Lateral column lengthening (LCL) using a rectangular shape graft for managing symptomatic flexible flatfoot showed acceptable early functional and radiological outcomes.

PURPOSE: We aimed to report the results of performing lateral column lengthening (LCL) using a rectangular-shaped graft to correct the flat foot deformity. METHODS: A total of 28 feet of 19 patients (10 males, 9 females) having an average age of 10 ± 3.2 years who were unresponsive to conservative management underwent flat foot deformity correction through LCL procedure supplemented with rectangular-shaped graft harvested from the fibula. Functional assessment was performed according to the American Orthopedic Foot and Ankle Society (AOFAS) scale. The radiographic assessment consisted of four parameters, Meary's angle in both anteroposterior (AP) and lateral (Lat.) views, calcaneal inclination angle (CIA), and calcaneocuboid angle (CCA). RESULTS: After an average of 30.2 ± 8.1 months, the AOFAS improved significantly from 46.7 ± 10.2 preoperatively to 86.7 ± 9.5 at the last follow up (P < 0.05). All the osteotomies showed healing at an average of 10.3 ± 2.7 weeks. All the radiological parameters showed significant improvement at the last follow up compared to the preoperative measurements, CIA from 6.3 ± 2.8-19.3 ± 3.5, Lat. Meary's angle from 19.3 ± 4.9-5.8 ± 2.5, AP Meary's Angle from 19.3 ± 5.8-6.1 ± 3.1, and CCA from 23.9 ± 8.2-6.8 ± 4.5, (P < 0.05). No pain at the site of the fibular osteotomy was reported in any of the patients. CONCLUSION: Lateral column lengthening using a rectangular graft effectively restores bony alignment with good radiological and clinical results, high patient satisfaction, and acceptable complications.

Understanding the Aorta-Spine Relation in Idiopathic Scoliosis: Value of Noncontrast CT-Derived Curved Coronal Reformats and 3D Volume Images.

BACKGROUND: Investigating axial position and longitudinal bending of the aorta in relation to spine curvature in adolescent idiopathic scoliosis patients could help surgeons in planning of spine surgeries. METHODS: Noncontrast computed tomography (CT) scans of 27 consecutive patients with adolescent idiopathic scoliosis (19 right and 8 left curves) and 16 control subjects were retrospectively reviewed. Using semiautomated software, centerline was drawn along the descending aorta, and curved reformat was generated. Aorta tortuosity index (TI) was calculated as (centerline length/straight line distance) - 1 × 100. The spine centerline was drawn from T1 to L5, and curve index (CI) was similarly calculated. The aorta centerline angle was measured. Apical vertebral-rotation angle and multilevel aorto-vertebral angles were measured on axial CT. Three-dimensional volume-rendered images of the aorta were generated using a manual region grow function. RESULTS: Mean (± standard deviation) Cobb's angle was 63.8 ± 34.6°. The spine CI of patients (9.7 ± 7.11) was significantly higher than controls (0.28 ± 0.22), P = .00001. Aorta TI in scoliosis was significantly higher than controls (6.4 ± 7.2 versus 0.6 ± 0.5, P = .0001). The aorta centerline angle was steeper in scoliosis than controls (140 ± 26.8° versus 170 ± 3.6°). Correlations were excellent between the aorta TI and each of Cobb's angle, spine CI, and vertebral rotation angle (r = 0.851 to 0.867, all P < .001). Aorto-vertebral angles were significantly different between right scoliosis and left scoliosis patients and control groups at T6, T7, T8, L2, and L3 levels. CONCLUSIONS: Aortic curvature increases in proportion to the degree of scoliosis. The aorta follows the concavity of scoliosis in right and left curves. In the axial CT plane, the aorta in both right and left scoliosis is maximally rotated away from its normal position at T7 and is closest to its normal position at T11 to T12. CLINICAL RELEVANCE: Quantitative evaluation of aortic curvature combined with preoperative reconstructed CT images could be beneficial for surgeons in planning of spine surgeries.

Ganz osteotomy for treatment of hip dysplasia through intra-pelvic approach. Early results.

Ganz periacetabular osteotomy (PAO) is a technically demanding surgical procedure. It requires cutting around the acetabulum to mobilize it under fluoro- scopic control. The radiolucent table and good quality imaging are mandatory to perform this osteotomy in a safe way. Modification of Ganz osteotomy was developed a with minimal soft tissue exposure using intra-pelvic approach which allows direct visualization of the quadrilateral plate. The purpose of the present study was to review the early results in the initial group of patients who had this procedure. The Ganz PAO was performed on 8 cases painful dysplastic hips, using the intra-pelvic approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. The acetabular fragment was medialized and redirected anterolaterally then fixed with 3 screws. The pre-operative Harris hip score mean was 66.8 and improved to be 92.7 (p value <0.0005) and this was statistically significant. Radiologically the CEA improved in the pre-operative X-ray from mean of 13.12 degree to 28.37 degrees (p value <0.0005) and this was statistically significant. Painful dysplastic hips should be treated before function becomes seriously impaired. The Ganz osteotomy through an intra-pelvic approach, can be done with minimal exposure to radiation in a relatively short time.

Can polyaryletherketone cage be used to achieve union and maintain correction in anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot?

A structural graft is often used to maintain correction and achieve union after anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot. Autograft, the current gold standard, is limited in availability and configuration and is associated with donor site morbidity in as much as 48%, whereas the alternative allograft carries risks of disease transmission and collapse. Polyaryletherketone cage, with a healing rate similar to that of autograft, high stability, and no donor-site morbidity, has been used in spine surgery. However, its use has not been documented in foot and ankle surgery. We reviewed 15 patients with painful flatfeet after failure of conservative treatment who were treated by anterior calcaneal lengthening osteotomy using polyaryletherketone cage instead of bone graft. Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). The male-female ratio was 1:1.5 (six males, nine females). Mean age at time of surgery was 10.8 ± 1.7 years (range, 8-13.5 years). Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). Nine patients had a unilateral procedure and three had a simultaneous bilateral procedure, for a total of 15 operated feet (seven right and eight left). The paired t-test result was statistically significant in comparison of radiographic measurements at presurgery and postsurgery with P value <0.001. All cases showed full union clinically and radiographically at last follow-ups and no complications occurred. Our data suggest that polyaryletherketone cage may be used as a structural graft option for anterior calcaneal lengthening osteotomy.

Epidemiological Characteristics of Traumatic Spinal Cord Injury (TSCI) in the Middle-East and North-Africa (MENA) Region: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically search the literature and to summarize current evidence pertaining to the epidemiology of SCI in the MENA region incidence, gender, age, type of the injury and etiology of the injury. METHODS: Embase, PubMed, Scopus, Web of Science and EBSCOhost were systematically searched from their dates of inception till July 2017 for English and non-English language articles. Also, regional databases were searched. Data were extracted from eligible articles and pooled under the random effect model using R. References of the included articles were also screened for potentially relevant studies. RESULTS: We identified 29 articles from seven countries in the MENA region (Turkey, Iran, Saudi Arabia, Egypt, Jordan, Kuwait and Qatar). The mean age of the cases at time of injury was 31.32 (95% CI: 28.74-33.91). The random pooled annual incidence of TSCI per million was 23.24 (95% CI: 5.64-49.21). Pooled proportion of male gender was 77% (95% CI 73-80%) of the cases. Complete paraplegia was the most common type of injury. Thoracic level injury predominated. Also, the most commonly affected age group was 20-29 then 30-39. Motor vehicle accidents were found to be the leading cause of injury, then falls, gunshot, violence and sports. Further meta-regression analysis showed no association between age and etiology of the injury. CONCLUSION: This review shows lack of evidence about SCI in most countries of the MENA region. More epidemiological studies are needed.

Preventing Proximal Adjacent Level Kyphosis With Strap Stabilization.

A substantial proportion of patients develop proximal junctional kyphosis following spinal surgery. To combat this postoperative change, several techniques have focused on maintaining the structural integrity of adjacent spinal levels and adapting the proximal end of the fusion construct to accommodate the increased mechanical stressors produced by long spinal fusion. The use of Mersilene tape (Ethicon, Somerville, New Jersey) for spine and orthopedic surgery is well documented, although considerably less is known about its use for preventing proximal junctional kyphosis. This article describes a proposed technique using Mersilene tape to provide a check-rein strap stabilization at the proximal end of fusion constructs. Initial data suggest that use of this technique may prevent formation of proximal junctional kyphosis. [Orthopedics. 2016; 39(4):e794-e799.].