Computer-assisted hemivertebral resection for congenital spinal deformity

No studies have reported on osteotomies utilizing a navigation system in congenital scoliosis surgery. This study aimed to evaluate the surgical outcomes of eight patients with congenital scoliosis or kyphoscoliosis due to hemivertebrae treated by computer-assisted hemivertebral resection using only a posterior approach. Eight consecutive patients (two scoliotics and six kyphoscoliotics) managed by computer-assisted hemivertebral resection using only a posterior approach with transpedicular instrumentation were investigated retrospectively. A CT-based navigation system was used to confirm the positions of the vertebra, spinal cord and aorta in real-time when we inserted a pedicle screw and conducted the osteotomy. The mean patient age at surgery was 18 years (range 11-41 years). The mean follow-up was 46 months (range 18-84 months). Before surgery, the mean kyphotic curve was 55.8A degrees (range 26-83A degrees), and the mean scoliotic curve was 50.0A degrees (range 36-62A degrees). At the final follow-up period, the curves averaged 23.2A degrees (range 15-40A degrees) and 31.6A degrees (range 21-44A degrees), respectively, yielding kyphotic angle corrections of 32.7A degrees (range 11-58A degrees) and Cobb angle correction rates of 36.8% (range 24.1-48.3%). A total of 72 pedicle screws were inserted with the navigation system, and two screws revealed a perforating pedicle. No neurovascular complications occurred. The perforation rate was 2.8%. Hemivertebral resection via a single posterior approach is less invasive than combined anterior and posterior approaches; however, this procedure increases the risk of spinal cord and vascular injuries. Computer-assisted hemivertebral resection enables safe and accurate performance of a hemivertebral resection via a single posterior approach.ArticleJOURNAL OF ORTHOPAEDIC SCIENCE. 16(5):503-509 (2011)journal articl

Hodgkin's disease of the thoracic vertebrae

BACKGROUND CONTEXT: Hodgkin's disease rarely occurs in the spine, which is usually a setting for the advanced form of the disease. PURPOSE: To describe an unusual case of isolated, primary spinal Hodgkin's disease and to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the thoracic spine. STUDY DESIGN/SETTING: A case report of a 28-year-old woman who presented with back pain and progressive weakness in the lower extremities as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae. METHODS: We report a new case of spinal cord compression resulting from Hodgkin's disease of the thoracic vertebrae. Decompression surgery was performed in the patient, followed by antibiotic treatment. RESULTS: Antibiotic therapy temporarily improved inflammation and fever. However, magnetic resonance imaging (MRI) evaluation showed that the inflammatory reaction in the lesion was not completely resolved. The disease progressed and later investigations revealed Hodgkin's disease, which improved with a course of chemotherapy and radiation. CONCLUSIONS: Hodgkin's disease should be considered in the differential diagnosis of spinal neoplastic lesions with clinical features similar to spondylitis. Because MRI evaluation showed that the vertebral disc was maintained in this case, the presence of a tumor rather than inflammation should have been suspected.ArticleSPINE JOURNAL. 13(8):E59-E63 (2013)journal articl