Independent of the surgical technique used, the cervical spine had a tendency to decompensate and acquire a kyphotic sagittal profile. Constructs based on all pedicle screws have a stronger hypokyphotic effect on the thoracic spine, with a predisposition to greater decompensation of the cervical spine. Kyphotic changes in the C2-C7 sagittal alignment induced by scoliosis correction are correlated with the level of the upper-instrumented vertebra.

Objective: To determine the postoperative changes produced in coronal balance of patients with adolescent idiopathic scoliosis (AIS) and Lenke type 5 curves, carrying out a pre-and postoperative analysis of the following radiological parameters: last arthrodesed vertebral level, L4 tilt, translation of the apical vertebra, lumbosacral obliquity, Cobb angle, and previous coronal balance. Methods: 20 patients with a diagnosis of AIS with Lenke type 5 curves, in mean follow-up of 36 months (Range: 24 to 48), were evaluated. The mean age at surgery was 15.3 years (Range: 13 to 20 years), and the distribution by sex was 16 women and 4 en. Results: In our series, we found a direct correlation between AVTL and LSTOA, and postoperative coronal balance, both in the group of patients that improved (14 patients) and in those with worsening of coronal balance (six patients). Conclusion: in the case series evaluated, AVTL and LSTOA were the specific radiographic parameters.Keywords: Spinal curvatures; Scoliosis; Postural balance; Spinal fusion. RESUMO Objetivo: Determinar as modificações pós-operatórias produzidas no equilíbrio coronal dos pacientes com escoliose idiopática do adolescente (EIA) e curvas de Lenke tipo 5, realizando uma análise pre e pós-operatória dos seguintes parâmetros radiológicos RESUMENObjetivo: Determinar las modificaciones postoperatorias que se producen en el balance coronal de los pacientes con escoliosis idiopática del adolescente (EIA) con curvas de Lenke tipo 5, realizando un análisis pre y postoperatorio de los siguientes parámetros radiológicos: último nivel vertebral artrodesado, inclinación de L4, traslación de vértebra apical, obliquidade lumbosacra, ángulo de Cobb y balance coronal previo. Métodos: Se evaluaron 20 pacientes con diagnóstico de EIA con curvas de Lenke tipo 5, con un seguimiento promedio de 36 meses (R: 24 a 48). La edad promedio al momento de la cirugía fue de 15,3 años (R: 13 a 20 años), siendo la distribución por sexo de 16 mujeres y 4 hombres. Resultados: En nuestra serie hemos detectado una correlación directa entre el AVTL y el LSTOA con el balance coronal postoperatorio, tanto en el grupo de los pacientes que mejoraron (14 pacientes), como en aquellos en los que el balance coronal empeoró (6 pacientes). Conclusión: De la serie evaluada, fueron el AVTL y el LSTOA, los parámetros radiográficos específicos.Descriptores: Curvaturas de la columna vertebral; Escoliosis; Postural balance; Fusión vertebral.

Background Management of orthopedic prostheses infections (PI) in children is a main challenge, not only for the complexity of the disease but also for the scarce of evidence in this field.ObjectivesTo describe the burden of PI and to analyze clinical and epidemiological aspects in pediatric patients.Methods Retrospective study in a tertiary pediatric hospital. Clinical charts of patients <18 years who underwent surgery for bone and/or joint implantation at “R. Gutierrez” Children’s Hospital in Buenos Aires from January 2007 to December 2016 were reviewed, and all PI cases were analyzed. PI was defined as early (E) when presentation was within 3 months of prothesis implantation, delayed (D) when presenting between 3–24 months and late (L) if presenting beyond 2 years.Results811 surgeries performed; 89 PI detected: E(n = 63); D(n = 9), L(n = 17); 58% male; median(m) age: 13 years (range[r] 4–20); m hospital stay 30 days (r 6–180). Annual incidence: 11% (CI95%: 8.9–13.1) (Figure 1). Underlying conditions: scoliosis (58.4%), malignancy (16.8%). Clinical features are detailed in Figure 2. Bacterial isolation in 63 (70.8%) cases, 51(57.3%) with a single microorganism (Figure 3). Gram(+) bacteria were isolated in 58% of E PI, 86% of D PI and 49% of L PI. Gram(−) pathogens in 49% of E PI and in 38% of L PI. Three febrile PI (3,4%) had Gram(+) bacteremia, two of them L PI. No differences were seen in white blood cell count (WBC) and C-reactive protein(CRP) levels on admission in children with and without bacteremia, nor among the different types of PI; m WBC 9000/mm3 (r 3200–25550), m CRP 37 mg/l (r 1–270). WBC on admission in MRSA PI was significantly higher, P < 0,01. Duration of EV treatment was different according to type of microorganism (P 0.03), higher in PI by Gram(−). Forty-eight (53.9%) cases continued with trimethoprim-sulfamoxazole orally, without side effects requiring its discontinuation. Total treatment duration (m): 189 days (r 28–756). Eighty-two children (92.1%) underwent surgical toilette, 37 (45.1%) required more than one. Six (6.7%) presented relapse and eight (9%) reinfection.Conclusion· PI in children is a considerable burden, with high morbidity. · Incidence of bacteremia was low. · Results of the study could help to delineate preventive strategies and improve decision making in PI in children.Disclosures All authors No reported disclosures.

RESUMENObjetivo: Determinar el comportamiento del segmento lumbar, no artrodesado, en el plano coronal luego de fusiones torácicas selectivas en pacientes con escoliosis idiopática del adolescente con curvas Lenke 1. Métodos: Se evaluaron 21 pacientes con un seguimiento promedio de 29,71 meses (rango: 24-60 meses) mediante análisis clínico y radiográfico retrospectivos de pacientes que presentaron escoliosis idiopáticas del adolescente, con curvas Lenke tipo 1 (ABC). Resultados: En todos los pacientes, en los que se produjo un desequilibrio en el plano coronal, se constató la progresión del valor angular de la curva lumbar no artrodesada al final del seguimiento. Conclusión: La curva lumbar no artrodesada progresó al final del seguimiento, en todos los pacientes con desequilibrio confirmado en el plano coronal (3/21). iNTROdUCCióNEn la actualidad, el manejo de las escoliosis idiopáticas torácicas asociadas a una curva lumbar no estructurada genera controversias para determinar el nivel distal de la fusión 1 . El objetivo del cirujano espinal es ahorrar niveles de artrodesis, mantener el balance de la columna con movilidad y disminuir la incidencia de la degeneración discal en la vida adulta 2,3 . El consenso general indica que se acepta la fusión selectiva torácica en deformidades con curvas lumbares flexibles (tipo Lenke 1 con modificadores A y B), pero aún hay controversias en las de tipo C 4 . El número de estudios con un seguimiento prolongado es limitado. Aunque la fusión selectiva tiene la ventaja de preservar la movilidad de los segmentos lumbares, en algunos casos, podría producirse la descompensación posoperatoria en el plano coronal 1,2,5 . Teniendo en cuenta esto, el desafío es pronosticar si el comportamiento del segmento lumbar no fusionado será agresivo o no evolutivo. Para tal fin, se determinarán una serie de elementos que ayudarán a descifrar dicho comportamiento. MATERiAl y MéTOdOSEstudio retrospectivo clínico y radiográfico de tipo serie de casos. Se evaluaron 21 pacientes, con un seguimiento promedio de 29.71 meses (rango: de 24 a 60 meses) mediante el análisis clínico y radiográfico retrospectivo de pacientes con escoliosis idiopática Coluna/Columna. 2012; 11(2): 145-7

Introduction The selection of fusion levels in thoracic kyphosis been controversial, the incidence of juvenile kyphosis ranges from 1 to 8% being more common in males. Patients and Methods This study is a retrospective study case series type, level of evidence IV. We evaluated 15 patients with Scheuermann disease treated with posterior transpedicular fixation and osteotomies. Overall, two cases were excluded for not meeting the minimum monitoring time 2 years. The average age at time of surgery was 16.2 years. Patients were evaluated clinically and radiologically pre- and postsurgery to assess results and determine common factors of complications. Results In the series studied found that the percentage correction achieved was 49%, with a loss of correction 3 degrees at follow-up, the incidence of PJK was 23%, two of three patients presented the following factors in common: apex above T5, cervical hyperlordosis, SVA more than 4 cm, increased pelvic incidence, stiffness deformity, proximal fixation with hooks above T3, in the third case ended with pedicle screws. Conclusion Transpedicular fixation system and posterior spinal osteotomy is effective for the treatment of kyphosis by Scheuermann disease; the power of this type of correction techniques may arise in the pediatric population increased incidence of proximal junction kyphosis in patients with highest apex, curve stiffer, cervical hyperlordosis, and lower percentage of correction.