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The purpose of this study was to retrospectively investigate the causes of failure in the first operation and the revision procedure for patients with congenital scoliosis due to hemivertebra. Nineteen patients who underwent the revision operations because of failure in the first operation were included in this study. All the malformations were identified as fully segmented hemivertebra, including 16 cases in thoracolumbar vertebra (T10: three patients; T12: seven patients; L1: six patients), and three cases in thoracic vertebra (T8). The causes of failure in the first operation and the outcome of revision procedure for patients were retrospectively analyzed. All patients were successfully performed the personalized revision surgeries. The failure reasons of the first operation included limitations of the first operation procedure, no or incomplete resection of the malformed hemivertebra, improper operation during surgery, improper internal fixation material, and improper internal fixation scope. The average postoperative scoliosis Cobb's angle and kyphosis Cobb's angle were corrected from 54.1°preoperatively to 23.1°postoperatively, and 59.3°preoperatively to 25.8°post-operatively, respectively. The average postoperative distance between the C7 plumb line and the center sacral vertical line was decreased from 2.5 cm preoperatively to 1.5 cm postoperatively. The average follow-up period was 2.2 years. No serious complication was observed. The cause of the failure of the first operations for the congenital scoliosis due to hemivertebra is verified. Our study may provide a basis for the treatment of congenital scoliosis due to hemivertebra.

Background: Osteopontin (OPN) is reportedly involved in bone desorption, formation and ectopic calcification. We sought to investigate the role of OPN gene polymorphism in the susceptibility to Cervical spondylotic myelopathy (CSM) and in predicting the outcome anterior cervical corpectomy and fusion (ACF). Methods: A total of 187 patients diagnosed with CSM and 233 sex and age matched healthy controls were enrolled in this study. All CSM patients received ACF and were followed up for 24 months. The polymorphisms of OPN gene at 3 loci, namely, -156 G>GG, -443 C>T and -66T>G were determined. Results: The -66T>G genotype was significantly different between CSM patients and controls. Compared to the -66TT carriers, the -66GG genotype carriers had a higher risk for developing CSM (adjusted Odd Ratio=2.58, adjusted P=0.001). In contrast, the genotype distributions of the -156G/GG and -443C/T loci were not significantly different between the CSM and control groups. OPN gene polymorphism did not determine the pre-operative severity of CSM patients, but the -66T>G genotype was significantly associated with the clinical outcome of CSM after ACF treatment. The -66T>G did not affect the serum OPN level, but affect the local expressions of OPN and a serious of key inflammatory factors in the intervertebral disc samples. Conclusion: Our study shows the OPN -66T>G genetic polymorphism contributes to patients' susceptibility to CSM and could be indicative of the outcome of ACF surgery.

Clinical results of posterior fusion plus pedicle screw fixation in the treatment of upper cervical spine instability were taken under consideration. 24 patients with atlantoaxial instability were treated with C1-2 pedicle screws and rods fixation under general anesthesia. There were 18 males and 6 females with mean age of 49.8 years (age range 17-69 years). The postoperative radiographs verified good position of all screws, with satisfactory atlantoaxial reduction. Follow-up for 3-45 months (average 23 months) showed no spinal cord and vertebral artery injury or interfixation failure. Atlantoaxial alignment and stability were restored without complication due to instrumentation. In conclusion, posterior atlantoaxial pedicle screw and rod fixation provide immediate three-dimensional rigid fixation of atlantoaxial joint and are more effective techniques compared with previously reported techniques.

BackgroundPrevious studies have demonstrated that pelvic incidence and sacral slope are significantly greater in idiopathic scoliosis patients compared with normal adolescents. However, whether these sagittal parameters are related to the progression of scoliosis remain unknown. The present was designed to determine the differences in the sagittal profiles among thoracic idiopathic scoliosis patients with different potentials for curve progression.MethodsNinety-seven outpatient idiopathic scoliosis patients enrolled from June 2008 to June 2011 were divided to three groups according to different Cobb angles and growth potentials: (1) non-progression of thoracic curve group, Risser sign of 5 and Cobb’s angle < 40°; (2) moderate progression of thoracic curve group, Risser sign of 5 and Cobb’s angle ≥ 40°; and (3) severe progression of thoracic curve group, Risser sign ≤ 3 and Cobb’s angle ≥ 40°. All patients underwent whole spinal anteroposterior and lateral X-ray in standing position, and the sagittal parameters were measured, including thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt.ResultsThe average thoracic scoliosis Cobb’s angle in the non-progression group was significantly less than that in the moderate progression group (P < 0.01) and severe progression group (P < 0.01), but there was no statistical difference in the average thoracic scoliosis Cobb’s angle between the severe progression group and moderate progression group. The average thoracic kyphosis angle in the severe progression group (9° ± 4°) was significantly smaller than that in the non-progression group (18° ± 6°, P < 0.01) and moderate progression group (14° ± 5°, P < 0.05). No statistical differences were present in the average lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt among the three groups.ConclusionsThoracic hypokyphosis is strongly related with the curve progression in thoracic idiopathic scoliosis patients, but not pelvic sagittal profiles.