The aim of this study was to analyze clinical and radiologic results of an arthroscopic medial plication with the pullout technique and to define indications and limitations of this procedure for patellar instability. Records of 45 patients treated for patellar instability with arthroscopic medial plication with the pullout technique were reviewed. The mean patient age was 22.8±8.3 years. The tibial tuberosity-trochlear groove distance, trochlear depth (TD), and Insall-Salvati ratio were measured using magnetic resonance imaging taken preoperatively. Patients were evaluated clinically by the Insall and Kujala score and radiographically by measuring the congruence angle, lateral patellofemoral angle, and lateral patellar translation pre- and postoperatively. Patients were classified into 2 groups: group 1 comprised 23 patients with TD greater than or equal to 3.0 mm and group 2 comprised 22 patients with TD less than 3.0 mm. A significant improvement (P=.007) in postoperative clinical scores compared with preoperative values was observed. The congruence angle improved to 11.0°±20.6° (P=.006), the lateral patellofemoral angle improved to -1.6°±7.7° (P≤.0001), and the lateral patellar translation improved to 8.7±5.3 mm (P≤.0001) postoperatively. There were 5 (11%) failure cases. No significant difference existed in the number of failure cases and clinical scores between the 2 groups. This arthroscopic medial soft tissue pullout technique showed good clinical and radiologic results for patellar instability even in the presence of mild to moderate trochlear dysplasia. However, the technique showed limited success in severe trochlear dysplasia cases.

Percutaneous thoracoplasty-only procedure gives significant rib humps correction and satisfactory clinical outcome. However, progression of the curve was observed after surgery. This suggests that the convex ribs function as a buttress for curve progression.

In the cervical spine, the combined ossification of the ligamentum flavum (OLF) and posterior longitudinal ligament is rarely seen. Patients are usually treated with cervical laminectomy or laminoplasty with OLF resection. In most of the cases, OLF is adhered to the dura and there is a risk of dural tear or cerebrospinal fluid (CSF) leakage during its resection. In this case report, the authors present results of laminectomy with debulking instead of complete excision of OLF for spinal cord decompression in a cervical myelopathy case in which OLF was adhered to the dura. A 69-year-old man presented with insidious onset weakness in bilateral lower limbs and unsteady gait, which he had experienced 1 month. He has a history of neck pain with left upper limb radiation for the last 2 years. Magnetic resonance imaging showed C5-6 severe central canal stenosis with underlying myelomalacia. Computed tomography showed ossification posterior longitudinal ligament and OLF contributing to severe central canal stenosis at the C5-6 level. The patient underwent C4-C6 laminectomy, debulking of OLF, posterior instrumentation, and fusion with autogenous bone graft from C3 to C6. A histological specimen showed osseous tissue within the ligamentum flavum. After surgery the patient's symptoms improved and no recurrence was observed at 4 years after surgery. The symptoms of myelopathy were successfully treated with debulking instead of complete excision of OLF, thus reducing the risk of dural tear or CSF leakage.

Background Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux. Case Description A 15-year-old girl with severe thoracolumbar kyphoscoliosis visited our scoliosis research institute complaining of back pain, positional imbalance, intermittent respiratory tract infections, and gastrointestinal discomfort such as pain, dysphagia, and heartburn for several years. On preoperative CT, her abdominal organs were in a deviant position, and esophagogastroduodenoscopy revealed severe reflux gastroesophagitis, Los Angeles classification (LA) Grade D, and a sliding hiatus hernia. After kyphoscoliosis correction, the patient's truncal balance and pain improved. Postoperatively, the patient reported abdominal pain and dysphagia that gradually subsided after 3 weeks. At 1 year, the patient had no abdominal complaints secondary to reflux gastroesophagitis, and episodes of recurrent respiratory tract infections were substantially reduced. Postoperative evaluation showed the reflux gastroesophagitis had improved to LA Grade A. Postoperative CT showed the abdominal cavity had expanded and the abdominal organs were more centered. Literature Review The association between scoliosis and reflux gastroesophagitis is well documented. However, the secondary effects of scoliosis correction on gastrointestinal symptoms caused by reflux gastroesophagitis have not been investigated in detail. Purpose and Clinical Relevance This patient illustrates the relationship between spinal deformity and gastrointestinal symptoms. Postural balance correction resulted in the alleviation of reflux gastroesophagitis symptoms secondary to hiatus hernia.

IntroductionLumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis.Case reportThe authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58-year-old woman who suffered chronic back pain and neurogenic claudication. Plain radiography revealed grade I degenerative spondylolisthesis at L2–L3, L3–L4 and L4–L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2–S1 spinal cord compression at the lumbar spine. Patient underwent L2–S1 decompression laminectomy and posterior lateral fusion of L2–S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up.ConclusionThorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous.