Background Data: Balloon kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques were designed to avoid loss of the reduction before cement injection and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack ® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoracolumbar spine. Patients and Methods: During the period from April 2016 to March 2018, seventeen patients who sustained recent osteoporotic VCFs of the thoracolumbar spine, presenting with intractable back pain following one-month trial of conservative treatment, were included. Patients with pathological fractures, those with neurological deficits, or those medically unfit were excluded. The study included 6 males and 11 females with mean age of 60.37 years. Fractures were surgically treated using the Spine Jack ® system that was inserted percutaneously through the transpedicular approach. Back pain intensity and degree of functional recovery were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI), respectively, whereas segmental deformity of the fractured vertebra was evaluated using standing plain X-rays and CT scan, including measurement of the local kyphotic angle and Beck Index. Results: Patients were followed for at least 6 months (mean 7.4±1.2). At final follow-up, there was significant improvement in mean VAS score (7.3 to 2.9) and mean ODI score (61.4 to 28.7). Postoperative imaging showed significant improvements in mean Beck Index (0.68 to 0.77) and mean local kyphotic angle (21.4° to 14.3°). Cement leakage was noted in 2 patients (11.7%) with no clinical relevance. None of the patients developed neurological deterioration, adjacent fracture, or hardware-related complication during the follow-up. Conclusion: Percutaneous stabilization of osteoporotic VCFs of the thoracolumbar spine using the Spine Jack ® system is effective and safe even with posterior wall involvement, with significantly better outcome in terms of pain relief, functional recovery, and vertebral body restoration. (2019ESJ182)

Background Data: Percutaneous screws fixation became popular as it depends on minimal muscle destruction and no para-spinal muscle stripping. However, there is a lot of disadvantages of percutaneous fixation technique including the high radiation exposure. Complications reported in conventional midline approach including muscle stripping from lamina and spinous processes and long-term postoperative pain and muscle weakness led the spine surgeon to rediscover minimally invasive technique to manage spinal fractures through posterior approach. One of these techniques is Wiltse technique which access the pedicle through blunt dissection between the longissimus muscle and multifidus muscle. Purpose: This study aims to compare pedicle screw fixation via Wiltse approach, and the traditional posterior midline approach outcome. Study Design: Prospective comparative study. Patients and Methods: A total of 36 patients of single-level thoracolumbar fractures without neurologic injury underwent pedicle screw fixation using two different approaches. Twenty patients were treated using conventional technique (Group 1 ), and 16 patients were operated using Wiltse technique (Group 2 ). Screw placement accuracy rate, operative time, blood loss, postoperative hospitalization time, radiation exposure time, postoperative improvement of Cobb angle for regional kyphosis, functional disability index using Oswestry Disability Index, and Visual Analogue Scale (VAS) of the two groups were compared. Results: There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and Cobb angle improvement between the two groups. However, the Wiltse technique had obvious advantages over the conventional technique in operative time, blood loss, hospitalization time, ODI improvement and postoperative short-term improvement in VAS. Conclusion: Our data suggest that pedicle screw insertion using Wiltse technique for treatment of thoracolumbar fracture has the advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no significant increased radiation exposure. (2018ESJ160)

Background: Extradural hematoma (EDH) resembles a potentially life-threatening condition following head injury in children. EDHs are less common in children, with few reports had studied the outcome of such patients. Aim: The current analysis presents the etiology, clinical features and management of 34 patients with traumatic EDHs and identifies the possible factors that could predict the outcome. Patients and Methods: Patients with traumatic EDH in the age group (0-18) years, admitted to Suez Canal teaching hospital Between January 2013 and March 2016, were analyzed prospectively. Mode of injury, clinical course, radiological findings and management details were evaluated, and the outcome was measured 3 months after discharge using the pediatric extended Glasgow outcome scale (GOS-E). Results: The study included 24 boys and 10 girls, with mean age of 9.7 years. Traffic accident was the commonest mode of injury. The mean Glasgow Coma Scale (GCS) score at presentation was 12.1±2.3, and headache was the most frequent symptom (61.7%). Most patients (65%) were managed conservatively, while 35% were operated upon. Favorable outcome was achieved in 91.1% of patients, and the mortality rate was 5.8%. Univariate analysis demonstrated an association of the final GOS-E score with the initial Glasgow Coma scale (GCS) score, the mode of injury and the presence of pupillary abnormality or intradural injury. Conclusions: EDHs can develop following mild head injury in alert children. Favorable outcome was the rule in most children with traumatic EDHs. Traffic accident as a mode of injury, low initial GCS score and the presence of pupillary abnormality or intradural injury are statistically significant factors that were linked to a worse outcome.