Hybrid versus total sublaminar wires in patients with spinal muscular atrophy undergoing scoliosis surgery

Background Early versions of spinal muscular atrophy (SMA) scoliosis correction surgery often involved sublaminar devices. Recently, the utilization of pedicle screws has gained much popularity. Pedicle screws are generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit their application in the thoracic spine, resulting in a hybrid construct involving pedicle screws and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis are often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in patients with SMA scoliosis. Methods We retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2017. The radiographic assessments included deformity correction and progressive changes in the major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of construct. Results Thirty-three patients were included in this study. There were 14 and 19 patients in the wiring and hybrid construct groups, respectively. The hybrid construct group demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and a reduced progression of the major curve angle at the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of the apical vertebral rotation angle and the major curve (r = 0.528, p = 0.002). Conclusion This study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation as well as less major curve progression than sublaminar wire instrumentation alone in patients with SMA scoliosis. Level of evidence III

Hybrid versus Total Sublaminar Wires in Patients With Spinal Muscular Atrophy Undergoing Scoliosis Surgery

BackgroundEarly versions of spinal muscular atrophy (SMA) scoliosis correction surgeries often involved sublaminar devices. Recently the utilization of pedicle screw is gaining much popularity. Pedicle screw generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit the application of pedicle screw in the thoracic spine, resulting in a hybrid construct of the pedicle screw and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis is often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcome of using hybrid constructs of the pedicle screw and sublaminar wire and that of sublaminar wire alone in patients with SMA scoliosis.MethodsWe retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2015. The radiographic assessments included the deformity correction and the progressive change of major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of constructs.ResultsThirty-three patients were included in this study. There were 14 and 19 patients in the wiring and the hybrid construct groups, respectively. The hybrid construct demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and reduced the progression of major curve angle after the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of apical vertebral rotation angle and major curve (r = 0.528, p = 0.002).ConclusionThis study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation, as well as less major curve progression in comparison with sublaminar wire in patients with SMA scoliosis.Level of evidence III

Endodontic regenerative treatment for internal radicular resorption using bio-ceramic material, case report

The internal resorption of the internal radicular conduct is a process than can be both physiological or pathological, being the osteoclasts, odontoclasts and dentinoclast responsible for said process. 49-year-old female patient, refers orthodontic treatment at age 20, attends a dental check-up due to pain when chewing. Dental organ (DO) #11 was diagnosed with internal root resorption and symptomatic, suppurative apical periodontitis. Treatment started performing an endodontic access and taking a conductometry reading with an apical foramen locator, using a precision hybrid instrumentation technique and applying hypochlorite irrigation, the intra-canal was medicated with chemically pure calcium hydroxide for 7 days. The canal obturation was repaired infiltrating a bio-ceramic material (BIO-C Sealer) followed by the placement of the single cone using a vertical condensation technique.

The surgical treatment of severe Scheuermann’s kyphosis

Aims To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management. Methods We reviewed 88 consecutive patients with a severe Scheuermann's kyphosis who had undergone posterior spinal fusion with closing wedge osteotomies and hybrid instrumentation. There were 55 males and 33 females with a mean age of 15.9 years (12.0 to 24.7) at the time of surgery. We recorded their demographics, spinopelvic parameters, surgical correction, and perioperative data, and assessed the impact of surgical complications on outcome using the Scoliosis Research Society (SRS)-22 questionnaire. Results The mean follow-up was 8.4 years (2 to 14.9). There were 85 patients (96.6%) with a thoracic deformity. Posterior spinal fusion with closing-wedge osteotomies and hybrid instrumentation was used in 86 patients; two patients underwent combined anterior and posterior spinal fusion. The mean kyphosis was corrected from 94.5° to 47.5° (p < 0.001). Coronal and sagittal balance returned to normal. The rate of complications was 12.5%: there were no neurological deficits, implant failure, or revision surgery. SRS-22 scores improved from a mean 3.6 (1.3 to 4.1) to 4.6 (4.2 to 5.0) at two years (p < 0.001) with a high rate of patient satisfaction. Non-smokers and patients with lower preoperative SRS-22 scores showed greater improvement in their quality of life. Sagittal pelvic balance did not change after correction of the kyphosis and correlated with lumbar lordosis but not with thoracic or thoracolumbar kyphosis. Conclusion Posterior spinal fusion using hybrid instrumentation, closing-wedge osteotomies, and iliac bone grafting achieves satisfactory correction of a severe kyphosis resulting in improvements in physical and mental health and a high degree of patient-reported satisfaction. Cite this article: Bone Joint J 2021;103-B(1):148–156.