Current classification systems for adult degenerative scoliosis.

At present, a big effort of the scientific community has been directed toward a more proper and standardized approach to the patients affected by degenerative scoliosis, and recent attention has turned toward the development of classification schemes. A literature analysis highlighted several classification schemes developed for degenerative scoliosis patients: the Simmons classification system, the Aebi system, the Faldini working classification system, the Schwab system, and the Scoliosis Research Society system. Aim of the current manuscript is to scrutinize the available literature in order to provide a comprehensive overview of these current classification schemes for adult scoliosis, by describing and commenting clinical development, limits and potential of their application together with their implications for surgical planning.

Single level cervical fusion by an anterior approach using autologous bone graft influences the adjacent levels degenerative changes: clinical and radiographic results at 10-year minimum follow-up.

INTRODUCTION: Cervical degenerative pathology can produce pain and disability and, in case of failure of conservative treatment surgery is indicated. MATERIALS AND METHODS: 107 patients affected by single level cervical degenerative pathology were surgically treated by Cloward procedure. On radiographs, the sagittal segmental alignment (SSA) of the affected level and sagittal alignment of the cervical spine were measured. RESULTS: Preoperatively, mean SSA was 0.6° and at the last follow-up 1.8°. In particular, adjacent-level degeneration occurred more frequently in Group A than in Group B. CONCLUSION: Lordotic SSA angle can be considered a protective factor against adjacent-level degeneration.

Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone.

BACKGROUND: In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease. METHODS AND MATERIALS: Twenty-five patients affected by single-level cervical degenerative pathology between C4 and C7 were enrolled in this study. The clinical findings were assessed using the Neck Disability Index and the Visual Analog Scale. Surgical outcomes were rated according to Odom's criteria at last follow-up. Fusion was graded as poor, average, good or excellent by assessing the radiographs. Cervical spine alignment was evaluated by sagittal segmental alignment and sagittal alignment of the whole cervical spine preoperatively, 6 months postoperatively and at the last follow-up. RESULTS: Twenty-five patients underwent ACDF using a PEEK anatomical cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C4-C5 in 5 patients, C5-C6 in 12 patients and C6-C7 in 8 patients. Preoperatively, average NDI was 34, 13 at 6 months, and 10 at latest follow-up. The mean preoperative VAS was 7; the mean postoperative VAS at latest follow-up was 3. Good or excellent fusion was achieved in all patients within 10 months (mean 5 months). Preoperatively, average sagittal segmental alignment (SSA) was 0.2° and average sagittal alignment of the cervical spine (SACS) 15.8°. Six months after surgery, average SSA was 1.8° and average SACS 20.9°, and at last follow-up, average SSA was 1.6° and average SACS 18.5°. CONCLUSION: Anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed.

Use of homologous bone graft in the treatment of aseptic forearm nonunion.

The dyaphyseal nonunion of forearm bones is a complication that changes the normal interaction between radius and ulna, which may lead to forearm malfunction. We reviewed 14 patients treated by surgical technique included a homologous bone graft in combination with a plate. The mean age was 31 years (range, 18-45 years) at the time of surgery. Minimum follow-up was 2 years (mean, 5 years; range, 2-13 years). There were no intraoperative or postoperative complications. At last follow-up, all forearm bones had remodelled. The mean visual analogue pain scale was 1 (range, 0-4). There was a high success rate regarding forearm alignment and functional results; all patients recovered daily and working activities quickly. This surgical technique in treatment of aseptic forearm nonunion by combining homologous bone graft with a plate led to bone healing, improved forearm function, and a durable outcome with long-term follow-up.