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Objective: Adult scoliosis (AS) is often associated with rotational thoracolumbar (TL) kyphosis. The impact of surgical correction on lumbar sagittal distribution, ideal sagittal plane matching, and mechanical complications is still underexplored. Methods: In this retrospective study, prospectively collected data were analyzed from a multicenter adult deformity database. Inclusion criteria were surgical patients with AS and TL/L curves > 30°, T10-L2 sagittal kyphosis (TLK) > 20°, and at least a 2-year follow-up. We analyzed preoperative and postoperative variables and studied the consequences of TL sagittal change on ideal type mismatch and on mechanical complications using univariate and multivariate logistic regression analyses, and compared patients with high pelvic incidence (PI > 50°) versus those with low PI (PI

The Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI) are two commonly used self-rating outcome instruments in patients with lumbar spinal disorders. No formal crosswalk between them exists that would otherwise allow the scores of one to be interpreted in terms of the other. We aimed to create such a mapping function.We performed a secondary analysis of ODI and COMI data previously collected from 3324 patients (57 ± 17y; 60.3% female) at baseline and 1y after surgical or conservative treatment. Correlations between scores and Cohen's kappa for agreement (κ) regarding achievement of the minimal clinically important change (MCIC) score on each instrument (ODI, 12.8 points; COMI, 2.2 points) were calculated, and regression models were built. The latter were tested for accuracy in an independent set of registry data from 634 patients (60 ± 15y; 56.8% female).All pairs of measures were significantly positively correlated (baseline, 0.73; 1y follow-up (FU), 0.84; change-scores, 0.73). MCIC for COMI was achieved in 53.9% patients and for ODI, in 52.4%, with 78% agreement on an individual basis (κ = 0.56). Standard errors for the regression slopes and intercepts were low, indicating excellent prediction at the group level, but root mean square residuals (reflecting individual error) were relatively high. ODI was predicted as COMI × 7.13-4.20 (at baseline), COMI × 6.34 + 2.67 (at FU) and COMI × 5.18 + 1.92 (for change-score); COMI was predicted as ODI × 0.075 + 3.64 (baseline), ODI × 0.113 + 0.96 (FU), and ODI × 0.102 + 1.10 (change-score). ICCs were 0.63-0.87 for derived versus actual scores.Predictions at the group level were very good and met standards justifying the pooling of data. However, we caution against using individual values for treatment decisions, e.g. attempting to monitor patients over time, first with one instrument and then with the other, due to the lower statistical precision at the individual level. The ability to convert scores via the developed mapping function should open up more centres/registries for collaboration and facilitate the combining of data in meta-analyses.

INTRODUCTION The Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI) are two commonly used self-rating outcome instruments in patients with lumbar spinal disorders. No formal crosswalk between them exists that would otherwise allow the scores of one to be interpreted in terms of the other. We aimed to create such a mapping function. METHODS We performed a secondary analysis of ODI and COMI data previously collected from 3324 patients (57 ± 17y; 60.3% female) at baseline and 1y after surgical or conservative treatment. Correlations between scores and Cohen's kappa for agreement (κ) regarding achievement of the minimal clinically important change (MCIC) score on each instrument (ODI, 12.8 points; COMI, 2.2 points) were calculated, and regression models were built. The latter were tested for accuracy in an independent set of registry data from 634 patients (60 ± 15y; 56.8% female). RESULTS All pairs of measures were significantly positively correlated (baseline, 0.73; 1y follow-up (FU), 0.84; change-scores, 0.73). MCIC for COMI was achieved in 53.9% patients and for ODI, in 52.4%, with 78% agreement on an individual basis (κ = 0.56). Standard errors for the regression slopes and intercepts were low, indicating excellent prediction at the group level, but root mean square residuals (reflecting individual error) were relatively high. ODI was predicted as COMI × 7.13-4.20 (at baseline), COMI × 6.34 + 2.67 (at FU) and COMI × 5.18 + 1.92 (for change-score); COMI was predicted as ODI × 0.075 + 3.64 (baseline), ODI × 0.113 + 0.96 (FU), and ODI × 0.102 + 1.10 (change-score). ICCs were 0.63-0.87 for derived versus actual scores. CONCLUSION Predictions at the group level were very good and met standards justifying the pooling of data. However, we caution against using individual values for treatment decisions, e.g. attempting to monitor patients over time, first with one instrument and then with the other, due to the lower statistical precision at the individual level. The ability to convert scores via the developed mapping function should open up more centres/registries for collaboration and facilitate the combining of data in meta-analyses.

In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger ( 20y) patients, for whom the questionnaire was originally designed, is not currently known.Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit.Compared with the 20-item version, the 16-item solution significantly increased the fit (p 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French.In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation.

Resumen La fusion instrumentada lumbar por via posterior se realiza de manera habitual hoy en dia, aunque en algunas ocasiones puede inducir complicaciones que pueden llegar a ser devastadoras. Una de las causas, aunque poco frecuentes, de complicacion mayor es la malposicion de los tornillos pediculares, de ahi la importancia de ser metodicos a la hora de su colocacion, comprobando el correcto labrado del trayecto y su introduccion. Presentamos un caso de sangrado masivo tras la introduccion de un tornillo pedicular lumbar durante una cirugia por estenosis de canal. La malposicion del tornillo conllevo la inestabilidad hemodinamica intraoperatoria de la paciente tras el fracaso de los metodos habituales de control de sangrado en el campo quirurgico. La realizacion de una TAC con contraste evidencio lesion de la arteria intersegmentaria lumbar que fue finalmente controlada mediante embolizacion e implantacion de coil vascular.

Background Perioperative tranexamic acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures. Methods We conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed. Results Ninety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (P = 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (P = 0.06). TXA resulted in a significant decrease in intraoperative bleeding (P = 0.01) and total bleeding (P = 0.01) relative to placebo. The incidence of adverse events was similar in the two groups. Conclusions TXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss in adults undergoing major spinal surgery. Clinical trial registration NCT01136590.

Objective Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. Material and methods Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1–L1 length, thoracic T5–T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. Results Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1–L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5–T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. Conclusion For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.

Resumen Objetivo Evaluar el crecimiento longitudinal del torax y el control de la deformidad en una serie de pacientes con escoliosis juvenil tratados con barras de crecimiento aumentando los intervalos de tiempo entre alargamientos mas de seis meses. Material y metodos Estudio retrospectivo de ocho pacientes midiendo las siguientes variables: el angulo de Cobb, la traslacion vertebral apical, el balance coronal, la longitud toracica T1-L1, la cifosis toracica T5-T12, el angulo de cifosis de union proximal (CUP) y la lordosis lumbar. Se registraron las complicaciones. Resultados Se evaluaron cinco escoliosis idiopaticas y tres casos de sindromica (media de edad 9,4 ± 1,5 anos). Se realizo una cirugia inicial y un promedio de dos retensados por paciente. El tiempo medio entre retensados fue de 15,7 meses. La correccion coronal final de la curva principal fue del 58%. La longitud toracica (T1-L1) preoperatoria fue de 20,8 cm, postoperatoria de 24,4 cm, y final de 26 cm. Al final del seguimiento el crecimiento medio del torax fue de 5,2 cm. La cifosis preoperatoria (T5-T12) fue 33,5°, y final 32,1°. El cambio en el angulo CUP fue de 2,5° en el seguimiento final. La mayoria de las complicaciones estuvieron relacionadas con la instrumentacion. Se encontraron dos infecciones superficiales de la herida. Conclusion En pacientes con escoliosis juvenil en formas «menos graves» tratados mediante barras de crecimiento, es posible espaciar los alargamientos mas de un ano y con ello disminuir el numero de cirugias y al mismo tiempo controlar la deformidad y permitir el crecimiento longitudinal toracico.

Objective The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). Patients and methods A retrospective matched cohort study was conducted on 73 patients (CI n = 37 and HL n = 36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. Results There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P P = .02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. Conclusion At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However, clinical differences were not observed as regards the SRS-22 scores.

Resumen Objetivo El objetivo de este trabajo es determinar si los resultados clinicos y radiologicos obtenidos en cuanto a correccion a largo plazo se mantienen de forma similar usando injerto de cresta iliaca ( CI ) o solo el hueso local (HL) en los pacientes intervenidos con escoliosis idiopatica del adolescente. Pacientes y metodos Se efectuo un estudio retrospectivo de cohortes homogeneas de 73 pacientes (CI n = 37 y HL n = 36) con escoliosis idiopatica intervenidos mediante artrodesis por via posterior con un seguimiento medio de 126 meses en el grupo CI y 66 meses en el grupo HL. Se compararon los resultados en cuanto a correccion quirurgica y perdida de la misma segun las mediciones de los angulos de Cobb en telerradiografias antero-posteriores y laterales preoperatorias, postoperatorias y finales, y se valoraron los resultados clinicos mediante el cuestionario SRS-22. Resultados En el grupo HL la correccion postoperatoria resulto significativamente mayor 61 ± 15% vs. 51 ± 14% del grupo CI (p Conclusiones Los pacientes intervenidos en los que se emplea injerto de CI tienen una perdida de correccion inferior a los pacientes en los que se emplea injerto de HL aunque no parece existir correlacion clinica de esta perdida de correccion.

Objetivo Estudiar los pacientes inmaduros con cartilago trirradiado abierto, operados de escoliosis, en busca de factores de riesgo y de prevencion para desarrollar un fenomeno de crankshaft (CP). Material y metodos Estudio retrospectivo de una cohorte de 26 pacientes esqueleticamente inmaduros. Seis se excluyeron por progresion de distinta etiologia. Se definio crankshaft como un aumento del Cobb mayor de 10°, o un incremento en la diferencia del angulo de Mehta (diferencia angulo vertebra-costilla, DAVC) mayor de 10°, o cualquier disminucion de la distancia apex-costilla toracica o aumento de la traslacion vertebral apical lumbar (AVT, sigla del ingles apical vertebral translation). Se compararon los pacientes con y sin desarrollo de CP para analizar los factores de riesgo preoperatorios, quirurgicos y postoperatorios. Se estudio la influencia de las distinta tecnicas quirurgicas. Resultados El seguimiento medio fue de 83,9 meses. Nueve pacientes (45%) desarrollaron el CP. Solo los parametros de inmadurez osea se asociaron al desarrollo de CP. Ningun parametro radiografico preoperatorio o postoperatorio parece influir en su desarrollo. La cantidad de correccion podria ser un factor de proteccion (41,4 vs. 61,4%; p = 0,06). El doble abordaje fue capaz de evitar el desarrollo de CP (0%) en comparacion con la instrumentacion unica posterior (44%), p = 0,02. Discusion No se ha conseguido demostrar que los siguientes factores preoperatorios predispongan a la aparicion de crankshaft: sexo o etiologia, cifosis T5-T12, hipocifosis apical, Cobb coronal, rotacion vertebral o DAVC. Tampoco parecen influir el Cobb postoperatorio residual, la cifosis conseguida, o la instrumentacion con alambres frente a ganchos. Conclusion En los pacientes con cartilago trirradiado abierto menores de 11 anos parece aconsejable corregir la escoliosis mediante doble abordaje para evitar el fenomeno del ciguenal o CP (progresion de la deformidad tras una artrodesis posterior por crecimiento anterior vertebral).

Objective To study young patients after scoliosis surgery in order to determine risk and prevention factors for developing a crankshaft phenomenon (CP). Methods Retrospective study of a cohort of 26 patients. Six were excluded due to progression of various conditions. Crankshaft was defined as an increase in the Cobb angle > 10°, or the Mehta angle (DAVC) > 10°, or any decrease in the apex-rib thoracic distance, or increase in the vertebral apical lumbar translation (TVA). Patients with and without CP development were compared in order to analyse preoperative, surgical and postoperative risk factors, as well as the influence of different surgical techniques. Results The mean follow-up was 83.9 months. Nine patients (45%) developed the crankshaft phenomenon. Only immaturity parameters were associated with development of CP. No preoperative or postoperative radiographic parameters appeared to influence its development. The amount of correction may be a protective factor (41.4% vs. 61.4%, P = .06). The double approach was able to prevent the development of CP (0%) compared with single posterior instrumentation (44%), P = .02. Discussion None of these preoperative factors seemed to predispose to CP: gender or etiology, T5–T12 kyphosis or apical hypokyphosis, coronal Cobb, vertebral rotation, or DAVC. The residual postoperative Cobb, achieved kyphosis, or wired instrumentation vs. hooks, also seemed to have no influence. Conclusion In patients with open triradiate cartilage under 11 years of age, it seems advisable to correct by double approach to avoid the appearance of the crankshaft phenomenon.

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation.

Resumen Objetivos Evaluar la validez clinica en EA de 2 nuevos parametros (ASS y ST) descritos recientemente para la evaluacion del perfil sagital espinopelvicos, y cuyo papel en EA no esta aun definido. Material y metodo Analisis prospectivo (no concurrente) radiografico y clinico de 59 cirugias primarias de EA (Cobb > 40°), minimo 2 anos de seguimiento. Para este trabajo dispusimos de radiografias y cuestionarios de salud de 49 pacientes. Se evaluo el cambio de los parametros radiograficos tras cirugia (test Wilcoxon) y la correlacion resultados clinicos-radiograficos-edad (test de Spearman y regresion lineal multiple). Resultados Mediana de seguimiento postoperatorio 8,5 anos. Mediana edad 49,5 anos. Hubo cambio estadisticamente significativo con la cirugia en ASS y ST (en ambos inferior a 5°), cifosis toracica (CT), lordosis lumbar (LL), rotacion pelvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlacion entre dolor y ASS-ST. Hubo correlacion significativa entre actividad y ASS, ST, LL, BS) y edad. Tras analisis multivariante solo la edad (ni ASS ni ST) persistio como posible predictor de menor actividad. Discusion Cuando predomina la deformidad frontal, los parametros radiograficos sagitales, incluidos los mas novedosos angulos, si bien si influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parametros clinicos. Conclusiones Los valores de SSA y ST varian escasamente con la cirugia. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA.

Resumen Objetivo Comparar los resultados de la correccion por via posterior con una construccion hibrida mediante el empleo de una liberacion posterior clasica y la liberacion posterior ampliada (LPA). Material y metodos Efectuamos un estudio de cohortes retrospectivo con 46 pacientes diagnosticados de escoliosis idiopatica del adolescente (EIA). Se realizo una correccion por via posterior mediante el empleo de una instrumentacion hibrida. En el primer grupo se realizo una liberacion posterior estandar (LPE) y en el segundo se realizo una LPA, y se resecaron todos los ligamentos posteriores y se realizo una facetectomia amplia bilateral. Se compararon los resultados de las mediciones en telerradiografias anteroposteriores y laterales preoperatorias, postoperatorias y a los 2 anos. Se valoraron los resultados clinicos mediante el cuestionario SRS 22. Resultados No hubo diferencias en cuanto al sexo, edad, tipo de curva, niveles instrumentados, tiempo quirurgico o Cobb preoperatorio (LPE: 60°±10°; LPA: 59°±8°) de la curva principal. En el grupo de LPA la correccion obtenida fue significativamente mayor en el postoperatorio (p Conclusion La LPA a multiples niveles mejora la correccion de la curva principal en el plano coronal en los pacientes con EIA, sin aumento de la incidencia de complicaciones, ademas de aumentar la superficie de artrodesis y facilitar la introduccion del alambrado.

Purpose To compare the results of posterior correction using hybrid instrumentation and classical posterior release with those obtained with an extended posterior release. Material and methods We carried out a retrospective cohort study of 46 patients diagnosed with adolescent idiopathic scoliosis (AIS). A posterior correction was carried out using hybrid instrumentation. In the first group, a standard posterior release (SPR) was performed, whereas in the second an extended release (EPR) was carried out, resecting all posterior ligaments and performing an extended bilateral facetectomy. The results of the measurements were compared using pre-op, post-op and 2-year-follow-up anteroposterior and lateral teleradiographs. Clinical results were evaluated using the SRS22 questionnaire. Results There were no differences as regards gender, age, curve type, instrumented levels, OR time or pre-op Cobb's angle (SPR: 60 ± 10; EPR: 59 ± 8) of the principal curve. In the extended release group the correction obtained was significantly greater at postop (p Conclusion Multiple-level posterior release improves correction of the principal curve on the coronal plane in patients with AIS, without an increase in the complications rate. The procedure also extends the arthrodesed area and facilitates introduction of the wires.

Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings.Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded.Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered.For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.

Summary We report a case of a patient who had lateral ankle pain with the diagnosis of stenosing tenosynovitis of the peroneal tendons caused by an osteochondroma of the peroneal tubercle.

The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL).A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire.There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3° vs. HL 8.5 ± 6.3°, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores.At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores.

To study young patients after scoliosis surgery in order to determine risk and prevention factors for developing a crankshaft phenomenon (CP).Retrospective study of a cohort of 26 skeletally immature patients. Six were excluded due to progression of various conditions. Crankshaft was defined as an increase in the Cobb angle10°, or an increase in the Mehta angle (DAVC)10°, or any decrease in the apex-rib thoracic distance, or increase in the apical vertebral translation (AVT). Patients with and without CP development were compared in order to analyse preoperative, surgical and postoperative risk factors, as well as the influence of different surgical techniques.The mean follow-up was 83.9 months. Nine patients (45%) developed the crankshaft phenomenon. Only immaturity parameters were associated with development of CP. No preoperative or postoperative radiographic parameters appeared to influence its development. The amount of correction may be a protective factor (41.4 vs. 61.4%; P=.06). The double approach was able to prevent the development of CP (0%) compared with single posterior instrumentation (44%), P=.02.None of these preoperative factors seemed to predispose to CP: gender or aetiology, T5-T12 kyphosis or apical hypokyphosis, coronal Cobb, vertebral rotation, or DAVC. The residual postoperative Cobb, achieved kyphosis, or wired instrumentation versus hooks, also seemed to have no influence.In patients with open triradiate cartilage under 11 years of age, it seems advisable to correct by double approach to avoid the appearance of the crankshaft phenomenon.

To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS.A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression).The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity.When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters.The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.