Level 1.

Our technique of ilio-lumbar fixation provides a stable and simple alternative to reconstruct potentially devastating instability of the lumbosacral junction. The 2 iliac screws, when used as described, make the procedure technically easier, reduce the hardware prominence without compromising the stability to construct and provide adequate bone graft.

This is a prospective observational study comparing cases with retrospective controls. The aim of the study is to compare rib regeneration with a scaffold placed intra-periosteally against no scaffold, after costectomy in adolescent idiopathic scoliosis. A prospective study was conducted at Amrita Institute of Medical Sciences on 16 consecutive patients (51 ribs) with adolescent idiopathic scoliosis who underwent costectomy and application of gel foam in the rib bed as a scaffold. These patients were compared with a retrospective group of 15 patients (33 ribs) who did not have the scaffold. All prospective and retrospective patients were followed up for a minimum period of 6 months and were analyzed radiographically for rib regeneration and morphology. A classification system was devised to include all possible morphologies of regenerate. The resulting data, when analyzed showed that majority of ribs re-grew to normal morphology in 3-6 months in the trial group. In comparison the regeneration in the retrospective controls was slower and poorer in quality. Ribs treated by placement of gel foam scaffold in the bed regenerate to a near normal radiological profile within 6 months of costectomy compared to a slower regeneration in those without gel foam scaffold.

It is generally believed that minimal access surgery may produce less change in pulmonary function than conventional open thoracotomy for scoliosis correction. Though there is considerable literature regarding changes in pulmonary function tests (PFT) after thoracotomy, there is scant data available regarding the effect of the magnitude of thoracic wall disruption on pulmonary function, particularly in the early postoperative weeks. This study aims to evaluate the effect of the size of incision on pulmonary function after anterior release and fusion in patients with moderate thoracic curves due to adolescent idiopathic scoliosis. The study group was made up of 19 patients with thoracic curves due to adolescent idiopathic scoliosis. The subjects had had thoracotomy for anterior release, followed by posterior instrumentation and fusion at a second sitting. The ten patients who had had conventional, large thoracotomy were placed in group A and the nine minimal access cases in group B. PFTs consisting of volume (FVC) and flow (FEV1) were obtained before the anterior release, 2 weeks later (before the posterior instrumented fusion), and 3 months after the posterior fusion. The degree of deformity in the sagittal and the coronal plane preoperatively and postoperatively were measured and documented. The mean preoperative pulmonary function was significantly less than the predicted values for both patient groups. There was a decline in the postoperative pulmonary function (both percentage predicted value and absolute value) in both groups at 2 weeks and at 3 months. The deterioration of pulmonary function was less in the small-thoracotomy group, but this difference between the groups was statistically significant only for the 2-week values. Our study shows that there is significant pulmonary function restriction even in patients with moderate thoracic curves. There was a lesser decline in pulmonary function in the minimal-access group, as compared with the standard thoracotomy group, but this difference was only in the early postoperative period and became insignificant by 3 months.

This study validates our hypothesis that the donor site morbidity after tricortical iliac crest graft harvesting is probably a structural issue and it can be reduced by reconstruction of the defect. It also highlights the fact that the Chitra-HABG block is an excellent material for reconstruction of the iliac crest defect, as it gets incorporated into the surrounding bone without adverse effects.