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Background: The orientation of the acetabulum has a fundamental role in impingement and instability of the hip, and the spinopelvic parameters are thought to predict the sagittal orientation of the acetabulum (SOA). However, similar to the acetabular version (axial orientation) and inclination (coronal orientation), the cephalic or caudal orientation of the acetabulum in the sagittal plane, or SOA, may primarily be an intrinsic feature of the acetabulum itself. Purpose: To determine whether the spinopelvic parameters predict the sagittal orientation of the acetabulum in individuals without lumbar deformity. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A retrospective analysis was performed in 89 patients (94 hips; 62 female, 27 male; mean ± SD age, 45.9 ± 15.4 years) without lumbosacral deformity who underwent magnetic resonance arthrogram (MRA) for assessment of hip pain. The SOA was determined in the sagittal cut MRA. A line was drawn at the distal limit of the anterior and posterior acetabular horns longitudinally to the transverse ligament, and the angle between this line and the axial plane represented the SOA. The sacral slope, pelvic incidence, and spinopelvic tilt were determined using a 3-dimensional cursor and the axial, sagittal, and coronal cuts. All MRA studies were performed with the patient in the supine position. Results: The SOA had a mean ± SD cephalic orientation of 18° ± 6.6°. No significant correlation was observed between the SOA and the sacral slope ( r = –0.03; P = .77). A weak correlation was observed between the SOA and the pelvic incidence ( r = 0.22; P = .03) and between the SOA and the spinopelvic tilt ( r = 0.41; P < .01). Conclusion: The SOA cannot be presumed based on the spinopelvic parameter. Similar to the well-known parameters to assess the axial and coronal orientation of the acetabulum, the assessment of the SOA demands acetabular-specific parameters. Additional studies are necessary to assess the SOA in asymptomatic hips, including disparities between genders. Clinically significant values for abnormal SOA of the acetabulum remain to be defined.

Purpose Over the past decade, a minimally invasive technique to address upper cervical spine pathology has been executed successfully within ENT and neurosurgical communities. One indication for this endoscopic transnasal surgery is to remove the odontoid process of C2. Methods We aim to provide a detailed description of the current state of endoscopic endonasal odontoidectomy (ETO) techniques through a systematic literature review. We also report the clinical course of a patient who underwent an ETO with involvement of an orthopedic spinal surgeon. It is our hope that by highlighting the feasibility and positive outcomes of this approach, it may propagate more broadly through the spine community. Results A 61-year-old male presented to clinic with complaints of neck pain that radiated into the right arm. He had a remote history of closed head injury as a professional boxer, as well as previous ACDF from C4 to C7. On exam, the patient was myelopathic with diffuse 4/5 weakness in all extremities. Imaging revealed a Type-1 odontoid fracture non-union and significant stenosis at the C1 level, with only 7.7 mm available for the cord. After conferring with an interdisciplinary team, the patient was indicated for C1 laminectomy with posterior spinal fusion of C1-C2 and endoscopic transnasal odontoidectomy. At 5-month follow-up, the patient has reported improved gait mechanics, absence of RUE paresthesias, and improved RUE strength. Conclusions ETO is a viable, safe alternative to previously used methods of odontoid resection. As familiarity with the procedure increases throughout the medical field, further research should determine the most effective methods of ameliorating known complications.

Subtrochanteric fractures occur in the proximal region of the femur. Anatomically speaking, the subtrochanteric region of the femur is defined as the interval between the lesser trochanter and approximately 5 cm below it, toward the isthmus of the femur [1,13]. Subtrochanteric fractures are relatively common, accounting for approximately 10% to 30% of all hip fractures [4,16]. The subtrochanteric region is subject to tensile and compressive stressors that are substantially greater than the patient's body weight [11] as well as rotational and bending forces that directly influence the observed fracture patterns. These fractures commonly have short proximal fragments of comminution, which are pulled into flexion by the forces of the iliopsoas attaching on the lesser trochanter [9,10]. Additionally, the comminution can be deformed into an abducted and externally rotated position as a result of the pull on the greater trochanter by the abductor muscles. This proximal Each author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution approved the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.