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Background Data: Thoracolumbar fractures are commonly managed by posterior pedicle screw fixation. Controversy about the number of levels involved in the fixation remains as the stability of the shortsegment fixation remains questionable. Recently, it has been shown that application of intermediate screw in the fractured vertebra improves the biomechanical stability of the short-segment construct. Purpose: To compare the outcome of long-segment fixation (LSF) versus short-segment fixation with intermediate screws (SSFIS) in the management of the thoracolumbar burst fractures. Study Design: A prospective, nonrandomized clinical controlled trial. Patients and Methods: Fifty patients with thoracolumbar burst fracture (T11-L2) types A3 and A4 AOSpine classification with a Thoracolumbar Injury Classification and Severity (TLICS) scale of more than 4 were treated between 2009 and 2014 with posterior pedicle screw fixation. Patients were divided into two groups according to the number of instrumented levels. Group 1 included 25 patients treated with LSF (two levels above and two levels below the fractured level) while Group 2 included 25 patients treated by SSFIS (one level above and one level below with 2 intermediate screws in the fractured level). The patients were evaluated for local kyphotic angle (LKA) correction and maintenance, anterior vertebral body height (AVH) compression, and Visual Analogue Scale (VAS) for back pain and treatment related complications. Construct failure was defined as screw pullout or instrument breakage. Results: The two groups were similar with regard to age, sex, fractured levels, fracture type, TLICS score, preoperative local kyphotic angle, and anterior vertebral body height compression. Postoperative correction of the local vertebral compression assessed with LKA and AVH significantly improved in both groups compared to the preoperative degree. There was no significant difference in the two groups in early postoperative or follow-up regarding the degree of correction and its maintenance. No construct failure or major treatment related complication was encountered in both groups with significant reduction of VAS and ODI in both groups between early postoperative and late follow-up (13.5±2 months).

Background: Elastic intramedullary nailing is a method of diaphyseal fracture osteosynthesis in children. This technique has many advantages. Namely, there is primary bone union with avoidance of growth plate injury, early weight bearing, and minimally invasive surgery with a short duration of hospitalization. Objective: In this study, we evaluated radiological and functional results of treatment of open tibial shaft fractures in children using intramedullary elastic nail. Patients and Methods: This study was a prospective clinical study that included 24 cases with open tibial fractures treated with intramedullary elastic nail at Zagazig University Hospital (ZUH), Egypt and in Tripoli Central Hospital in Libya from June 2020 until September 2020 with six months follow-up. All patients were assessed radiologically by anteroposterior and lateral plain radiographs of the tibia that included the knee and ankle to limit unnecessary radiation. Results: The majority of studied group were excellent in 19 cases clinically according to Ketenjian and Shelton Criteria and 23 cases were united using radiological assessment. Only two cases had superficial skin infection and just one case had delayed union. Conclusion: Flexible intramedullary nailing is an effective treatment option in patients with open fracture (gustilo type I, II), four to fifteen years age group.

Purpose We assessed the efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with low-grade isthmic spondylolisthesis. Methods We included 24 symptomatic patients who underwent MIS-TLIF between December 2017 and December 2020. Patients were followed up clinically by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and VAS for leg pain, as well as radiological radiographs after 6 weeks, 6 months, and at final follow-up (at least 12 months). Measured parameters included C7 sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), Meyerding slip grades, lumbar lordosis (LL), L1–L4 angle, L4–S1 angle, and segmental lordosis (SL) of the affected segment. The mismatch between the PI and LL was also measured. Results VAS for back, VAS for leg pain, and ODI significantly improved postoperatively (all p < 0.001). We observed significantly decreased mean values of PT and slip percentage and increased mean values of SS and LL (all p < 0.05). We observed a significant reduction in L1–L4 lordosis and a significant increase in L4–S1 lordosis. The final PT, SS, and LL (total and L1–L4) were significantly higher in group III patients (n = 15) than the values of group II patients (n = 9). None of the patients became unbalanced postoperative, and all patients had a normal matching between the PI and the LL postoperatively. Conclusions MIS-TLIF is a safe procedure for managing low-grade isthmic spondylolisthesis with significant improvement in clinical and radiological outcomes. It can correct and maintain a proper spinopelvic alignment.

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Background Data: Minimally invasive fenestration has evolved recently to become the modern standard surgical solution for degenerative lumbar spinal canal stenosis (DLCS). Purpose: To investigate the safety and the efficacy of the endoscopic fenestration for patients with monosegmental degenerative lumbar spinal canal stenosis. Study Design: Prospective clinical cohort study. Patients and Methods: Thirty-five consecutive patients with DLCS were treated with endoscopic fenestration. Patients were treated with METRx system (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), at Orthopedic Department, Zagazig University, between May 2012 and June 2015. Primary outcomes parameters included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary outcomes parameters included operative time, blood loss, preoperative and 3-month postoperative lumbar dynamic radiographs, and modified McNab criteria. Only patients who completed 36 months of follow-up were included in the final analysis of this study. Follow-up data were obtained from outpatient clinic follow-up visits by two independent physicians. Results: At the final follow-up, the improvement in claudicant leg pain and disability was statistically significant, and the endoscopic fenestration procedure did not affect the stability of the motion segment. The total success rate according to McNab criteria was 85.7% (30/35), fair 5.7% (2/35), and poor 8.6% (3/35). The mean NRS leg score significantly decreased from 7.3±1.5 preoperatively to 0.8±0.67 (P=0.001) postoperatively. The mean ODI score significantly decreased from 72.34±4.6 % preoperatively to 13.71±3.46 % postoperatively. There were no reported serious complications in any of our patients' study. Conclusion: Endoscopic fenestration is a safe and effective technique in patients with degenerative lumbar stenosis. It allows adequate decompression of the neural elements and preserves spinal stability. (2018ESJ145)