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Purpose: To evaluate the outcomes of scoliosis corrective surgery in Osteogenesis Imperfecta (OI) patients with primarily pedicles screw fixation in terms of correcting and maintaining the correction of the spinal deformity, and to assess for several peri-operative parameters and complications associated with this surgical treatment. Methods: Retrospective case series of 39 consecutive patients with OI treated surgically for scoliosis. The surgeries were performed between 2002 and 2020 by three different surgeons. All patients' medical peri-operative and post-operative charts were evaluated. Radiological assessment was performed by evaluation of the pre-operative, immediate post-operative and last follow-up plain radiographs. Results: There were 20 females and 19 males included in this review with a mean age of 14 years (range, 6–20 years) at the time of surgery. The median follow-up time was 7.9 years. The mean pre-operative cobb angle (CA) of the major curve was 76.5 degrees (SD ± 18.9), decreasing to 42.6 (SD ± 17.4) in the long-term post-operative follow-up (P < 0.001). A total of 21 adverse events in 16 patients were noted. Only 4 patients required subsequent invasive surgical treatment or prolonged hospital stay. All other patients were treated conservatively with no lasting complication. Conclusion: Scoliosis surgical correction in OI patients seems to yield acceptable results, with maintained coronal plane surgical correction in the long-term follow-up. Even though a high peri-operative complications rate is observed in this series, there were no long-term sequelae or lasting complications. Level of Evidence: Level IV, Case series. [ABSTRACT FROM AUTHOR]

Purpose: Fatigue stress fractures are a common overuse injury, frequently associated with high load-bearing endurance activities such as running, military training and aerobic exercise. While these fractures can arise at any site, sacral stress fractures are poorly studied with evidence consisting mainly of case reports and limited case series. This review aims to analyze and summarize all reports published to date describing cases of sacral stress fracture in athletes. Methods: PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on Stress Fractures of the Sacrum. Insufficiency fractures of the elderly were excluded. Results: The literature review revealed 49 studies reporting on 124 cases of sacral stress fractures. Seventy-six patients (61%) were professional or collegiate level athletes, and 37 (30%) were military recruits or police officers in training. Seventeen female athletes were identified as suffering from low bone mineral density (25%), 9 of which reported menstrual irregularities. Thirteen female patients (19%) had a history of eating disorders. Conclusion: While most sacral stress fractures occur in normal bones exposed to abnormal repetitive loads, the high percentage of lower bone mineral density can blur the lines between fatigue fractures and insufficiency fractures. The causes of these fractures are multifactorial. High endurance sports and the features of the female athlete triad were found in high percentage of the cases. Conservative treatment is the mainstay of treatment, consisting of ceasing of training and a period of rehabilitation and gradual return to training and competition. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between 4, 5, or 6 lumbar spine vertebrae and the presence of lumbar spinal pathologies. Methods: We reviewed all MRI reports and images performed between August 1st, 2018 and July 31st, 2019. Lumbar spine pathologies such as disc herniation, lytic spondylolisthesis, and spinal stenosis were recorded. The reviewer studied the T2 sagittal screening of the entire spine and counted down manually from C2 to T12 on the assumption that there are seven cervical and twelve dorsal vertebrae. We then recorded whether there were four, five, or six lumbar vertebrae. Results: Our work incorporated a total of 1985 patients for whom T2-weighted entire spine sagittal MR images were obtainable. The study cohort's average age was 52.2 ± 15.9 years, comprising 944 males and 1041 females. One hundred and thirty-three patients (6.7%) had 4 lumbar-type vertebrae; 1799 (90.6%) had 5 lumbar-type vertebrae; and 53 (2.7%) had 6 lumbar-type vertebrae. There was a statistically significant difference between the rates of 6 lumbar-type vertebrae in males versus females (p < 0.05). There was a statistically significant difference with more spinal stenosis patients in the 6 lumbar-type vertebrae compared to the 4 or 5 lumbar-type vertebrae groups (p < 0.001). Conclusion: Our study shows that spinal stenosis is significantly more common in patients with 6 lumbar-type vertebrae. [ABSTRACT FROM AUTHOR]

Purpose: To examine the efficacy and feasibility of T2-weighted whole-spine sagittal magnetic resonance imaging (MRI) screening for all patients who undergo MRI of the lumbar spine for any indication. Methods: A review of 1145 consecutive T2-weighted whole-spine sagittal MRI screening sequences performed for lumbar spine imaging was undertaken for the purposes of documenting the incidence and clinical significance of thoracic and cervical spine incidental findings, as well as to establish correlation between these pathologies and those found in the lumbar spine. Results: Out of the 1145 patients included in the study, 103 (9%) patients had incidental findings thought to be significant. These findings included cervical spinal stenosis (n = 85), thoracic disc herniation (n = 9), syrinx (n = 5), intradural tumor (n = 2), and signal changes within the spinal cord (n = 2). In follow-up exams, 35 patients had clinically significant findings which included cervical myelopathy (n = 25), thoracic myelopathy (n = 3), syrinx (n = 5) and intradural tumor (n = 2). Among the 172 patients presenting with lumbar spinal stenosis, 42 (24.4%) had such incidental findings, and of those 41 (23.8%) had cervical stenosis with spinal cord compression (p < 0.0001). Conclusion: T2-weighted whole-spine sagittal screening is useful in demonstrating clinically relevant incidental findings in any patients undergoing MRI of the lumbar spine. There is a statistically significant correlation between lumbar spinal stenosis and cervical spinal stenosis with spinal cord compression. [ABSTRACT FROM AUTHOR]

Purpose: Gas forming infection (GFI) of the spine is a rapidly progressive and potentially life-threatening infection. It can be a consequence of aetiologies such as Emphysematous Osteomyelitis (EOM), Necrotizing Fasciitis (NF), and Gas-containing Spinal Epidural Abscess (Gas-containing SEA). This review aims to summarize the characteristics of these subtypes of GFI, describing their aetiology, diagnosis, management, and prognosis. Methods: PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on gas forming infections of the spine or a known subtype. Cases of post-operative and iatrogenic spinal infection were excluded. Results: The literature review revealed 35 studies reporting on 28 cases of EOM, three cases of NF involving the spine and seven cases of Gas-containing SEA. Thirty studies reporting on 32 cases of GFI were available for data analysis. The mean age of the patients was 60.9 years and a concomitant diagnosis of diabetes mellitus was reported in 57.5% of patients infected. Fever and back pain were the most common presenting symptoms. The lumbar spine was the most commonly affected spinal segment. Mortality from EOM, NF and Gas-containing SEA were 34.8, 100 and 28.5%, respectively. Discussion: Gas forming infection of the spine is a rare condition with an extremely poor prognosis, requiring early and aggressive surgical treatment. A multi-disciplinary approach is necessary for management. Nonetheless, even in cases of early recognition and optimal management, multisystem failure may still occur, and mortality rates remain high due to the aggressive nature of this infection. Level of evidence: Systematic review of level IV studies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in the surgical management of lumbar degenerative spondylolisthesis and or spinal stenosis.Methods: During a 1-year period (June 2006 to July 2007), ten patients were enrolled in a non-randomized prospective clinical study. The primary indication was neurogenic claudication due to spinal stenosis with single-level degenerative spondylolisthesis. Patients were evaluated with X-rays and MRI scans, visual analog scale (VAS) for back and leg pain, the Oswestry disability questionnaire, and the SF-36 health survey preoperatively, at 6 weeks, 3 months and 6 months and at 1, 2, 3 and 7 years postoperatively.Results: The VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 19 at 7 years follow-up. The VAS score for worse leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 8.8 at 7 years follow-up. The ODI dropped from 49.1 preoperatively to 13.5 at 6 weeks and 7.8 at 7 years follow-up. MRI examination at 7 years after surgery did not demonstrate stenosis adjacent to the stabilized segment. Spondylolisthesis did not progress in any of the cases. One patient had a symptomatic L3-L4 far lateral disc herniation 5 years after surgery whose symptoms resolved with non-operative treatment. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction.Conclusion: In patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty with the TOPS System can maintain clinical improvement and radiologic stability over time. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the relationship between the location of the cervical cord compression and the increased signal intensity within the cervical cord on T2-weighted imaging (T2WI) in patients with cervical myelopathy and myelomalacia. Materials and methods: We reviewed 1,615 MRI reports from January 2011 to May 2013 from a single institution. Of the 1,615 reports reviewed, 168 patients were diagnosed with increased signal intensity within the cervical spine on T2WI. After applying the exclusion criteria 82 patients were included in the study. The MRIs of these 82 patients were then reviewed and the location of the increased signal intensity on T2WI in relation to the location of the pressure on the spinal cord was recorded. Results: In more than 50 % of the cases the lesions with increased signal intensity on T2WI either were located distal to the pressure on the spinal cord or started at the level of the pressure and extended to an area distal to the pressure. In 26 out of the 92 lesions with increased signal intensity on T2WI, the lesion started proximal to the pressure on the spinal cord and extended distal to it. In only 3 out of the 92 lesions, the lesion with increased signal intensity on T2WI was solely located proximal to the pressure on the spinal cord. In 5 other cases the lesion with increased signal intensity on T2WI started proximal to the level of pressure on the spinal cord and extended into the level of pressure on the spinal cord ( p < 0.001; Table 1). Conclusion: Cervical myelomalacia may appear proximal, distal or at the level of the compressed cord. It rarely appears solely proximal to the pressure area on the cord. [ABSTRACT FROM AUTHOR]

Purpose: To show the radiological results of adolescent idiopathic scoliosis (AIS) patients treated with posterior fusion using all-pedicle-screw construct with correction carried out using a convex rod reduction technique. Methods: Between October 2004 and June 2007, 42 AIS patients were treated with posterior fusion using all-pedicle-screw construct with correction done through the convex side. Two patients were lost to follow-up and were not included in the study. Forty patients had a minimum follow-up of 2 years. Patients were evaluated for the deformity correction in coronal and sagittal planes and for spinal balance. Results: The mean preoperative Cobb angle of the major curve and secondary minor curves was 60° and 41°, respectively. Immediate postoperative mean Cobb angle of the major curve and secondary minor curves was 17° and 13°, respectively. Postoperative 2-year average major curve loss of correction was 7 %. Postoperative 2-year average minor curve loss of correction was 5 %. Preoperative thoracic kyphosis of 28° was changed to 22° in 2-years follow-up. The loss of thoracic kyphosis was most noted in hyperkyphotic patients. Conclusions: The correction of AIS by convex-sided pedicular screws yields a coronal correction comparable to what is described in the literature for segmental concave-sided screws. [ABSTRACT FROM AUTHOR]