Introduction: Physiological aging frequently leads to degenerative changes and spinal deformity. In patients with hypolordotic fusions or ankylosing illnesses such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis, compensation mechanisms can be altered causing severe pain and disability. In addition, if a total hip replacement and/or knee replacement is performed, both pelvic and lower limbs compensation mechanisms could be damaged and prosthetic dislocation or impingement syndrome could be present. Pedicle subtraction osteotomy has proven to be the optimal correction technique for spinal deformation in patients suffering from a rigid spine. Case Presentation: A 70-year-old male patient with diffuse idiopathic skeletal hyperostosis criteria and a rigid lumbar kyphosis, who previously underwent a total hip and knee replacement, had severe disability. We then performed corrective surgery by doing a pedicle subtraction osteotomy. The procedure and outcomes are presented here. Conclusion: In symptomatic patients with sagittal imbalance and a rigid spine, pedicle subtraction osteotomy can indeed correct spinal deformity and re-establish sagittal balance.

Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

Introduction: Although frequently observed in magnetic resonance images, symptomatic thoracic disc herniations are rare. Surgical treatment is indicated when patients suffer from functional symptoms with no response to medical treatment, when neurologic symptoms appear or worsen or in the event of myelopathy. Posterolateral approaches are commonly accepted as the treatment for lateral and mediolateral disc herniations and non-calcified medial herniations. On the other hand, anterior approaches have been accepted to treat gigantic calcified medial disc herniations. Case presentation: This case report presents on a 57-year-old female patient suffering from thoracolumbar pain and impairment. The magnetic resonance study showed images compatible with a posteromedial T12-L1 disc herniation that, after medical treatment failure, required surgical treatment. Initially, a posterior approach was performed, resulting in the immediate postoperative period in motor and sensitive deficit of the lower left limb, so a surgical reintervention was performed using an anterior approach, obtaining good clinical and functional results. Conclusion: Thoracic disc herniations are uncommon. Surgical indication is decided in the presence of neurologic symptoms. Neurologic injury is a common complication due to the lesion’s characteristics and it can also be secondary to the surgical procedure. An adequate election of the surgical approach may minimize neurologic injuries.