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Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
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Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
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Scheuermann’s Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown.
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It has a prevalence of 0.4–8.3% in the population with a higher incidence in females.
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Clinical examination with x-rays is needed to differentiate and confirm this diagnosis.
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Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities.
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Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation.
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This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.
Department of Orthopedic Surgery, Spine Unit, Centre Hospitalier de l’Université de Montréal (CHUM), Canada.
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Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial.
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Management of vertebral fracture with percutaneous fixation was first reported in 2004.
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Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate.
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The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique.
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Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct.
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Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation.
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Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability.
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This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages.
Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026.
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Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.
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Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.
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Percutaneous fixation by ‘vertebroplasty’ is a tempting alternative for open surgical management of these fractures.
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Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.
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Early intervention is also gaining ground recently.
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Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.
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Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.
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In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed.
Cite this article: EFORT Open Rev 2017;2:293–299. DOI: 10.1302/2058-5241.2.160057
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Congenital scoliosis (CS) is a spinal deformity resulting from underlying spinal malformations with an incidence of 0.5–1/1000 births.
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CS makes up 10% of scoliotic deformities, of which 25% do not progress, 25% progress mildly and 50% need treatment depending on the age, curve characteristics and magnitude and type of anomaly.
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CS is associated with non-vertebral anomalies (genitourinary, musculoskeletal, cardiac, ribs anomalies, etc.) and intraspinal anomalies (syrinx and tethered cord).
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Imaging should include whole spine X-rays, CT scanner with reconstruction to better delineate the vertebral anomalies and MRI to visualize the neural elements.
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Treatment of CS in the majority of cases is non-surgical and relies on fusion techniques (in situ fusion and hemiepiphysiodeis), resection techniques (hemiverterba resection), and growth-friendly techniques (distraction and instrumentation without fusion).
