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Background Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications. Case Description This report presents the unique case of a patient with AS who developed a unilateral C5 palsy after the application of a hard collar for a C5/6 fracture, to our knowledge the first such case presented to date. The patient subsequently went on to an anterior fixation and partially recovered from the C5 palsy/injury. After the case report is an examination of the currently available literature and evidence exploring the factors that may contribute to C5 palsy after the application of a collar for acute fracture in AS. Conclusions We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.

Kyphotic deformity of the spine is a significant source of pain and disability. Sagittal and/or coronal malalignment of the spine can be secondary to numerous factors including trauma, infection, surgery (iatrogenic), congenital deformity, and degenerative changes. Surgical correction is often the definitive treatment for patients with severe or late stage deformity. There are several options for choice of osteotomy including the Smith-Peterson osteotomy, pedicle subtraction osteotomy, and vertebral resection osteotomy. This manuscript discusses the various types of osteotomies, indications, evaluation, and complications for the treatment of kyphosis.

Kyphotic deformity of the subaxial cervical spine can be debilitating to the patient, as well as challenging to the spine surgeon. Cervical kyphotic deformity is frequently progressive and can result in neurologic decline that mirrors the increase in deformity thus requiring surgical correction to alter the natural progression of the deformity. We review common etiologies, clinical and diagnostic workup, as well as pearls and pitfalls of each of the approaches to the cervical spine. Indications and contraindications for anterior, posterior, and combined approach are addressed.

Objective Posterior vertebral column resection (PVCR) is a versatile technique for correction of severe and rigid spinal deformities, but the high rate of neurological complications is a major disadvantage of this procedure. This study aimed to describe a modified PVCR technique for safe treatment of severe post-tuberculous kyphotic deformity. Methods Four consecutive patients with severe post-tuberculous kyphosis underwent modified PVCRs. Radical removal of the posterior elements was avoided by performing laminectomy in stages, and the posterior vertebral wall and the bases of the spinous processes were maintained throughout the procedure. Perioperative clinical presentation, imaging data, and operative variables were recorded. Results Desirable efficacy and clinical outcomes were obtained, including satisfactory correction rates and low estimated blood loss. Neurological status improved in all patients with preoperative neurological deficits, and no postoperative neurological complications were reported. Conclusions Modified PVCRs could prevent excessive handling or overstretching of the spinal cord, reduce bleeding, and provide more security in the correction of severe spinal deformities. Our initial experience showed that this modified procedure might be an alternative to conventional Schwab grade 6 osteotomy for the correction of severe post-tuberculous kyphotic deformity.

Late onset paraplegia is a rare complication of spinal tuberculosis. Disease reactivation and cord compression by internal gibbus are the common causes for neurological deficit. We report a patient with post-tubercular kyphotic deformity in whom the late onset paraplegia is caused by ossified ligamentum flavum above the level of kyphotic deformity. The deficit was attributable to the ossified ligamentum flavum and she recovered completely following posterior decompression and instrumented posterolateral fusion. To the best of our knowledge, this is the first report of this unusual cause of late onset paraplegia.

Fixed cervical or cervicothoracic kyphosis is a rare yet severely debilitating condition. When indicated, lower cervical or upper thoracic osteotomies may be used to address these deformities. This article describes the authors’ preferred surgical technique for T1 osteotomy. Using this technique, surgical correction of approximately 30° at the osteotomy site can be achieved. Significant improvement in patient-reported outcome measures and quality of life have been reported following this procedure. Despite its potential benefits, this is a technically challenging procedure and has a high rate of postoperative complications—up to 56.5%—and patients should be counseled as to the risks of this procedure and potential complications before surgery.

Management of spinal degenerative deformities always represents a challenge for the spinal surgeon. Proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery patients is a severe complication with potential need for revision surgery. We present the case of the patient had proximal junctional kyphosis after thoracolumbar junction short segment fusion surgery. Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity with a multifactorial etiology. Prevention of PJK is more important than the treatment. In order to prevent PJK, the risk factors should be considered before surgery. The patient should be carefully evaluated during surgical planning. It should be noted that prevention of proximal junctional kyphosis is easier than treatment.

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.

Background contextEither 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.PurposeThe 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 designA 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 sampleA 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 measuresAll 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.MethodsAnalysis 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

The Load Sharing Classification (LSC) allocates one to three points to each of three different radiological characteristics of traumatic thoracolumbar fractures: the vertebral body involved in the fracture, the displacement of the fracture parts and the kyphotic deformity. Added up, a minimal score of three and a maximal score of nine can be obtained. When the LSC score is three to six, a short segment pedicle screw fixation suffices. When the LSC score is seven to nine, a high rate of failure in patients with a short segment pedicle screw fixation exists. In these cases an anterior stabilising procedure of the spine is advised. The LSC has been examined by Dai and Jin, who claim an almost perfect inter- and intraobserver agreement, according to the Landis and Koch criteria. Dai and Jin only present results for the separate three items of the LSC and for the total LSC scores. Observer agreement for the two LSC score categories (three to six and seven to nine) have not been studied. The aim of this study is to study the inter- and intraobserver agreement of the LSC for the total score, the three separate items and also for the two LSC score categories. Three observers determine twice the LSC scores of forty traumatic thoracolumbar fractures. The average standard Cohen's kappa values for the separate LSC items range between 0.06 and 0.48. For the total LSC score the average standard Cohen's kappa and weighted kappa values are 0.22 and 0.67 respectively. For the two LSC score categories, there is unanimous agreement in 55% of the cases and a majority agreement in 40%. In the remaining 5% of the fractures there is a split decision. Standard Cohen's kappa value for the two LSC score categories is 0.53. The standard Cohen's kappa values can be rated as fair to moderate. From these data it can be concluded that the inter- and intraobserver reliability of the Load Sharing Classification of Spinal fractures can be rated as fair.

Background Burst fractures account for more than half of all thoracolumbar fractures, which often cause a neurologic deficit and present a significant economic burden to the family and society. Accepted methods of treatment of thoracolumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. However, the management of thoracolumbar burst fractures has been the subject of much controversy. Methods Publications reporting clinical data relating to the thoracolumbar burst fractures were reviewed. These articles were determined via review of the results of PubMed searches and articles gathered through compilation of references from those articles. Results There exist different criteria for the choice of the management based on the severity of kyphotic deformity, canal compromise, vertebral height loss, and neurologic status. To our knowledge, none of the existing criteria for the treatment of thoracolumbar burst fractures are generally accepted. Conclusions In thoracolumbar burst fractures without a neurologic deficit, there is no superiority of conservative therapy over operative therapy. When the neurologic involvement is significant, the choice of operative management is advised. Also, there is no obvious superiority of one approach over the other.

The disease mainly affects the sacroiliac joints and spine. It ischaracterised by inflammation and ossification of the interverteb-ral discs, ligamentous structures and facet joints. Over time thespine tends to become rigid and kyphotic deformity is common.This may result in a long rigid lever arm, and is particularlyvulnerable to fracture. Osteoporosis associated with reducedfunctional activity and comorbidities add further to the vulner-ability of the spine. Spinal fracture in this condition is associatedwith a high rate of neurological injury.

IntroductionThe study is an outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity, who underwent single stage anterior corpectomy and posterior de...

Postlaminectomy instability of the cervical spine can be managed either anteriorly or posteriorly. The posterior procedures that have been described are best performed at the time of the original decompressive procedure. Thus, the development of a kyphotic deformity is prevented. Generally, it is technically easier to achieve anterior stabilization and arthrodesis if a postlaminectomy kyphosis develops.

The objective of this study is to investigate the biomechanical effects of the occlusal conditions on problems in musculoskeletal dysfunction of the head and neck. We have tried to simulate the spine deformities in the cervical region caused by the malocclusion using a displacement incremental method (DIM) in the pseudo-three-dimensional finite element method (FEM) based on the spanning element theory. For the simulation of the deformity process, a DIM was used to accumulate the displacements at each stage of FEM analysis iteratively. The same loads were repeatedly applied on the displaced model o that the defomity gradually developed. The development process of postural abnormality or kyphotic deformity of the spine was simulated under a malocclusion condition.

magnetic resonance imaging demonstrating metastatic involvement of T5, T6 and T7 vertebrae with pathological fracture of T6, kyphotic deformity and loss of cord signal secondary to bony retropulsion and anterior epidural tumour extension. Post-operative sagittal (C) and axial (D) computed tomography showing corpectomies extending from T5 to T7 with expandable titanium cage insertion and bilateral pedicle screw fixation with longitudinal adjoining rods (arrows). 65S Proceedings of the BASS 2015 Bath Meeting / The Spine Journal 15 (2015) 50S–85S

Clinically silent cervicodorsal fracture may occur following upper-thoracic injury in the presence of a characteristic buckling injury to the sternum. Failure to recognise the association may result in gross kyphotic deformity. Three examples are provided, illustrating the role of radiology in the management of this complex traumatic lesion.