Fractured vertebra antedisplacement reconstruction technique: a feasible treatment choice for posttraumatic thoracolumbar kyphosis.

OBJECTIVE: The goal of this study was to evaluate the feasibility of the fractured vertebra antedisplacement reconstruction technique for the treatment of posttraumatic thoracolumbar kyphosis (PTK). METHODS: A total of 22 patients with PTK who were treated with the fractured vertebra antedisplacement reconstruction technique were retrospectively analyzed. The radiological evaluation included global kyphosis, thoracolumbar angle, and sagittal vertical axis. The clinical evaluation included visual analog scale pain score, Oswestry Disability Index score, SF-12 Health Survey score, and American Spinal Injury Association grade. The complications were recorded. RESULTS: The mean global kyphosis was 55.0° ± 12.6° preoperatively, 8.5° ± 5.0° postoperatively, and 10.3° ± 4.8° at the latest follow-up (p < 0.001). The average total kyphosis correction achieved was 44.7° ± 14.2°, with a range of 23.4°-79.4°, indicating a mean final correction of 80.1%. The mean thoracolumbar angle was 46.2° ± 13.2° preoperatively, 6.6° ± 4.5° postoperatively, and 7.6° ± 4.2° at the latest follow-up (p < 0.001). The mean sagittal vertical axis was improved significantly, from 51.1 ± 24.2 mm preoperatively to 28.5 ± 17.4 mm at the latest follow-up (p = 0.001). One patient (4.5%) experienced single intervertebral fusion nonunion, and 1 patient (4.5%) experienced distal screw loosening. No patients experienced any neurological deterioration. The visual analog scale pain score, Oswestry Disability Index score, SF-12 Health Survey score, and American Spinal Injury Association grade achieved significant improvement at the latest follow-up. CONCLUSIONS: Fractured vertebra antedisplacement reconstruction technique can effectively correct kyphosis, reconstruct spinal stability, and improve the patient's symptoms and neurological function. This technique is safer, minimally traumatic, and less technically demanding to avoid osteotomy-related complications. It is a feasible treatment choice for PTK.

Surgical management of posttraumatic thoracolumbar Kyphosis: A review.

Kyphosis is a condition in which there is a curvature of the spine that causes a bowing of the back, which in turn leads to slouching posture or hunchback. There are several types of Kyphosis, including posttraumatic Kyphosis, which usually occurs in the thoracic region. There are several techniques used for the surgical management of posttraumatic thoracolumbar Kyphosis. We aimed to discuss the surgical treatment of posttraumatic thoracolumbar Kyphosis. We searched for articles included in this review through scientific websites using different keywords. The articles were chosen based on inclusion criteria. The articles included in this review were published between 2006 and 2018. The review was written under titles in the discussion part. The outcome of the surgical management of posttraumatic thoracolumbar Kyphosis depends on the accurate selection of the proper surgical approach.

Prevalence, Features, and Predictive Factors of Spontaneous Spinal Arthrodesis in Posttraumatic Thoracolumbar Kyphosis.

OBJECTIVE: Spontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in posttraumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features, and predictive factors of SSA in patients with PTK. METHODS: In this retrospective study, 70 patients with PTK were included. Data on the clinical and radiologic parameters were obtained and evaluated. According to whether there was SSA or not, patients were divided into an SSA group (n = 45) or a non-SSA group (n = 25). A binary logistic regression analysis was used to identify the predictive factors for SSA. RESULTS: The incidence of SSA in PTK was 64%. Among 45 patients with PTK with SSA, SSA was present as a solid bridging anterior osteophyte along the vertebral bodies in 11 patients, posterior contiguous bony growth through the facet joints bilaterally in 13 patients, bony formation in both anterior and posterior elements in 18 patients, and direct contiguous bony formation from the injured vertebral body to the adjacent one in 3 patients. Patients with longer disease duration, larger local Cobb angle, and anterior wall height loss (AWHL) ratio of injured vertebral body, and less kyphosis flexibility index were significantly more likely to develop SSA. The parameter of AWHL remained significant in binary logistic regression analysis. CONCLUSIONS: SSA in PTK was common, and the SSA sign presented in various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.

Postoperative quality of life in patients with ankylosing spondylitis and thoracolumbar kyphosis: risk factors and personalized sagittal reconstruction strategy.

OBJECTIVE: The aim of this study was to investigate the factors affecting postoperative quality of life in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK), and establish a personalized sagittal reconstruction strategy. METHODS: Patients with AS and TLK who underwent pedicle subtraction osteotomy (PSO) from February 2009 to May 2019 were retrospectively included. Quality of life and spinal sagittal radiographic parameters were collected before surgery and at the last follow-up. Patients were divided into two groups based on the attainment of minimal clinically important difference (MCID) on the Bath Ankylosing Spondylitis Functional Index and Oswestry Disability Index. Comparisons of radiographic parameters and clinical outcomes were conducted between and within groups. Regression analysis was used to identify the risk factors within the missing MCID cohort. Sagittal reconstruction equations were established using the pelvic incidence (PI) and thoracic inlet angle (TIA) in the reached MCID cohort. RESULTS: The study comprised 82 participants. Significant improvements were observed in most radiographic parameters and all quality-of-life indicators during the final follow-up compared with the preoperative measures (p < 0.05). Factors including cervical lordosis (CL) ≥ 18° (OR 9.75, 95% CI 2.26-58.01, p = 0.005), chin-brow vertical angle (CBVA) ≥ 25° (OR 14.7, 95% CI 3.29-91.21, p = 0.001), and pelvic tilt (PT) ≥ 33° (OR 21.77, 95% CI 5.92-103.44, p < 0.001) independently correlated with a failure to attain MCID (p < 0.05). Sagittal realignment targets were constructed as follows: sacral slope (SS) = 0.84 PI - 17.4° (R2 = 0.81, p < 0.001), thoracic kyphosis (TK) = 0.51 PI + 10.8° (R2 = 0.46, p = 0.002), neck tilt (NT) = 0.52 TIA - 5.8° (R2 = 0.49, p < 0.001), and T1 slope (T1S) = 0.48 TIA + 5.8° (R2 = 0.45, p = 0.002). CONCLUSIONS: PSO proved efficacious in treating AS complicated by TLK, yielding favorable outcomes. CBVA ≥ 25°, CL ≥ 18°, and PT ≥ 33° were the primary factors affecting postoperative quality of life in patients with AS. The personalized sagittal reconstruction strategy in this study focused on the subjective sensations and daily needs of patients with AS, which were delineated by the equations SS = 0.84 PI - 17.4°, TK = 0.51 PI + 10.8°, NT = 0.52 TIA - 5.8°, and T1S = 0.48 TIA + 5.8°.

Influence of thoracolumbar kyphosis on postoperative spinal alignment in patients with Lenke type 5C adolescent idiopathic scoliosis.

PURPOSE: This study aimed to examine the changes in thoracolumbar kyphosis (TLK) following correction surgery in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) and to evaluate its influence on postoperative spinal alignment and clinical outcomes. METHODS: Sixty-six patients with Lenke type 5C AIS were included and followed up for a minimum of 5 years after surgery. First, the patients were divided into two groups according to the preoperative TLK angle (Study 1; Kyphosis and Lordosis group). The patients were further classified into two groups according to the presence or absence of postoperative changes in TLK (Study 2; Changed and Maintained groups). Finally, the outcome variables were compared between these groups and analyzed for spinal alignment and clinical outcomes. RESULTS: In Study 1, patients demonstrated a significant kyphotic change in the Lordosis group and a significant lordotic change in the Kyphosis group postoperatively. No statistically significant differences were found between the two groups when comparing the pre- and postoperative coronal and sagittal alignment. In Study 2, there were no statistically significant differences between the Changed and the Maintained groups in each spinal alignment pre- and postoperatively. Each domain of the Scoliosis Research Society 22-item questionnaire remained unchanged at 5 years postoperation. CONCLUSION: In many patients with Lenke type 5C AIS, TLK changed significantly and approached 0° after surgery. However, the magnitude of the preoperative TLK and the presence or absence of improvement did not affect postoperative spinal alignment. Furthermore, the patients had satisfactory clinical outcomes irrespective of TLK modification. LEVEL OF EVIDENCE: III.

Correlation between Degenerative Thoracolumbar Kyphosis and Lumbar Posterior Muscle.

The relationship between spinal alignment, particularly degenerative thoracolumbar kyphosis (DTLK) combined with lumbar spine stenosis (LSS), and paraspinal muscle content remains underexplored. This study aimed to elucidate the characteristics of paraspinal muscle distribution in DTLK patients and its association with lumbar lordosis (LL) and body mass index (BMI). METHODS: A case-control study was conducted comparing 126 patients with DTLK and LSS against 87 control patients. The lumbar crossing indentation value (LCIV) was introduced as a novel measurement for paraspinal muscle content, and its relationship with thoracolumbar kyphosis (TLK), BMI, and LL was assessed. RESULTS: LCIV in DTLK patients was found to be lower than in the control group, with a progressive increase from the upper to lower lumbar spine. In the control group, paraspinal muscle content was observed to increase with age and BMI, and LCIV was higher in males. However, the DTLK group showed no gender difference. LCIV in the DTLK group was more pronounced in patients with increased LL. The degree of TLK was not influenced by BMI but was associated with the content of the paravertebral muscle. CONCLUSIONS: Paraspinal muscle content, as measured by LCIV, is significantly associated with DTLK and LSS. The study emphasizes the importance of considering paraspinal muscle health in DTLK patients and offers valuable insights for diagnosis and therapeutic interventions.

Is the pelvic incidence a determinant factor for kyphosis curve patterns of ankylosing spondylitis patients?

To investigate the influence of pelvic incidence (PI) on the kyphosis curve patterns and clinical outcomes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis and to construct a classification of AS according to the PI value for surgical decision-making. 107 AS patients underwent single-level lumbar pedicle subtraction osteotomy (PSO) and finished a minimal of 2-year follow-up. All patients were divided into three groups: low PI (PI ≤ 40°), moderate PI (40° < PI ≤ 60°), and high PI (PI > 60°). Standing lateral radiographs were taken to evaluate the location of kyphotic apex, thoracic kyphosis (TK), lumbar lordosis (LL), C7 sagittal vertical axis (SVA), spino-sacral angle (SSA), global kyphosis (GK), PI, sacral slope (SS), and pelvic tilt (PT). Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate quality of life. Before surgery, a significant difference was shown in the average LL and the mean GK in high PI group was the largest among the three groups. Correction of SVA, GK and LL in high PI group was the smallest among the three group. No significant difference in clinical outcomes was found among the three groups before surgery and at the final follow-up. Regarding the preoperative sagittal profile, the kyphosis curve pattern of moderate PI group is similar to that of low PI group. For AS patients in these two groups, harmonious sagittal alignment can be restored by a single-level PSO. However, the sagittal imbalance is insufficiently realigned by a single-level PSO in a patient with high PI.

Atypical Scheuermann's disease with severe kyphosis and negative sagittal balance in the thoracolumbar region: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Scheuermann's kyphosis is a structural deformity of the thoracolumbar spine that is classified in typical (thoracic) and atypical (lumbar and thoracolumbar) Scheuermann's disease. Surgical intervention is reserved for those with progressive kyphosis, intractable pain and neurological impairment. Although, previous literature focuses on the correction of the thoracic kyphosis (TK), recent lines of evidence recommend considering all the sagittal balance parameters when performing a surgery. We herein, report a posterior-only approach in a patient with Scheuermann's kyphosis, considering all the sagittal balance parameters. CASE PRESENTATION: The patient was a 17-year-old boy with a kyphotic deformity in the lumbar region, with urinary retention and upper back intractable pain. The preoperative physical examination was normal except for a kyphotic gait. The patient was first treated with thoracic lumbosacral orthoses (TLSO) brace that was not effective; consequently, the patient underwent posterior only approach (pedicular screw fixation along with Smith-Peterson osteotomy) with correction of the sagittal balance and kyphosis. The patient's sign and symptoms improved significantly. The surgery was uneventful and no complication was recorded. The 1-year follow-up revealed normal neurological examination and normal sagittal balance parameters. CLINICAL DISCUSSION: Atypical Scheuermann's kyphosis with neurological impairment and progressive kyphosis should be treated with surgical intervention. CONCLUSION: Considering the sagittal parameters of the spine, the surgical intervention should be designed to correct the kyphosis and the other indices of the sagittal balance. Posterior-only approach is safe and effective method for correction of the TK and improving the signs and symptoms of the patients.

Walking status and spinopelvic parameters in young children with achondroplasia: 10-year follow-up.

PURPOSE: Thoracolumbar kyphosis (TLK) is common in children with achondroplasia and resolves in 90% by 10 years of age. Our purpose was to describe the natural progression of TLK in a cohort of pre-walking children with achondroplasia. METHODS: A single-center, retrospective review identified 62 children (32 male, 30 female) with achondroplasia. Clinical information and sagittal spinopelvic parameters were collected. The children were divided into positive pelvic tilt (PT) and negative PT. All parents were routinely counseled about unsupported sitting. RESULTS: Spontaneous resolution rate was 64.5% at 1-year post-walking, 74.2% at 5 years of age, and 88.7% at 10 years of age. None of the children required posterior spinal decompression and fusion for progressive deformity or symptomatic spinal stenosis. At 1-year post-walking, the negative PT group had a higher sacral slope (p = 0.006), higher lumbar lordosis (p < 0.001), and lower pelvic incidence (p < 0.001). This relationship remained constant up to 10 years of age, and there was no association with TLK. CONCLUSION: In this largest series to date, spontaneous resolution of TLK in children with achondroplasia was 64.5% at 1-year post-walking, 74.2% at 5 years of age, and 88.7% in children followed to 10 years of age. With early identification and regular follow-up with patient education, no patient in this series required treatment or developed symptomatic spinal stenosis. While not predictive of resolution of TLK, the dichotomous presentation of PT in young children with achondroplasia persists at 5 and 10 years of age and reliably predicts the spinopelvic parameters. LEVEL OF EVIDENCE: III-retrospective comparative study.

Achondroplasia natural history study (CLARITY): 60-year experience in orthopedic surgery from four skeletal dysplasia centers.

BACKGROUND: The purpose of this study was to describe the frequency and risk factors for orthopedic surgery in patients with achondroplasia. CLARITY (The Achondroplasia Natural History Study) includes clinical data from achondroplasia patients receiving treatment at four skeletal dysplasia centers in the United States from 1957 to 2018. Data were entered and stored in a Research Electronic Data Capture (REDCap) database. RESULTS: Information from one thousand three hundred and seventy-four patients with achondroplasia were included in this study. Four hundred and eight (29.7%) patients had at least one orthopedic surgery during their lifetime and 299 (21.8%) patients underwent multiple procedures. 12.7% (n = 175) of patients underwent spine surgery at a mean age at first surgery of 22.4 ± 15.3 years old. The median age was 16.7 years old (0.1-67.4). 21.2% (n = 291) of patients underwent lower extremity surgery at a mean age at first surgery of 9.9 ± 8.3 years old with a median age of 8.2 years (0.2-57.8). The most common spinal procedure was decompression (152 patients underwent 271 laminectomy procedures), while the most common lower extremity procedure was osteotomy (200 patients underwent 434 procedures). Fifty-eight (4.2%) patients had both a spine and lower extremity surgery. Specific risk factors increasing the likelihood of orthopedic surgery included: patients with hydrocephalus requiring shunt placement having higher odds of undergoing spine surgery (OR 1.97, 95% CI 1.14-3.26); patients having a cervicomedullary decompression also had higher odds of undergoing spine surgery (OR 1.85, 95% CI 1.30-2.63); and having lower extremity surgery increased the odds of spine surgery (OR 2.05, 95% CI 1.45-2.90). CONCLUSIONS: Orthopedic surgery was a common occurrence in achondroplasia with 29.7% of patients undergoing at least one orthopedic procedure. Spine surgery (12.7%) was less common and occurred at a later age than lower extremity surgery (21.2%). Cervicomedullary decompression and hydrocephalus with shunt placement were associated with an increased risk for spine surgery. The results from CLARITY, the largest natural history study of achondroplasia, should aid clinicians in counseling patients and families about orthopedic surgery.

Impacts of gait biomechanics of patients with thoracolumbar kyphosis secondary to Scheuermann's disease.

Introduction: Thoracolumbar kyphosis (TLK) is a common feature in patients with spinal deformities. However, due to limited studies, the impacts of TLK on gait have not been reported. The objective of the study was to quantify and evaluate the impacts of gait biomechanics of patients with TLK secondary to Scheuermann's disease. Methods: Twenty cases of Scheuermann's disease patients with TLK and twenty cases of asymptomatic participants were recruited into this study. And the gait motion analysis was conducted. Results: The stride length was shorter in the TLK group compared to control group (1.24 ± 0.11 m vs. 1.36 ± 0.21 m, p = 0.04). Compared to control group, the stride time and step time were more prolonged in the TLK group (1.18 ± 0.11s vs. 1.11 ± 0.08 s, p = 0.03; 0.59 ± 0.06 s vs. 0.56 ± 0.04 s, p = 0.04). The gait speed of the TLK group was significantly slower than it of control group (1.05 ± 0.12 m/s vs. 1.17 ± 0.14 m/s, p = 0.01); In the sagittal plane, the range of motion (ROM) of the hip in the TLK group was significantly smaller than that of the control group (37.71 ± 4.35° vs. 40.05 ± 3.71°, p = 0.00). In the transverse plane, the adduction/abduction ROMs of the knee and ankle, as well as the internal and external rotation of the knee, were smaller in TLK group than ROMs in the control group (4.66 ± 2.21° vs. 5.61 ± 1.82°, p = 0.00; 11.48 ± 3.97° vs. 13.16 ± 5.6°, p = 0.02; 9.00 ± 5.14° vs. 12.95 ± 5.78°, p = 0.00). Discussion: The main finding of this study was that measurements of gait patterns and joint movement of the TLK group were significantly lower than those of the control group. And these impacts have the potential to exacerbate degenerative progress of joints in the lower extremities. These abnormal features of gait can also serve as a guideline for physicians to focus on TLK in these patients.

Escala de discapacidad de Oswestry en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética

Introducción: Cuando se valora la cifosis toracolumbar por espondilitis anquilopoyética, se debe medir la repercusión funcional para mejorar la calidad de vida del paciente y solucionar los problemas de una atención adecuada. En consecuencia, se necesitan nuevos conocimientos que implementen una técnica quirúrgica y la escala de discapacidad de Oswestry, método innovador con cambios cualitativos en beneficio de los enfermos. Objetivo: Evaluar los resultados funcionales con la escala de Oswestry en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética. Método: Se realizó un estudio tipo descriptivo, retrospectivo, longitudinal a 16 pacientes con cifosis toracolumbar por espondilitis anquilopoyética, intervenidos con la técnica de osteotomía de sustracción pedicular, en el Servicio de Ortopedia del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", durante el período de marzo de 2001 a marzo de 2021. Resultados: Se obtuvo un buen resultado funcional y mejoró la calidad de vida de los pacientes. Conclusiones: La escala de Oswestry resulta viable, fácil de administrar y puntuar; además, presenta características métricas adecuadas para la evaluación funcional en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética.

Introduction: When evaluating thoracolumbar kyphosis due to ankylopoietic spondylitis, the functional impact should be measured to improve the patient's quality of life and solve the problems of adequate care. Consequently, knowledge is needed to implement a surgical technique and the Oswestry disability scale, an innovative method with qualitative changes for the benefit of patients. Objective: To evaluate the functional results with the Oswestry scale in the correction of thoracolumbar kyphosis by ankylopoietic spondylitis. Method: A descriptive, retrospective, longitudinal study was performed on 16 patients with thoracolumbar kyphosis due to ankylopoietic spondylitis, who underwent surgery using the technique of pediatric subtractive osteotomy, in the Orthopedic Service of "Hermanos Ameijeiras" Clinical Surgical Hospital during the period from March 2001 and March 2021. Results: A good functional result was obtained and the quality of life of the patients improved. Conclusions: The Oswestry scale is feasible, easy to administer and score; in addition, it has adequate metric characteristics for the functional evaluation in the correction of thoracolumbar kyphosis by ankylopoietic spondylitis.

Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation.

PURPOSE: To determine the clinical- and surgical-related factors of hip joint structural changes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who underwent PSO. METHODS: Hip involvement was assessed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and defined by a score of at least 2. 52 patients with BASRI-h scores maintained and 78 patients with BASRI-h scores increased during follow-up were retrospectively reviewed. Clinical data were recorded. Radiological assessment was performed preoperatively, postoperatively, and at the final follow-up. RESULTS: No significant difference existed in age, gender and follow-up time between the groups, but earlier onset of AS, longer disease and kyphotic duration, and worse Bath Ankylosing Spondylitis Functional Index (BASFI) scores at the final follow-up were observed in patients with BASRI-h scores increased (P < 0.05). Besides, global kyphosis (GK), T1-pelvic angle (TPA), pelvic tilt (PT) and anterior pelvic plane angle (APPA) were always larger in patients with BASRI-h scores increased, accompanied with more sacral fixation (P < 0.05). Multivariate logistics regression showed that earlier onset of AS, longer kyphotic duration, larger preoperative GK, sacral fixation and larger APPA during follow-up were independent risk factors. CONCLUSION: Earlier onset of AS and longer kyphotic duration were the clinical risk factors of hip joint structural changes in AS patients following PSO, while larger preoperative GK, sacral fixation in PSO and larger APPA during follow-up were the surgical-related factors. Surgeons should inform patients with risk factors of the possibility for severe hip joint structural changes after PSO.

Treatment of rigid post-traumatic thoracolumbar kyphosis by a novel technique of spinal joints release.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of a novel technique named spinal joints release (SJR) and observe its efficacy in treating rigid post-traumatic thoracolumbar kyphosis (RPTK). METHODS: RPTK patients who were treated by SJR with facet resection, limited laminotomy, clearance of the intervertebral space, and release of the anterior longitudinal ligament through the intervertebral foramen and disc of injury segment from August 2015 to August 2021 were reviewed. Intervertebral space release, internal fixation segment, operation time, and intraoperative blood loss were recorded. The intraoperative, postoperative, and final follow-up complications were observed. An improvement in the VAS score and ODI index was observed. Spinal cord functional recovery was evaluated by American Spinal Injury Association Impairment Scale (AIS). Improvement of local kyphosis (Cobb angle) was evaluated by radiography. RESULTS: Forty-three patients were successfully treated by the SJR surgical technique. Open-wedge anterior intervertebral disc space was performed in 31 cases, and repeated release and dissection of the anterior longitudinal ligament and callus were performed in 12 cases. There was no lateral annulus fibrosis release in 11 cases, the anterior half release of lateral annulus fibrosis in 27 cases, and complete release in five cases. There were five cases of screw placement failure in one or two side pedicles of the injured vertebrae due to excessive resection of the facets and improper pre-bending of the rod. Sagittal displacement occurred in four cases at the released segment due to the complete release of bilateral lateral annulus fibrosus. Autologous granular bone + Cage was implanted in 32 cases, and autologous granular bone was implanted in 11 cases. There were no serious complications. The average operation time was 224 ± 31 min, and intraoperative blood loss was 450 ± 225 mL. All the patients were followed up with an average of 26 ± 8.5 months. The VAS scores and ODI index improved significantly at the final follow-up. All of the 17 patients with incomplete spinal cord injury achieved more than one grade of neurological recovery at the final follow-up. An 87% correction rate of kyphosis was achieved and maintained, with the Cobb angle decreasing from 27.7° preoperatively to 5.4° at the final follow-up. CONCLUSION: Posterior SJR surgery for patients with RPTK has the advantages of less trauma and less blood loss, and kyphosis correction is satisfactory.

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors.

OBJECTIVE: Junctional kyphosis is a common complication after corrective long spinal fusion for adult spinal deformity. Whereas there is still a paucity of data on junctional kyphosis, specifically among late posttraumatic thoracolumbar kyphosis (LPTK) patients. Thus, the aim of this study was to investigate the characteristics and risk factors of junctional kyphosis in LPTK patients receiving long segmental instrumented fusion. METHODS: We retrospectively reviewed a cohort of LPTK patients who had received long segmental instrumented fusion (>4 segments) in our center between January 2012 and January 2019. Radiographic assessments included the sagittal alignment, pelvic parameters, bone quality on CT images, and measurements of the cross-sectional area (CSA, cross-sectional area of muscle-vertebral body ratio × 100) and fat saturation fraction (FSF, cross-sectional area of fat-muscle body ratio × 100) of paraspinal muscles. Patients in this study were divided into those with junctional kyphosis or failure (Group J) and those without (Group NJ) during follow-up. Group J included patients with junctional kyphosis (Group JK) and patients with junctional failure (Group JF). RESULTS: A total of 65 patients (16 males and 49 females, average age 56.5 ± 23.4 years) were enrolled in this study. After (32.7 ± 8.5) months follow-up, 15 patients (23.1%) experienced junctional kyphosis, and four of them deteriorated into junctional failure. Eighty percent (12/15) of junctional kyphosis was identified within 6 months after surgery. In comparison with Group NJ, Group J were older (P = 0.026), longer fusion levels (P < 0.001), greater thoracic kyphosis (P = 0.01), greater global kyphosis (P = 0.023), lower bone quality (P < 0.001), less CSA (P = 0.005) and higher FSF (P <0.001) of paraspinal muscles. Preoperative global kyphosis more than 48.5° (P = 0.001, odds ratio 1.793) and FSF more than 48.4 (P = 0.010, odds ratio 2.916) were identified as independent risk factors of junctional kyphosis. Based on the statistical differences among Group NJ, Group JK and Group JF (P < 0.001), Group JF had lower bone quality than Group NJ (P < 0.001) and Group JK (P = 0.015). In terms of patient-reported outcomes, patients in Group JF had worse outcomes in ODI and VAS scores, and PCS and MCS of SF-36 than Group NJ and group JK CONCLUSION: The prevalence of junctional kyphosis was 23.1% in LPTK patients after long segmental instrumented fusion. Preoperative hyperkyphosis and advanced fatty degeneration of paraspinal muscles were independent risk factors of junctional kyphosis. Patients with lower bone quality were more likely to develop junctional failure.

Does the Change of Acetabular Anteversion Result From Lumbar Pedicle Subtraction Osteotomy in Ankylosing Spondylitis-Related Kyphosis After Primary Total Hip Arthroplasty?

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the change in acetabular anteversion (AA) after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who have already undergone total hip arthroplasty (THA). METHODS: AS patients with thoracolumbar kyphosis following lumbar PSO from January 2005 to January 2020 were retrospectively reviewed. Only the patients performed with THA prior to the PSO were included. AA was measured on the full-length standing posterior-anterior radiographs using the ellipse method. RESULTS: Twenty patients (34 hips) with a mean age of 36.8 years (range, 22 to 63 years) were included. After lumbar PSO, AA was reduced from 18.59° to 5.85° (P < 0.001). Postoperative change in AA was correlated with the spinal deformity correction. Additionally, the change in AA postoperatively was correlated with pelvic incidence (PI) (R = 0.346, P = 0.045). Although the postoperative change in sagittal vertical axis (SVA) was larger in the patients after L2 or L3 PSO (153.97 mm vs 70.03 mm, P = 0.006), no difference was found in the postoperative change in AA (12.83° vs 10.96°, P = 0.540) compared with the patients following L1 PSO. CONCLUSIONS: AA was significantly decreased following lumbar PSO and the postoperative change in AA was correlated with the magnitude of spinal deformity correction. Notably, the effect of osteotomy level on the postoperative change in AA was limited in the AS patients underwent 1-level PSO.

Surgical Correction of Distal Junctional Kyphosis.

Distal junctional kyphosis (DJK) is defined as the development of a kyphotic angulation over 10 degrees below a fusion construct and has been described as a complication of the treatment of adolescent idiopathic scoliosis, Scheuermann kyphosis, adult spinal deformity, and cervical deformity. There are some inherent risk factors to DJK: multilevel fusions, damage to the midline soft tissues including interspinous/supraspinous ligaments, T5-T12 thoracic kyphosis, T11-L2 thoracolumbar kyphosis, and increased mismatch between cervical lordosis and T1 slope. A 53-year-old male presented with cervicalgia, inability to sustain horizontal gaze, and kyphosis-enabled forward head posture. He underwent C3-T1 posterior decompression and fusion as treatment for cervical myelopathy 18 months prior. Neurologic examination was normal, with appreciable protrusion of the T1 vertebral spinous process. Surgery was initiated through subperiosteal exposure of C2-T6, followed by removal of previously set instrumentation, placement of new screws, and posterior column osteotomies of selected segments. Final steps involved compression across excised portions, locking pedicle screws, and a multirod insertion after closure of the posterior column osteotomies by compression maneuvers. Correction for DJK encompasses sagittal alignment restoration, a stable construct, and a good biological environment for healing. Failure of DJK realignment can occur if the patient's ligaments deteriorate distal to the construct or fractures develop in vertebral bodies at the lowest instrumented vertebra or lowest instrumented vertebra +1. One year after surgery, the patient's condition improved, evidenced from both patient self-report and a standing posture radiograph.

Spinal Stenosis and Thoracolumbar Kyphosis in Achondroplasia / 罕见病研究

Achondroplasia (ACH) is a rare autosomal-dominant genetic disease resulting from a mutation in the fibroblast growth factor receptor-3 (FGFR3) gene. It is characterized by asymmetric short stature. Spinal stenosis and thoracolumbar kyphosis (TLK) are common findings in ACH patients. Severe TLK can exacerbate spinal stenosis, leading to neurological complications. This paper provides a brief review of the pathophysiological mechanisms, clinical characteristics, and treatments for spinal stenosis and TLK in ACH patients. Recently, three new drugs targeting FGFR3; vosoritide, recifercept, and infigratinib, have completed or are undergoing clinical trials. They have shown promising preliminary results in preventing spinal stenosis and TLK.

Evaluation of preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis.

BACKGROUND: To evaluate the accuracy of different preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis and analyze its clinical significance. METHODS: Twenty-two cases of AS patients with thoracolumbar or lumbar kyphosis, from January 2015 to December 2018, who underwent one-level SPO surgery in our hospital, were retrospectively reviewed. The sagittal parameters were measured at pre-operation and last follow up using Surgimap software, and theoretical values of sagittal parameters were calculated according to pre-operative PI. The osteotomy angles of different methods were measured using Surgimap software. Paired t test was used to for the statistical analysis. RESULTS: The mean follow-up time of all patients was 30.00 [Formula: see text] 3.56 months. The osteotomy sites were located at T12 in 3 cases, L1 in 6 cases, L2 in 9 cases, and L3 in 4 cases. Compared to pre-operative sagittal parameters, post-operative PT, SS, LL, and SVA were significantly improved (P [Formula: see text] 0.05). Compared to the OVA (46.57 [Formula: see text] 2.32 [Formula: see text]), there was a significantly larger angle predicted by Surgimap method (53.80 [Formula: see text] 9.79 [Formula: see text]), CAM-HA method (56.61 [Formula: see text] 8.58 [Formula: see text]), and HP-HA method (60.07 [Formula: see text] 13.58 [Formula: see text]), respectively (P [Formula: see text] 0.05). But no significant difference was found between the postoperative osteotomy angle and those of SFA method (51.24 [Formula: see text] 12.14 [Formula: see text]) and FBI method (48.08 [Formula: see text] 12.49 [Formula: see text]) (P [Formula: see text] 0.05). CONCLUSION: For AS patients with thoracolumbar or lumbar kyphosis, the SFA method, FBI method, and Surgimap method can be used to predict the osteotomy angle precisely, however, considering the rationality of parameter settings and the operability, SFA method is relatively more suitable for such population.

Meeting Report from 2nd ICCBH-ERN BOND Spinal Complications in Children and Adults with Achondroplasia Workshop, Dublin, Ireland, 2nd July 2022.

A pre-meeting workshop on spinal complications in children and adults with achondroplasia was held in Dublin, Ireland at the 10th International Conference on Children's Bone Health (ICCBH) 2-5 July 2022. The pathophysiology, natural history and medical/surgical management of thoraco-lumbar kyphosis and spinal stenosis remains poorly described in the literature. The structure of the workshop consisted of lectures, a debate and an interactive round table discussion. In total over 100 delegates affiliated to over 70 institutions from 20 countries were in attendance.