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Background Congenital scoliosis caused by failure of multiply vertebral segmentation with concave fused rib or unsegmented bar combined with contralateralhemivertebra is usually rigid and produces enormous asymmetric growth. Fusionless techniques have less advantage and come with some complications. Paucity of data was reported for children with complex congenital scoliosis using two-staged osteotomy surgery. Methods From 2006 to 2016, 11 patients less than 10 years old undergoing two staged osteotomy surgery for complex rigid congenital scoliosis were retrospectively reviewed. The analysis included age at initial surgery, second surgery and at the latest follow-up, and complications. Changes in coronal major curve, thoracic kyphosis, lumbar lodorsis, apex vertebra translation, T1-T12 length, T1-S1 length, trunk shift, and SVAwere included in radiological evaluation. Results In all, the mean follow-up was 72.5 ± 23.8 (42 to 112) months. The mean flexibility of the spine was 17.4 and 17.8 % before two surgeries. The mean age at the initial surgery was 6.6 ± 2.6 (2.5–10) years. The mean fusion level was 4.6 ± 1.3 (2 to 6) segments. The mean scoliosis improved from 67.4° to 23.7° after initial surgery and was 17.4° at the latest follow-up. The average increase of T1-S1 length was 0.92 cm per year. No patients had neurological complications. Conclusions Two-staged osteotomy surgery including hemivertebrae resection or Y-shaped osteotomy can achieve good radiological and clinical outcomes without severe complications. This procedure can be an option of treatment for complex congenital scoliosis.

Background: Intrathoracic ribs are very rare congenital anomalies, and often discovered incidentally on chest X-ray. Since its first description by Lutz in 1947, approximately 50 cases have been reported in the literature till date. The aim is to review the all reported intrathoracic ribs, summarize their clinical features, and propose a potential classification. Methods: All relevant literatures were searched and reviewed. The terms include intrathoracic rib, intrathoracic bifid rib, trans-thoracic rib and intrathoracic rib anomaly. We have summarized the first finding events, origination, distribution, related anomalies and imaging features of intrathoracic rib, and propose an updated classification. Results: The patients' age at initial finding was from six weeks to 79 years old. Of all, sixty percent was less than 30 years old. There was no difference in gender. Most of them were reported by authors in western countries (85.3%, 58/68), and incidental findings by radiologist and respiratory physician. The intrathoracic rib occurs more frequently on the right side, and is usually single and unilateral. According to the new classification, type I and II was account for 45.6% and 35.3%, respectively. Conclusion: Intrathoracic rib is rare findings in clinical practice. It is useful that radiologists or clinician are familiarized with the imaging appearances of these malformations. These anomalies reflect some disturbances during the embryo development, leading us to propose a potential classification that could contribute to a better understanding of this rib anomaly.

Background Two ipsilateral hemivertebrae is less common and presents severe growth imbalance caused by the vertebral anomalies. However, there is a paucity of reports regarding to two ipsilateral thoracolumbar hemivertebrae. The purpose of present study is to evaluate the long-term outcomes of the posterior surgical correction of thoraco-lumbar spine deformity caused by two ipsilateral hemivertebrae. Methods From 2006 to 2014, a total of 14 consecutive pediatric patients with congenital thoraco-lumbar hemivertebrae were treated by posterior excision of hemivertebrae with short segment fusion. The following parameters were measured: coronal major curvature, cranial and caudal compensatory curvature, segmental kyphosis, lumbar lordosis, trunk shift, apical vertebra translation and sagittal vertical axis. These results were compared and evaluated in preoperatively, immediately postoperatively and at the final follow-up. All patients had a minimum of 5 years follow-up. Results The mean age at surgery was 11.1 ± 4.8 years (2yos to 17yos). The mean follow-up period was 80.2 ± 19.4 months (60mons to 117mons). There was a mean improvement of 74.2% in the coronal major curve from a mean angle of 64.1° before surgery to 15.8° at the final follow-up. The cranial and caudal curves improved of 69.8 and 69.0% from 25.6° to 7.7°, 26.9 to 8.2, respectively. The mean thoraco-lumbar kyphosis was 59.9° before and 13.6° after surgery, 20.8° at the final follow-up. Alignment in the coronal and sagittal plane was either maintained or improved within normal values in all patients. Conclusions Good correction and spinal balance can be achieved by posterior-only hemivertebrectomy in patients with thoracolumbar kyphocsoliosis caused by two ipsilateral hemivertebra. The complication of neurological injury is low but a technically demanding procedure. More attention should be paid in residual curve progression after surgery.

To evaluate the clinical and radiological outcomes for patients who undergone posterior-only lumbosacral hemivertebrectomy with short fusion with minimum two year follow-up. From 2005 to 2016, a consecutive series of 16 paediatrics scoliosis due to lumbosacral hemivertebrae were included in this study. They were treated by one stage posterior hemivertebrae resection with bilateral or unilateral short fusion. Coronal and sagittal parameters and pelvic obliquity were measured at pre-operatively, immediate post-operatively and at final follow-up. The outcome and efficacy of the correction were investigated. The mean age was 10.4 ± 3.4 years (3–15 years). The mean follow-up period was 38.8 ± 16.2 months (24–79 months). The mean segmental scoliosis was 35.4 ± 9.2 and 7.7 ± 5.4 pre-operatively and post-operatively (78.4% correction rate) and 8.2 ± 5.0 (77%) at the latest follow-up. The compensatory coronal curve of 28.6 ± 16.1 was spontaneously corrected to 8.0 ± 8.4 in post-operatively 12.0 ± 8.4 at final follow-up. Trunk shift was significantly improved on both coronal (RTS 86.1%) and sagittal plane (68.7%) after the surgery and kept stable during the follow-up. Sacral tilt of 14.2 ± 5.3 was significantly improved to 4.7 ± 3.6 at final follow-up. There was no significant difference between bilateral and unilateral instrumentation groups (P > 0.05). One case had implants failure, and the incidence rate is 6.3%. Early posterior hemivertebrectomy with short fusion is effective in the treatment of lumbosacral hemivertebrae. It can achieve good coronal curve correction, sacral tilt, and trunk shift improvement. No neurological complications were found. Importantly, it can prevent secondary structural deformities and potentially save fusion level.

Introduction: Goldenhar syndrome includes a wide spectrum of congenital anomalies involving structures arising from the first and second branchial arches. It is characterized by impaired development of structures such as eyes, ears (with or without hearing loss), lip, tongue, palate, mandible, maxilla, and deformations of vertebrae. The etiology of this syndrome is unclear since it varies genetically and is linked to a plethora of reasons. Case Report: A 13-year-old male presented to the Orthopedic Department with complaints of back bulge with bilateral microtia since birth. X-ray and computed tomography revealed severe congenital kyphoscoliosis. Posterior vertebral column resection surgery with instrumentation and anterior cage support with bone graft fusion were performed. A postoperative plain X-ray film demonstrated a good correction rate. His follow-up was asymptomatic and well balanced in the sagittal and coronal planes at 6 months following operation. Systemic involvement was clinically and radiographically assessed. Conclusion: Patients with Goldenhar syndrome due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitates an individual approach to each single patient and involvement of a team of specialists in treatment planning. Although complex scoliosis surgery could be achieved safely in Goldenhar syndrome patients, careful preoperative management is required.

A 13-year-old boy who had hump-back was taken to the hospital. The whole spine posteroanterior and lateral radiograph showed failures of segmentation from T5 to T8 vertebra, as well as laminae fusion, diagnosed congenital thoracic kyphoscoliosis. Spinal fusion surgery was suggested because of the potential progress of segmental kyphosis. However, unusual imaging revealed that four thoracic cavity compartments were separated by two deformed ribs extending inferolaterally in bilateral hemithorax (figure 1A). Figure 1 Intrathoracic rib. Chest radiograph showing four thoracic cavity compartments separated by two deformed ribs extending inferolaterally in bilateral hemithorax (A). In the coronal CT scan, the focal additional compartment was formed with …

Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P p Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

Background context Fusionless scoliosis surgery is frequently performed in children. Many studies have analyzed the effects of spinal growth modulation by tethering the anterior and anterolateral aspects of the spine in animal models. However, few studies have reported the disc health and spinal motion in spines with posterior unilateral elastic tethering. Purpose To analyze the regional radiography, biochemistry, and histology of spinal motion segments fixed by posterior unilateral elastic tethering. Study design A randomized controlled trial. Outcome measures Preoperative and postoperative radiographs of the spines were taken. After an 8-week recovery period, the spines were harvested en bloc and underwent radiographic, biochemical, and histologic analyses. Methods Fifteen 3-month-old swine were randomly divided into three groups. Instrumentation was performed posteriorly in the swine. In the elastic fixation (EF) group, five swine were instrumented on the left side of the lumbar vertebrae from L1 to L5 with pedicle screws that were connected with a unilateral elastic tether with tension to produce a curve on the spine. The same surgery was performed in the five animals of the metal rod fixation (MF) group, in which the screws were connected with metal rods and curves were established. In the control group, five animals were instrumented with five screws with no connecting cable. Results Scoliosis and lordosis were created in the coronal and sagittal planes in both the EF and MF groups. On average, the Cobb angles were 12.16°±1.37° and 9.10°±2.02° (p=.023) in the coronal plane and 17.44°±11.29° and 5.32°±3.06° (p=.049) in the sagittal plane in the two groups, respectively. The vertebrae and discs wedged on the tethered side in the two groups showed no significant differences (p>.05). The thickness of end-plate epiphysis on the fixed side was significantly decreased in the two groups (p=.032 and p=.024). No apparent change was found in the gross morphology of the discs in the two groups. The distribution of collagen types I and II decreased and that of matrix metalloprotease-3 (MMP-3) increased in both the EF and MF groups. Additionally, the proteoglycan synthesis decreased in the two groups. Conclusions Unilateral elastic tethering resulted in vertebral wedging and scoliosis. Although changes in collagen and MMP-3 distribution, proteoglycan synthesis, end-plate epiphysis, and disc thickness were observed, the tethered discs and end plates did not demonstrate gross morphologic signs of degeneration.

To determine: (1) the relationship of thoracic cage parameters and preoperative pulmonary function tests (PFTs) in congenital scoliosis (CS) patients. (2) if patients with rib deformity have greater impairment of PFTs than those without rib deformity.A total of 218 patients with CS and pulmonary dysfunction (FVC 80 %) were conducted in one spine center between Jan 2009 and Mar 2013. The demographic distribution, medical records, PFTs and radiographs of all patients were collected. The association of PFTs and thoracic cage deformities was analyzed.In total, 143 patients (65.6 %) had a clinically relevant impairment of pulmonary function. They had smaller BMI, larger thoracic transverse and anteroposterior diameter, more thorax height, scoliotic angle and number of involved vertebra than no clinically impairment. PFTs were negative correlation significantly with scoliotic angle, number of involved vertebra and thoracic sagittal diameter, while thorax height is significant positive. The T1-12 height was significant positive correlation with age, stature, weight, thoracic transverse and sagittal longitudinal diameter, while negative correlation with scoliotic curve, number of involved vertebra, as well as kyphotic angle. PFTs do not correlate with T1-12 height, but significantly associated with the rib anomalies. The FVC and FEV1 were significantly lower in patients with rib anomalies than without rib anomalies. There was no association between the pulmonary function and the location of rib deformities.PFTs correlate significantly with scoliotic angle, number of involved vertebra, thoracic sagittal diameter, and thorax height. PFTs were significantly lower in patients with rib anomalies, particular to the patients with fused rib.

To determine the reliability of pedicle screws placed in children younger than 7 years of age, and to evaluate the effect of pedicle screw insertion on further growth of the vertebra and spinal canal.A retrospective study of 35 consecutive patients through Jan 2003-Dec 2010 for congenital scoliosis in7 years children was performed at one spine center. Patients undergoing pedicle screw instrumentation of at least two levels, which had been followed-up for at least 24 months were included. Measurements were performed in instrumented and adjacent non-instrumented levels. The effect of pedicle screw insertion on further growth was evaluated.The average age at surgery was 4.4 year (53 months, range, 23-84 months). 190 segments in 35 patients met the inclusion criteria. 77 segments had no screws and 113 had at least one screw. There was a significant difference between the pre-operative and final follow-up values of the measurement of spinal canal and vertebral body parameters (P0.001). No significant difference existed between growth rates of vertebral bodies and the sagittal diameters of spinal canal with or without screws. The growth rates of vertebral bodies in lumbar spine were higher than in thoracic spine in both instrumented and adjacent groups.Pedicle screw instrumentation does not cause a retardation effect on the development of vertebral bodies and the spinal canal in children at an early age. It is a safe and reliable procedure to achieve a stable fixation.

Study design A retrospective study. Objective To compare the clinical outcomes of different surgical strategy for patients with congenital scoliosis (CS) and type I split cord malformation (SCM). Summary of background data CS associated with type I SCM is a challenge for spine surgeon because of the high potential rate of neurological compromise. Traditionally, bony spur resection (BR) has been indicated before any procedure for scoliosis correction. Methods From May 2002 to February 2013, 82 CS patients with type I SCM who underwent corrective surgery at our center were retrospectively reviewed. There were 20 male and 62 female patients with an average age of 13.8 years (4-39 yrs) at surgery. They were divided into two groups according to different surgical strategy. The patients in the BR group underwent staged prophylactic neurosurgery or one-stage BR before corrective surgery, whereas patients in the nonresection (NR) group underwent one-stage corrective surgery without addressing bony spur. Results There were 15 patients in the BR group and 67 patients in the NR group. No significant differences were detected in preoperative characteristics between two groups. The average follow up was 37 months (24-105 months). In the BR group, the correction rate was 53.0% and 45.9% at the final follow up. Whereas, in the NR group, the correction rate was 48.5% and 42.1% at the final follow up. Compared with the NR group, the operation time and blood loss were statistically higher in the BR group. Five patients experienced transient neurological complications and one patient in the BR group suffered permanent neurological damage of incomplete loss bladder control. Conclusion One-stage corrective surgery could be safe and effective for patients with CS and SCM. For patients with intact or stable neurological status, prophylactic neurosurgical intervention to remove bony spur before curve correction may not be necessary. Level of evidence 4.

Bacterial infection related to epidural catheterizations could occur. In general, the incidence of postoperative infection at the insertion site is very low. Paucity literatures are reported for paraspinal muscle infection after epidural analgesia in parturient. We report a case of paraspinal muscle infection shortly after epidural analgesia in a parturient, who was subjected to because of threatened preterm labor. Epidural morphine was administered for 2 days for childbirth pain control. She began to have constant low-back pain and fever on postpartum Day 2. Magnetic resonance image revealed a broad area of subcutaneous edema with a continuum along the catheter trajectory deep to the paraspinal muscles. A catheter-related bacterial infection was suspected. The surgical debridement and drainage was required combined with intravenous antibiotics on postpartum Day 3. She was soon cured uncomplicatedly. Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. A literature search yielded 7 other cases of catheter-related epidural abscess or soft tissue infection. Vigilance for these infections, especially in postpartum patients with backache, is needed. Moreover, early detection and proper treatment of infectious signs at postanesthetic visit are very important.

Rationale Hemivertebrae, which are the most frequent cause of congenital scoliosis, pose a challenge in terms of prognosis and therapy. The current gold standard treatment congenital scoliosis due to a lumbar and thoracic hemivertebra would be hemivertebra resection and short level posterior spinal fusion. Paucity literatures are reported for the treatment of hemivertebra by convex fusion with posterior hemivertebra excision. Patient concerns The patient was first noticed to have a spinal problem at 7 years of age. A radiograph showed two full segment hemivertebra respectively at T10, between L4 and L5, with the spine deviating to the right side. No treatment was given, but he was followed with serial radiographs. At the 15 month follow up, a surgery was performed due to scoliosis progression, consisting of a unilateral instrumentation from L4 to L5 without hemivertebrectomy or epiphysiodesis. One year after surgery, the thoracic curve became larger and larger and hump started to progress as he grew. Diagnoses Congenital scoliosis; Full segment hemivertebra at T10 and L4/5. Interventions The full segment hemivertebra between L4 and L5 was excised and fusion in revision procedure. Transpedicular screws were inserted on the convex side in L4 and S1 and a rod was applied. A chart and radiological review were record at 8 years after final surgery. Outcomes Eight years after the final surgery, the patient was completely pain-free, motion of the lumbar spine was preserved and the physiological curvatures were maintained. Good coronal and sagittal alignment of the spine was observed clinically and radiographically. Lessons In summary, our case showed that unilateral instrumentation without hemivertebrectomy can result in an unacceptable deformity. However, the excellent outcome can be achieved when hemivertebra was excised. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile for very young children with lumbosacral hemivertebra. Early recognition and resection combined with limited fusion were needed for these patients.

Study design Retrospective review. Objective To investigate the clinical manifestations and radiological characteristics of Klippel-Feil syndrome (KFS) in congenital scoliosis (CS). To identify the incidence of spinal or extraspinal abnormities in KFS. Summary of background data KFS is an uncommon condition, characterized as improper segmentation of one or more cervical spine segments. "Scoliosis" is potentially the most common manifestation associated with KFS. However, the clinical manifestations and radiological characteristics of KFS in patients with CS are less reported. Methods A total of 516 patients with CS from January 2009 to March 2013 were identified from a single institution. The demographic distribution and clinical and radiographical data were collected. Cervical regions were also designated as high (O-C2), mid (C2-C4), and low (C4-T1). The incidence of intra- and extraspinal abnormalities associated with KFS was investigated. Results In total, 28 patients (5.42%) had been identified with KFS, which included 8 males and 20 females. The mean coronal cervical alignment was 20.6° and sagittal alignment was 29.9°. KFS type I was found in 14 patients (50.0%), type II in 6 (21.4%), and type III in 8 (28.6%). Congenitally fused cervical segment is more common in the mid and lower cervical spine region (85.7%, 24/28). In the 28 patients with KFS, 11 have intraspinal anomalies (32.1%) and 6 have extraskeletal anomalies (21.4%). Thirteen patients (46.4%) exhibited rib anomalies. The incidence of rib anomalies showed no significant difference in CS patients with KFS and without KFS (P>0.05). A half of the patients with KFS have hemivertebrae; however, the incidence of hemivertebrae showed no significant difference in CS patients with KFS and without KFS (P>0.05). Conclusion The incidence of KFS was 5.42% in patients with CS. Congenitally fused cervical patterns are more common in the mid and lower cervical spine region. The incidence of rib anomalies, intraspinal abnormities, and hemivertebra was not increased in CS patients with KFS. Level of evidence 4.

Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.

Study design Retrospective review. Objective To identify the incidence and characteristics of rib anomalies in patients with congenital scoliosis (CS) in a Chinese population. Summary of background data Rib deformities and intraspinal anomalies often coexist in individuals with CS. Rib deformities may assist in diagnosing occult anomalies in these patients. The incidence of rib anomalies and the relationship between rib and vertebral abnormalities in Chinese patients with CS have not been reported. Methods A total of 382 patients operated on at Peking Union Medical College Hospital during January 2010 to October 2012 were identified from a single institutional database. The demographic distribution, clinical and radiographical data were collected to investigate the incidence of rib anomalies, and the vertebral and intraspinal abnormalities associated with it. Results A total of 192 patients (50.3%) were documented with rib anomalies including numerical variation (46.4%) and structural changes (72.4%). Missing ribs was the most commonly seen anomaly in these patients, accounting for 43.8% of the rib anomalies. Of the patients with rib anomalies, a slightly higher proportion of patients had simple anomalies, 106 (55.2%) versus 86 (44.8%). Rib changes were most common in patients with thoracic or thoracolumbar vertebral anomalies, and occurred most frequently on the concave side (65.5%) or in the lower thoracic spine (36.5%). The overall incidence rate of intraspinal anomalies was 40.1% (153/382), and these were most commonly seen in patients with thoracic vertebral anomalies or with upper and middle thoracic rib anomalies. Conclusion The incidence of rib anomalies was 50.3% in surgical patients with CS. The rib anomalies vary with the location and type of vertebral anomalies. The incidence of intraspinal anomalies was significantly higher in patients with rib anomalies than in those without rib anomalies. Level of evidence 4.

To determine the safety and efficacy of intraoperative cell salvage system in decreasing the need for allogeneic transfusions in a cohort of scoliosis patients undergoing primary posterior spinal fusion with segmental spinal instrumentation.A total of 110 consecutive scoliosis patients undergoing posterior instrumented spinal fusion were randomized into two groups according to whether a cell saver machine for intraoperative blood salvage was used or not. Data included age, body mass index, perioperative hemoglobin levels, surgical time, levels fused, perioperative estimated blood loss, perioperative transfusions and incidence of transfusion-related complications. A Chi-square test and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates to investigate the predictive factors of perioperative transfusion.Perioperative allogenic blood transfusion rate was lower in the cell saver group (14.5 versus 32.7%, p = 0.025). Mean intraoperative red blood cell transfusion requirement was also lower (0.21 U/pt versus 0.58 U/pt, p = 0.032). A multivariate analysis demonstrated that no. of fused segments (OR: 1.472; p = 0.005), preoperative hemoglobin level (OR: 0.901; p = 0.001), and the use of cell saver system (OR: 0.133; p = 0.003) had a trend toward significance in predicting likelihood of transfusion.Cell saver use significantly reduces the need for allogeneic blood in spine deformity surgery, particularly in patients with low preoperative hemoglobin or longer operation time. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for scoliosis patients.

Study design Retrospective study of a series of 226 consecutive Chinese patients with congenital scoliosis. Objective To identify the incidence of intraspinal abnormalities and other organ defects in surgical patients with congenital scoliosis in Chinese population. Summary of background data Previous studies have revealed high rates of intraspinal anomalies and other organ defects in patients with congenital scoliosis. The incidence of abnormalities in patients with congenital scoliosis in Chinese population has not been reported. Methods A total of 226 patients with congenital scoliosis underwent surgical treatment in Peking Union Medical College Hospital between January 2005 and March 2011 were identified. A definitive diagnosis of congenital scoliosis for all patients was made. Complete data were reviewed, including medical records, plain radiograph, magnetic resonance (MR) image of the whole spine, echocardiography, and renal ultrasound. The incidence of intraspinal abnormalities and other organ defects were analyzed. Results Intraspinal abnormalities were found in 99 (43%) patients. Diastematomyelia was identified to be the most common intraspinal pathological anomaly, which was different from the previous reports. The incidence of intraspinal anomaly in patients with failures of segmentation and mixed defects were significantly higher than those with failures of formation. Patients with thoracic hemivertebrae were found to have a higher incidence of intraspinal abnormalities than patients with lumbar hemivertebrae. Patients with intraspinal abnormality had a higher incidence of positive clinical findings than those with normal magnetic resonance imaging. However, the difference between the 2 groups was not statistically significant. Other organic defects were found in 91(40%) patients. Cardiac defects were detected in 18%, urogenital anomalies in 12%, and gastrointestinal anomalies in 5% of the patients in this study. Conclusion Diastematomyelia was found to be the most common intraspinal pathological anomaly and cardiac defects were the most common extraspinal anomaly in surgical patients with congenital scoliosis in this study. Magnetic resonance imaging, echocardiography, and ultrasound should be part of routine evaluation in all congenital cases before surgery, no matter positive clinical findings were found or not. Level of evidence 3.

The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively. We performed a systematic literature search up to November 2014, using Medline, Embase, and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and Cochrane Back Review Group editorial board. We used the Newcastle-Ottawa quality assessment scale (NOS-scale) to assess the quality. Five observational studies were considered eligible for analysis based on the evaluation of 1596 identified papers. The mean overall difference in the Scoliosis Research Society questionnaire 22 between the surgical and nonsurgical groups was not statistically significant (95% CI: -0.17 to 0.21, P = 0.84). The pooled mean difference in progression of slip between the surgical and nonsurgical groups was no significant difference (OR: 0.47, 95% CI: 0.12-1.81, P = 0.27, I = 0%). Because of the preponderance of uncontrolled case series, low-quality evidence indicates that the quality of life and progression of slips was no significant difference between surgery and nonoperation group. Nonoperative patients had no radiologic progression of their slip during the follow-up period.

Background Articular cartilage injury remains a major challenge in orthopedic surgery. This study aimed to identify differences in gene expression and molecular responses between neonatal and adult articular cartilage during the healing of an injury. Methods An established in vitro model was used to compare the transcriptional response to cartilage injury in neonatal and adult sheep by microarray analysis of gene expression. Total RNA was isolated from tissue samples, linearly amplified, and 15,208 ovine probes were applied to cDNA microarray. Validation for selected genes was obtained by real-time quantitative polymerase chain reaction (RT-qPCR). Results We found 1,075 (11.6%) differentially expressed probe sets in adult injured cartilage relative to normal cartilage. A total of 1,016 (11.0%) probe sets were differentially expressed in neonatal injured cartilage relative to normal cartilage. A total of 1,492 (16.1%) probe sets were differentially expressed in adult normal cartilage relative to neonatal normal cartilage. A total of 1,411 (15.3%) probe sets were differentially expressed in adult injured cartilage relative to neonatal injured cartilage. Significant functional clusters included genes associated with wound healing, articular protection, inflammation, and energy metabolism. Selected genes (PPARG, LDH, TOM, HIF1A, SMAD7, and NF-κB) were also found and validated by RT-qPCR. Conclusions There are significant differences in gene expression between neonatal and adult ovine articular cartilage following acute injury. They are partly due to intrinsic differences in the process of development, and partly to different biological responses to mechanical trauma between neonatal and adult articular cartilage.