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Purpose: To assess the radiological outcomes and complications focusing on distal junctional failure (DJF) of adult spinal deformity patients who underwent thoracolumbar fixation with the use of offset sublaminar hooks (OSH) distally. Methods: Retrospective review of a prospective, multicenter adult spinal deformity database (2 sites). Inclusion criteria were age of at least 18 years, presence of a spinal deformity with thoraco-lumbar instrumentation ending distally with OSH (pelvis excluded), with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Data was analyzed using descriptive statistics. Statistical significance was set to p< 0.05. Results: 32 patients met the inclusion criteria, with the main etiologies being Scheuermann kyphosis and post-traumatic kyphosis. There was a significant correction of thoracic or thoraco-lumbar kyphosis (from 83° to 45° in case of posterior column osteotomy, p< 0.001, and from 49° to 11° in case of a three-column osteotomy, p< 0.001). DJF occurred in 9.3% of the patients including 1 patient who presented distal hook dislodgement and 2 patients who presented a compression fracture below the lowest instrumented vertebra. Oswestry Disability Index score improved in the majority of the patients (from 34.3 to 18.1, p< 0.05). Conclusions: This is the first paper to propose offset sublaminar hook as a safe and efficient tool for protection of the distal end of the construct in kyphotic ASD surgery when not going down to the pelvis. It showed satisfactory radiological and clinical outcome with an acceptable rate of complications and no distal junctional failure that required revision surgery.

Study design: Case report. Objective: To describe a rare case of thoracolumbar kyphoscoliosis secondary to a butterfly vertebra in an adult, and its surgical correction technique. Background: Kyphoscoliosis secondary to an isolated butterfly vertebra is rare and its management can be very challenging. Methods: We report the case of a 39-year-old male, complaining of chronic middle and low back pain with unsteady gait and altered sensation of lower extremities. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 60° between T10 and T12, with a short thoracolumbar scoliosis of 32 degrees. CT scan confirmed the presence of a butterfly vertebra at the level of T11 with posterior arch fusion between T10 and T12. MRI showed cord compression at the apex of the kyphosis associated to syringomyelia. Results: The patient underwent a posterior resection of the T11 butterfly vertebra with instrumentation from T8 to L2, and use of a one-sided domino on the convex side and a mesh cage on the concave side for asymmetrical correction and vertebral height preservation. Thoracolumbar kyphosis was corrected to 10°. Scoliosis was corrected to 6°. He could walk on day 2 with a satisfactory clinical and radiological result at 2 years. Conclusion: Literature is sparse on the management of thoracolumbar kyphoscoliosis secondary to butterfly vertebra in the context of neurological impairment. The current case described a surgical treatment strategy to correct both deformity planes simultaneously by a vertebral resection performed through a posterior only approach.

Pedicle subtraction osteotomy has been thoroughly described and studied over the past 2 decades, being applied mainly in the lumbar spine, followed by the thoracic spine. Our better understanding of alignment biomechanics, and the progressive refinements of the surgical technique over time made it a very efficient procedure for the management of fixed sagittal malalignment. However, a long learning curve is mandatory to mitigate the associated risks particularly neurological deficits and achieve satisfactory clinical and radiological outcomes with an acceptable rate of complications.

Purpose: To evaluate the pain and functional effect of the COVID-19 pandemic on patients with ASD reflected by their response to SRS-22, ODI, and SF-36 questionnaires. Methods: Patients who had stable pain and functional outcome scores over the preceding 2 years were enrolled in a local prospectively collected adult spinal deformity (ASD) database. A reanalysis of their SRS22, ODI and SF-36 data 14 days into confinement were compared to their last pre-confinement scores. Results: 89 patients were included in this study (average age 60.7 years, 91% female) with an average time from last FU until confinement of 9.6 months. The ODI total score worsened by 5 points post-confinement with no difference seen in personal care, walking and social life. In contrast, the SRS-22 score showed small improvements in function/activity and satisfaction, but no significant differences for the other domains. Similarly, the SF-36 showed small improvements in physical function, physical and emotional role, vitality and PCS. Conclusion: The global COVID-19 pandemic and ensuing confinement had variable overall effects on ASD patients, without the expected marked worsening. In addition, this study illustrates that the SRS-22 questionnaire is less influenced by environmental and psychological factors than the ODI supporting its objectivity and accuracy in the evaluation of the QoL of ASD patients.

Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD).

Prospective study.

L’Échelle d’Évaluation Numérique (EEN) lombaire et radiculaire est effectuée en routine clinique. L’évolution des symptômes, notamment après une chirurgie de déformation rachidienne, peut rendre difficile l’interprétation des résultats cliniques et de l’impact réel d’une chirurgie rachidienne. L’objectif de cette étude est d’évaluer l’EEN global correspondant à la somme de l’EEN lombaire et radiculaire. L’hypothèse est que ce paramètre simple est corrélé aux scores de qualités de vie et aux paramètres radiologiques sagittaux.

Le déséquilibre sagittal est un facteur prédictif du résultat postopératoire pour les patients atteints de DRA. L’influence de l’âge sur ces paramètres a été décrite dans la population asymptomatique. L’objectif de cette étude est d’identifier la relation entre les paramètres radiologiques de l’équilibre sagittal et l’âge ; et la corrélation entre les scores de qualité de vie pour les patients opérés (O) et non opérés (NO). L’hypothèse est que les paramètres radiologiques de l’équilibre sagittal influencent en partie l’indication chirurgicale dans les DRA.

L’indication chirurgicale dans les déformations de l’adulte est difficile à poser, car elle concerne une population très hétérogène. L’âge est un paramètre reconnu, mais aucune étude exhaustive incluant l’ensemble des paramètres radioclinique n’est décrite. L’objectif est d’évaluer l’impact des paramètres radio-clinique sur l’indication chirurgicale.