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Background: Pelvic balance is a version of the pelvis defined by pelvic orientation parameters of PT and SS. Two distinct versions of pelvis are defined: (1) balanced characterized by a relatively low PT and high SS, and (2) unbalanced with relatively high PT and low SS meaning excessive retroversion of the pelvis. It was proved for patients with a high-grade spondylolisthesis that rebalancing of the pelvis can positively affect clinical outcomes. Little is known about the impact of such rebalancing in low-grade isthmic spondylolisthesis.Purpose: To determine whether clinical outcomes correlated with rebalancing of the pelvis after surgical correction of mid- and low-grade adult isthmic spondylolisthesis.Methods: One hundred and three adult patients with a mid- and low-grade isthmic slip were the participants. Clinical outcomes were assessed at least 2 years after the surgery with the use of the Oswestry Disability Index (ODI) and a back pain visual analogue scale. Statistical analysis was used to identify differences in clinical outcomes between patients (1) with a balanced and unbalanced pelvis postoperatively, (2) who regained and did not regain pelvic balance postoperatively, (3) who maintained and lost pelvic balance postoperatively, and (4) with reduced and increased postoperative PT.Results: There were no significant differences in clinical outcomes between patients with a balanced and unbalanced pelvis postoperatively regardless of whether they lost, maintained, or regained pelvic balance after the surgery (Student's t test for independent variables or the non-parametric Mann-Whitney U, p value = 0.05). No correlation (Spearman's rank correlation) was found between postoperative reduction of PT and postoperative: (1) level of back pain (r = -0.10, p = 0.3063), (2) degree of reduction in back pain (r = 0.03, p = 0.7927), (3) ODI scores (r = -0.18, p = 0.0696), and (4) degree of reduction in ODI scores (r = 0.13, p = 0.1893).Conclusions: Radiological improvement of pelvic balance after surgical correction of mid- and low-grade isthmic spondylolisthesis did not correlate with clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction The first year of life offers a unique insight into the interaction of function and form. Functional pathology - the core issue of manual medicine - has a far bigger influence on development than later in life. Materials and methods Based on 20 years of practical experience and more than 30 000 babies treated, the effect of spinal manipulation is demonstrated by analysing a random sample of 150 babies treated for 'excessive crying' (drawn from the 1277 babies treated in 2006). Results In more than half of these cases a complete normalization could be achieved by one treatment in the ensuing week. Other than one antero-posterior X-ray of the cervical spine, no investigative diagnostics were necessary. All of these children - and their families - suffered from weeks of crying; other therapies were completely unsuccessful, which led them to seek help in our consultation. Discussion The effectiveness of manual therapy in these cases seems to be obvious enough to warrant serious consideration in the treatment of soi-disant colic. For systematic studies, we shall need the co-operation of paediatric clinics. [ABSTRACT FROM AUTHOR]

Spine surgery is a continuously evolving field. Traditional posterior midline approaches to the lumbar spine are associated with muscle injury. Common mechanisms of injury include ischemia, denervation, and mechanical disruption of tendinous attachments of lumbar muscles. Muscle injury may be documented with chemical markers (creatinine kinase, aldolase, proinflammatory cytokines), by imaging studies, or with muscle biopsy. Minimally disruptive surgical approaches to the spine have the potential to minimize the trauma to muscular structures and thus improve the outcomes of surgery. The impact of minimally invasive spinal surgery on long-term clinical outcomes remains unknown. State-of-the-art pathophysiology of minimally invasive spine surgery is presented in this review., (Georg Thieme Verlag KG Stuttgart · New York.)

The author discusses the principles and role of frameless image-guided surgery in operative treatment of brain and spine. Short overview of the method is presented in a way comprehensible for medical professionals from outside neurosurgical and orthopaedic fields. The author presents the importance of image-guided technologies in development of minimally invasive and less destructive surgery of brain and spine.

Objective: The authors present a new method of minimally invasive surgical management of lumbar burst fractures through the posterior approach. The method includes minimally invasive corpectomy and interbody fusion, both of which are performed through a keyhole approach, and percutaneous pedicle screw fixation of the fracture. The technique of the posterior keyhole corpectomy presented in this report is a novel and original concept of the first author (AM). The percutaneous pedicle screw stabilization is performed with the use of a percutaneous instrumentation system (Sextant; Medtronic, Inc., Minneapolis, MN). The Sextant system has been dedicated and used in nontrauma degenerative cases; the novel aspect of this system is its application in spine fractures. Indications for the method include Denis classification subtype B or Magerl subtype A.3.1 burst fractures. Both subtypes represent fractures with failure and retropulsion of the upper part of the vertebral body., Methods: The clinical experience of this study includes four cases of burst fractures with significant retropulsion and occlusion of the spinal canal. Long-term results were assessed at a minimum follow-up period of 1 year (maximum, 3.5 yr). The follow-up assessments included: 1) the quality of decompression and reconstruction of the spinal canal (computed tomographic and magnetic resonance imaging scanning); 2) the stability of the operated segment (dynamic x-rays); 3) the quality of interbody fusion (computed tomographic scanning and dynamic x-rays); and 4) correction of the fracture kyphosis and its postoperative loss (measurements of Cobb angles for the assessment of sagittal plane deformity). The minimum armamentarium requirements for this method include a typical micro lumbar discectomy retractor set; a surgical microscope; two-plane intraoperative fluoroscopy; and a system for percutaneous pedicle screw stabilization (Sextant). "Posterior keyhole corpectomy" indicates corpectomy of the posterior upper half of the vertebral body or removal of the retropulsed bone fragment via two keyhole skin incisions on both sides of the spinous process (each skin incision measures 2 to 3 cm long). Exposure of the retropulsed fragment (the posterior upper part of the vertebral body) is achieved by medial or complete facetectomy along with complete or medial resection of the pedicle. This has to be performed bilaterally. Percutaneous stabilization requires four additional stab skin incisions., Results: We observed no surgery-related complications (neurological, hardware, dural tears, or deep or superficial wound infections); there was perfect decompression and clearance of the spinal canal (confirmed by computed tomographic and magnetic resonance imaging scanning); and there was solid stability at the affected segments (confirmed by dynamic x-rays). Healed fusion was noted in all patients but one. The latter patient had no clinical symptoms of spinal instability. Kyphotic deformity was corrected and reversed into lordosis in three patients. Loss of deformity correction was noted in all patients; however, all patients retained lordotic alignment of the affected segment., Conclusion: The advantages of this method include sparing the posterior elements (lamina, spinous process, supraspinous and interspinous ligaments, and paravertebral muscles), safety of the decompression provided by the use of a surgical microscope, and perfect illumination of the operating field. The drawbacks of the method include limitation to certain types of burst fractures, the method is surgically demanding, and the method requires development of a special retractor system to eliminate the cumbersome alternate insertion and the reinsertions of the typical microdiscectomy retractor set.

The authors present their experience in the minimally invasive posterior keyhole lumbar corpectomy with transpedicular stabilization. This technique involves the removal of the posterior part of the affected vertebral body with the pedicle screw fixation through four 2-3 cm long skin incisions on the back. Two cephalad skin incisions provide an approach for corpectomy and instrumentation of the upper pedicles of the construct. Two caudal skin incisions provide an approach for instrumentation of the lower pedicles of the construct. The minimum armamentarium requirement includes classic micro lumbar discectomy retractor set and intraoperative fluoroscopy. According to the authors' best knowledge this is the first minimally invasive posterior keyhole lumbar corpectomy ever reported in the literature (2002). This is also the first minimally invasive transpedicular fixation ever performed in Poland (2002). This technique was presented during EANS Congress (Lisbon, September 2003). Some reports have recently appeared in the literature on percutaneous pedicle screw fixation of the lumbar spine in non traumatic cases. A special instrumentarium system (Sextant by Medtronic) has been developed and used in this type of minimally invasive stabilization. Although this system has not been dedicated for spine fractures it is feasible in trauma cases. We have one case of L2 burst fracture fixed percutaneously with Sextant.

The authors present the diagnostic methods and basic surgical procedures used in treatment of spinal neoplasms. Both metastatic and primary spinal tumours lead to instability and loss of the protective function. Spinal cord can be damaged by compression or increased mobility of the vertebral column. Pain is reported as common symptom. Investigations include: plain X-ray films, myelography, radioisotope bone scan, CT, MRI and needle biopsy. The goal of surgery is to improve the quality of life with preservation of neurological function, reduction of pain and assured spinal stability. Indications for surgery are related with patient's general condition, grade of neoplasmatic disease, neurological symptoms and spinal involvement. Curative surgery include total removal of the tumour with affected vertebral body, followed by spinal stabilization. Palliative surgery as partial tumour removal, partial removal of the vertebral body or laminectomy are performed for spinal decompression. In the majority of cases surgery is combined with radiotheraphy, chemiotheraphy and treatment of pain., Main goal of surgery in the treatment of spinal metastatic lesions are: tumor removal (cytoreduction), protection of the spinal cord and spinal stabilization. The choice of surgical treatment depends on spinal involvement and neurological status.

Developmental abnormalities or inflammatory disorders provoke deformations and instability of the craniocervical junction. The most dangerous results of these lesions are: sudden brainstem compression or cervical myelopathy. The authors propose the guidelines for surgical management of non-traumatic deformities caused by: a) rheumatoid arthritis of the spine, b) congenital anatomic changes of the occipit and odontoid. Main goals of surgical treatment are decompression and stabilization. The choice of surgical approach and method depends on pathology. It is very important to estimate individual anatomic changes and mobility--possibility of reduction. The authors discuss surgical methods actually used for fusion and decompression of the occipitocervical junction.