No Significant Radiological Signs of Adult Spinal Deformity Progression after a Mean of 11 Years of Follow-Up Following Harrington Rod Instrumentation Removal and Watchful Waiting.

The study aimed to assess long-term radiological outcomes in patients from our institution who were primarily treated for adolescent idiopathic scoliosis with surgical correction using Harrington rod (HR) instrumentation, and afterward with watchful waiting of residual spinal deformity after HR removal, whereby no patient consented to spinal deformity correction. A single-institution case series of 12 patients was retrospectively evaluated. Preoperative and most recent post-instrumentation removal radiographic measurements were compared, along with baseline characteristics. The average age of patients (all females) at the time of HR instrumentation removal was 38 ± 10 years (median 40, range 19-54). The mean follow-up from the HR instrumentation implantation to the HR instrumentation removal was 21 ± 10 years (median 25, range 2-37), with a further mean of 11 ± 10 years (median 7, range 2-36) of follow-up following HR instrumentation removal and watchful waiting. No significant change in radiological parameters was observed: LL (p = 0.504), TK (p = 0.164), PT (p = 0.165), SS (p = 0.129), PI (p = 0.174), PI-LL (p = 0.291), SVA (p = 0.233), C7-CSVL (p = 0.387), SSA (p = 0.894), TPA (p = 0.121), and coronal Cobb angle (proximal (p = 0.538), main thoracic (p = 0.136), and lumbar (p = 0.413)). No significant change in coronal or sagittal parameters was observed in this single-institution long-term radiological outcome study of adults following HR instrumentation removal and watchful waiting of residual spinal deformity.

Ossification of ligamentum flavum related to progressive thoracic myelopathy and acute paraplegia in a Central-European male with a thoracic kyphoscoliosis.

The ossification of the ligamentum flavum (OLF) presents a significant risk factor in the development of spinal cord compression in the (lower) thoracic spine, particularly in eastern Asian elderly males. The definite causes for OLF have not yet been fully uncovered, whereby age, genetics, metabolic disorders and mechanical stress are deemed among the most plausible pathophysiological factors in OLF. Spinal deformities (mostly kyphotic) are associated with an excess in tensile forces, which may lead to hypertrophy and OLF. This unique case of OLF-related acute paraplegia and progressive thoracic myelopathy in a Central-European male patient may indicate the role of a (kyphoscoliotic) spinal deformity in the initiation and progression of the OLF-related (thoracic) myelopathy. Promptly initiated surgical decompression and (partial) deformity correction may, along with proper subsequent intradisciplinary rehabilitation process, greatly improve the clinical outcome post-treatment, especially in terms of quality of life and residual pain.

Electromagnetic Navigation Assisted Patient-Personalized Femoral Osteotomy for Acute Correction of Posttraumatic Residual Multiplanar Femoral Deformity with Shortening.

Improper healing of a femoral shaft fracture can result in posttraumatic residual multiplanar femoral deformity and limb shortening, which can be restored with a corrective osteotomy. Predominantly in complex posttraumatic circumstances, the use of computer assistance in orthopaedic surgery may facilitate meticulous preoperative planning, and further improve the accuracy and safety of such procedures, potentially resulting in better clinical outcomes. Herein, we present a unique case of electromagnetic navigation assisted patient-personalized femoral osteotomy for acute correction of posttraumatic residual multiplanar femoral deformity with shortening.