Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.

This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corrected by Zielke VDS instrumentation. The results were analysed to demonstrate the correction in all three planes. Satisfactory correction was obtained, and was particularly good in the sagittal and horizontal planes. There were no disadvantages from the thoracotomy.

The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reintervention for late endoleaks or endograft migrations.

IntroductionThe most feared complication in spinal surgery is paraplegia. In a large reported series the risk of a cord lesion in spinal deformity surgery has been found to be 0.5-1.7%. Risk signs noted are congenital deformity, kyphosis, postradiation deformity and larger (more than 100º) curves. The lesions are caused by cord stretching in instrumented patients or direct trauma [12].We report an unusual metabolic complication which caused transient paresis of the proximal leg muscles after scoliosis surgery. Case reportA 15-year-old Turkish girl (B.U., 162 cm, 42 kg) was admitted for surgical correction of severe thoracic scoliosis. The patient presented with a marfanoid habitus and a thoracic curve of 116º (Cobb). Preoperative neurological examination was unremarkable and the MRI of the spinal cord revealed no cord abnormalities. Halogravity traction and anterior release, followed by further traction and finally posterior instrumentation were scheduled. After a 5-week period of traction, anterior release Th4-L1 was performed uneventfully in controlled hypotension. The right segmental arteries Th5-Th12 were ligated. Autologous iliac bone and rib grafts were placed in the disc spaces on the concave side of the curve. The cell saver technique was used (400 ml autotransfusion), central venous pressure was monitored (6-11 mm H 2 O) and fluid intake was adjusted accordingly. The Stagnara wake-up test and postoperative function were normal, with forceful dorsi-and plantarflexion bilaterally.During the following day the patient developed symmetrical paresis of the hip and knee flexors and extensors (0/5). The dorsiand plantarflexion of the feet were still forceful (4/5) and sensibility was not disturbed in either leg. Patellar tendon jerks and Achilles tendon reflexes were absent. There were no evident pyramidal signs. Rectal tone was normal, as was examination of the upper extremities. The neurologist additionally disclosed a decreased T5-10 sensibility on the right hemithorax and suspected a traumatic cord lesion. A CT scan of the thoracic spine was performed, and intraspinal haematoma and dislocation of intersomatic rib grafts were ruled out. A psychological exploration of the patient revealed no suspicion of simulation. At that time a routine blood check showed decreased potassium (2.8 mmol/l) and haemoglobin (8.4 mg/%) levels. Other parameters including serum pH (7.36) and sodium (138 mmol/l) were within normal limits. There were no electrocardiographic changes present.Intravenous potassium substitution (20 mEq/h) was started under continuous ECG monitoring. Red blood cells (2 units, 350 ml) were transfused to correct anaemia. A 24-h urine measurement and electromyography were initiated to determine the aetiology of the hypokalaemia, but the paresis resolved before the evaluations were finished. Secondary hypokalaemia caused by a transcellular shift due to metabolic acidosis was ruled out by arterial blood gases (serum pH 7.36). Since the patient was normothermic, increased Abstract Paralysis following scoliosis...