From Looking at the Floor to Looking Forward: A Case of Hyperkyphotic Spine in an Ankylosing Spondylitis Patient.

Ankylosing spondylitis (AS) is a chronic inflammatory disorder characterized by progressive spinal stiffness and deformity, primarily affecting the sacroiliac joints, spine, and pelvis. In advanced cases, untreated AS can lead to severe kyphosis, resulting in debilitating functional impairment and a significantly reduced quality of life. We present a case of a patient with a fixed thoracolumbar kyphotic deformity that severely affected his daily function. He underwent an L1 and L4 pedicle subtraction osteotomy (PSO) and posterior spinal instrumentation. This case highlights the challenges associated with correcting rigid spinal deformities in AS patients, where surgical intervention is often the only option to restore function and quality of life. Despite the high risk of complications, advancements in surgical techniques and implants have improved outcomes even in the most complex cases. Detailed preoperative planning, precise surgical execution, and cautious postoperative management are crucial for successful outcomes in such high-risk procedures.

Early Occipitocervical Fusion Surgery in a Rare Clinical Encounter of Non-traumatic Atlantooccipital Subluxation (AOS) in Down Syndrome (Trisomy 21).

Subluxation of the atlantooccipital joint in patients with underlying Down syndrome is an extremely rare orthopedic condition. The condition can pose life-threatening risks if not promptly diagnosed and treated in the early stage. Yet, there have been documented cases of survival following atlantooccipital subluxation or dislocation. Atlantooccipital subluxation (AOS) is usually identified during screening in children with Down syndrome for atlantoaxial subluxation (AAS). Therefore, careful evaluation of the atlantooccipital joint from radiographs is also essential. It is crucial to emphasize the clinical significance of AOS. Here the authors present the case of a fifteen-year-old girl with underlying Down syndrome (trisomy 21) who survived a sudden onset of non-traumatic atlantooccipital subluxation with spinal cord compression. There are only a few cases were reported in patients with Down syndrome (trisomy 21) and only two cases with surgically treated atlantooccipital (C0C1) subluxation have been reported. This case is of particular interest as it represents the first reported case of atlantooccipital (C0C1) subluxation with spinal cord compression in Down syndrome that underwent occipitocervical fusion surgery during the acute presentation, resulting in significant neurological recovery. Her neurology symptoms and physical functions showed remarkable improvement post-surgery, and she is doing well at the one-year follow-up in the clinic. Early surgery during acute presentation in this case resulted in good surgical outcomes and improved patient quality of life.

Four-Year Outcomes of Corrective Surgery With Anterior and Posterior Instrumentation Combined With Kyphectomy for a Patient With Congenital Kyphoscoliosis and Underlying Myelomeningocele.

Patients with myelomeningocele associated with severe kyphoscoliosis usually presented with rigid and angulated gibbus at their back. The condition causes this group of patients to face difficulties in their daily activities, especially in sitting and lying in supine positions. They are also prone to have a pressure sore over the gibbus and encounter the risk of infection. Here the authors would present a case of a four-year-old girl with underlying myelomeningocele who was diagnosed with worsening kyphoscoliosis along her growth. Her whole spine x-ray radiograph revealed a kyphosis angle of 80° between the T11 and L4 levels. The patient underwent a deformity corrective surgery with total kyphectomy in a combination of anterior and posterior spinal instrumentation. In the present case, we were able to obtain sufficient correction of the spinal kyphotic deformity in that patient in a single-stage surgery with satisfactory surgical outcomes at a four years follow-up.

Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: The Treatment Algorithm and Outcome.

Introduction Managing patients who present with symptoms of cervical myelopathy secondary to cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. Various factors such as the number of levels involved with OPLL, types of OPLL, canal occupying ratio, K-line characteristics, and C2-C7 lordosis angle were found to guide decision-making and surgical approaches in managing this condition. However, no clear treatment algorithm has been published. This study aims to investigate the outcome of the management of cervical OPLL using a treatment algorithm used in a tertiary university hospital. Methods This is a retrospective cross-sectional study. Patients with cervical myelopathy secondary to cervical OPLL who were treated surgically in our center from 2014 to 2020 were included in this study. Demographic data and preoperative parameters that determined the treatment given according to our treatment algorithm were analyzed. Result A total of 24 patients fit the inclusion and exclusion criteria of the study. The mean recovery rate for all groups is 61.8[Formula: see text]21.9% and the mean postoperative neck disability index (NDI) is 17.83[Formula: see text]16.67%. There was a statistically significant difference between preoperative and postoperative Japanese Orthopaedic Association (JOA) scores for both anterior and posterior surgery subgroups. Conclusion We believe that the treatment algorithm used in our center could benefit other surgeons as a guide in managing patients who suffer from cervical myelopathy secondary to cervical OPLL. Further study including newer techniques would increase the surgeon's arsenal in providing the best outcome in managing this condition.

Revision Spinal Surgery for Posterior Migration of Tantalum Cage: Tips and Tricks.

The porous property of tantalum metal coupled with its high frictional surface and biocompatibility has made it an ideal biomaterial to facilitate bony fusion. This biomaterial is not unfamiliar to surgeons as it has been utilized with good clinical outcomes in arthroplasty. The usage of tantalum cages in spine surgery has gained traction. Complications resulting from the use of tantalum cage in lumbar fusion surgery were rarely reported. Here the authors would present a case of revision spinal surgery where the tantalum cage underwent migration from the previous posterior lumbar interbody fusion surgery. We further discuss ways to prevent such complications, precautions, tips, and tricks that could help other surgeons while dealing with this complication.