Purpose To assess if the evaluation of the spino-pelvic balance can be effective in the surgical decision making of the high-grade high dysplastic developmental spondylolisthesis (HDDS). Methods Sixteen patients affected with high-grade HDDS (6 treated with ''in situ'' fusion, and 10 with reduction and fusion) were retrospectively evaluated. A clinical and radiological assessment of the deformity correction was carried out, with a minimum follow-up of 2 years. The differences between the pre-and postoperative measures were statistically analyzed using a two-tailed, paired t test. Results The six patients treated with ''in situ'' fusion showed no statistically significant change at the last followup relative to pelvic tilt (PT), sacral slope (SS), and grade, while the 10 patients treated with reduction showed significant changes: PT significantly decreased following surgery, while SS and grade significantly increased. Conclusions The analysis of the spino-pelvic sagittal balance allows to identify two types of HDDS: the balanced deformities, which do not need reduction, and the unbalanced deformities, in which correction is needed.

Introduction The posterior transpedicular fixation technique is a standard procedure for stabilizing the injured thoracolumbar spine but the long-term results of this approach are controversial. Clear guidelines are missing and the literature shows complete disagreement regarding indications, approaches, surgical techniques, and type of fixation. Material and method The objective of this study is to investigate if the surgical treatment by posterior approach alone is always enough to prevent the late kyphotic deformity through the retrospective analysis of 219 patients affected with a thoracolumbar injury. Follow-up examinations included radiographic measurements of the sagittal index (SI) and the sagittal plane kyphosis (SPK). Result Results show that, at the follow-up, the SI remains almost stable after the surgical correction, while the SPK (which describes the eventual injury of the affected intervertebral disc) decreases indicating a progressive regional kyphotic deformity. Thus, in some cases posterior fixation alone is not sufficient for long-term spinal stabilization and often can be not effective to prevent the late kyphotic deformity.

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Pediatric intervertebral disc calcification (PIDC) is an uncommon disease with an unclear etiology. The clinical picture may suggest a severe spinal disease, thus involving an extensive differential diagnosis. The aim of this study was to find a diagnostic and treatment approach for PIDC on the basis of the literature. The Medline, Embase, Web of Science, and Cochrane Systematic Review databases were searched for relevant studies, whose reference lists were checked manually for additional articles. For each study, year of publication, study design, demographics, onset type, history of trauma, clinical and neurological signs and symptoms, imaging studies performed, blood test results, treatment strategies, and outcomes were recorded. The charts of eight patients with symptomatic PIDC treated at our institution from 2000 to 2016 were reviewed. Of 1522 articles identified by the search, 51 level IV studies involving 91 patients fulfilled the inclusion criteria. Most patients were treated conservatively and achieved complete recovery. Of the 13 patients who were treated surgically, one had a persistent myelopathy at the final follow-up. All the patients of our case series were treated conservatively and achieved complete symptom resolution at the final follow-up. PIDC is predominantly a benign and self-limiting condition. Surgery should be considered only in case of failure of conservative treatment in the presence of severe neurological impairment and myelopathy. Level of Evidence: IV (case series and systematic review of level IV studies).

Fractures of the forearm are common injuries in adults. Particularly, both-bone fractures of the radius and ulna are frequently encountered by orthopedic surgeons. To date, these fractures are typically treated with open reduction and internal fixation, because of the propensity for malunion of the radius and ulna and the resulting loss of forearm rotation. We propose a modification of the classic double approach for both-bone fractures of the distal radius and ulna. Indeed, we described a minimal and anatomic approach to prevent complications such as the heterotopic ossification of the interosseus membrane and vascular-nervous lesions. By a single anterior incision, we utilize 2 windows to expose the medial and lateral compartments of the forearm. In this way, we avoid the handling of the interosseous membrane, and we protect the ulnar, median, and radial nerves from the surgical approach. This technique is indicated for complex distal radius and ulna fractures. We exclude open fractures, and Monteggia, Galeazzi, or Essex-Lopresti lesions. In this report, we describe the surgical anatomy, surgical approach, and complications regarding this approach.

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Purpose: The objective of this study was to examine the association between compressive cervical myeloradicular pathology and neuropathy of the median nerve at the wrist and verify the validity of the hypothesis of DCS. Method:The study includes a retrospective analysis of 301 patients, 204 women (68.4%) and 97 men (31.6%), consecutively treated for CTS by release of the median nerve at the wrist, to detect the presence of any cervical disease able to satisfy the hypothesis of a DCH. Results:Revisiting 301 cases of neuropathy of the median nerve at the wrist and applying all the anatomical and physiopathological restrictions requests to a DCS, about 25% of all patients with CTS have a double compression but only in 7.3 % of cases (16 patients) it was possible to find appropriate correlations between proximal and distal lesion necessary to explain a DCH. Conclusions:The DCH has anatomic and pathophysiologic restrictions that make it not applicable in the many clinical situations of coexistence of proximal cervical compression and carpal tunnel. This hypothesis is invoked clinically far more often than is warranted and often contradictory of this often-mentioned DCS have appeared in the literature. So not always the coexistence of a cervical root lesion (CRLs) with carpal tunnel syndrome identifies a double-crush syndrome.