Background The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University. Objective The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws. Methods The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution. Results There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout. Conclusion The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.

Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the range of motion of the atlantoaxial joint after odontoid fracture healing is complete. Purpose: To assess the clinical and radiological outcome of the posterior C1-C2 temporary fixation technique in the treatment of a new odontoid fracture. Study Design: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. Patients and Methods: Twelve consecutive patients, suffering from type-II odontoid fracture, were retrospectively recruited for this study. The age ranged between 15 and 43 years with a mean age being 24±11.6 years. Eight patients were males and four were females. All cases suffered from acute posttraumatic type-II dens fracture. Eight patients suffered from reducible subluxation and four cases were in place. Only two patients were suffering from partial neurologic deficit preoperatively (grade 4). All patients were submitted to Harms' atlantoaxial fixation procedure. Surgical removal of the implants was done after a mean of 15.5 (range, 12-20 weeks) weeks from the first surgery. All patients had MSCT scan to assess healing and then dynamic MSCT scan after removal to assess C1-C2 ROM. Results: All of our twelve patients completed the two procedures without significant events. Two patients with preoperative neurological illness had improved gradually with physiotherapy. All patients had complete healing of their factures. Postoperative dynamic CT scan showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°. Significantly better functional outcomes were observed after the temporary fixation removal using Visual Analog Scale (VAS) score for neck pain (P=0.0033), neck stiffness, and the patient satisfaction. Conclusion: Posterior atlantoaxial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved. (2019ESJ187)

The article does not contain information about medical device(s)/drug(s). No funds were received in support of this work. The authors report no conflict of interest.

Background Vertebral column resection (VCR) is a well-known technique used for correction of complex spinal deformities. VCR could be done through a posterior only approach (Pvcr), or a combined anteroposterior approach, with almost comparable results. Early studies of Pvcr have reported high rates of complications, while subsequent studies have reported a reasonable complication rate. In this study, the authors represent and evaluate the initial results of using the Pvcr technique to correct complex pediatric deformities. Objective To evaluate the safety and efficacy of performing Pvcr to correct complex pediatric deformities. Methods Retrospective cohort study of data was collected from the database of pediatric deformity patients who were operated for correction of their deformities using posterior instrumentation and Pvcr at a single institution from 2015 to 2019. Results Twenty-one pediatric patients with a mean age 15.2 ± 3.5 years were enrolled in this study. The mean follow-up period was 26.3 ± 3.1 months. The mean Cobb angle has been decreased significantly from 82.9 ± 23.9 degrees to 28.8 ± 14.2 immediately after correction (correction rate 66.9 ± 10.8%, p < 0.001) with slight increase to 30.2 ± 14.9 after 24 months of follow-up (correction loss 4.3 ± 3.1%). The mean kyphotic angle has decreased significantly from 74.1 ± 15.9 to 25.4 ± 4.5 immediately after correction (correction rate 65.4 ± 2.9%, p < 0.001) with slight increase to 26.7 ± 5.2 after 24 months of follow-up (correction loss 4.8 ± 3.5%). The mean estimated blood loss was 2816.7 ± 1441.5 ml. The mean operative time was 339 ± 84.3 min. Self-image domain (part of SRS-22 questionnaire) has significantly improved from a mean preoperative of 2.3 ± 0.5 to a mean postoperative of 3.9 ± 0.4 after 24 months of correction (p < 0.001). As regards complications, chest tubes were inserted in 17 cases (81%), one case (4.8%) had suffered from deep wound infection and temporary respiratory failure, while 3 cases (14.3%) had neurological deficits. Conclusion Posterior vertebral column resection is considered a highly effective release procedure that aids in the correction of almost any type of complex pediatric deformities with a correction rate reaching 66.9 ± 10.8%. However, Pvcr is a challenging procedure with high estimated blood loss and risk of neurological deficits, so it must be done only by experienced spine surgeons in the presence of good anesthesia and neuromonitoring teams.

Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed. Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction. Study Design: Retrospective clinical case cohort study. Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com). Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.