after the surgery were evaluated. We also analyze the correlations among the radiological, clinical, psychological, and mental evaluations. Results Mean thoracic kyphosis changed from 38.5° to 33.3°. Mean lumbar lordosis was corrected from 13.8° to 26.1°, and the SVA was improved from 110.8 mm to 49.7 mm. There was significant improvement in the SF-36, BASDAI, BASFI, HADS, and HLC-C scores. The SVA changes were closely linked to BASFI and psychological status, especially anxiety and depression. Conclusions The scores of disease status, general health, and psychological status were improved significantly after correction of kyphotic deformity. And the correction of sagittal imbalance was correlated significantly with anxiety and depression. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Either an anterior approach or a posterior approach, which aims to decompress the spinal cord and restore the sagittal alignment, has been adopted to treat multilevel cervical degenerative myelopathy (CDM) associated with kyphosis. However, there is controversy on the optimal surgical strategy for the treatment of multilevel CDM with kyphotic deformity because of the complications of each surgical approach. Purpose: The purpose of this study was to investigate the surgical efficacy of enlarged laminectomy (removing the inside edge of facet joints and decompressing the nerve foramina) and lateral mass screw fixation for the treatment of multilevel CDM associated with kyphosis. Study design: A retrospective radiographic and clinical study to access the efficacy of enlarged laminectomy with lateral mass screw fixation in the treatment of multilevel CDM related to kyphosis. Patient sample: A total of 43 patients (28 men and 15 women; average age, 59.6 years) with multilevel CDM correlated to kyphosis were obtained in the study. Outcome measures: All radiological data were recorded on computer-based measurement from preoperative or postoperative X-ray, magnetic resonance imaging (MRI), and computed tomography. All neurological parameters were accessed in each patient. Methods: Analysis consisted of: Japanese Orthopedic Association (JOA) score, recovery rate, curvature index (CI), the expansion degree and drift-back distance of the spinal cord, axial symptom severity, and C5 root palsy. The recovery rate based on the JOA score was calculated for each patient. Cervical CI as well as the expansion degree and drift-back distance of the spinal cord was measured using MRI. Axial symptom severity was quantified by a visual analog scale (VAS). Statistical analysis was performed using paired t test with significance set at p<.05. Results: Enlarged laminectomy was performed over a mean of 3.97 levels (range, 3–5 levels). Follow-up information was obtained at a mean of 2.8 years (range, 1.5–5 years) after surgery. Analysis of the final follow-up data showed significant differences before and after surgery in the JOA score (t=24.17, p<.001), CI improvement (t=21.89, p<.001), the anteroposterior diameter at the level of maximum compression of the spinal cord (t=9.54, p<.001), and VAS score (t=13.30, p<.001). The mean spinal cord posterior shift was 4.72±1.10 mm (range, 0–6.71 mm). X-rays confirmed that bone grafts were completely fused at a mean of 3 months after surgery. During the follow-up period, only two patients (4.7%) did not obtain complete recovery, four patients (9.3%) experienced axial symptoms; there were no C5 root palsy and instrument failures noted in this series. Conclusion: Enlarged laminectomy with fixation for the management of multilevel CDM is demonstrated to be an effective strategy for improving neurological function, restoring the normal cervical lordosis, and decreasing the incidence of axial symptoms and C5 root palsy, but there is a need for randomized controlled studies with long-term follow-up to confirm and clarify these results. [Copyright &y& Elsevier]

Abstract: Background context: Long-term results of patients treated with conventional laminoplasty have shown a significant number of patients complicated with kyphotic deformity. The authors hypothesize that by maintaining the spinous process–ligament–muscle complex (SPLMC) during laminoplasty, followed by postoperative muscle strengthening exercises, the formation of kyphosis can be decreased. Purpose: To evaluate the incidence of kyphosis in a select patient group undergoing laminoplasty with preservation of the SPLMC followed by neck strengthening exercises. Study design/setting: A midterm retrospective study of 30 patients following laminoplasty with preservation of the SPLMC. Patient sample: Thirty consecutive patients with cervical myelopathy attributable to multilevel cervical spinal stenosis underwent laminoplasty with preservation of the SPLMC from April 1998 to July 2002. Outcome measures: Preoperative and postoperative Japanese Orthopedic Association (JOA) scores, Guigui angles, and axial symptoms were measured. Methods: Thirty patients with multiple-level cervical myelopathy were studied. Fourteen had a normal lordotic curve, whereas 16 had a straight curve. All these patients underwent laminoplasty with preservation of the SPLMC. For the first 6 months, isometric neck muscle exercises were performed. After this time, the intensity of the exercises was gradually increased. Results: The average preoperative JOA score was 5.8±1.4. Mean JOA score at 3.8 years follow-up was 13.6±2.1. The recovery ratio was 69%. All 14 presurgical lordotic curves remained lordotic. Fourteen of the 16 straight spines improved to a lordotic configuration. Using the Guigui method, the preoperative lordotic angle was corrected by approximately 9 degrees (mean preoperative of 9.89±1.13 degrees, mean postoperative of 18.66±1.85 degrees), and the preoperative straight angle was corrected by approximately 15 degrees (mean preoperative of 0.91±2.14 degrees, mean postoperative of 15.88±1.71 degrees). Conclusions: Laminoplasty with preservation of the SPLMC followed by appropriate postoperative muscle exercises may be an encouraging way to maintain or restore the physiological curve and prevent kyphotic deformity at a medium term follow-up. [Copyright &y& Elsevier]

Background Context: A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis. Purpose: To evaluate our preliminary results of a pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of thoracolumbar kyphotic deformities. Study Design/setting: Case series Methods: Eleven patients with a symptomatic kyphotic deformity were treated with a thoracolumbar pedicle subtraction osteotomy in combination with a multilevel correction. The mean follow-up was 42.8 months (range 26-105). The clinical outcome, radiographic correction, and perioperative complications were analyzed. The results in six more traditional indications (ankylosing spondylitis, kyphoscoliosis, congenital and posttraumatic deformity), were compared with the results in a subgroup of five cases with a rigid thoracolumbar hyperkyphosis. Results: All patients had a kyphotic thoracolumbar junction. An average of 5.8 levels was involved in the corrective fusion. A pedicle subtraction was always performed between the level Th10 and L2 to correct the sagittal balance. A lordotic correction of 38.8 (range 25-49) degrees was established with this fusion. The osteotomy contributed 66% (26.9 degrees) of the correction, whereas the remaining correction came from multilevel facetectomies. The visual analogue scale for both pain and impairment improved significantly (p<.005) for the entire group. Statistical analysis on the results for both subgroups separately was inappropriate because of the small number of patients available; however, overall both subgroups appeared to do equally well. All patients were very satisfied with the result and would choose surgical treatment again. No major complications were encountered. Conclusions: A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be considered as an adjunctive tool in the surgical treatment of a rigid thoracolumbar (Scheuermann's) kyphosis. [ABSTRACT FROM AUTHOR]

Background Although recent work has focused on characterizing quantitative magnetic resonance imaging (MRI) markers that may predict outcome among patients with cervical degenerative conditions, little is known about their reliability. Measurement and reporting of these markers is time-consuming and nonstandardized, preventing routine use in clinical care. Methods We retrospectively analyzed cervical MRI among subjects prospectively enrolled in a health outcomes study of elective surgery for degenerative cervical spine conditions. Two radiologists independently reviewed MRI for presence or absence and length of cord signal change, level of worst cord compression, axial anteroposterior (AP) and lateral spinal cord diameter, midsagittal AP diameter, and kyphosis. Interobserver reliability was compared using kappa and intraclass correlation coefficient (ICC). Results Inclusion criteria were met by 209 patients who had MRI available for review. Most patients were female (58%) and middle-aged (mean age 51 years), and 54% had a diagnosis of myelopathy. Reliability was fair for cord signal change on T1 (κ = 0.33) and good on T2 (κ = 0.74) images. Among patients with T2 change ( n = 22), reliability for signal change length was good (ICC = 0.67). For level of worst compression, reliability was good (κ = 0.79). For AP cord diameter, reliability was very good (ICC = 0.82; T2/midsagittal) and good (ICC = 0.66; T2/axial). Reliability was moderate for lateral cord diameter (ICC = 0.55; T2/axial) and good for kyphosis (κ = 0.76). Conclusions Good and very good reliability observed in measuring T2-weighted spinal cord signal change, level of worst compression, AP cord diameter, and kyphosis support use of these markers in standardized reporting, which could be incorporated into routine clinical use. [ABSTRACT FROM AUTHOR]