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Objective@#The scientific community knows little about the long-term influence of coronavirus disease 2019 (COVID-19) on olfactory dysfunction (OD). With the COVID-19 pandemic ongoing worldwide, the risk of imported cases remains high. In China, it is necessary to understand OD in imported cases.@*Methods@#A prospective follow-up design was adopted. A total of 11 self-reported patients with COVID-19 and OD from Xi'an No. 8 Hospital were followed between August 19, 2021, and December 12, 2021. Demographics, clinical characteristics, laboratory and radiological findings, and treatment outcomes were analyzed at admission. We surveyed the patients via telephone for recurrence and sequelae at the 1-, 6-, and 12-month follow-up.@*Results@#Eleven patients with OD were enrolled; of these, 54.5% (6/11) had hyposmia and 45.5% (5/11) had anosmia. 63.6% (7/11) reported OD before or on the day of admission as their initial symptom; of these, 42.9% (3/7) described OD as the only symptom. All patients in the study received combined treatment with traditional Chinese medicine and Western medicine, and 72.7% (8/11) had partially or fully recovered at discharge. In terms of OD recovery at the 12-month follow-up, 45.5% (5/11) reported at least one sequela, 81.8% (9/11) had recovered completely, 18.2% (2/11) had recovered partially, and there were no recurrent cases.@*Conclusions@#Our data revealed that OD frequently presented as the initial or even the only symptom among imported cases. Most OD improvements occurred in the first 2 weeks after onset, and patients with COVID-19 and OD had favorable treatment outcomes during long-term follow-up. A better understanding of the pathogenesis and appropriate treatment of OD is needed to guide clinicians in the care of these patients.

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Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.

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STUDY DESIGN: retrospective comparative study. INTRODUCTION: The standard surgical technique for double major adolescent idiopathic scoliosis (AIS) has been the fusion of both thoracic and thoracolumbar/lumbar curves from the posterior approach. Although short anterior correction is established in AIS with single thoracic or thoracolumbar/lumbar curves, anterior correction in double major curves has not yet been described. The purpose of this study is to compare this novel technique with standard posterior pedicle screw instrumentation in double major AIS. METHODS: 19 consecutive patients with a double major AIS were treated surgically either with pedicle screw instrumentation and posterior fusion (n = 11) or dual anterior short instrumentation and fusion (n = 8) of both curves. The mean follow-up was 5.6 ± 3 years (2-10 years). Clinical and radiologic results, results of pulmonary function, and Scoliosis Research Society (SRS) questionnaire are analyzed and compared. RESULTS: The length of fusion was 7.6 ± 0.7 vertebrae with the anterior technique and 12 ± 1 vertebrae with the posterior technique (p < .001). Cobb angle correction was 78% and 53% in thoracic curves, and 80% and 59% in lumbar curves with posterior and anterior technique respectively (p < .05). The preoperative pulmonary function remained unchanged to the last follow-up in both groups. The scores of SRS-24 questionnaire were similar preoperatively and at the last follow-up in both groups. CONCLUSION: This novel technique of dual sequential short anterior correction is an alternative to the standard posterior long fusions in the double major AIS. A significantly less amount of mobile segments needs to be fused leaving the thoracolumbar junction mobile and saving at least one lumbar mobile segment distally. LEVEL OF EVIDENCE: Level III.

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INTRODUCTION: With increasing age, ubiquitous degeneration processes lead to a narrowing of the spinal canal. Degenerative lumbar spinal stenosis (DLSS) causes functional disability and is associated with back and lower extremity pain in older individuals. The goal of this study was to determine if decompression surgery can be performed safely and provide a stable benefit in our octogenarian patient population. METHODS: In this retrospective study, 121 patients over the age of 80 (mean age: 82.7 years SD: 2.4 years) with the diagnosis of central spinal canal stenosis who underwent posterior decompression surgery without fusion for DLSS between January 2006 and August 2013 were followed up from November to December 2013. Peri- and post-operative complications were recorded. Walking distances and visual analogue scale (VAS) scores were determined before surgery and at follow up time (mean follow up time 36 months). Patient's satisfaction with treatment was documented with the overall satisfaction degree scale in Zurich Claudicatio Questionnaire (ZCQ). RESULTS: The peri-operative complication rate was 6.6% with five dural tears, two wound infections and one epidural haematoma. Four patients required revision surgery (three re-decompression and one secondary spondylodesis). Walking distance improved from 147 meters (SD ±110 m) to 340 m (SD ±170 m) p < .001. Pain improved with change of the VAS scores from 7.2 (SD ±1.2) to 4.5 (SD ±1.0), p < .001. The overall satisfaction scale in ZCQ was 2.2 at follow up. CONCLUSION: A minimal surgical intervention, namely decompression, improves walking ability, decreases pain and has marginal potential for complications in patients with DLSS who are over 80 years old.

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STUDY DESIGN: Retrospective analysis of data from patients participating in the Lumbar Spinal Stenosis Outcome Study (LSOS). OBJECTIVE: The aim of LSOS was to assess clinical outcomes after surgical or nonoperative treatment in patients with and without prior epidural steroid injections. SUMMARY OF BACKGROUND DATA: Epidural steroid injections (ESI), a common treatment modality, reduce symptoms in the short-term, but according to a subgroup analysis from the Spine Patient Outcomes Research Trial (SPORT) they reduce the amount of improvement after subsequent surgical or nonoperative treatment. METHODS: The data of 281 patients with lumbar spinal stenosis who had completed baseline and 6-month follow-up assessments were analyzed. Patients completed the Spinal Stenosis Measure (SSM). Changes in the SSM scores from baseline to follow-up were compared between patients with and without prior ESI, for the surgical and nonsurgical treatment groups. RESULTS: The mean (SD) age of the patients was 75 (8.7) years. 229 patients underwent surgery and 111 of these had received an ESI in the 12 months before surgery. Of the 52 patients treated nonoperatively, 29 had received a prior ESI. The unadjusted changes (improvement) in the SSM-symptom scores between baseline and 6 months' follow up were: surgery and prior ESI 0.95, surgery and no prior ESI 0.78 (P = 0.15); no surgery and prior ESI 0.28, no surgery and no prior ESI 0.29 (P = 0.85). When adjusted for confounding factors, the reduction in SSM-symptom score was greater for surgery than for nonoperative treatment by 0.41 points (P < 0.001); the effect of having had an ESI prior to study entry was -0.08 (P = 0.40). CONCLUSION: The analysis of outcomes in the LSOS cohort provided no evidence that ESIs have a negative effect on the short-term outcome of surgery or nonoperative treatment in patients with lumbar spinal stenosis. LEVEL OF EVIDENCE: 3.

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The "bone-on-bone" reconstruction for adolescent idiopathic scoliosis is reviewed in this article. Extensive use over the past 18 years has identified it's functional benefits outstanding clinical results, and very limited complications. This is an extensive update of it's application, since it's introduction, 18 years ago.

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STUDY DESIGN: This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. OBJECTIVES: To examine whether outcome and quality of life might improve after decompression surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. SUMMARY AND BACKGROUND DATA: Lumbar decompression surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. METHODS: Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. RESULTS: Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. CONCLUSION: Patients 80 years or older can expect a clinically meaningful improvement after lumbar decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. LEVEL OF EVIDENCE: 3.

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PURPOSE: Several risk factors and causes of adjacent segment disease have been debated; however, no quantitative relationship to spino-pelvic parameters has been established so far. A retrospective case-control study was carried out to investigate spino-pelvic alignment in patients with adjacent segment disease compared to a control group. METHODS: 45 patients (ASDis) were identified that underwent revision surgery for adjacent segment disease after on average 49 months (7-125), 39 patients were selected as control group (CTRL) similar in the distribution of the matching variables, such as age, gender, preoperative degenerative changes, and numbers of segments fused with a mean follow-up of 84 months (61-142) (total n = 84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL), sacral slope, pelvic incidence (PI), and tilt. RESULTS: Significant differences between ASDis and CTRL groups on preoperative radiographs were seen for PI (60.9 ± 10.0° vs. 51.7 ± 10.4°, p = 0.001) and LL (48.1 ± 12.5° vs. 53.8 ± 10.8°, p = 0.012). Pelvic incidence was put into relation to lumbar lordosis by calculating the difference between pelvic incidence and lumbar lordosis (∆PILL = PI-LL, ASDis 12.5 ± 16.7° vs. CTRL 3.4 ± 12.1°, p = 0.001). A cutoff value of 9.8° was determined by logistic regression and ROC analysis and patients classified into a type A (∆PILL <10°) and a type B (∆PILL ≥10°) alignment according to pelvic incidence-lumbar lordosis mismatch. In type A spino-pelvic alignment, 25.5 % of patients underwent revision surgery for adjacent segment disease, whereas 78.3 % of patients classified as type B alignment had revision surgery. Classification of patients into type A and B alignments yields a sensitivity for predicting adjacent segment disease of 71 %, a specificity of 81 % and an odds ratio of 10.6. CONCLUSION: In degenerative disease of the lumbar spine a high pelvic incidence with diminished lumbar lordosis seems to predispose to adjacent segment disease. Patients with such pelvic incidence-lumbar lordosis mismatch exhibit a 10-times higher risk for undergoing revision surgery than controls if sagittal malalignment is maintained after lumbar fusion surgery.

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OBJECTIVE: To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery. MATERIALS AND METHODS: A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery. RESULTS: Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation. CONCLUSIONS: The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity.

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OBJECTIVE: The multifidus muscle is the only paraspinal lumbar muscle that is innervated by a single nerve root. This study aimes to evaluate if the asymmetry of the multifidus muscle is related to the severity of compression of the nerve root or the duration of radiculopathy. METHODS: MRI scans of 79 patients with symptomatic single level, unilateral, lumbar radiculopathy were reviewed for this retrospective case series with a nested case-control study. The cross-sectional area (CSA) of the multifidus muscle and the perpendicular distance of the multifidus to the lamina (MLD) were measured bilaterally by two radiologists and set into relation to the severity of nerve compression, duration of radiculopathy and probability of an indication for surgical decompression. RESULTS: In 67 recessal and 12 foraminal symptomatic nerve root compressions, neither the MLD ratio (severe 1.19 ± 0.55 vs less severe nerve compression: 1.12 ± 0.30, p = 0.664) nor the CSA ratio (severe 1 ± 0.16 vs less severe 0.98 ± 0.13, p = 0.577) nor the duration of symptoms significantly correlated with the degree of nerve compression. MR measurements of multifidus were not different in patients with (n = 20) and those without (n = 59) clinical muscle weakness in the extremity caused by nerve root compression. A MLD >1.5 was, however, associated with the probability of an indication for surgical decompression (OR 3, specificity 92%, PPV 73%). CONCLUSIONS: Asymmetry of the multifidus muscle correlates with neither the severity nor the duration of nerve root compression in the lumbar spine. Severe asymmetry with substantial multifidus atrophy seems associated with the probability of an indication of surgical decompression.

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OBJECTIVE: To evaluate the sensitivity of contact heat evoked potentials (CHEPs) compared with dermatomal somatosensory evoked potentials (dSSEPs) and clinical sensory testing in myelopathic spinal cord disorders (SCDs). METHODS: In a prospective cohort study, light-touch (LT) and pinprick (PP) testing was complemented by dermatomal CHEPs and dSSEPs in patients with a confirmed SCD as defined by MRI. Patients with different etiologies (i.e., traumatic and nontraumatic) and varying degrees of spinal cord damage (i.e., completeness) were included. SCD was distinguished into 3 categories according to MRI pattern and neurologic examination: a) complete, b) incomplete-diffuse, and c) central or anterior cord damage. RESULTS: Seventy-five patients were included (complete n = 7, incomplete-diffuse n = 33, central/anterior n = 35). In total, 319 dermatomes were tested with combined CHEPs and dSSEPs. CHEPs, dSSEPs, and clinical sensory testing were comparably sensitive to detect the myelopathy in complete (CHEPs 100%, dSSEPs 91%, PP and LT 82%) and incomplete-diffuse (CHEPs 92%, dSSEPs and PP 86%, LT 81%, p > 0.05 for all comparisons) cord damage. In central/anterior cord damage, CHEPs showed a significantly higher sensitivity than dSSEPs (89% compared with 24%, p < 0.001) and clinical sensory testing (PP 62%, LT 57%, p < 0.05). A subclinical sensory impairment was detected more frequently by CHEPs than dSSEPs (60% compared with 29%, p = 0.001). CONCLUSIONS: Assessment of spinothalamic pathways with CHEPs is reliable and revealed the highest sensitivity in all SCDs. Specifically in incomplete lesions that spare dorsal pathways, CHEPs are sensitive to complement the clinical diagnosis.

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STUDY DESIGN: Matched case-control study. OBJECTIVE: To find the amount of progression of deformity and its clinical consequences in the long term after implant removal (IR) as a result of late infection in adolescent idiopathic scoliosis (AIS). BACKGROUND SUMMARY: Late IR is occasionally necessary after instrumented posterior correction of AIS because of late implant infection or implant-associated pain. The long-term outcome is not yet known because of the lack of studies with a comparable control group. METHODS: We observed 50 patients with AIS, who had pedicle screw instrumentation for posterior correction, for at least 10 years. Seven of these patients needed IR after 3.4 years (range, 1.1-7.9 years) years because of late implant-associated infection. We matched these patients with another 7 who had no complications (control), by curve type, Risser stage, age, and gender. We performed radiological measurements preoperatively, at 6 weeks, and 2, 5, and 10 years postoperatively. All patients completed the SRS-24 questionnaire at 2- and 10-year follow-up. RESULTS: Although the curve magnitude of the main thoracic curve was similar preoperatively (Cobb angle: IR, 57°±6°; control, 57°±10°) and corrected equally (IR, 18°±4°; control, 20°±7°) at 6 weeks, the deformity progressed in the IR group at 2 years (IR, 25°±11°; control, 17°±6°) and became statistically different at 10 years (IR, 31°±10°; control, 19°±6°; p<.05). There was no significant difference in total Scoliosis Research Society score between groups (IR, 99±13; control, 90±17; p>.05) at 10 years. CONCLUSIONS: Late implant removal after posterior correction of thoracic AIS with pedicle screw instrumentation results in a loss of Cobb angle correction of about one third in coronal plane at 10-year follow-up, but without clinical relevance, as measured by the Scoliosis Research Society-24 questionnaire.

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STUDY DESIGN: Prospective radiographic cohort study. OBJECTIVE: To study the extent of bony decompression and dural sac expansion after laminectomy (including subtotal laminectomy and laminotomy with midline resection), bilateral fenestration, and unilateral fenestration with contralateral undercutting in lumbar spinal canal stenosis. Further, to investigate differences of incidence and extent of early postoperative epidural hematoma in these approaches. SUMMARY OF BACKGROUND DATA: There are different techniques of decompression in lumbar spinal stenosis. An overall good clinical outcome has been reported with different biomechanical consequences, but no morphometric comparative reports exist on these approaches. METHODS: Using the data of a previous prospective study of 30 patients, who underwent lumbar decompression for degenerative stenosis, 49 levels treated with 3 different kinds of surgical approaches were analyzed: (1) laminectomy (including subtotal laminectomy, laminotomy with midline resection); (2) bilateral fenestration; and (3) unilateral fenestration with contralateral undercutting. In all 3 groups, the cross-sectional area of the maximum bony stenosis and dural sac compression (bony margins and dural sac expansion) were measured in each operated level before and after the operation. Occurrence of epidural hematoma and its size were noted in the 3 groups. RESULTS: Median postoperative bony stenosis was not significantly different in the groups, being 330 mm(2), 333.5 mm(2), and 261.5 mm(2), respectively, in groups 1, 2, and 3. There was no statistically significant difference between the median postoperative extension of dural sac areas in the 3 groups, measuring 125 mm(2), 123 mm(2), and 137 mm(2). The incidence of epidural hematoma was similar in the 3 groups. Levels where postoperative epidural hematoma was detected had larger bony decompression independent of the surgical approach compared with the whole group. CONCLUSIONS: Unilateral and bilateral approaches achieve a similar amount of dural sac extension by a lesser extent of bony resection in comparison with the laminectomy approach. There is a tendency of increased postoperative hematoma in approaches with greater bony decompression area.

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PURPOSE: Since early 1990s pedicle screws in thoracic spine have been used in posterior correction of adolescent idiopathic scoliosis (AIS). Long-term results are scarce. We report clinical, radiological and pulmonary function results of 48 consecutive patients with 10-year minimal follow-up. METHODS: Forty-eight consecutive patients (42 females, 6 males) with 41 Lenke 1 (lumbar modifier A = 19, B = 8, C = 14), 7 Lenke 2 (lumbar modifier A = 2, B = 4, C = 1) were operated for AIS from posterior with pedicle screw alone instrumentation. Risser stage at the time of operation was 0-3 in 24, more than 3 in 24 patients. Mean age was 15.3 years. The data were prospectively collected preoperatively, at 6 weeks, 2 years and 10 years postoperatively. Cobb angle, sagittal and coronal balance, distal adjacent disc angle and lowest fused vertebral tilt were documented at all time-points. Choice of fusion levels is described. Not every vertebra was instrumented with pedicle screws. The implant density was average one pedicle screw per vertebra or 50 %. Derotation and translation of apical vertebrae on the concave side were performed for correction. The overall outcome and the outcome of different curve types were analyzed statistically. RESULTS: Lowest instrumented vertebra (LIV) was distal end vertebra in two-thirds of the patients and was one below distal end vertebra in one-third of the patients. The main thoracic curve correction was 63 %, from 58° ± 12° preoperative to 21° ± 9° at 6 weeks. The Cobb angle was 23° ± 10° at 2 years and 26° ± 10° at 10 years. The apical vertebral rotation improved 35 %, the non-instrumented lumbar curves improved 47 %, the distal adjacent disc angle decreased from 6° ± 3° preoperatively to -2° ± 4° postoperatively and the last instrumented vertebral tilt decreased from 23° ± 8° preoperatively to 5° ± 5° postoperatively. All these parameters remained stable up to 10-year follow-up. The scoliosis correction was not associated with any change in the preoperative thoracic kyphosis and lumbar lordosis. The % FVC remained unchanged with 74 ± 21 % preoperatively to 74 ± 11 % at 2 years and 75 ± 10 % at 10 years. The SRS-24 score was 93 ± 18 points at 2 years and 95 ± 22 points at 10 years. There were no neurological complications, no pedicle screw-related complications. CONCLUSION: Posterior correction of thoracic AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. An implant density of 50 % is sufficient to achieve these results. LIV can be the distal end vertebra or one below the distal end vertebra depending on the position of the distal end vertebra to the centre sacral line. The preoperative pulmonary function does not change on long term.

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PURPOSE: The SRS-24 questionnaire was originally validated using methods of classical test theory, but internal construct validity has never been shown. Internal construct validity, i.e. unidimensionality and linearity, is a fundamental arithmetic requirement and needs to be shown for a scale for summating any set of Likert-type items. Here, internal construct validity of the SRS-24 questionnaire in adolescent idiopathic scoliosis (AIS) patients is analyzed. METHODS: 232 SRS-24 questionnaires distributed to 116 patients with AIS pre-operatively and at postoperative follow-up were analyzed. 103 patients were females; the average age was 16.5 ± 7.1 years. The questionnaires were subjected to Rasch analysis using the RUMM2020 software package. RESULTS: All seven domains of the SRS-24 showed misfit to the Rasch model, and three of seven were unidimensional. Unidimensionality and linearity could only be achieved for an aggregate score by separating pre- and postoperative items and omitting items which caused model misfit. Reducing the questionnaire to six pre-operative items (p = 0.098; 2.25% t tests) and five postoperative items (p = 0.267; 3.70% t tests) yields model fit and unidimensionality for both summated scores. The person-separation indices (PSI) were 0.67 and 0.69, respectively, for the pre- and postoperative patients. CONCLUSIONS: The SRS-24 score is a non-linear and multidimensional construct. Adding the items into a single value is therefore not supported and invalid in principle. Making profound changes to the questionnaire yields a score which fulfills the properties of internal construct validity and supports its use a change score for outcome measurement.

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INTRODUCTION: This is a prospective study of adolescent patients in whom idiopathic thoracic scoliosis was corrected by short anterior fusion through a mini-open thoracotomy approach. Clinical, radiological and pulmonary function results of minimal 2-year (2-6) follow-up are presented. MATERIALS AND METHODS: Consecutive 62 patients with Lenke 1 and 2 curves, having main thoracic scoliosis of up to 75°, were prospectively included. The shoulder imbalance in Lenke 2 patients was less than 20 mm. Thoracic scoliosis was corrected by short anterior fusion. The thoracic spine was exposed by an 8-cm mini-open thoracotomy incision. The operation technique and choosing of fusion levels are thoroughly described. Complete 360° discectomies and convex side vertebral endplates osteotomies are essential for deformity corrections with short fusions. Single-rod 5.5-mm titanium implants were used. The age at the time of operation was mean 15.2 years; 56 patients had a single thoracic curve and 6 patients had a double thoracic curve. There were almost equal numbers of patients with lumbar modifier A, B or C. The average length of fusion was 5.5 (4-7) vertebrae. The average length of fusion was 3.5 (2-6) vertebrae shorter than the average curve length. RESULTS: The instrumented thoracic curves improved by 58.3% at 6 weeks and 56.3% at the last follow-up. Apex thoracic vertebral rotation improved by 73.78% at 6 weeks and 76.24% at the last follow-up. The non-instrumented upper thoracic curve improved by 25% in double thoracic scoliosis, where the mid-thoracic curve was selectively fused, and the non-instrumented lumbar curves improved by 33.9% at the last follow-up. The radiological changes from 6 weeks to the last follow-up were statistically not significant. The clinical rib hump improved by 54% at the last follow-up. There were no significant changes in the pulmonary function. FVC% was 81.04% preoperatively, 76.41% at 6 months and 80.38% at the 2-year follow-up. The results of SRS 24 questionnaire improved from a total of 61.40 points preoperatively to 100.50 points at 6 months and 98.62 points at the 2-year follow-up. There were no neurological or thoracotomy related complications, no pseudarthrosis, no implant pullout or breakage. CONCLUSION: A good deformity correction without loss of correction or adding on, a good cosmetic result and good patient's satisfaction were achieved through shorter than end-to-end thoracic fusions. The radiological residual deformity is acceptable. Anterior correction of thoracic scoliosis with a short spinal fusion is recommended to keep the large part of the spine mobile. A very short fusion, small thoracotomy incision, low-profile implants and complete closure of parietal pleura are keys to prevent reduction in postoperative lung function.

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OBJECTIVE: The description of the operation technique and retrospective review of 15 consecutive patients who were treated by posterior sacral dome resection and single-stage reduction with pedicle screw fixation for high-grade, high-dysplastic spondylolisthesis. MATERIALS AND METHODS: All the patients had high-grade, high-dysplastic spondylolisthesis L5 and were treated by posterior sacral dome resection and posterior single-stage reduction from L4-S1. The average age at the time of surgery was 17.3 (11-28) years. The average follow-up time is 5.5 (2-11.6) years. Clinical and radiological data were retrospectively reviewed. RESULTS: Spondylolisthesis was reduced from average 99% preoperative to 29% at the last follow-up. L5 incidence improved from 74° to 56°, the lumbosacral angle improved from 15° kyphosis to 6° lordosis, lumbar lordosis decreased from 69° to 53° from preoperative to the last follow-up. While pelvic incidence of 77° remained unchanged, sacral slope decreased from 51° to 46° and pelvic tilt increased from 25° to 30°. Clinical outcome was subjectively rated to be much better than before surgery by 14 out of 15 patients. Four out of 15 patients had temporary sensory impairment of the L5 nerve root which resolved completely within 12 weeks. There were no permanent neurological complications or no pseudarthrosis. CONCLUSION: The sacral dome resection is a shortening osteotomy of the lumbosacral spine which allows a single-stage reduction of L5 without lengthening of lumbosacral region in high-grade spondylolisthesis, which helps to avoid neurological complications. This is a safe surgical technique resulting in a good multidimensional deformity correction and restoration of spino-pelvic alignment towards normal values with a satisfactory clinical outcome.

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Isthmic spondylolisthesis is a common cause of low back pain in children. It is associated with a defect in the pars interarticularis of the vertebra. The treatment depends on the clinical course and degree of spondylolisthesis. Low-grade isthmic spondylolisthesis usually shows a benign course without significant progression and therefore, conservative treatment is advised. Although isthmic pars defect can heal, initial existing degree of slippage persists. A complete reversion of deformity was never described yet. We present the case of a 7½-year-old girl with symptomatic grade 2 isthmic spondylolisthesis according to the Meyerding classification. Without any specific therapy, there was a radiologically documented near total reversion of slippage and total relief of clinical symptoms during 8 years of follow-up. Computed tomography scan after this period showed persisting pars interarticularis defect without signs of healing. This case report indicates that during growth, spontaneous reversion of vertebral slip in isthmic spondylolisthesis can occur, even without healing of the pars defect.

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