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Background: The description of the measurement technique of the posterior occiput-third cervical spine (OC3) angle-before performing occipitocervical fusion is still controversial. Setting an appropriate alignment in occipitocervical instrumentation is important for successful fixation surgery. Several methods were used for quantifying occipitocervical alignment on the lateral radiograph. This study was performed to describe a measurement technique of OC3 angle and comparing reliability and reproducibility in the measurement of occipitocervical angle with previous method. The purpose of this study was to determine the best technique for assessing this angle. Materials and methods: Three hundred and twenty-six lateral cervical spine radiographs from volunteers without spinal disorder were taken in neutral position and collected from June 2011 to December 2012. Analysis consisted of measurement of the OC3 angle and posterior occipitocervical angle. Inter- and intra-observer reliabilities were assessed using limit agreement test. Results: The mean OC3 angle measurements were approximately 107 (94-120) degrees. Intra- and inter-observer error assessed by 95% limit agreement was approximately ±5.5 and ±7.5, while the POCA measurements were approximately 108 (94-120) degrees. Intra- and inter-observer error assessed by 95% limit agreement was approximately ±13.3 and ±18.2. Conclusion: The OC3 angle measurement is a simple method, good inter- and intra-observer reliabilities to measure of the occipitocervical angle. That can be useful to setting the patient's position and facilitate confirmation of the occipitocervical neutral position during occipitocervical fusion. [ABSTRACT FROM AUTHOR]

Background: Treatment of spondyloptosis is challenging. Dr. Gaines first developed and reported the L5 vertebrectomy approach for spondyloptosis with satisfactory long-term outcomes. This procedure has been rarely performed in the new era. Objective: To report a rare and complex procedure L5 vertebrectomy (Gaines procedure, which now is a rare procedure and has been reported only by Dr. Gaines) for the treatment spondyloptosis. Case Report: This study is case report and review of literature. We performed L5 vertebrectomy for the treatment of spondyloptosis and the results of the procedures was good. Conclusion: Surgical treatment of spondyloptosis is difficult and complex. The L5 vertebrectomy, a rare and complex procedure, remains a predictable option, with excellent fusion rates and improved clinical alignment. [ABSTRACT FROM AUTHOR]

Background: A few studies had reported the spinal deformity associated with neurological symptoms in PRS patients., Objective: To report the management of myelopathy fromflexible thoracic kyphoscoliosis in Pierre Robin sequence (PRS) patient., Material and Method: A 15-year-old PRS patient with thoracic kyphoscolsis developed myelopathy symptom for 4 months. Posterior instrumentation (Cotrel-Dubousset) from T1-T9 was done to correct her deformity without decompression., Results: Her motor power improved to grade 5/5 two months after operation. Her urological symptom returned to normal at 4-month postoperatively., Conclusion: Myelopathy from flexible kyphotic deformity in PRS patients can be successfully treated by posterior correction and fusion without decompression.

Background: Autologous bone harvested from the iliac crest is the gold standard for lumbar spinal fusion. However postoperative donor site pain and morbidity have been reported. Local bone graft is insufficient and contains some soft-tissue attachment. Therefore, Healos (DePuy Spine, Raynham, MA, USA) is currently bone graft substitute that was introduced for spinal fusion with good results but radiographic fusion rate has not been clearly defined yet., Objective: To assess the radiographic fusion rate of HEALOS with bone marrow aspiration versus autologous bone graft in the same patients undergoing posterolateral lumbar fusion., Material and Method: A retrospective radiographic outcome study of radiographic fusion rate from plain radiographs in 55patients indicatedforposterolateral lumbar fusion in Lerdsin General Hospital between April 2005 and December 2006 was done. The patients were implanted with HEALOS collagen-hydroxyapatite sponge with bone marrow aspiration and local bone graft on each side of Posterolateral Lumbar Fusion. Twenty-seven patients were included in the present study according to the authors'inclusion criteria. Plain radiographs were collected and radiographic fusion rate was assessed for at least two years follow-up., Results: The two years post operative radiographic fusion rate was 29.63% (8/27) in Healos/BMA group and 62.96% (17/27) in LBG group. At three-years follow-up, radiographic fusion rate of 36.84% (7/19) was achieved in the Healos/ BMA group and 78.93% (15/19) in the LBG group., Conclusion: In the present study, Healos collagen-hydroxyapatite sponge with bone marrow aspiration had lower radiographic fusion rate when compared to local bone graft in posterolateral lumbar fusion at two years post operative. The results of the Healos/BMA group was increased fusion rate with time but remained lower than LBG group at three and four years follow-up.

Objective: A retrospective study was performed in case with three and four levels degenerative cervical spondylosis that underwent anterior cervical discectomy and fusion (ACDF) with polyetheretherketone (PEEK) cages and anterior cervical plate to evaluate the efficacy and outcome., Material and Method: Clinical and radiographic results of 16 patients (6 women and 10 men) between January 2006 and June 2009 with follow-up more than 24 months were evaluated Spinal curvature, segmental sagittal angulations, construct height and the radiographic fusion success rate were measured Odom's criteria, visual analog scale (VAS), Nurick and modified JOA (Japanese Orthopedic Association) score were used to assess the clinical results., Results: There was significant difference between pre- and post-operative in degree of lordosis, segmental Cobb angle and clinical outcomes (p < 0.01). Clinical outcomes were classified as 'excellent' or 'good' according to Odom's criteria in 14 patients (success rate: 87.5%). Mean follow-up period was 36 months. Flexion and extension lateral radiographs showed 100% fusion rate. The construct height and sagittal alignment were maintained on the final follow-up observations. No cage failure, subsiding or dislodgement was showed on follow-up radiographs., Conclusion: Interbody fusion with PEEK cages packed with bone substitute and aspirated bone marrow which additions of cervical plate eliminate the complications of graft harvest and is a good option for the treatment of patients with three and four levels degenerative cervical spondylosis.

Objective: To determine the outcome of hydroxyapatite (HA) mixed with autogenous bone marrow (BM) and local bone graft in posterolateral lumbar fusion., Material and Method: Twenty-three patients who had posterolateral fusion with posterior instrument using HA mixed with BM and local bone graft between December 2003 and August 2005 were prospective analyzed. Degree of pain using visual analog scale (VAS) was evaluated at preoperative and 2, 4, 6, 9, 12, and 24 postoperative months. Radiographs were assessed for spinal fusion at 4, 6, 9, 12, and 24 postoperative months., Results: The improvement of pain was demonstrated in all patients postoperatively. Radiographic outcomes revealed solid and doubtful fusion in one of 23 patients (4.3%) and 13 of 23 patients (56.5%) at six months respectively. After two-year follow-up, one patient had solid fusion while 22 patients (95.6%) had doubtful fusion., Conclusion: Despite the posterolateral lumbar fusion using HA mixed with BM and local bone graft provided good clinical results, the radiographic results of spinal fusion were questionable in most cases.

Summary of Background Data: The association between the facet tropism and the development of lumbar disc herniation has been studied; however the results remain controversial., Objective: To determine the association between the facet tropism and the development of lumbar disc herniation., Study Design: A cross-sectional study., Material and Method: MRI of 34 patients with lumbar disc herniation was evaluated. Two orthopedic surgeons measured facet joint angle and determined the degenerative status of L3-4, L4-5, and L5-SI. Facet tropism was defined as the difference between the angle of the right and left facet more than 5 degrees., Results: The average difference of facet joint angle of HNP group was higher than normal group in the same level. There was no statistically significant correlation between the facet tropism and lumbar disc herniation., Conclusion: These results do not indicate any relationship between the facet tropism and lumbar disc herniation.

Objective: Evaluate the results of the posterior instrumentation for the correction of adolescent idiopathic scoliosis (AIS) in Lerdsin Hospital., Material and Method: A retrospective study was conducted to determine the effectiveness of surgical treatment of idiopathic scoliosis in Lerdsin Hospital. The pre-operative, immediate post operative, and the most recent follow-up (minimum 2 years) x-ray of 17 patients were evaluated for curve correction and spinal balance., Result: The present study found that the curvatures in thoracic King type II and III were corrected by about 58% post operatively. The curve progressed 3 degrees (5%) at the end of 2 years. For lumbar curve in King types I and II, there was the correction of 51% and 59%. After 2 years, the curve progressed around 6 degrees (7%) and 8 degrees (14%). Trunk balance was corrected by 60% in King type III. Degrees of thoracic kyphosis was decreased about 4 degrees., Conclusion: Frontal and sagittal thoracic and lumbar curve correction can be satisfactorily obtained by posterior spinal correction with instrumentation.