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MINI: This is a long-term prospective cohort study comparing the radiographic outcomes of anterior versus posterior instrumentation for Lenke 5 adolescent idiopathic scoliosis. Both approaches were comparable in terms of radiographic outcomes up to 10 years. The posterior approach is more prone to developing proximal junctional kyphosis. STUDY DESIGN: Prospective cohort study. OBJECTIVE: To compare the long-term, radiographic coronal and sagittal outcomes of these two approaches at 10-year follow-up. SUMMARY OF BACKGROUND DATA: Both anterior and posterior instrumented fusions have been found to be safe and effective treatments for Lenke 5 adolescent idiopathic scoliosis with up to 2 to 5 years of follow-up. Few studies follow patients beyond this duration. METHODS: 36 patients who underwent anterior (n = 25) or posterior instrumented spinal fusion (n = 11) for Lenke 5 adolescent idiopathic scoliosis over a 4-year period were recruited and followed for 10 years. Preoperative clinical data include patient's age and age of menarche. Operative data included instrumented levels, duration of surgery, and surgical blood loss. Postoperative data included duration of hospital stay, duration of intensive care unit stay, and complications. Pre- and postoperative radiographic data collected include coronal Cobb angles for structural thoracolumbar/lumbar curves, and sagittal angles-sagittal vertical axis, thoracic kyphosis, global lumbar angle, pelvic incidence, pelvic tilt, sacral slope, and upper and lower end vertebrae. RESULTS: Posterior surgery had a shorter operative time (P < 0.010) and hospital stay (P < 0.010). Coronal plane deformity improved by a mean of 74% in the anterior group and 71% in the posterior group. There was no significant change at 10 years in both groups (anterior P = 0.455 and posterior P = 0.325). Sagittal parameters remained unchanged. There was a higher incidence of proximal junctional kyphosis in the posterior (45%) compared to the anterior (16%) group (P < 0.010). CONCLUSION: Both anterior and posterior instrumentation and fusion are successful surgeries after 10 years of follow-up. They are comparable with regards to their ability to achieve and maintain good correction of scoliotic deformities and have a low rate of pseudoarthrosis and instrument failure. Ideal sagittal parameters are maintained up to 10 years of follow-up. LEVEL OF EVIDENCE: 3.

Prospective cohort study. To compare the long-term, radiographic coronal and sagittal outcomes of these two approaches at 10-year follow-up. Both anterior and posterior instrumented fusions have been found to be safe and effective treatments for Lenke 5 adolescent idiopathic scoliosis with up to 2 to 5 years of follow-up. Few studies follow patients beyond this duration. 36 patients who underwent anterior (n = 25) or posterior instrumented spinal fusion (n = 11) for Lenke 5 adolescent idiopathic scoliosis over a 4-year period were recruited and followed for 10 years. Preoperative clinical data include patient's age and age of menarche. Operative data included instrumented levels, duration of surgery, and surgical blood loss. Postoperative data included duration of hospital stay, duration of intensive care unit stay, and complications. Pre- and postoperative radiographic data collected include coronal Cobb angles for structural thoracolumbar/lumbar curves, and sagittal angles­sagittal vertical axis, thoracic kyphosis, global lumbar angle, pelvic incidence, pelvic tilt, sacral slope, and upper and lower end vertebrae. Posterior surgery had a shorter operative time (P < 0.010) and hospital stay (P < 0.010). Coronal plane deformity improved by a mean of 74% in the anterior group and 71% in the posterior group. There was no significant change at 10 years in both groups (anterior P = 0.455 and posterior P = 0.325). Sagittal parameters remained unchanged. There was a higher incidence of proximal junctional kyphosis in the posterior (45%) compared to the anterior (16%) group (P < 0.010). Both anterior and posterior instrumentation and fusion are successful surgeries after 10 years of follow-up. They are comparable with regards to their ability to achieve and maintain good correction of scoliotic deformities and have a low rate of pseudoarthrosis and instrument failure. Ideal sagittal parameters are maintained up to 10 years of follow-up. Level of Evidence: 3.

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A large variety of vertebral tumours undergoes transarterial embolisation (TAE) prior to surgery. However, the subsequent intra-operative blood loss is unpredictable. This retrospective analysis, aims to determine the impact of various factors that may potentially influence the estimated intra-operative blood loss (EBL) in these patients. The study included 56 consecutive patients with spinal tumours who underwent pre-operative TAE. Demographic information, treatment history, tumour type, MRI characteristics, angiographic appearance, embolisation technique and surgical invasiveness were correlated with EBL using univariate and multivariate analysis. Mean EBL was 1317 mls. On univariate analysis, haematological/primary tumours, MRI hypervascularity and selective embolisation were significantly (P < 0.05) associated with increased EBL. A total angiographic devascularisation and embolisation of additional segments above and/or below the involved level were significantly associated with decreased EBL. There was no significant association with hypervascular angiographic appearance or surgical invasiveness. MRI and angiographic hypervascularity were not entirely concordant, especially for the category of moderately vascularised metastases. After multivariate analysis, MRI hypervascularity (1434 vs. 929 mls, P = 0.018) and embolisation of additional segments (1082 vs. 1607 mls, P = 0.003) remained significantly correlated with EBL. In conclusion, during pre-operative TAE of spinal tumours, routine angiographic interrogation of additional levels above and below the involved segment should be made, with a low threshold for embolising them, if safely performable. Compared to angiographic gold standard, MRI hypervascularity is probably a better predictor of EBL.

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STUDY DESIGN: A prospective observational study. PURPOSE: To evaluate the role of nucleoplasty in the management of discogenic axial back pain; to determine the influence of concordant pain during provocative discography, annular tear and loss of disc height on the outcome of nucleoplasty. OVERVIEW OF LITERATURE: The role of nucleoplasty in the management of radicular leg pain due to disc herniation is known. However, the data regarding its role in the management of discogenic axial back pain is scarce. METHODS: A prospective evaluation of 30 patients with discogenic axial back pain undergoing nucleoplasty was performed. Pain, functional disability and quality of life were assessed using the 100 mm visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. RESULTS: The mean reduction in VAS was 31.03 and 29.03; mean reduction in ODI was 24.53 and 20.60; and mean increment in SF-36 was 13.58 and 12.30, at 6 months and at 12 months, respectively. The differences were statistically significant (p <0.05). Concordant pain during provocative discography, annular tear and loss of disc height did not affect a clinically significant improvement in any of the three outcomes (p =0.882, 0.213, and 0.170; respectively). CONCLUSIONS: Nucleoplasty produced statistically significant improvements in pain, functional disability and quality of life in patients with discogenic low back pain at 6 months and at 12 months. Concordant pain during provocative discography, annular tear and loss of disc height did not influence any of the outcomes after nucleoplasty in patients with discogenic axial back pain.

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This is the first-reported case of an isolated thoracic spine relapse of a stage 1 testicular seminoma more than 1 year after surgery and radiotherapy. We report a 38-year-old gentleman, who underwent radical orchidectomy and adjuvant retroperitoneal irradiation for a pure testicular seminoma, presenting with acute cord compression from an isolated T8 relapse 14 months after the index surgery. Decompressive laminectomy with instrumentation was performed with adjuvant chemoradiotherapy. The patient gained full neurological recovery and has remained disease-free for 4 years. Testicular seminomas rarely relapse in the spine after treatment with surgery and radiotherapy, and it is usually the lumbar spine that is involved. Spinal relapse also commonly presents with pain rather than acute cord compression. This case report discusses the unique behaviour of testicular seminomas and their presentation in vertebral relapse. We also present a summary of the available literature on isolated thoracic spine relapse of testicular seminomas.

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