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Recent literature supports the surgical reduction of high-grade spondylolisthesis, particularly with an unbalanced pelvis and spine. Drop foot is the most common neurological complication reported in the literature. Scoliosis Research Society database reported only one patient (child) with cauda equina syndrome after surgery for dysplastic high-grade lumbosacral spondylolisthesis. The lack of longitudinal clinical follow-up of that patient limited their result. There is another report of 12 cauda equina syndrome cases after in situ arthrodesis for lumbosacral spondylolisthesis. The current report is the first case in the literature of cauda equina syndrome after partial reduction of dysplastic high-grade lumbosacral spondylolisthesis in a child. The aim was to raise awareness of the possibility of this post-operative complication happening in children and the possibility of avoiding it. A child who developed a cauda equina syndrome as an early neurological complication after surgery, which recovered completely 6 weeks after revision surgery, is reported. During the revision surgery, an L5-S1 transforaminal interbody fusion was performed by insertion of polyetheretherketone cage. Bilateral anal compound muscle action potential is seen after implant removal and sacral dome resection. Using somatosensory, motor evoked potential and continuous electromyogram for both rectal and external bladder sphincters in children with high-grade lumbosacral dysplastic spondylolisthesis undergoing surgical reduction are important to prevent a devastating neurological complication. Sacral dome resection and appropriate L5-S1 discectomy prevent stretching of the cauda equina over the posterosuperior border of the sacrum postoperatively.

BACKGROUND: Posterior lumbar fusions are a common and successful procedure, yet surgical site infection (SSI) is still prevalent and causes significant morbidity. Obesity is a well-established risk factor for SSI. Still, the accuracy of the body mass index (BMI) caused some to suggest other metrics that are more representative of the thickness of the soft-tissue envelope in the surgical site. METHODS: A retrospective review of all cases that developed SSI following posterior lumbar fusion over the past 5 years was done. An age and gender-matched control group was formed from the lumbar fusion cases that did not develop SSI. Demographic and clinical data were collected, and morphometric measurements of the soft-tissue envelope were performed at the level of L4 for all cases on standing x-ray imaging and magnetic resonance imaging (MRI). RESULTS: A total of 366 patients underwent posterior lumbar fusion, 26 of whom developed SSI. BMI and skin to spinous process measurements on x-ray imaging—not MRI—were found to be significantly associated with SSI. Regression analysis further confirmed the strength of the association. CONCLUSION: While BMI and MRI measurements are useful, wound depth measurements on x-ray imaging can be predictive of SSI in lumbar fusion cases. CLINICAL RELEVACE: Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds. LEVEL OF EVIDENCE: 3.

Purpose of the Study: The aim is to report the natural history, type of treatment received and quality of life improvement of adolescent patients with isthmic low-grade lumbosacral spondylolisthesis with a slip of less than 25%. Methods: The complete records of 299 prospective patients (127 males and 172 females) with isthmic low-grade lumbosacral spondylolisthesis referred to an orthopedic clinic were reviewed. Radiological parameters, Micheli scale, and quality of life measured by the SRS-22 questionnaire were measured at the first visit and a minimum 5-year follow-up. Results: The average follow-up time is 5.7 ± 1.4 years. The main complaint at the initial presentation was lower back pain in 107 patients, and three patients had lower back pain and lower limbs radiculopathy. Scoliosis was found in 38 patients in the initial radiograph. One-hundred-eighty-nine patients (63%) were asymptomatic at the time of presentation. At the last follow-up; SRS-22 were 4.21 ± 0.6, 4.21 ± 0.7, 4.31 ± 0.5, 4.21 ± 0.7, 4.2 ± 0.7 for total, pain, function, mental, and self-image scores, respectively. The patients with grade one lumbosacral spondylolisthesis with normal morphology of the sacrum had responded well to the nonsurgical treatment modalities. No patient has progressed during the follow-up, and no patient underwent surgical intervention for back pain. The slip percent was relatively lower in patients with low back pain. The average slip percentage was 15.5 ± 8.4 among the asymptomatic patients and 13 ± 9 among patients who presented with low back pain ([Formula: see text] value = 0.009). Conclusion: Adolescent patients with grade one isthmic lumbosacral spondylolisthesis have very good prognosis with nonoperative modalities and they have an almost normal quality of life at the end of follow-up. A long follow-up in an outpatient clinic with X-Rays series might not be indicated for all patients with low-grade spondylolisthesis, specifically if the slip is less than 25%.

Purpose Observational studies suggest that most low-grade patients treated nonoperatively will have a successful clinical outcome. However, the changes in pelvic incidence as related to the risk of progression remain unknown. Methods The complete records of 301 prospective patients (129 males 172 females) with low-grade spondylolisthesis aged 12.3 years ± 3.1 years were reviewed. Radiological parameters (pelvic incidence, lumbosacral angle, and percentage of slip) and quality of life were measured at the first visit and a minimum 2-year follow-up. Patients with an increase in pelvic incidence by more than 5 degrees at the last follow-up were included in group 1, and otherwise included in group 2. Results The average follow-up time is 4.6 ± 2.3 years. The slip percentage was 14.6 ± 8.8 at the initial visit and 15.8 ± 9 at the last follow-up (P

Introduction. Spine fusion surgery is an increasingly popular procedure, but the patient experience is variable and the cost is high. Enhanced recovery after surgery (ERAS) pathways can provide a standardized plan for spine fusion cases, improving quality of care and reducing costs. We report an early attempt at the implementation of such a pathway and compare it to a historical cohort. Methods. All adult patients undergoing elective posterior thoracolumbar spine fusion in 2019 and 2020 were included in the study. The ERAS protocol implementation started in January 2020. The study cohort was all cases performed in 2020—after implementation of ERAS—while the historical cohort was cases from 2019. Demographic and clinical data were collected and compared between the groups. Results. Ninety-three patients were included in the study. The study cohort (ERAS) included 42 patients, while the comparison group (pre-ERAS) included 51 patients. Demographic and preoperative clinical data were similar between the two groups. However, postoperative clinical data showed that ERAS resulted in less reliance on analgesics, earlier mobilization, and a reduced length of stay. Complication and readmission rates were unchanged. Conclusion. ERAS can reduce costs while maintaining or improving clinical outcomes for spinal fusion surgery.

To perform a cross-cultural adaptation and validation of Saudi Arabic (SA) version of SRS-30 and test it on Saudi patients with adolescent idiopathic scoliosis (AIS).A retrospective analysis of prospective collected data of 322 patients with AIS. The cross-cultural adaptation process was performed using the American Association of Orthopedic Surgeons (AAOS) Outcomes Committee method. A pre-test analysis was conducted on 30 patients. All patients had completed the SRS-22r and SF-12 preoperatively and 198 patients had completed the SA version of SRS-30 and SF-12 postoperatively twice at six weeks interval. The validity and internal consistency were tested using the interclass correlation coefficient (ICC), Cronbach alpha, person correlation coefficient, and confidence interval (CI).There are 288 (89.4%) girls and 34 (10.6%) boys and the average age is 15 ± 2.3 years (range from 10-21 years). The majority of patients have a Lenke type 1 curve (41%) and only 14% have a Lenke type 5 and 6. The overall Cronbach alpha (CA) of all SRS-30 domains is 0.87. However, the Cronbach alpha for the satisfaction, and function domains slightly lower than the original English questionnaire.The Saudi Arabic version of SRS-30 is a reliable and valid instrument and can be applied to evaluate the quality of life in patients with AIS.

Loss Of Primary Containment (LOPC) due to hydrocarbon leakage from bolted flange joint has always been one of the main issues that leads to catastrophic fire and explosion in operating platforms and plants. Oil and gas companies have been putting many efforts to reduce Health, Safety and Environment (HSE) incidences due to the flange joint integrity issues. PETRONAS, which operates many oil and gas platforms, has also made series of improvement in lesson learnt and enhanced best practices to find a wholesome solution to achieve sustainable zero hydrocarbon leak from bolted flange joint. Loss Of Primary Containment (LOPC) due to hydrocarbon leakage from bolted flange joint is one of major concerns in oil and gas industry, which may cause catastrophic fire and explosion at platforms and plants. Bolted Flange Joint Integrity (BFJI) digitalization program is designed to emphasize on end-to-end digital solution addressing three main important aspects towards sustainable flange leak free operation that included correct design and specification, good quality flange joint components and correct work execution.

BACKGROUND: Mid-term clinical and radiological evaluation of a carbon-fiber cage in multilevel cervical spondylosis (MCS). Anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMC) has shown satisfactory outcomes, but with subsidence of up to 20%. Conventional long-fiber carbon fiber cages have shown a safe profile in discectomy/fusion (ACDF) but with minimal data in the setting of corpectomy. METHODS: Retrospective review of a single centre multi-surgeon cohort of MCS patients from 2007–2012. Follow-up period was a minimum of 3.5 years, mean 6 years. Outcomes included peri-operative, clinical [Nurick, European Myelopathy, Visual Analogue Scores (VAS), modified Japanese Orthopaedic Association (mJOA) scores and radiographic (C2C7, Cobb & ROM angles)]. RESULTS: A total of 102 consecutive patients were included. Mean length of stay was 5.5 (SD 3.5) days, blood loss 322 (SD 358) mL and operative time 98 (SD 31) min. Corpectomy levels included 72 single-level ACCF and 30 multiple ACCF. Fourteen had peri-operative complications. Three patients required early cage revisions. Mean pain scores improved from VAS neck 4.6 to 2.6 (P3 mm across the instrumented level were present in 5 patients, all of which displayed fusion of either grade 1 or 2. 7 had C2C7 kyphosis. Severe subsidence (>3 mm) was seen in 9 cases (13%). CONCLUSIONS: Mid-term outcomes of this carbon-fiber cage indicate that it is safe and durable for the treatment of MCS with a similar radiological profile to that of TMC.

To investigate the effectiveness of surgical reduction in high-grade spondylolisthesis in maintaining or restoring a normal pelvic balance, as related to the QoL. It is a retrospective analysis of prospectively collected data of 60 patients (17 males, 43 females) aged 15 ± 3.1 years who underwent surgery for high-grade spondylolisthesis and were followed for a minimum of 2 years after surgery. Patients with a residual high-grade slip following surgery were referred to the postoperative high-grade (PHG) group, while patients with a residual low-grade slip were referred to the postoperative low-grade (PLG) group. Pelvic balance was assessed from pelvic tilt and sacral slope, in order to identify patients with a balanced pelvis or unbalanced pelvis. The SRS-22 questionnaire was completed before surgery and at last follow-up. Postoperatively, there were 36 patients with a balanced pelvis and 24 patients with an unbalanced pelvis. The improvement in QoL was better in patients with a postoperative balanced pelvis. There were 14 patients in the PHG group and 46 patients in the PLG group. Four of seven patients (57%) in the PHG group and 21 of 26 patients (81%) in the PLG group with a preoperative balanced pelvis maintained a balanced pelvis postoperatively (P = 0.1). None of the patients in the PHG group and 11 of 20 patients (55%) in the PLG group improved from an unbalanced to a balanced pelvis postoperatively (P

Study design: Case-Control Study Objectives: To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in Adolescent Idiopathic Scoliosis (AIS) patients treated with posterior instrumentation. Summary of background data: PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. Methods: This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar X-rays were acquired for each subject preoperatively and at two years follow up. Two global sagittal alignment parameters were calculated, i.e. the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). Results: Among normal adolescents, the average OD-HA and CCOM-HA angles were -2.3°±2° and -1.5°±1.8°, respectively. Among AIS patients the average OD-HA and CCOM-HA angles were respectively -2.3°±1.9° and -1.3°±1.8° preoperatively and -2.8°±1.7° and -1.9°±1.7° at the last follow up. 13% of the patients developed PJK postoperatively. Case-by-case analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. Conclusions: OD-HA and CCOM-HA angles remain almost constant among normal group and patients, pre- and post-operatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, PJK could be a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant. Level of Evidence: III BiomecAM chair on musculoskeletal modeling, with the support of Cotrel and ParisTech Foundations, Société Générale, Covea and Proteor.