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  • Journal of Neurosurgery: Pediatrics x
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Jae Hwan Cho, Chang Ju Hwang, Young Hyun Choi, Dong-Ho Lee and Choon Sung Lee

surgery on cervical sagittal alignment (CSA) is not clearly defined. Cervical lordosis has been reported to decrease following corrective surgery in patients with Lenke type 1 AIS. 6 In addition, the cervical spine may tend to decompensate independent of the surgical technique. 14 However, there have been varied opinions on postoperative CSA. Reportedly, the effect of corrective surgery on CSA may be determined based on the preoperative thoracic sagittal profile, 18 that is, cervical lordosis improves postoperatively in patients with preoperative hypokyphosis

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Kazunori Hayashi, Hiromitsu Toyoda, Hidetomi Terai, Akinobu Suzuki, Masatoshi Hoshino, Koji Tamai, Shoichiro Ohyama and Hiroaki Nakamura

P osterior spinal fusion is a common treatment method for adolescent idiopathic scoliosis (AIS) when conservative treatment is ineffective. Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment. 4 , 13 , 16 Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment. 15 The kinematic relationship between the global sagittal alignment and

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Weiguo Zhu, Zhen Liu, Shifu Sha, Jing Guo, Hongda Bao, Leilei Xu, Yong Qiu and Zezhang Zhu

paid to the sitting sagittal profile. Previous studies had demonstrated that prolonged sitting was associated with the low-back pain and other lumbar disability. 1 , 6 Therefore, full knowledge of the sagittal plane of the spine and pelvis in the sitting position is also of critical importance. In 2012, Endo et al. 3 first documented the normal sagittal spinopelvic alignment in sitting in 50 healthy adults, which revealed decreased lumbar lordosis (LL) and sacral slope (SS), accompanied with increased pelvic tilt (PT) compared to standing sagittal alignment. The

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Federico De Iure, Luca Boriani and Stefano Boriani

, her upper limb function was normal, and the sagittal alignment and range of motion in the upper cervical spine were normal. Discussion Anterior and posterior fusion techniques, with and without internal fixation, have been widely adopted in the past for the treatment of instability in the upper cervical spine. 5 , 8 , 12 At present, surgical management of odontoid synchondrosis fractures by posterior fusion is generally used in cases of secondary displacement or nonunion. 3 , 5 Nevertheless, complications related to surgery in pediatric patients can be

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Ashwin Viswanathan, Katherine Relyea, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen and Andrew Jea

kyphotic deformity of 73° (T5–12) centered at T8–9. Left: The child's baseline sagittal alignment is shown. Right: Sagittal alignment at 3 months postlaminoplasty. Operation Given the interval development of significant kyphosis, our patient was offered surgical correction and stabilization. As she had previously undergone a laminoplasty, PS fixation was believed to be a superior biomechanical choice compared with a laminar hook construct. However, the patient's thoracic pedicles were small and sclerotic, making direct placement of thoracic PSs unlikely to

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Loyola V. Gressot, Akash J. Patel, Steven W. Hwang, Daniel H. Fulkerson and Andrew Jea

have obviated this complication. At 6 months after surgery, there was a slight loss of correction of the pelvic obliquity but no loss of correction of the coronal or sagittal alignment of the spine. Moreover, there was an expected halo around the contralateral right iliac screw. However, a CT scan obtained 3 months after surgery showed bridging bone spanning the instrumented spinal segments. A third patient (Case 14) developed wound breakdown with formation of a sinus tract in communication with the spinal instrumentation, and deep wound infection necessitating

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Liang Xu, Zhonghui Chen, Yong Qiu, Xi Chen, Song Li, Changzhi Du, Qingshuang Zhou and Xu Sun

groups underwent correction surgery with posterior-only instrumentation and careful neuromonitoring. All AMC patients and those AIS patients with curve flexibility less than 30% underwent Ponte osteotomies, which consisted of resection of the posterior elements through the facet joints and posterior ligaments at the apex and at the superior and inferior adjacent levels. 9 , 20 After osteotomy, rods were contoured to normal sagittal alignment and then were attached to the screws at the proximal and distal ends. Once the rod was anchored at the bottom screw with a

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Leonardo Rangel-Castilla, Steven W. Hwang, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen and Andrew Jea

-spine radiograph demonstrating maintenance of sagittal alignment and no evidence of instrumentation failure at 3 months after surgery. F ig . 5. Postoperative coronal view (left) and sagittal CT reconstruction (right) obtained at 11 months showing osseous fusion incorporating and bridging the instrumentation construct. Discussion Spinal spondylitis is the most common manifestation of osteoarticular TB, and 1%–3% of patients with TB have skeletal involvement. Most common in the first 3 decades of life, it is the leading cause of paraplegia in developing

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Zvi Lidar, Shlomi Constantini, Gilad J. Regev and Khalil Salame

removed through a posterior approach, after which a C2–5 fusion was performed using an autologous rib graft and cables. The cables were chosen to secure the ribs to the C-2 and C-5 laminae without fixation of motion segments. The procedure was well tolerated by the patient. Postoperatively, a halo vest was applied. At 5 months' follow-up, improvement of the left hemiparesis was noted. Computed tomography and MRI studies ( Figs. 3 and 4 ), showed complete relief of the cord compression, successful anterior and posterior fusion and stable sagittal alignment, thus the

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Brian J. Kelley, Michele H. Johnson, Alexander O. Vortmeyer, Brian G. Smith and Khalid M. Abbed

C orrection of spinal deformity in the pediatric population is a challenging surgical problem given limitations related to bone size and the need to accommodate future growth. While corrective surgery is often delayed to allow for additional growth as well as further development of bony structures to improve options for spinal instrumentation, certain conditions necessitate more urgent surgical intervention. Kyphosis is a condition characterized by abnormal sagittal alignment of the spine and is not often encountered in the pediatric population. While