Recurrent ossification of the posterior longitudinal ligament in the upper thoracic region 10 years after initial decompression

Background: Posterior decompression surgery consisting of laminoplasty is generally considered be the treatment of choice for upper thoracic OPLL. Here, we describe a patient who, 10 years following a C3–T4 level laminectomy, developed recurrent OPLL at the T2–3 level with kyphosis requiring a posterior fusion. Case Description: A 64-year-old male with CT documented OPLL at the C3–4, C6–7, and T1–4 levels, originally underwent a cervicothoracic laminectomy with good results. However, 10 years later, when T2–3 OPLL recurred along with kyphosis, he warranted an additional posterior fusion. Conclusion: Due to the long-term risks of developing kyphotic deformity/instability, more patients undergoing initial decompressive surgery alone for upper thoracic OPLL should be considered for primary fusions.

Syrinx regression after correction of iatrogenic kyphotic deformity: illustrative case

BACKGROUND Syringomyelia has a long-established association with pediatric scoliosis, but few data exist on the relationship of syringomyelia to pediatric kyphotic deformities. OBSERVATIONS This report reviewed a unique case of rapid and sustained regression of syringomyelia in a 13-year-old girl after surgical correction of iatrogenic kyphotic deformity. LESSONS In cases of syringomyelia associated with acquired spinal deformity, treatment of deformity to resolve an associated subarachnoid block should be considered because it may obviate the need for direct treatment of syrinx.

Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

Complications after Spinal Surgery in Patients with Parkinson’s Disease

Background: Several studies have shown that spinal surgeries in patients who suffer from Parkinson’s Disease have a high rate of complications. These patients often need revision surgery. Objective: This is a retrospective study involving 21 patients with Parkinson’s Disease. This study aimed to examine the complications after spinal surgery. Methods: We studied 21 patients with Parkinson’s Disease retrospectively, who had undergone a previous operation by the same surgeon between 2004 to 2019. There were 11 females and 10 males. The mean age was 71.9 years (range, 52 to 85). However, the initial diagnosis and types of surgery were different. The mean time of follow-up for each patient was 3.6 years (ranging from 2 to 8 years). Results: Most of the patients had a post-operative complication within a period of three years. Τhe most common complication was kyphotic deformity and camptocormia. Twelve patients (57.1%) underwent revision surgery, and three patients (14.2%) denied treatment. In four patients (19.04%), kyphotic deformity or stooped posture remained. Only one patient (4.7%) presented with no complication in a follow-up of 8 years. Conclusion: Patients with Parkinson’s disease have a high rate of complications after spinal surgery and often need revision surgery. For this literature review, the overall number of patients was 502, and the mean revision rate was 43.6%. The surgeon must inform patients of possible complications, and a thorough post-operative observation must be implemented.

Assessment of new method of posterior spinal fusion in the treatment of patients with posttraumatic kyphotic deformity of the thoracic and lumbar spine

Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.

Utilization of anterior lumbar interbody fusion for severe kyphotic deformity secondary to Pott’s disease: illustrative case

BACKGROUND Spinal tuberculosis may result in severe kyphotic deformity. Effective restoration of lordosis and correction of sagittal balance often requires invasive osteotomies associated with significant morbidity. The advantages of focusing on symptomatic management and staging in the initial treatment of these deformities have not been well reported to date. OBSERVATIONS The authors reported the case of a 64-year-old Vietnamese woman with a history of spinal tuberculosis who underwent anterior lumbar interbody fusion (ALIF) for symptomatic treatment of L5–S1 radiculopathy resulting from fixed kyphotic deformity. Postoperatively, the patient experienced near immediate symptom improvement, and radiographic evidence at 1-year follow-up showed continued lordotic correction of 30° as well as stable sagittal balance. LESSONS In this case, an L5–S1 ALIF was sufficient to treat the patient’s acute symptoms and provided satisfactory correction of a tuberculosis-associated fixed kyphotic deformity while effectively delaying more invasive measures, such as a vertebral column resection. Patients with adult spinal deformity may benefit from less invasive staging procedures before treating these deformities with larger surgeries.