Kappa: Preliminary Results on a Novel Technique for Pelvic Fixation in Adult Spinal Deformity Correction.

Study Design: Retrospective cohort study. Objectives: Pelvic fixation in degenerative spinal deformation is as crucial as demanding. Several pelvic anchoring technics have been described, but loosening rates remain high for most solutions. Here is described the "Kappa" technic, combining ilio-sacral screws to S2A1 screws at 2 years of follow-up. Methods: Thirteen patients that underwent a spinal deformity correction with "Kappa" fixation to the pelvis and with more than 2 years of follow-up were prospectively included in this study. The surgical technic is described, and clinical and radiographic data have been collected for all patients. Results: The population exhibited an important pre-operative sagittal imbalance (mean SVA of 104,4 mm, mean PI-LL mismatch of 22,8°) that had improved significatively after surgery (mean SVA of 75,5 mm and mean PI-LL mismatch of 4,9°). No loosening of pull-out of the implants was to deplore at 2 years of follow-up. Conclusions: The association of ilio-sacral screw, resistant to pull-out because of the traction axis perpendicular to the construct, to S2A1 screws, known to be effective in sagittal balance restoration seems to be an effective and safe option to pelvic fixation for adult spinal deformity correction. Level of Evidence: IV.

Degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) frequently leads to severe neurologic disability but is still frequently underdiagnosed. One explanation may be the variability of the symptoms presented by the patients, from paresthesia to quadriplegia, making it another great masquerader. What do we know? How can we manage better these patients? We will review the keys points concerning its challenging diagnosis (clinical and radiologic), some of the recent discoveries about DCM, notably the underlying genetic mutations identified, linked to its pathophysiology, before addressing the consensual points concerning its management and the major evolutive risk: acute decompensation.

Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis?

STUDY DESIGN: Retrospective cohort. OBJECTIVE: The aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis and its related clinical symptoms. INTRODUCTION: Adults with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debatable. METHODS: Patients operated for symptomatic LSS with lumbar scoliosis (Cobb angle >20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic examination. Coronal and sagittal radiographic parameters, rotatory subluxation (RS), and spondylolisthesis were analyzed on full spine radiographs. Computed tomographic scan multiplanar reconstructions were performed to measure central, foraminal, and lateral recess stenosis, from T10 to the sacrum. RESULTS: A total of 76 patients were included (69 ± 9 years old, 77% female). Sixty percent had neurogenic claudication, and L5 was the most common radicular pain (41%). The mean Cobb angle was 33° ± 16°. Overall, 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. Sixty patients had RS (most frequent level L3-L4). In 50% of the cohort, RS was located at the junction between the lumbar and lumbosacral curves. In 70% (n = 53) of the patients, central stenosis occurred at the junction between the lumbar and lumbosacral curves. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbosacral curve. L5 radicular pain was significantly more frequent in case of lumbosacral contra-curve and right coronal malalignment. CONCLUSION: LSS is frequent in lumbar scoliosis. Relationships exist between curve characteristics and symptomatic LSS in lumbar scoliosis; especially, concavity of the lumbosacral contra-curve and the junctional level between the lumbar curve and the lumbosacral contra-curve. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least perform decompression because perfect planned treatment for stenosis and scoliosis correction might not always be possible because of the patient's general health status. LEVEL OF EVIDENCE: Level 4.