Background The kyphotic deformity is more than just a cosmetic disfigurement. It is potentially life-threatening and disturbs the quality of life by causing cardiopulmonary dysfunction, spinal imbalance, and other associated problems. Corrective surgery is challenging but it is needed to bring the spinal balance back thus halting the progressiveness of the deformity. The cantilever technique is a gold standard to correct the sagittal plane deformity. Methods This is a review article with some case illustrations from Author's experience. Objective We aim to review the cantilever technique for kyphotic correction in spondylitis tuberculosis patients. Conclusion The cantilever technique is the standard for sagittal plane deformity correction that can be applied for kyphotic deformity correction in spondylitis tuberculosis cases. Developing the safest techniques and instrumentation is crucial to achieving spinal balance with minimal risk of morbidities.

Background To compare two methods of preoperative traction (Cotrel traction exercises and skull tongs femoral traction) in severe scoliosis treatment. Methods We collected retrospective data of severe (>80°) and rigid scoliosis patients who underwent preoperative traction before correction surgery from 2016 to 2018. The first group consisted of patients who underwent Cotrel traction exercises and second group underwent continuous-progressively increasing Skull Tongs Femoral Traction (STFT) traction. Posterior fusion was performed in all patients. Intraoperative parameters (blood loss, operation time and level instrumented) and radiologic change (initial, post-traction and postoperative Cobb Angle) was evaluated and analyzed. Results Thirty consecutive case of severe and rigid scoliosis were included (15 in each group). Despite Cotrel group having larger initial Cobb angle, the amount of post traction correction was statistically similar in both groups (16.4 ° and 11.8 ° , in STFT and Cotrel group respectively). Mean traction duration was 14.0 days for Cotrel group and 12 days for STFT. There were also no significant differences in postoperative curve correction rate between two groups, although STFT group had a slightly higher correction rate (69.3 ° vs 55.0 ° ). No major/neurologic complication were found in our series. Conclusions Both preoperative traction methods were found safe and beneficial to reduce preoperative curve degree before definitive scoliosis correction surgery. Although, no statistical difference were found between two methods, STFT may provide better correction rate. Level of evidence 3.

Background Vertebral osteomyelitis is rare. Finding the right etiological agent is important to administer antibiotic regimen accordingly. The occurrence of this disease in endemic countries raises the susceptibility of a more common infection such as tuberculosis and pyogenic bacteria. Salmonella spp . infection is also common in endemic countries; however, extra-intestinal manifestation is very rare. Methods We present an extremely rare case of salmonella vertebral osteomyelitis (SVO) in the upper thoracic vertebrae of a 64-year-old patient with history of cardiac surgery and other pre-existing comorbidities. SVO was treated by antibiotics, surgical debridement and spinal stabilization. Results Three weeks after surgery and intravenous antibiotics, the patient recovered and was discharged without fever and back pain, with excellent motoric improvement. Conclusion Salmonella infection must be considered to be one of possible etiological agents in patients with suggestive spondylitis in emerging countries, especially in those with comorbidities.

Introduction: Free-hand technique is one of the techniques used by spine surgeon during pedicle screw instrumentation of surgical correction of spinal deformities, including scoliosis. The previous studies showed that this technique is safe. However, some inherent factors may influence its outcomes, including screw breaching which is potentially violates spinal cord and other intimate structures. To con?rm the safety and accuracy of this technique, additional study measuring the breach rate of pedicle screw placement in scoliosis is mandatory. Materials and Methods: We performed a retrospective study of patients with adolescent idiopathic scoliosis (AIS) from Fatmawati General Hospital, Jakarta, treated for surgical correction during a period of 2017–2018 using free-hand technique for pedicle screw instrumentation. Post-operative computed tomography scan (CT scan) was analyzed to measure the medial and lateral breaches. P < 0.05 was deemed to be statistically significant. Results: A total of 94 pedicle screws from six female patients with AIS were included in our study. Overall breach occurred in 33% instrumented screws, the majority of it was a low-grade breach. Of the breached screws, medial and lateral breach occurred in 20% and 12% of screws, respectively. There were no differences in the overall, medial, and lateral breaches between thoracic and lumbar vertebrae (P > 0.05). Medial breach was significantly higher in middle thoracic segment compared to other thoracic segments (P = 0.048). Risk of medial breach was 3 times higher in the convex side of deformity (P = 0.012), whereas risk of lateral breach was 4.6 times higher in the concave side of the deformity (P = 0.021). Conclusion: The majority of breached screws were low-grade violation within the safe zone, with no neurological sequelae. Our study found that free-hand technique is safe and effective method of pedicle screw instrumentation for correction of AIS. Some inherent factors may influence the risk of