Posterior Lumbar Interbody Fusion with Preservation of Posterior Structures for Management of Lumbar Spondylolisthesis

Introduction: Successful posterior lumbar interbody fusion requires excessive removal of posterior spinal elements and distraction of neural structures. It also requires a large amount of bone graft. The authors have developed this technique to assess results of treatment of degenerative spondylolisthesis by posterior lumbar interbody fusion with preservation of posterior spinal elements and also to examine the safety and efficacy of the recapping T-saw laminoplasty technique for the management of degenerative lumbar spondylolisthesis using posterior lumbar interbody fusion by interbody cages with preservation of posterior elements. Methodology: Twenty-five patients with degenerative spondylolisthesis underwent recapping T-saw laminoplasty in the lumbar spine for posterior lumbar interbody fusion with interbody cage. The T-saw was used for the division of the posterior elements. After discectomy and insertion of cages, the excised lamina was replaced exactly in situ to their original anatomic position. Patients were followed neurologically and radiologically. Result: Only one lamina was excised and replaced again. Primary bone healing was obtained in all patients by four to six months post surgery. No complications such as postoperative spinal canal stenosis, facet arthrosis, or kyphosis were observed. Conclusion: This technique of posterior lumbar interbody fusion through recapping laminoplasty provide wide space for easier insertion of cages and allow anatomic reconstruction of the vertebral arch preserving its important mechanical roles.

Minimally invasive resection of pediatric osteoid osteomas: A report of two cases

Background: Spinal osteoid osteomas (OOs) are common benign bone tumors that most frequently affect the posterior elements. They occasionally (e.g., 10% of the time) necessitate surgical resection for intractable pain. Given their small size and posterior positions, many may be amenable to minimally invasive surgical approaches. Case Description: We describe two cases of spinal OOs involving patients 11 and 17 years of age with lesions, respectively, at T7 and C4. Conclusion: Minimally invasive approaches for resection of small bony spinal OOs are safe and technically achievable approaches.

Spinal osteoid osteoma: Surgical resection and review of literature

Background: Osteoid osteoma (OO) is a rare benign tumor of the spine that involves the posterior elements with 75% tumors involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy. Methods: From 2011 to 2017, we evaluated cases of OO managed by posterior surgical resection while also reviewing the appropriate literature. Results: We assessed five patients (three males and two females) averaging 36.60 years of age diagnosed with spinal OOs. Two involved the lumbar posterior elements, two were thoracic, and one was in the C3 lateral mass. All patients underwent histopathological confirmation of OO. They were managed by posterior surgical resection with/without stabilization. No lesions recurred over the minimum follow-up period of 24 months. Conclusion: Surgical excision is the optimal treatment modality for treating spinal OOs. The five patients in this study demonstrated good functional outcomes without recurrences. Further, the literature confirms that the optimal approach to these tumors is complete surgical excision with/without radiofrequency ablation.

Fibrodysplasia Ossificans Progressiva (Stoneman Syndrome) – A Rare Skeletal Dysplasia

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare skeletal dysplasia with characteristic imaging and clinical findings, which includes bilateral hallux valgus, monophalangic great toes with short and stout first metatarsals, heterotopic ossification of muscles and connective tissues, short broad femoral necks, pseudo exostoses, short and stout first metacarpals, C2-C7 facet joint fusion, large posterior elements, and tall narrow vertebral bodies. We present a case of an 8-year-old male child who came with complaints of multiple progressive hard swellings over the neck, chest, and abdomen with restriction of movements for a duration of 2 years and deformity of great toe on both sides since birth. On clinical examination, the patient had multiple non-tender hard bony swellings in neck, chest, and abdominal wall with bilateral hallux valgus deformity. Radiographic examination revealed well- defined rib-like ectopic osseous outgrowths in the posterior aspect of neck, soft tissues of chest and abdominal wall, bilateral hallux valgus, monophalangic great toe and short first metatarsals with normal cervical vertebral bodies, posterior elements, short first metacarpals bilaterally, and pseudo exostoses in medial aspect of upper one-third of both tibia. With the above classic findings, the diagnosis of FOP was made. Early diagnosis of the condition is very important in these cases as intramuscular injections, biopsies, and trivial trauma can exacerbate the condition with painful flare-ups.

Two-Stage Procedure Planning for the Surgical Correction of Severe Congenital Kyphosis: A Technical Case Report

Congenital kyphosis is a less common spinal malformation, which can progress and cause neurological deficits. The treatment of severe cases is complicated. There are several techniques of surgical intervention for the correction of kyphosis, but the selection of surgical methods is entirely dependent on the patient’s condition. This article reports a 14-year-old girl with severe congenital kyphosis, who underwent hemiepiphysiodesis at age 2. Last year, her neurological deterioration began and led to paraplegia over a couple of months. To treat her, we performed 2-stage multi-level vertebral column resection (Schwab type 6). First, she underwent anterior T12-L1-L2 complete corpectomy and cord decompression. Then, the resection of posterior elements from T12 to L2 and posterior fusion with instrumentation from T8 to L5 were performed. However, concerning this kind of severe deformity, we suggest using 3D planning, which facilitates the operation.