Purpose: To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented. Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized. Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years. Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.

Introduction Achieving adequate surgery for early onset scoliosis (EOS) is difficult because of many challenges including the need to correct the deformity, the need to allow adequate spine growth, to allow adequate lung development, and the need to minimize complications. GSP system was found to solve these troubles with minimal complications in comparison with other techniques. This is a preliminary analysis and report about the efficacy and safety of GSP system in treating patients with early onset scoliosis Patients and Methods This is a combined prospective and retrospective study of 15 patients (9 females and 6 males) with EOS. The age ranged between 3.5 and 7 years old. All patients were treated with GSP system in our hospital and were prospectively followed for a minimum of 1 year. The following parameters were measured both preoperatively and posteoperatively and at each follow up visit. 1- Cobb's angle correction. 2-T1-S1 height. 3-apical vertebral translation (AVT). 4-space available for the lung (SAL) ratio. 5-shoulder and pelvic balance. Also all surgical details were recorded including, single or dual rod technique used, operative time, blood loss, and intraoperative complications. Post-operative follow up schedule at 8 weeks and every 6 months for serial lengthening and assessment of the previous parameters after each lengthening. Any complication during follow up is recorded. This group was compared with a similar historical cohort treated earlier by Growing Rods. Results Surgical details -blood loss 90ml (80–300). -operative time 1.5 hours. -number of rods (3 cases single rod and 7 cases dual rods). -number of lengthening procedures 0–4 times. -number of additional procedures 4. Follow up - Mean follow up 4months (3–18) months. - Cobb's angle corrected from (90.4) to (44). -AVT improved from 54mm to 34mm -T1-S1 height improved from 210mm to 305mm. -SAL ratio improved from 89% to 84%. Intraoperative complications. -pleural injury 5 cases. -others 0. Postoperative complications -Screw pull-out 2 cases. -hook dislodgement 0. -neurological injury 0. -infection 2 cases (superficial wound infection). -prominent metal 1 case. -metal failure 2 cases (single rod group) Conclusion GSP seems to be a good and economic option for management of EOS with proper patient selection and proper surgical technique

Introduction Massive hemorrhage and massive blood transfusion are not uncommon in spinal deformity surgery. There are many factors which may affect the perioperative blood loss. Multiple studies showed the beneficial effects of parentral tranexamic acid (TXA) in decreasing intraoperative blood loss but there is a lack of knowledge about the effect of topical use of tranexamic acid. The aim of this study is to evaluate the effect of using tranexamic acid topically versus parentrally on the amount of intra operative blood loss. Material and Methods Between 2011 and 2014, eighty three patients (49 females/34 males, mean age 17 ± 4 ys, body weight 49 ± 6 kg) underwent correction (in the form of multiple Ponte osteotomies, PSO, PVCR) and posterior spinal fusion for spinal deformity (57 AIS, 14 congenital scoliosis, 12 syndromic). These patients were randomized into one of three groups. In group 1 (n = 31 patients), TXA was used topically. TXA was sprayed directly in the wound and sponges soaked with it were used. In group 2 (n = 29 patients), intravenous TXA was used intra-operatively. In group 3 (n = 23 patients), TXA acid was used neither topically nor systemically. Intraoperative blood loss and the number of blood units transfused were recorded for all patients. The three groups were comparable in the mean age, body weight, operative time, type of deformity, type of osteotomy, number of fused segments, number of screws used. Results The mean operative time was (240 minute ± 50). The mean blood loss in group 1 was 1353 ± 273 cc, 1271 ±279 cc in group 2, and 1430 ± 311 cc in group 3. The mean number of blood units transfused in group 1 was 2.65 ± 0.587, 2.3 ± 0.571 in group 2, and 3.4 ± 0.5 in group 3. There were no significant differences in intraoperative blood loss and number of units of transfused blood between the first and second groups while there was a significant difference between them and the control group. One patient developed DVT in the intravenous TXA group. Conclusion Topical TXA is as effective as intravenous TXA and may be used safely to decrease the need for blood transfusion and intraoperative blood loss.

Introduction The incidence of junctional kyphosis (JK) varies in the literature from 7% to 40%. We here present our experience with JK. The aim of this work is investigate the incidence of JK after long spinal segment fusion, to identify the underlying factors leading to its development, and to discuss treatment outcome. Patients and Methods This combined retrospective/prospective cohort study included sixty-four consecutive patients (40 women and 24 men) with a mean age of 20.7 years, who underwent long segment spinal fusion (≥ 5 vertebrae) for treatment of spinal deformity. The average length of follow-up was 2 years. Risk factors analyzed included patients’ factors, surgical factors, and radiographical parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, and pelvic incidence. Results Radiological JK occurred in 14 patients (22%). Ten cases were proximal junctional kyphosis (PJK), two cases were intercalary junctional kyphosis (IJK), and two cases were distal Junctional Kyphosis (DJK). Only seven patients (50%) out of the 14 with JK were symptomatic. Six cases have undergone revision surgery. In nine cases, the original deformity was kyphosis (1 Ankylosing spondylitisS, 1 post-tuberculous, 3 Sheuermann's kyphosis, 4 congenital kyphosis). The other 5 cases were scoliosis (3 idiopathic and 2 congenital). Preoperative TK more than 40 ° was associated with PJK. In all cases PI, PT, SS, SVA were within normal range, but it was noticed that SVA had negative values in 5 cases. LIV in the dorsolumbar junction was associated with DJK. Conclusion Pre-existing TK more than 40°was identified as an independent risk factor. Negative sagittal balance may be a risk factor for PJK. A surgical strategy to minimize Junctional kyphosis may include careful preoperative planning for reconstructions with a goal of optimal postoperative alignment.

Introduction There has been controversial data about the effect of cage size on radiological and clinical outcome of anterior cervical discectomy and fusion (ACDF). Oversized cages have been linked to higher incidence of non-union, adjacent segment disease, and unfavorable clinical outcomes. The aim of this work is to evaluate the effect of an oversized PEEK cage on the radiological and clinical outcomes in ACDF. Patients and Methods Between January 2012 to July 2014, 57 patients (29 single level, 15 double levels, 8 three levels, 5 four levels) underwent ACDF using a stand-alone oversized PEEK cages. They were 35 males and 22 females with mean age 56 ± 13.5 years. The minimum follow up period is one year. The following parameters were measured preoperatively, postoperatively and at final follow up: cervical lordosis (in degrees), disc height (in mm), motion at operated level (in degrees), radiological ASD (present or not) and VAS for neck pain, VAS for arm pain. All complications were as well recorded. Results The mean cervical lordosis changed from 25°±5.5 postoperative to 7°±4.5 at final follow up. The mean disc height was 5± 2 mm preop, 7 ± 1.5 mm postop and 6 ± 1 mm at final follow up. Residual motion at operated level was observed at 1 year follow up X-rays in 2 patients (one double level and one 3-level) with average 5°. None of them had neck pain and no revision was required. In the postoperative X-rays, the suprajacent level was always observed to be slightly narrowed; this narrowing gradually diminished during the follow up. Radiological ASD developed in 9 patients (16%), all of them remained to date asymptomatic. The average improvement in VAS for neck pain was 27%±8.5 and the average improvement in VAS for arm pain was 33%±9.5. At the final follow up, fusion was achieved in 55 patients (96%) and clinical outcome was excellent. Radiological loss of the postoperative disc height and cervical lordosis and development of radiological ASD did not correlate to poor clinical outcome. No single case of cage dislodgement was observed in this series. Conclusion The use of a stand-alone oversized PEEK cage in ACDF seems to minimize the incidence of cage dislodgment even in multiple levels ACDF. Despite some radiological settlement and loss of cervical lordosis, an excellent clinical outcome was maintained.