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To explore the surgical outcome of patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended posterior column osteotomy (PCO) plus unilateral cage strutting (UCS). From Jan 2012 to Aug 2017, 23 patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended PCO plus UCS technique (study group) and 13 patients who underwent asymmetrical pedicle subtraction osteotomy (PSO) technique (control group) were retrospectively reviewed; the radiological features, including coronal/sagittal deformity, and clinical evaluation including Oswestry Disability Index (ODI), visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores-lumbar were assessed before surgery and at follow-up. All patients underwent the operation successfully. There was no difference in fusion level, blood loss, and follow-up duration between the two groups; the operation time and length of hospital stay were shorter in study group than that in control group. All patients achieved significant correction of both scoliotic and kyphotic deformity and maintained the correction at minimum of two year follow-up, without any difference in deformity correction and correction loss between the two groups. All patients got back pain and leg pain alleviation and neurological function improvement at two year follow-up, without any difference between the two groups. The incidence of complications was lower in study group than that in control group. Multilevel extended PCO plus UCS procedure could achieve significant correction of scoliosis and kyphosis in the treatment of degenerative lumbar kyphoscoliosis, presenting less surgery time, lower incidence of complication, and shorter hospital stay when compared with the asymmetric PSO technique.

Treating acetabular fractures with open reduction and internal fixation (ORIF) may lead to poorer outcomes in older patients. As data for osteoporotic acetabular fractures are limited, we compared primary total hip replacement (THR) with ORIF for treating osteoporotic acetabular fractures, including those with posterior column instability. All patients with osteoporotic acetabular fractures, treated with ORIF or primary THR from 2005 to 2015, were assessed retrospectively for clinical and radiologic outcomes. Indication criteria for selecting primary THR were evaluated. Twenty-three patients were treated with ORIF and nine with primary THR (performed with an anti-protrusion cage). If the posterior column was unstable, THR was combined with posterior column bridge plating. Indications for THR were the presence of a comminuted fracture pattern, approach-related risk factors for ORIF, and mobilization issues. Biomechanical reconstruction was acceptable with THR. Acetabular component loosening was observed only once. Secondary THR was indicated in 45 % of the ORIF cases. ORIF for acetabular fracture in older patients is unsatisfactory and may be even worse for osteoporotic fractures. Immobilization for long-term restricted weight bearing after ORIF is hazardous. Primary THR may enable early post-operative full weight-bearing. Various techniques, affording fixation of the unstable acetabular columns, are described. In THR with an anti-protrusion cage, only dorsal column instability needs to be addressed. The described technique achieved sufficient acetabular component stability. Primary THR with an anti-protrusion cage is an advantageous option to ORIF and should be strongly considered for osteoporotic acetabular fractures.

Surgical treatment of acetabular fractures with plate fixation is challenging for orthopaedic surgeons because of variations of the surface curvature and complex fracture patterns of the acetabulum. We present our experience with pre-operative computer-assisted virtual simulation and three-dimensional (3D) printing techniques for the surgical treatment of acetabular fractures, especially in terms of operative time and surgical outcomes. Twenty-nine patients with acetabular fractures treated with locking plates were included in this retrospective study (conventional locking plate fixation, n = 17; 3D-printing-assisted precontoured locking plate fixation, n = 12). Fracture types were classified according to the Letournel-Judet classification. Surgical duration, instrumentation time, blood loss, post-operative fracture reduction quality, and complication rates were compared between the two surgical groups. The 3D-printing group had a significantly shorter total surgical duration and instrumentation time for fractures with posterior wall or posterior column involvement (222.75 ± 48.12 and 35.75 ± 9.21 minutes, respectively; P

The goal of this study was to evaluate the safety and efficacy of a new technique for posterior column fixation through the standard ilioinguinal approach. We conducted a retrospective review involving 33 consecutive patients with complex acetabular fractures treated using a short buttress plate fixation of posterior column through single ilioinguinal approach. Radiographic evaluation was performed using criteria described by Matta. Functional outcome was assessed using modified Postel Merle D’Aubigne score. Between 2008 and 2013, 33 adult patients with mean age of 46 years and mean follow up of 37.5 months were enrolled. Anatomic reduction was obtained in 61 % of cases, imperfect reduction in 24 % of cases and poor reduction in 15 % of cases. The average modified Merle d’Aubigne score was 15: categorized as excellent in seven, good in 18, fair in three, and poor in four. One patient died at 15 days because of pulmonary embolism. Four patients sustained temporary lateral femoral cutaneous palsy. At final follow up, two patients had severe post-traumatic arthritis; one of them underwent a total hip arthroplasty at 93 months. None of the patients had loss of reduction. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures is a safe and effective method.

We present our experience of using a newly modified Stoppa approach combined with a lateral approach to the iliac crest in patients with acetabular fractures in reference to fracture reduction and fixation, technical aspects, and the incidence of complications.We used a consecutive group of 29 adult patients with acetabular fractures treated operatively with a newly modified Stoppa approach between 2009 and 2011. The newly modified Stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. This approach was combined with a lateral approach on the iliac crest for fractures of the iliac wing.All the patients were followed up for at least 1.5 years. Of the 29 patients, ten anterior column, two associated both column, seven anterior column with posterior hemi-transverse, four transverse, and six T-type fractures. The average blood loss was 950 mL, and average operative time was 155 minutes. Anatomic or satisfactory reduction was achieved in 96 % of the acetabular fractures. Two patients had mild symptoms of the lateral femoral cutaneous nerve and improved within three months.The newly modified Stoppa approach provides excellent visualization to the anterior column, quadrilateral surface and permits good postoperative results for treatment of acetabular fractures. We considered this technique as a viable alternative for the ilioinguinal approach when exposure of the anterior acetabulum is needed.

To investigate the usefulness of titanium lamina mesh for posterior column reconstruction after total en bloc spondylectomy in patients with spinal tumour and evaluate the radiographic outcomes of this method.Eight patients who underwent total en bloc spondylectomy with posterior column reconstruction using titanium lamina mesh and bone graft to treat a spinal tumour were included in this study. The mean age at the time of surgery was 50.6 years (range, 16.5-70.9 years) and the mean follow-up duration was 50.2 months (range, 28.1-68.7 months). The pathological lesions were located from the T2 to L1 vertebrae. There were four patients in each primary and metastatic tumour group. For the posterior column reconstruction, titanium lamina mesh was used and bone graft was applied over the lamina mesh. Radiographic evaluation was used to investigate the displacement of lamina mesh and union of the grafted bone above lamina mesh.At the postoperative six month follow-up, a bony bridge on the titanium mesh between upper and lower adjacent lamina was observed in all cases, except for one with infection. On the last follow-up, there was no collapse or displacement of titanium lamina mesh, and there was no instability or malalignment of the spinal column.Posterior column reconstruction using titanium lamina mesh during total en bloc spondylectomy for spinal tumour was a useful surgical option that provided new lamina reconstruction for stability of spinal column and protection of the neural elements.

Ten fresh frozen specimens of a hemipelvis, including the hip joint, capsule and proximal femur, from elderly cadavers were used to evaluate three methods of internal fixation of isolated posterior column osteotomies. Intact and reconstructed specimens were tested at 30 degrees and 60 degrees of hip flexion in a specially designed joint simulator. The three methods of fixation used were a single 3.5 mm reconstruction plate, two such plates, and a 4.5 mm lag screw with a single plate. Motion at the fracture site in three orthogonal directions, and the overall stiffness of the construct, were recorded simultaneously. No significant differences were noted in stiffness for the three procedures and all retained 80% of the intact stiffness. At 60 degrees of flexion, smaller interfragmentary compliances were allowed by fixation with a lag screw and a neutralisation plate (p < 0.05). At 30 degrees, the position of the load plane relative to the fracture plane allowed less interfragmentary motion, so that no significant differences were found between the 3 methods.

Between 1991 and 2002 we treated 48 patients surgically for thoracolumbar burst fractures associated with flexion-distraction injury of the posterior elements. The degree of kyphotic deformity and the degree of vertebral wedging deformity were measured on plain lateral radiographs. The spinal canal compromise was measured on computer tomography. The mean postoperative follow-up was 70 (24-108) months. The preoperative kyphosis averaged 25.7 degrees and the mean sagittal index was 28.8 degrees . The mean wedging deformity of the fractured vertebral body was 46% (24-66%). The mean preoperative spinal canal compromise secondary to retropulsed bony fragments was 64%. Immediately after surgery, the correction of kyphosis averaged 98%. There was no loss of correction at the final follow-up. A satisfactory reduction and good stabilisation with solid fusion were achieved in all cases.

Dear Editor, We read the comments by Jain Saurabh [1] concerning our article [2]. Thank you for the comments. Conservative treatment with antituberculosis drugs and external immobilisation is the first choice. Aggressive surgical treatment should be adopted in the management of indicated patients with spinal tuberculosis. We treated more than 15 patients conservatively. Only 15 indicated patients failed to respond to the conservative treatment. Indications for surgery are neurological deficits, spinal instability, severe and progressive kyphosis, no response to chemotherapeutic treatment, non-diagnostic biopsy and large paraspinal abscess. Despite effective treatment for spinal tuberculosis, it is common to find residual kyphosis and instability at the end of treatment. In our 15 patients this resulted in an improvement in the correction of the deformity. At follow-up, progression of kyphosis was seen. The posterior internal fixation through the posterior column of the spine keeps the internal fixation away from the tuberculous focus, which is beneficial for tubercular resolution. The term resection/debridement should not be interchanged. The aim of this clinical study was to assess the efficacy of one-stage surgical management for children with spinal tuberculosis by anterior decompression, bone grafting, posterior instrumentation, and fusion; but there are too few indicated cases to resolve the issue.