Motion capture evaluation of sagittal spino-pelvic biomechanics after lumbar spinal fusion.

Purpose: The spine and pelvis coexist as a dynamic linked system in which spinal and pelvic parameters are correlated. Investigation of this system can inform the understanding and treatment of spinal deformity. Here, we demonstrate the use of motion capture technology to measure spine biomechanical parameters using a novel testing apparatus.

Does It Matter: Total Hip Arthroplasty or Lumbar Spinal Fusion First? Preoperative Sagittal Spinopelvic Measurements Guide Patient-Specific Surgical Strategies in Patients Requiring Both.

Background: In patients requiring both total hip arthroplasty (THA) and lumbar spinal fusion (LSF), consideration of preoperative sagittal spinopelvic measurements can aid in the prediction of postfusion compensatory changes in pelvic tilt (PT) and inform adjustments to traditional THA cup anteversion. This study aims to identify relationships between spinopelvic measurements and post-THA hip instability and to determine if procedure order reveals a difference in hip dislocation rate.

Methods: Patients at a single practice site who received both THA and LSF between 2005 and 2015 (292: 158 = LSF prior to THA, 134 = THA prior to LSF) were retrospectively reviewed for incidents of THA instability.

The Four Fixation Points of the Axis: Technique and Case Report.

Background: Instrumentation of the axis can be accomplished through a variety of techniques including transarticular screw fixation, pars and pedicle screw fixation, translaminar screw fixation, and posterior wiring. We report on the evolution of the axial 4-screw technique.

Methods: Retrospective case review.

Extreme proximal junctional kyphosis-a complication of delayed lambdoid suture closure in Hajdu-Cheney syndrome: a case report and literature review.

Purpose: To describe the manifestations, surgical treatment, and potential complications of Hajdu-Cheney syndrome (HCS), and the management of these complications.

Methods: The clinical presentation, management and outcome of HCS with severe osteoporosis and open skull sutures is presented, together with a literature review.

Results: A 20-year-old female with HCS underwent posterior occipitocervical fusion for symptoms of progressive basilar invagination.

Complications in Adult Patients with Down Syndrome Undergoing Cervical Spine Surgery Using Current Instrumentation Techniques and rhBMP-2: A Long-Term Follow-Up.

 Cervical spine pathologies are common in Down syndrome (DS) patients. Cervical pathologies may cause cord compression and neurologic deterioration if left untreated. Complication rates of 73-100% have been reported in DS patients after cervical spine surgery in historical studies.

Comparison of radiographic sagittal spinopelvic alignment between skeletally immature and skeletally mature individuals with Scheuermann's disease.

Purpose: The aim of this study was to compare radiographic sagittal spinopelvic parameters between skeletally immature and skeletally mature patients with Scheuermann's disease (SD).

Methods: Cross-sectional analysis of standing postero-anterior and lateral radiographs of the spine of patients with SD was performed. Sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured on the lateral radiographs.

Radiographic spinopelvic parameters in skeletally mature patients with Scheuermann disease.

Study Design: Retrospective radiographical analysis of sagittal spinopelvic parameters in skeletally mature patients with Scheuermann disease (SD).

Objective: To analyze anatomical and positional parameters of spinopelvic sagittal alignment in mature patients with SD.

Summary Of Background Data: Sagittal spinopelvic alignment has already been characterized in normal subjects and deviations in sagittal parameters have been reported for various spinal pathologies.

Lumbar Spondylolysis and Spondylolisthesis in Down Syndrome: A Cross-sectional Study at One Institution.

Study Design: Retrospective cross-sectional study.

Objectives: To describe lumbar spondylolysis and spondylolisthesis and establish their prevalence in individuals with Down syndrome.

Summary Of Background Data: Orthopedic problems in Down syndrome are variable and numerous.

Comparison of radiographic and surface topography measurements in adolescents with idiopathic scoliosis.

Purpose: In patients with adolescent idiopathic scoliosis (AIS), radiographic surveillance is the gold standard of assessing spinal deformity, but has negative long-term effects. The Formetric 4D surface topography system was compared to standard radiography as a safer option for evaluating patients with AIS.

Methods: Fourteen volunteers with typical AIS patient stature had 30 repeated Formetric 4D measurements taken, and reproducibility was assessed.

Convex hemiepiphysiodesis: the limits of vertebral stapling.

Study Design: We performed a retrospective chart review of patients with nonadolescent idiopathic scoliosis who underwent open vertebral stapling for treatment of spinal deformity.

Objective: The objective of this study was to determine the efficacy of vertebral stapling in patients with scoliosis. Measurements included initial deformity correction and maintenance of correction.

The Scoliosis Research Society Health-Related Quality of Life (SRS-30) age-gender normative data: an analysis of 1346 adult subjects unaffected by scoliosis.

Study Design: Prospective, cross-sectional study.

Objective: To determine Scoliosis Research Society (SRS)-30 health-related quality of life (HRQOL) reference values by age and gender in an adult population unaffected by scoliosis thereby allowing clinicians and investigators to compare individual and/or groups of spinal deformity patients to their generational peers.

Summary Of Background Data: Normative data are collected to establish means and standard deviations of health-related quality of life outcomes representative of a population.

The use of the T1 sagittal angle in predicting overall sagittal balance of the spine.

Background Context: A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult.

A comparison of magnetic and radiographic imaging artifact after using three types of metal rods: stainless steel, titanium, and vitallium.

Background Context: After spinal fusion surgery, postoperative management often includes imaging with either computed tomography (CT) or magnetic resonance imaging (MRI) to assess the spinal canal and nerve roots. The metallic implants used in the fusion can cause artifact that interferes with this imaging, reducing their diagnostic value. Stainless steel is known to produce large amounts of artifact, whereas titanium is known to produce significantly less.

Atlantoaxial rotatory fixation in the setting of associated congenital malformations: a modified classification system.

Study Design: A case report.

Objective: To raise awareness of the development of atlantoaxial rotatory fixation (AARF) in the setting of congenital vertebral anomalies/malformations.

Summary Of Background Data: Klippel-Feil Syndrome (KFS) is a complex, heterogeneous condition noted as congenital fusion of 2 or more cervical vertebrae with or without spinal or extraspinal manifestations.

Intraoperative techniques to reduce the potential of set-screw loosening in long spinal constructs: a static and fatigue biomechanical investigation.

Study Design: The purpose of this study was to investigate the effects of implant selection and set-screw tightening technique on the loosening torques in long scoliosis constructs after long-term biaxial fatigue loading.

Summary Of Background Data: Expanded use of pedicle screws in the correction of long scoliotic curves and the mechanical demands on segmental fixation systems requires surgeon awareness of revisiting set screws to ensure full screw/rod engagement and minimize the potential of set-screw loosening and/or rod slippage postoperatively.

Methods: Biomechanical tests were performed to evaluate the effect of set-screw tightening techniques and rod approximation on screw/rod interface strength.

Iatrogenic thoracic outlet syndrome secondary to vertical expandable prosthetic titanium rib expansion thoracoplasty: pathogenesis and strategies for prevention/treatment.

Background: An innovative treatment for thoracic insufficiency syndrome involves a vertical expansion of the chest wall through a horizontal chest wall osteotomy maintained by a distraction device (vertical expandable prosthetic titanium rib or VEPTR). Upper-extremity neurovascular dysfunction has been reported after expansion. The purposes of this study are to identify potential etiologies for compression of the brachial plexus after expansion thoracoplasty and to suggest strategies to reduce the incidence of this complication.

Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis.

Study Design: Diagnostic testing.

Objective: The goal of this study is to measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS).

Arterial injury following percutaneous vertebral augmentation: a case report.

Study Design: Case report.

Objective: To report a case of injury to a segmental branch of the L4 lumbar artery following kyphoplasty.

Summary Of Background Data: To our knowledge, arterial injury following vertebral augmentation has not been described.

Selective anterior fusion and instrumentation for the treatment of neuromuscular scoliosis.

Study Design: A retrospective cohort study was conducted.

Objective: To evaluate the results of anterior spinal fusion with anterior instrumentation alone in selected patients with neuromuscular scoliosis.

Summary Of Background Data: Traditionally posterior spinal fusion with instrumentation has been done, usually to the pelvis, to achieve correction of neuromuscular scoliosis.