Introduction The incidence of junctional kyphosis (JK) varies in the literature from 7% to 40%. We here present our experience with JK. The aim of this work is investigate the incidence of JK after long spinal segment fusion, to identify the underlying factors leading to its development, and to discuss treatment outcome. Patients and Methods This combined retrospective/prospective cohort study included sixty-four consecutive patients (40 women and 24 men) with a mean age of 20.7 years, who underwent long segment spinal fusion (≥ 5 vertebrae) for treatment of spinal deformity. The average length of follow-up was 2 years. Risk factors analyzed included patients’ factors, surgical factors, and radiographical parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, and pelvic incidence. Results Radiological JK occurred in 14 patients (22%). Ten cases were proximal junctional kyphosis (PJK), two cases were intercalary junctional kyphosis (IJK), and two cases were distal Junctional Kyphosis (DJK). Only seven patients (50%) out of the 14 with JK were symptomatic. Six cases have undergone revision surgery. In nine cases, the original deformity was kyphosis (1 Ankylosing spondylitisS, 1 post-tuberculous, 3 Sheuermann's kyphosis, 4 congenital kyphosis). The other 5 cases were scoliosis (3 idiopathic and 2 congenital). Preoperative TK more than 40 ° was associated with PJK. In all cases PI, PT, SS, SVA were within normal range, but it was noticed that SVA had negative values in 5 cases. LIV in the dorsolumbar junction was associated with DJK. Conclusion Pre-existing TK more than 40°was identified as an independent risk factor. Negative sagittal balance may be a risk factor for PJK. A surgical strategy to minimize Junctional kyphosis may include careful preoperative planning for reconstructions with a goal of optimal postoperative alignment.

Pott's disease is a known disorder that affects the spine causing various degree of disability for the patients that ranges from mild to severe kyphosis with or without neurological deficits. In most cases single level is affected and in fewer numbers two levels are affected. Rarely more than two levels are affected. In this case we present a case of Pott's disease affecting five adjacent segments with vertebral sequestration. This is 43 years old female patient presented to Assuit university hospital with history of repeated attacks of back pain and mild fever since 4 years the patient received empirical antibiotic after which she said that she partially improved and after then the patient became accustomed to repeat the antibiotic with no medical consultation. Later on the pain became sever but no neurological manifestations then she had X-ray and MRI with diagnosis of long segment vertebral osteomyelitis affecting T7-T12. Posterior costotransversectomy approach was done and the sequestrated vertebral bodies and intervening discs were excised and sent for culture sensitivity and biopsy and mesh cage was applied to bridge the defect and pedicle screws are inserted from T5 to L2, and later on antituberculous regimen was started after the diagnosis was established. Postoperatively the neurological status was intact and the pain improved; 6 month follow up showed good bone healing. Stable cage and pedicle screws and much improvement in the general status of the patient.

Introduction Early onset spinal deformities (EOSD) are spinal deformities before five years. Early surgical intervention is often necessary to avoid the eventually disastrous complications due to deformity progression like restrictive pulmonary functions. Posterior vertebral column resection (PVCR) achieves the best correction in severe and complex deformities. We present our experience in PVCR in five cases with EOSD. Patients and Methods PVCR was done in five cases (2 males and 3 females) with congenital hemivertebra with a mean age of 4.3 years. Two cases were only kyphotic while the other three cases had additional scoliosis. One case presented with progressive lower limb spasticity. All cases were managed by one level PVCR. Shilla growth guiding technique was done in two cases to allow future growth. One patient had short segment fusion, and two had long segment fusion. The patients were followed up for a mean of 21 (12–36) months. Results The patient with paraplegia improved completely over the three postoperative months. The local kyphosis improved by 92% (59° to 4.5°). The mean thoracic kyphosis improved by35% (38.25° to 24.5°). The mean sagittal vertical axis decreased by 71% and 19% (38.37 to 11 to 30.8 mm) postoperatively and at last follow up respectively. Lumbar lordosis reduced by 22% (47.5° to 37°). The associated scoliosis completely corrected from 29° to 0°. The mean operation time was 482.5 minute, with 3075 ml blood loss. One patient with myelocele had pseudarthrosis and metal failure necessitated revision. The patient with short segment fixation developed an asymptomatic, non-progressive proximal junctional kyphosis immediately postoperatively. No revision or extension of fusion was needed. Conclusion PVCR appears to be an effective technique to treat severe EOSD with limitation of fused segments to allow further growth.