European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The sagittal vertical axis (SVA) is a meaningful measurement and widely used for evaluating sagittal balance, and is considered a design standard for surgery, including most ankylosing spondylitis (AS) kyphotic deformity planning. However, recent research indicates that the C7 plumb line is actually not the center of gravity (CG) line. Therefore, whether there is a better radiological marker as the CG of the trunk for AS thoracolumbar kyphosis remains unknown. This research is to investigate a radiological marker for the CG of the trunk in lateral radiographs for AS thoracolumbar kyphosis. ⋯ The hilus pulmonis fell approximately on the hip axis both pre- and post-operatively. It was a better marker as the center of gravity of the trunk for deformity planning for AS thoracolumbar kyphosis.
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This study aimed to determine whether Ponte osteotomy combined with skip pedicle screw fixation (SPSF) can improve the correction rate and restore thoracic kyphosis for patients with adolescent idiopathic scoliosis. ⋯ Ponte osteotomy was combined with SPSF in case of rigid curve. CCI was significantly greater in the Ponte group. Postoperative thoracic kyphotic angles were identical in both groups.
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Thoracic adolescent idiopathic scoliosis (AIS) curves (Lenke 1-4) are often characterized by hypokyphosis. Sagittal alignment remains challenging to correct, even with recent posterior segmental instrumentation. Some authors recommend anterior endoscopic release (AER) to reduce anterior column height, and facilitate thoracic kyphosis correction. The aim of this study was to assess the contribution of AER to sagittal correction in hypokyphotic AIS. ⋯ Although previous studies have suggested that thoracoscopic release improved correction compared to posterior surgery alone, the current study did not confirm this finding. Moreover, results of the current series showed that no significant benefit can be expected from AER in terms of sagittal plane improvement when the posteromedial translation technique is used, even in challenging hypokyphotic patients.
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Failure to select the appropriate lowest instrumented vertebra (LIV) in selective lumbar fusion (SLF) for thoracolumbar/lumbar curves (LC) can result in adding-on in the lumbar curve (LC) or the need for fusion extension due to a decompensating thoracic curve (TC). The selection criteria that predict optimal outcomes still need to be refined. The objectives of the current study were to identify risk factors for failure of anterior scoliosis correction and fusion (ASF) as well as predictors of optimal outcomes and ASF efficacy for SLF. ⋯ A high chance of achieving a target LC ≤ 20° and a low risk of revision was dependent on LC-bending, preoperative LC and TC, and a LIV at SV-1 with non-parallel LIVDA. Our risk model analysis may support the selection of a safe LIV to achieve the target LC.
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To evaluate the outcome and complications of a novel technique for the treatment of progressive thoracolumbar kyphosis in children with mucopolysaccharidosis (MPS). ⋯ Anterior and posterior spinal arthrodesis with segmental pedicle screw instrumentation is a safety and reliable technique for the treatment of severe thoracolumbar kyphosis in children with MPS. This technique achieves excellent correction of the deformity with adequate decompression of the spinal canal. The fusion is limited to the thoracolumbar junction and interferes minimally with the longitudinal growth of the thorax. No neurological complications or intraoperative spinal cord monitoring events occurred. No loss of correction or junctional kyphosis was observed.