Background: Anterior vertebral body tethering (AVBT) offers a dynamic fusion less correction option for children with adolescent idiopathic scoliosis (AIS). Few existing clinical studies evaluating novel AVBT in skeletally immature children have questioned the midterm efficacy with concerns of overcorrection and curve progression with remaining growth. The current study investigates the effect of this technique in skeletally mature children (Risser ! 4 and Sanders ! 7) with AIS with limited remaining growth potential.Methods: We evaluated skeletally mature children with AIS who underwent the AVBT technique for a single structural major curve between 408 and 808 with !50% flexibility on dynamic radiographs and a minimum of 1 year of follow-up. Pertinent clinical and radiographic data collected include skeletal maturity, curve type, Cobb angle, sagittal parameters, and a patient-reported outcome measure Scoliosis Research Society-22 (SRS-22) questionnaire.Results: All 10 children were female with a mean age of 14.9 6 2.7 years at the time of surgery. The mean followup was 24.1 6 3.6 months. The mean Risser and Sanders scores were 4.2 6 0.6 and 7.2 6 0.6, respectively. Three patients had major thoracic curves, and 7 patients had thoracolumbar/lumbar curves. Cranial and caudal instrumented levels were T5 and L4. Mean preoperative Cobb's angle was 52.08 6 11.68 and was corrected to 15.98 6 6.88 on the first erect postoperative radiograph, with stabilization of corrected curve at the 1-year follow-up (mean Cobb's angle of 15.38 6 8.78). Mean preoperative and postoperative SRS-22 scores were 78.0 6 3.2 and 92.5 6 3.1, respectively (P , .01). No complications were noted until the last follow-up.Conclusion: Our preliminary experience with this novel AVBT as an alternative technique to fusion to stabilize progressive idiopathic scoliosis in skeletally mature children is promising.

The significant improvements observed in interobserver reliability of the TLISS system suggest that the classification system can be taught effectively and be readily incorporated into daily practice. The strong correlation values obtained at the second assessment time suggest that the TLISS system may be reproducibly used to describe thoracolumbar injuries.

Background: Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment.Methods: This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures.Results: Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24-192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 458 to 38 postoperatively, with improvement in sacral slope from 138 to 358. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks.Conclusion: Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible.Level of Evidence: IV

Background: Transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw instrumentation is a well-accepted technique in lumbar degenerative disc disorder. Unilateral instrumentation in TLIF has been reported in the literature. This study aims to compare the clinical and radiological outcomes of unilateral and bilateral instrumented TLIF in a selected series of patients.Methods: We retrospectively analyzed patients operated with unilateral pedicle screw fixation in TLIF (UPSF TLIF) or with bilateral pedicle screw fixation in TLIF (BPSF TLIF) with a minimum of 2 years of follow-up. Patients were evaluated at regular intervals for functional and radiological outcomes. Functional outcome was assessed using the Oswestry disability index (ODI) and visual analog score (VAS) preoperatively and at 6 months, 1 year, and 2 years after surgery. Fusion rates were assessed using Bridwell interbody fusion grading.Results: Our study shows that there was a significant improvement in VAS and ODI in both groups at 2 years follow-up, and there was no significant difference in improvements between the groups. The complication rates between the groups were similar. The fusion rate in UPSF TLIF was 97.3% and was 98.34% in BPSF TLIF; this was not statistically significant between groups. There is a significant difference in terms of blood loss, duration of surgery, and average duration of hospital stay between the groups (P , .001), favoring UPSF TLIF.Conclusions: Unilateral pedicle screw fixation in open TLIF is comparable with bilateral pedicle screw fixation in terms of patient-reported clinical outcomes, fusion rates, and complication rates with the additional benefits of less operative time, less blood loss, shorter hospitalization, and less cost in selective cases.

Case IA thirty year old male presented with complaints of simple snoring for the past 3 years. He had crescendo decrescendo type of breathing during this period. He did not complain of dysphagia, neck pain or limitation of neck movements. Examination revealed a hemispherical mass in the midline of the posterior pharyngeal wall measuring 2 cms x 2 cms in diameter extending from the level of the soft palate to the tip of the epiglottis, and laterally to the level of the posterior tonsillar pillar on either side. Mucous membrane over the swelling appeared healthy and on palpation revealed a bony hard, non tender smooth immobile mass. There was no cervical lymphadenopathy. On indirect laryngoscopy the mass was seen partially occluding the view of the laryngeal air way and both the vocal cords moved normally. Skiagrams of the cervical spine revealed a bridging osteophyte over the anterior aspect of C1 and C2 vertebrae (fig 1) with no evidence of sclerosis or erosion. The intervertebral space appeared normal. Ossification of the ligamentum nuchae was noted ( fig.l). Skiagrams of the lumbosacral spine and the dorsal spine were normal. Haematological investigations viz. Serum calcium, Phosphorous, Alkaline Phosphatase and proteins were not contributory. A mini sleep study (ECG monitoring, X-ray chest and. pulse oximetry) was done during sleep, were not contributory, Polysomonography

Study Design: Prospective cohort. Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. Results: Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01). Conclusion: Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.

Study Design: Retrospective cohort study.Purpose: This study aimed to evaluate the clinical and radiological outcomes of nonfusion anterior scoliosis correction (NFASC) in patients with idiopathic scoliosis and comprehensively analyze its principles.Overview of Literature: NFASC is a novel revolutionary motion-preserving surgery for idiopathic scoliosis. However, clinical data related to this procedure remain scarce, with no conclusive guidelines regarding case indications, proper technique, and possible complications.Methods: This study included patients with adolescent idiopathic scoliosis (AIS) who were treated with NFASC for a structural major curve (Cobb angle, 40°–80°) with more than 50% flexibility on dynamic X-rays. The mean follow-up was 26±12.2 months (range, 12– 60 months). Clinical and radiological data such as skeletal maturity, curve type, Cobb angle, surgery details, and Scoliosis Research Society-22 revised (SRS-22r) questionnaire were collected. Statistically significant trends were examined by post hoc analysis following repeated measures analysis of variance test.Results: A total of 75 patients (70 females, five males) were included, with a mean age of 14.96±2.69 years. The mean Risser and Sanders scores were 4.22±0.7 and 7.15±0.74, respectively. The mean main thoracic Cobb angles at the first and second follow-up (17.2°±5.36° and 16.92°±5.06°, respectively) were significantly lower than the preoperative Cobb angles (52.11°±7.74°) (<i>p</i> <0.05). Similarly, the mean thoracolumbar/lumbar Cobb angle significantly improved from the preoperative period (51.45°±11.26°) to the first follow-up (13.48°±5.11°) and last follow-up (14.24°±4.85°) (<i>p</i> <0.05). The mean preoperative and postoperative SRS-22r scores were 78.0±3.2 and 92.5±3.1, respectively (<i>p</i> <0.05). None of the patients had any complications until the most recent follow-up.Conclusions: NFASC offers promising curve correction and curve progression stabilization in patients with AIS, with a low risk for complications and preservation of spinal mobility and sagittal parameters. Thus, it proves to be a favorable alternative to fusion modality.

Background: Since the introduction of magnetic resonance imaging (MRI) into clinical practice in the mid-1980s, the role of computed tomography myelography (CTM) has become less important in spinal diagnostics but remains a method that is probably even superior to MRI for special clinical issues. The study aims to report the diagnostic utility of CTM as an adjunct to MRI in lumbar degenerative disc disorder (DDD).Methods: Included were 20 patients who presented with symptomatic DDD but with MRI findings that did not correlate with the clinical features. These patients underwent CTM as an additional imaging technique to aid preoperative surgical decision-making. Both imaging modalities were compared for the identification of the impinging pathology as well as the number of levels of compression.Results: MRI revealed compression and/or impingement at 38 levels, whereas CTM revealed these at 29 levels. Of 20 patients, 18 underwent surgery, and a total of 29 levels were decompressed as localized in the CTM. The visual analog scale (VAS) score for back pain and leg pain at baseline were 6 6 0.7 and 76 0.4, respectively, and at 6 months postintervention (surgical/conservative) were 2 6 0.8 and 0.3 6 0.1, respectively. The Oswestry Disability Index scores at baseline and 6 months postintervention were 56 6 6.9 and 18 6 4.2, respectively (P , .0001). There was agreement on the number of levels between MRI and CTM in 10 patients (50%). MRI overestimated the number of involved levels in 9 patients (45%), whereas in the remaining 1 patient (5%), MRI underestimated the number of involved levels. The weighted j value for agreement between MRI and CTM on the number of levels involved necessitating decompression was 0.4 (95% CI, 0.18-0.77; P ¼ .0009).Conclusions: CTM has a role as an adjunct imaging modality to formulate an effective management plan in patients presenting with symptomatic lumbar DDD in cases where MRI findings are inconclusive and ambiguous.