Journal of Spine

The aim of surgical treatment of adolescent idiopathic scoliosis (AIS) is to achieve a balanced spine. Distal addingon is a postoperative phenomenon in AIS, which is characterized by a progressive correction loss. A 13-Year-old girl with AIS who underwent posterior arthrodesis showed aggravation of the disequilibrium under the last instrumented vertebra (LIV) 30 months post operatively and an increase of the lumbar curvature with no evident cause. Extension surgery was made and per operatively we noticed that the distal end of the arthrodesis was disengaged and that the left rod was conflicting with the upper left articular process of L2. Among the causes of adding-on we report in this article a particular etiology that consists in a conflict with the instrumentation material. This conflict has to be looked for postoperatively if an adding-on phenomenon is suspected in addition to a distally protruding rod, and could motivate a CT scan imaging for diagnosis.

Disequilibrium between bone resorption and bone formation may cause osteoporosis that reduces bone integrity and physiological function of skeletal system. Osteoblast and osteoclast genesis are two major of biological events that act in bone turnover and dynamic rate of bone remodeling. Ample evidences have been revealed that RANK-L/ OPG, Wnt and BMP Pathways are crucial pathways involved in osteoporosis. Treatment of osteoporosis is becoming important task in post menopause women and old people. Current treatment strategies with osteoporosis drugs are mainly by inhibiting the bone-resorbtion. However, these synthetic medicines have limitless side effects. Several studies have established the important of a group of small non-coding RNAs (MiRNAs) which involve in pathogenesis osteoporosis, bone remodeling, osteoblast differentiation and osteoclast formation and has consider as a gold biomarker for osteoporosis treatment. The pathogenicity factors of osteoporosis, pathways involved in the disease and potential replacement treatment have been emphasized in this paper.

Objective: Scoliosis with associated intraspinal anomalies may be treated either before the correction of spinal deformities or during the same session. Our study elucidates the impact of the timing of single- or two-stage neurosurgical and deformity treatment of intraspinal pathologies with the outcomes of serious spinal deformities and discusses the preferable method.
Methods: Patients who were operated either concurrently or in two stages, due to intraspinal anomalies associated with rigid spinal deformities, were radiologically and clinically examined. Patients’ ages during the neurosurgical treatment and at the time of deformity treatment, period between two surgeries, follow-up period, clinical and radiological results and encountered complications were recorded.
Results: Nineteen patients (13 females, 6 males) underwent surgery for spinal deformities associated with intraspinal pathologies between 2007 and 2014. Fifteen (78.9%) patients underwent a two-stage surgery and four (21.1%) patients’ concurrent surgeries. Mean age of the patients at the time of intraspinal pathology surgery was 8.6 ± 6.9 years and at posterior spinal fusion (PSF) 13.4 ± 3.9 years. The period between the two surgeries was 54.2 ± 67.5 months on average and the mean follow-up period was 39.8 ± 22.2 months. The anteroposterior Cobb’s angle was measured as 68.2° ± 27.1° preoperatively and 29.1° ± 18.7° at final examination (p=0.00). Visual analog scale score was 8.1 ± 1 preoperatively and 1.1 ± 0.2 at the final follow-up (p=0.00).
Conclusion: The etiology, extent of deformity, curve progression and patient’s age were indicative in the surgical treatment of intraspinal pathologies and spinal curves. Concurrent surgical interventions may be recommended to avoid additional complications and for quicker recovery.