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Introduction Erosive intervertebral osteochondritis is the destructive form of intervertebral osteochondrosis with inflammatory degeneration of the intervertebral disk. In Modic type I classification, there is an inflammation in vertebral plates and bone marrow, with MRI hypersignal in T2, STIR and T1 with Gadolinium sequences, and hyposignal in T1-weighted MRI; there is no change in the intensity of disk signal. The main difference of erosive intervertebral osteochondritis with Modic I changes is that there is a hypersignal in the disk itself in T2, STIR, and T1 with Gadolinium sequences, in addition to the characteristic changes of Modic I. The erosive intervertebral osteochondritis is rarely mentioned in the spine literature, and sometimes it is controversial because of its similarity with MRI imagenology of infectious disease. But there are clinical characteristics, imagenology, and blood test that help to analyze and make differential diagnosis with infectious diskitis. Modic has only one mention to the hyperintensity of disk with Gadolinium, probably due to fibrovascular granulation. Our aim is to analyze the clinical and radiological presentation of patients with lumbar and cervical erosive intervertebral osteochondritis, and to describe their treatment and outcomes. Materials and Methods A retrospective analysis of patients with lumbar and cervical erosive intervertebral osteochondritis. There were 28 patients, 14 female and 14 male. Average age was 44 years (range: 29 to 57). Mean follow-up was 27 months (range: 12 months to 8 years). A total of 23 cases affected lumbar spine and 5 cases affected cervical spine. The study consisted in static and dynamic X-ray of lumbar and cervical spine, CT scan, MRI enhanced with Gadolinium, diskitis serologic tests (sedimentation rate, white cell counting, CRP, procalcitonin), and psychological evaluation. No needle biopsy was performed in lumbar cases. In two cervical cases treated with fusion, the disk was send to biopsy and culture. All patients had only axial pain, with lumbar and cervical muscle contracture, rigidity, and limited mobility. No one had neurologic symptoms. The most characteristic clinical finding was severe pain in the back during sneeze and percussion. Treatment was conservative in 13 of the 23 lumbar cases. Surgical treatment was performed in 10 lumbar cases (8 female, 2 male): 4 open posterolateral pedicle screw fusion with autologous bone graft, 3 MISS posterolateral pedicle screw fusion witht bone substitute, and 3 percutaneous pedicle screws fixation and fusion with bone substitutes (Mozaic). The conservative treatment was based on restriction of activity and NSAID. Physiotherapy was needed for several weeks, especially in female patients. There was 10/14 (71.4%) female patients with associated fibromyalgia that were treated with psychotherapy and anxiolytic and antidepressant medication when needed. In cervical cases, three were treated conservatively and in two cases (both female) anterior cervical diskectomy and fusion with cage and pla...

Introduction Proximal junctional kyphosis (PJK) is a relatively frequent complication of spinal deformity surgery which can result in significant symptoms and potential neurological compromise. Reconstruction of PJK in the cervico-thoracic junction usually entails proximal extension of fixation to the cervical spine, with a compromise of function in this young population. Material and Methods We designed a retrospective review of clinical and radiological features in a consecutive series of patients treated for PJK of the upper thoracic spine. Objective: discuss the use of an anterior plus posterior reconstructive technique which aims to avoid proximal extension into the cervical spine for the management of PJK in the pediatric deformity population. Patients: Three patients with spinal deformity (neuromuscular scoliosis 2, Scheuermanns kyphosis 1) developing progressive PJK were operated with an anterior and posterior reconstruction. Clinical and radiographic follow-up is analyses with a minimum of 9 months.  Results All patients were successfully managed with adequate control of the progressive deformity and proximal extension into the cervical spine was significantly limited with this anterior and posterior approach.  Conclusions For this selected group of patients with upper thoracic PJK, an interior and posterior surgical reconstruction was successful in managing the condition with limited extension into the cervical spine, thus avoiding greater future functional compromise.

Introduction Several different growing rod techniques have been described in the literature to treat progressive scoliosis in young children. The purpose of this retrospective clinical study is to evaluate the effect of dual growing rod and posterior apical convex fusion in early onset scoliosis (EOS). Material and Methods This study retrospectively reviewed the clinical records and radiographs of the 11 children with progressive EOS who failed to respond to conservative treatment and underwent fusionless surgery using dual growing rod and posterior apical convex fusion. Results Fusionless dual growing rod and posterior apical convex fusion allowed maintaining scoliosis correction in all the patients. At an average of 3.1 ± 0.8 years after initial surgery, 11 patients showed a correction of 39. 9% in the magnitude of the original curvature (the average preoperative Cobb angle was 56 [range, 40.96–89.5] and postoperative was 34.27 [range, 24.69–58]). Trunk height increase was documented in all patients. Rod failure was found in three patients. Conclusion Preliminary results from these series of patients show that the presented fusionless dual growing rod and posterior apical convex fusion allows maintaining correction of progressive EOS while permitting spinal growth with a low-complication rate. This procedure is efficacious as long as some guidelines are respected.