This retrospective study aimed to investigate the safety and accuracy of applying 3D printing surgical guide templates in osteotomy of ankylosing spondylitis cases. Between June 2015 and October 2018, 16 patients with ankylosing spondylitis were treated in our hospital: 11 males and 5 females; ranging in age from 19 to 42 years (average 28.0±6.6 years). Before the operation, a CT scan of the thoracolumbar vertebrae was performed, and thus designed the osteotomy segment and osteotomy angle, established 3D models, and printed osteotomy guide templates. The perioperative period and imaging indexes were recorded to evaluate the curative effect. After the surgery, no complications were found. Operation time: 256.3±35.4 min; Blood loss: 2096.9± 350.1ml; The duration of hospitalization was 10.4±2.1 days. There was no significant difference between the vertebral osteotomy angle measured 1 month after surgery and the preoperative plan at the last follow-up (P > 0.05). TLK, LL, SVA, and CBVA were significantly improved after surgery (p < 0.05). Patients were followed up for 12 to 36 months, with an average of 24.7(±7.8) months. There were no special cases except one case of upper fixed vertebral compression fracture which was conservatively cured. The patients maintained good osteotomy and orthosis, with healed osteotomy surface. No adverse events such as broken nails or rods were observed. This study proved that the 3D-printed surgical guide is safe, feasible, and accurate in the orthopedic osteotomy of ankylosing spondylitis.

Background:Pedicle screw placement during deformity correction surgeries for complex kyphoscoliosis is challenging, due to the grossly altered anatomy and distorted screw placement landmarks.Screw misplacement leads to devastating complications like vascular injury and neurological deficit. Assistive technologies like intraoperative navigation or robotic guidance which can improve screw placement accuracy are costly and not widely available in lower-middle-income countries(LMIC). Methods:Patient-specific 3D-printed models were used pre-operatively as surgical simulators to execute pedicle screw placement for twenty-three cases(15 males, 8 females) of complex kyphoscoliosis.A computed tomography(CT) analysis of the model was performed to assess pedicle screw position and make suitable modifications in trajectories prior to the actual surgery. During surgery, pedicle screws were placed using free-hand technique according to planned trajectories.Pedicle screw placement was assessed on a post-operative CT using Gertzbein-Robbins(GR) classification.Clinical and neurological outcomes were analyzed using VAS and ASIA scores.Cost-effectiveness was analyzed by comparison with a historic cohort of similar cases operated using intraoperative-navigation.Results:The mean follow-up was 14.4 +/- 1.4 (12-18) months.The mean operative time and intraoperative blood loss were, 262.8 +/- 64.3 (180 - 380)min and 407.8 +/- 144.2 (250 - 750)ml, respectively.The screws were intra-pedicular(Gr A) in 92.5%(298/322) pedicles while, 6.2%(20/322) pedicles showed non-critical breaches.No critical breaches were observed.There were no neurological deficits at follow-up. The mean additional cost incurred per surgery for the use of navigation was 880 +/- 299 USD (600 - 1200 USD).Conclusion: 3D-printed patient-specific spine models are a very effective low-cost alternative to navigation and robotics for performing complex spine deformity correction surgeries in LMIC countries.

Introduction:
Mehta casting was described in 2005 as a non-invasive treatment method for early-onset scoliosis before the age of 5 years. The aim of Mehta casting is to delay or hopefully avoid the need for surgery. This method includes serial casting of the patients after applying axial traction, using a specially designed table that secures the head and pelvis giving free access for the cast to be applied circumferentially. Unfortunately, this Many hospitals in developing countries lack this spica table for small children.
METHOD:
In our institute we were faced by the limited resources to have the original Mehta casting table. Hence, we invented a table that could achieve the Mehta table principle but much less expensive. This table consists of a parallel metal frame then by the help of gauze we make one longitudinal and two horizontal ribbons like bands to support the head, body and arms of small children leaving legs free for traction. This allow 360 degrees access for plaster cast to be applied and correction to be done also the gauze ribbons are easy cut after placement of the cast.
24 cases of early onset scoliosis; 20 cases with idiopathic infantile scoliosis ; age (2-6 years) and 4 with congenital scoliosis. the average curve Cobb angle were 20-45 degree. case was applied for 2 months and changed after a one month rest period.
results: Cobb angle reduced after the first cast average 5-20 degrees.
conclusion: out modification can effectively allow the principles of original Mehta table

Introduction: Osteotomy and internal fixation in open surgery are used to treat spinal kyphosis, but these surgeries may lead to significant morbidity because of extensive dissection and massive blood loss. Our team has designed a minimally invasive method combining mini-incision osteotomy of pedicle subtraction osteotomy (PSO) or bone-disc-bone osteotomy (BDBO) with freehand minimally invasive pedicle screw fixation (freehand MIPS) for the treatment of spinal kyphosis deformity. In this study, we report the 2-year follow-up data of thirteen cases.
Methods: Thirteen patients diagnosed with spinal kyphosis deformity and sagittal unbalance of SVA > 5cm and apical vertebrae from T10 to L5 were recruited, and received freehand MIPS combined with mini-incision osteotomy. Baseline information including age, gender, diagnosis, underlying disease, and operation history were collected. Preoperative and postoperative imaging data (X-ray, 3D-CT, MRI) and clinical data were also collected.
Results: Clinical follow-up was available for thirteen patients for at least two years. Spinal kyphosis deformities were dramatically corrected, and the sagittal spinal-pelvic parameters remained unchanged during the follow-ups. Back VAS and ODI significantly improved after surgery. 3 patients presented with ASIA D, and 10 presented with ASIA E before surgery. All 13 patients reached ASIA E at the 3-month follow-up. Although 3 cases of BDBO had transient decline of muscle strength immediately after surgery, neurologic deficit improved from ASIA C to E, and they regained ambulatory ability and urinary sphincter function during 3 months.
Conclusions: Freehand MIPS combined with mini-incision osteotomy is a good choice of surgical treatment for spinal kyphosis deformity.

Introduction:
Brace treatment remains proven and effective for growing AIS. The gold standard for surgery is dorsal correction and fusion. Today VBT is actively introduced, but it is associated with complications and reoperations up to 60%.
Materials and methods:
The prospective study included 56 patients 16-22 yy with anterior correction of AIS in 2019-2022 yy. The ASC differs from VBT by the implantation of 2 screws into the vertebral body, the deformity stabilization with 2 cords and performing deformity apex nucleotomy for derotation. All patients had right-sided Lenke I with preserved mobility according to functional radiographs and Risser 4-5. The m:f=1:4. X-ray, Cobb angle and Risser assessment, MRI, SRS-22, postoperative complications registration performed.
Results:
The results evaluation was 1 year PostOp. The Cobb PreOp was 45.6° (35-57°), and PostOp - 24.7° (12-37°), p<0.05. According to the SRS-22 questionnaire, 49 patients would agree to re-surgical treatment, six found it difficult to answer, one refused. Pneumothorax occurred in 6 patients, chylothorax in 1 patient. The total number of complications was 7 (12.5%). There were no cord breaks, deformity overcorrection, or loss of correction.
Conclusion:
ASC consider to be used after brace treatment in case it failed and allows to eliminate all complications associated with the spine growth which are associated with VBT technology. The authors propose conducting a prospective study with the brace treatment in AIS growing patients and the ASC in patients with Risser 4-5 with maintaining indications for surgical treatment, but minimizing the risks associated with spinal growth.

Introduction: The APC technique actively remodulates the most-wedged vertebra via a compressive force applied on convex side, providing a novel surgical option to the treat EOS patients. The current study extends earlier clinical studies on the APC technique by focusing evaluating the biomechanics using FEA. Methods: 4 patient-specific FEA models were developed to match radiograph data. These pre-op models were then used to simulate the surgical process. Finally, the effect of gravity forces and 1- year spinal growth was simulated. Recorded parameters included Cobb angle, AVT, vertebral wedging and spinal height. Results: The correction in the ratio of convex to concave-side vertebral height for the 3 vertebrae in the tethered area averaged at 3.84% compared to 0.5% in the control vertebrae. Further, on average, results showed a Cobb angle correction was 50% (~30 degrees), a AVT reduction of 46% (2.8 cm) post-surgery. Additionally, at the 12-month follow-up, the same parameters indicated a maintenance of correction for all patient models. Conclusion: The results indicate a significant correction of the vertebral wedging, with the correctional effect being transferred beyond the most-wedged vertebrae. At the macro-level also, the clinical parameters indicated good correction while allowing for spinal growth, comparable to current EOS literature across different techniques.

Our study examines the degree of three-dimensional curve correction achieved through vertebral body tethering (VBT), a surgical technique used to correct adolescent idiopathic scoliosis. The study included 39 patients who underwent treatment with the VBT system between 2020 and 2022. Preoperative and one-month follow-up radiographic parameters were collected according to the SDGS guidelines. Results showed significant improvements in the coronal plane correction of all measured Cobb degrees, as well as derotation in the MT curves. Other statistically significant improvements were observed in apex vertebral translation, clavicle angle, and trunk height. The study suggests that VBT could potentially compete with more established instrumentation techniques.

Adolescent idiopathic scoliosis (AIS) is a complex spinal deformity that can cause significant physical and psychological problems for affected individuals. Three-column fixation is a surgical technique that has been developed to treat severe cases of AIS. This study aims to evaluate the effectiveness and safety of three-column fixation in treating AIS.

During the period February 2009 to December 2022, 117 cases of AIS underwent surgical intervention at NITOR, BSOH, and other private hospitals in Dhaka. Seventy-nine were female, 38 were male, and ages ranged from 14 to 38. The pedicle is a power nucleus of the vertebra and offers a secure grip on all three columns. Pedicle screw instrumentation has the advantages of rigid fixation with improved 3D correction, and it has been accepted as a reliable method with a high margin of safety. So, all cases were corrected by transpedicular screws and rods in a single posterior approach. In every case, fusion was done in selected segments.

The total follow-up time was about thirteen years. All patients were assessed regarding the correction of deformities, cosmesis, and functional outcome. Eighty-one patients had average coronal plane cobb’s angle measuring about 70 degrees pre-operatively and 17.12 degrees immediate postoperative period. Six patients (5.12%) developed neurological deficits. Three were regained completely, and 80 % of patients improved cosmetically.
Overall outcome in the surgical treatment of Scoliosis in terms of cosmesis and patient expectation by transpedicular screws and rod system was satisfactory.

Objectives: The present review aims to compare the outcomes of surgical correction of AIS by posterior instrumentation with all-pedicle screws system (PS) with hybrid fixation using sublaminar elastic bands along with pedicle screws (HG) and establish the effectiveness of the above said hybrid fixation system against all pedicle screw
system.
Method: The study was conducted as per Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) and registered with PROSPERO. This review included studies conducted on patients having AIS and those which compared the use of all pedicle screws fixation system (PS) with hybrid fixation system using sublaminar bands along with pedicle screws (HG).
Results: A statistically significant improvement of the main curve (p = 0.007; SMD (IV, Random) = 0.54; 95% CI [0.15, 0.93]) is noticed in the PS group. There is no significant difference in terms of operative time, blood loss, number of levels fused, secondary curve correction and complication rates between the two groups.PS is seen to provide better results in preoperative hyperkyphosis whereas HG is seen to provide better results in preoperative hypokyphosis. The incidence of distal junctional kyphosis 2 years after surgery is 5% in PS and 1% in the HG group.
Conclusion: Hybrid constructs with pedicle screws and sublaminar bands are a safe option for surgical correction of AIS with reduced incidence of distal junctional kyphosis and complications. They have better deformity correction in sagittal planes as compared to PS group and is more effective in restoring the kyphosis post-operatively.