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Spring-assisted cranioplasty (SAC) for the treatment of craniosynostosis uses internal springs to produce dynamic changes in cranial shape over several months before its removal. The purpose of this study was to report the first Egyptian experiences with SAC in the treatment of children with sagittal synostosis and evaluate the preliminary outcome. A total of 17 consecutive patients with scaphocephaly underwent SAC with a midline osteotomy along the fused sagittal suture and insertion of 3 springs with bayonet-shaped ends across the opened suture. Operative time, blood transfusion requirements and length of ICU, total hospital stay, and complications graded according to Oxford protocol classification were recorded. Spring removal was performed once re-ossification of the cranial defect occurred. All patients successfully underwent SAC without significant complications. The mean age at surgery was 6.8 months. The mean time of the spring insertion surgery was 63 minutes (SD 9.7). Blood transfusion was needed in less than half of the patients (41.2%).The mean duration of hospital stay was 3.2 days. The mean timing of spring removal was 5.5 months (SD 0.4). The mean time of the second surgery (spring removal) was 22.8 minutes (SD 3.6). In conclusion, SAC can easily be incorporated into the treatment armamentarium of craniofacial surgeons. The technique offers a safe and minimally invasive option for the treatment of sagittal craniosynostosis with the benefit of limited dural undermining, minimal blood loss, operative time, anesthetic time, ICU stay, and hospital stay.

Background: Isthmic spondylolysis commonly occurs at L5 with causing low back pain in younger adults. Pars interarticularis fracture produced by repeated cumulative stress of the pars interarticularis resulting in pars microfracture, leading to bony defect. Persistent back pain and sometimes-radicular pain are common complaint. Objective: The aim of the current study was to evaluate the clinical results and complications after minimally invasive surgical approach of bilateral L5 pars interarticularis fracture by U shaped rod strategy technique. Patients and methods: A total 12 consecutive patients were reviewed retrospectively during the period from February 2019 to February 2022 with bilateral L5 pars interarticularis fracture. Preoperative symptoms, and postoperative results for those patients who underwent minimally invasive surgical approach for treatment of bilateral L5 pars interarticularis fracture, are all recorded. Results: Ten males and 2 females whose age ranged from 16 to 24 years. Clinical symptoms were: persistent low back pain in all patients (100%), radicular pain in 33% of patients (4 cases). The mean operative time was 82.5 (SD 11.8) minutes and the average blood loss was 206.5 (SD 47.8) ml. Post-operative assessments using the Oswestry scale showed improvement in 8 (66.6%). Three cases (25%) complain from mild back pain in exercise or during playing sport however the radiology showed good fusion. Failure of fusion with persistent of the complaint occurred only one case (0.08%) and re-surgery was done with the classic interbody fusion. Conclusion: Direct pars repair using U shaped road technique in bilateral fracture pars articularis in the lumbar spine should be the procedure of choice in the indicated cases with short hospital stay and early recovery to normal life.

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