Nonunion at the lumbosacral junction is a classic complication of long construct and deformity corrections. Iliac fixations have been extensively studied in the literature and have demonstrated superior biomechanical proprieties and lower complication rates. S2 alar iliac screws address the drawbacks of classical iliac screws but demonstrate similar biomechanical advantage. The main aim of this paper was to describe the S1 alar iliac (S1AI) screw fixation technique while evaluating our early results. S1AI screw fixation technique has the advantage of being able to achieve pelvic fixation without dissection to the S2 pedicle entry and is therefore a viable option for salvage of a failed S1 promontory screw.
Congenital Abnormalities ; Lumbosacral Region ; Pseudarthrosis

Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging problems in pediatric orthopaedics. The treatment goals are osteosynthesis, stabilization of the ankle mortise by fibular stabilization, and lower limb-length equalization. Each of these goals is difficult to accomplish but regardless of the surgical options, the basic biological considerations are the same: pseudarthrosis resection, biological bone bridging of the defect by stable fixation, and the correction of any angular deformity. The Ilizarov method is certainly valuable for the treatment of CPT because it can address not only pseudarthrosis but also all complex deformities associated with this condition. Leg-length discrepancy can be managed by proximal tibial lengthening using distraction osteogenesis combined with or without contralateral epiphysiodesis. However, treatment of CPT is fraught with complications due to the complex nature of the disease, and failure is common. Residual challenges, such as refracture, growth disturbance, and poor foot and ankle function with stiffness, are frequent and perplexing. Refracture is the most common and serious complication after primary healing and might result in the re-establishment of pseudarthrosis. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed. This review describes a multi-targeted approach for tackling these challenges, which utilizes the Ilizarov technique in atrophic-type CPT.
Humans ; *Ilizarov Technique/adverse effects ; Pseudarthrosis/*congenital/*surgery ; Tibia/*surgery

OBJECTIVE: Iliac screw fixation has been used to prevent premature loosening of sacral fixation and to provide more rigid fixation of the sacropelvic unit. We describe our technique for iliac screw placement and review our experience with this technique. METHODS: Thirteen consecutive patients who underwent spinopelvic fixation using iliac screws were enrolled. The indications for spinopelvic fixation included long segment fusions for spinal deformity and post-operative flat-back syndrome, symptomatic pseudoarthrosis of previous lumbosacral fusions, high-grade lumbosacral spondylolisthesis, lumbosacral tumors, and sacral fractures. Radiographic outcomes were assessed using plain radiographs, and computed tomographic scans. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and questionnaire about buttock pain. RESULTS: The median follow-up period was 33 months (range, 13-54 months). Radiographic fusion across the lumbosacral junction was obtained in all 13 patients. The average pre- and post-operative ODI scores were 40.0 and 17.5, respectively. The questionnaire for buttock pain revealed the following: 9 patients (69%) perceived improvement; 3 patients (23%) reported no change; and 1 patient (7.6%) had aggravation of pain. Two patients complained of prominence of the iliac hardware. The complications included one violation of the greater sciatic notch and one deep wound infection. CONCLUSION: Iliac screw fixation is a safe and valuable technique that provides added structural support to S1 screws in long-segment spinal fusions. Iliac screw fixation is an extensive surgical procedure with potential complications, but high success rates can be achieved when it is performed systematically and in appropriately selected patients.
Buttocks ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Surveys and Questionnaires ; Spinal Fusion ; Spondylolisthesis ; Wound Infection

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the radiographic and clinical results of two-level discectomies and fusion with plating and a singlelevel corpectomy with plating. SUMMARY OF LITERATURE REVIEW: Previous studies of multisegment fusion have shown decreased fusion rates correlating with the number of increasing levels, and the use of anterior plate in multilevel fusions may be warranted because of the increased pseudoarthrosis rates. MATERIALS AND METHODS: A total 30 consecutive patients operated at our institutions between Oct. 1995 and Mar. 2000 were entered into this study. Twenty patients with cervical spondylosis had performed two-level discectomies with tricortical bone grafts and plating, and ten patients with cervical myelopathy had a single-level corpectomy with plating. Follow up averaged 2.4 years, radiographic and clinical follow up evaluation was performed. We assessed the radiologic value by postoperative and follow-up sagittal radiograms at monthly intervals until fusion was judged to be solid, and the clinical evaluation by Odom's criteria. RESULTS: Comparing the radiographic data between the two groups of patients, the values were not different. Of the thirty patients, no non-unions occurred in all patients. The average amount of graft collapse for patients with single-level corpectomy with plating or a two-level discectomy with plating was less than 1 mm for both groups. And, the average amount of kyphotic deformity was less than 1 degrees for both groups. The clinical results of the operations graded by Odom's criteria are no statistical significance between the two groups. (p < 0.9, chi test) CONCLUSION: There is no significant statistical differences for two-level discectomies with plating and a single-level corpectomy with plating in fusion rate and clinical results, and each methods can be used a viable alternative procedure by anatomical structure that were primarily causing the neural impingement with more reliable fusion rates.
Congenital Abnormalities ; Diskectomy* ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Retrospective Studies ; Spinal Cord Diseases ; Spondylosis ; Transplants

BACKGROUND:Lumbar spine fractures treated conservatively or operatively may result in severe kyphotic deformity. Reliable operation plan should be made to prevent the development of delayed kyphosis in unstable lumbar spine fracture. STUDY DESIGN: Between September 1995 and March 1997, twelve cases with highly unstable lumbar spine fractures (7 according to'Load-sharing classification score') or fracture-dislocations were operated with combined retroperitoneal and posterior approach. The patients underwent anterior corpectomy, interbody fusion and short segment fixation with posterior transpedicular screws(1 level above and 1 level below). All patients were operated on the same day except one case. The patients were followed-up at least 12 months and mean follow-up period was 17.2 months after operation. The kyphotic angle was measured by Salter's method preoperative, immediate postoperative and at 12 months. RESULTS: There were 9 cases of burst fractures and 3 cases of fracture-dislocations. The mean kyphotic angle was 24degrees preoperatively, -5degrees postoperatively and -2degrees at 12 months follow-up. This means the patients regained normal lumbar lordosis after the operation and maintained on long term follow-up. There was no case of pseudoarthrosis or delayed kyphosis development during follow-up period. CONCLUSIONS: Highly unstable lumbar spine fracture with high load-sharing classification score could be treated to achieve normal lumbar lordosis immediate postoperatively and prevent kyphotic deformity on long-term follow-up evaluation with combined approach.
Animals ; Classification ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Pseudarthrosis ; Spine*

The indications for surgical treatment of spondylolisthesis are as follows:pain unrelieved by conservative treatment. Persistent neurologic signs. Progression of the slip or slip greater than 50 per cent. Postural deformity or walking difficulty due to tight hamstring muscles. The goal of operation for spondylolisthesis is to relieve radiculopathy and low back pain, and to prevent further progression of the slip through decompression of neural elements and fusion for pseudoarthrosis. The authors performed the posterior lumbar interbody fusion using Threaded Fusion Cage(TFC) on 23 patients with spondylolisthesis. All patients have been followed for 3 to 12 months. We then studied the clinical and radiological outcomes of these patients and verified the relationship between clinical outcomes and radiological findings. Summaries of the results are as followings. 1) Successful bone fusion was achieved in 20 out of 23 cases(87%). 2) Neurological signs were improved in 20 out of 23 cases(87%). 3) The majority of cases which demonstrated radiologic bone fusion also showed clinical improvement. Posterior lumbar interbody fusion using TFC was useful in the treatment of mild degree spondylolisthesis.
Congenital Abnormalities ; Decompression ; Humans ; Low Back Pain ; Muscles ; Neurologic Manifestations ; Pseudarthrosis ; Radiculopathy ; Spondylolisthesis* ; Walking

Nine scaphoid non-unions, which were treated by through curettage of the scar tissue on pseudarthrosis, iliac bone grafts between the fragments and Herbert screws fixation, were analysed. The average follow up period from operation was 16.9 months. The interval between the fracture and the time of the operation ranged from 10 months to 48 months(average 21.6 months). Average union time was 14 weeks after operation. The initial radiologic cystic changes disappeared and overall clinical results were improved. Mean postoperative range of motion of the wrist was flexion 55 and extension 45°. Three of them had DISI deformity preoperatively which their scapholunate angles (mean 104°) has been corrected after reduction (mean 75°). In one case among three DISI deformities, partial radial styloidectomy and triscaphe fusion were added (to bone graft and Herbert screw fixation). A case of incorrect positioning of the screw and a case of neuroma were complicated. Treatment of scaphoid nonunion with curettage of the scar tissue and iliac bone graft and Herbert screw fixation seems to be encouraging to regain the normal anatomy of scaphoid and function of the wrist.
Cicatrix ; Congenital Abnormalities ; Curettage ; Follow-Up Studies ; Neuroma ; Pseudarthrosis ; Range of Motion, Articular ; Transplants ; Wrist

Free vascularized fibula is often used in orthopaedic reconstructive surgery because the fibula is a straight cortical bone, long enough, and has a long vascular pedicle. But morbidity is occurred at the donor site which may cause problems at the ankle in children. We reviewed 10 causes who had free vascularized fibula transfer at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from January 1984 to June 1989. This study is attempted to evaluat the effects of fibular defect on the ankle in children and the results of treatment. Free vascularized fibula transfer was done in 5 cases due to ossifying fibroma, 3 cases due to nonunion of fracture and 2 cases due to congenital pseudoarthrosis. The average valgus deformity was 3 degrees in 2 cases in which distal tibiofibular fixation was done with one screw and 6 degrees in 8 cases in in which distal tibiofibular fixation was not done. Three cases had severe valgus deformity and secondary operation was done. The attended type of operation was distal tibiofibular fusion in 3 cases. The valgus deformity was changed after distal tibiofibular fusion from 4 degrees to 3 degrees in 3 cases. The size of fibular defect did not effect on the degree of valgus deformity of the ankle. In conclusion, fibular defect can cause valgus deformity of the ankle in children and early distal tibiofibular fusion is recommended to prevent valgus deformity of the ankle in growing child who as defect on fibular.
Ankle ; Child ; Congenital Abnormalities ; Fibroma, Ossifying ; Fibula ; Humans ; Pseudarthrosis ; Tissue Donors

Refractory deformity in ankylosing spondylitis is caused by loss of normal lordotic curvature in lumbar spine. For the correction of deformity, monosegmental osteotomy, intracorporal decancellation and multisegmental osteotomy are used. Among them, multisegmental osteotomy is reported to be safe because of its small correction amount at each level. Since 1989, authors treated 5 cases of ankylosing spondylitis with severe kyphotic deformity by multisegmental osteotomy and transpedicular instrumentation. All were young males between 22 and 35 years of age. Preoperative kyphotic deformity was 80°, 105°, 72°, 35°, 55° (Av. 70°) and amount of correction was 55°, 105°, 72°, 20°, 40° (Av. 58°) respectively. Levels for osteotony were 4 to 8 segments and correction at a level was 5° to 13° (Av. 8.3°). Normal standing upright posture and vision for straight forward were obtained in all. Instrumentation was Zielke in three Cotrel-Dubousset in two. One case of Zielke instrumentation showed rod failure. However, all showed solid bony union without any loss of correction or pseudoarthrosis. From the above experience, multisegmental osteotomy for the treatment of kyphotic deformity in ankylosing spondylitis was believed to be a safe and effective method of treatment.
Congenital Abnormalities ; Humans ; Male ; Methods ; Osteotomy ; Posture ; Pseudarthrosis ; Spine ; Spondylitis, Ankylosing

A total of 132 cases of structural scoliosis have been followed since Jan. 1963 up to Dec. 1976 at the Hanyang University Hospital. The present paper classified scoliosis according to the etiology and analyzed curve patterns and spinal deformties such as rotation and wedging. Various kinds of treatment were done and these included Milwaukee brace, posterior spinal fusion with or without Harrington instrumentation. The end results of these treatment were also analyzed. The results concluded from the present studies were as follows: 1. Poliomyelitis was the most common cause of structural scoliosis. Of 132 cases of scoliosis, paralytic scoliosis was 48.5% while idiopathic scoliosis was 31.1% and congenital scoliosis 9.8%. 2. In paralytic scoliosis lumbar curves were the most common pattern and thoracic and thoracolumbar curves were the next. 3. In idiopathic scoliosis, the most common pattern was the right thoracic. 4. Very severe curves over 80° were more frequent in paralytic than in idiopathic scoliosis, showing the percentage of 20.3% in paralytic scoliosis and 10.3% in idiopathic scoliosis respectively. 5. The number of vertebrae involved in primary curve was approximately the same in both paralytic and idiopathic scoliosis. 6. In paralytic scoliosis, as the curves progressed, rotation of vertebrae became more marked in lumbar curve than in thoracic curve, while wedging deformity was more severe in thoracic curve than in Jumbar curve. 7. The tendency of the rotation and wedging in thoracic and lumbar curve was the same in both idiopathic scoliosis and paralytic scoliosis. When the degree of curves was the same, rotation and wedging were slightly more severe in idiopathic than in paralytic scoliosis. 8. In congenital scoliosis hemivertebrae were the most common anomaly and the majority of congenital anomalies were located at lumbar region. 9. Treated with Milwaukee brace, 22.1% of original curve angle was corrected in idiopathic coliosis, 9.8% in paralytic scoliosis, and 7.3% in congenital scoliosis, respectively. The Milwaukee brace was effective in thoracic and thoracolumbar curves but not in lumbar curves. 10. In paralytic scoliosis treated with posterior spinal fusion without Harrington instrumentation, the final degree was 43.2 and the correction loss was 12.6% but with both posterior fusion and Harrington instrumentation, the final degree was 50.2 and the correction loss was 6.8%. 11. There were 2 cases of complication after posterior spinal fusion without Harrington instrumentation. One was pseudarthrosis and the other was bending of graft with some loss of correction. One case of complication occured after posterior spinal fusion with Harrington instrumentation. It was a case of displacement of distraction hook on the rod.
Braces ; Clinical Study ; Congenital Abnormalities ; Lumbosacral Region ; Poliomyelitis ; Pseudarthrosis ; Scoliosis ; Spinal Fusion ; Spine ; Transplants