Marco Fava

Background: Sciatic scoliosis is a nonstructural, compensatory spinal deformity secondary to lumbar disc herniation. In adolescents and young adults, sciatic scoliosis is frequently misdiagnosed as adolescent idiopathic scoliosis due to the low prevalence of lumbar disc herniation in this demographic. Early clinical suspicion is essential, as radiographic features, particularly minimal or absent vertebral rotation on standing radiographs, help distinguish sciatic scoliosis from structural curves such as adolescent idiopathic scoliosis. Key differentiating features include painful scoliosis, a highly positive straight leg raise test, and minimal or absent vertebral rotation on standing radiographs. Delayed diagnosis or inappropriate management may result in residual deformity, highlighting the importance of early surgical decompression. Despite recognition for decades, the literature is fragmented, largely composed of case reports, small series, and retrospective studies, with heterogeneous definitions, radiological assessments, and outcome measures. Objective: Provide a comprehensive, up-to-date systematic synthesis of the clinical presentation, radiological characteristics, management strategies, and outcomes of lumbar disc herniation-associated sciatic scoliosis. Methods: Thirteen studies evaluating conventional open discectomy and minimally invasive endoscopic procedures (FEID/PELD) were included. Data on demographics, surgical approach, clinical improvement (VAS, ODI, Macnab), and radiographic correction (Cobb angle, trunk list, sagittal alignment) were extracted and synthesized. Results: Surgical decompression consistently leads to clinical improvement. Trunk list and coronal deformity were rapidly corrected, with resolution rates ≥ 85% within 6 months across most series. Both open and endoscopic approaches were effective, with minimally invasive techniques offering advantages in tissue preservation and recovery. Conclusions: Sciatic Scoliosis is a reversible, nonstructural deformity that responds reliably to surgical decompression. Accurate recognition, particularly in adolescents and young adults, and timely intervention targeting the underlying nerve root compression are critical for optimal outcomes. This review consolidates fragmented evidence, providing a comprehensive synthesis of current knowledge.

Introduction: Currently, static interbody cages are the gold standard for achieving solid arthrodesis in the spine, enhancing segmental stability, obtaining neuroforaminal decompression, and improving as well as maintaining segmental lordosis. It is well known that restoring sagittal balance and segmental lordosis is crucial for long-term outcomes in lumbar spine fusion. For some cases, expandable interbody cages are emerging as an alternative to static cages. This study aims to evaluate the radiographic outcomes and complications of standard open transforaminal lumbar interbody fusion (TLIF). Methods: A standard open TLIF procedure using expandable cages was performed at 1 to 3 levels in 71 patients (129 levels in total), with a follow-up of two years. All patients underwent radiological assessments preoperatively, immediately postoperatively, and at one and two years postoperatively. Radiological evaluation was conducted using standing lateral X-rays. Results: Segmental lordosis (SL) increased significantly from the preoperative value (9.0° ± 3.6°) to 24 months postoperatively (15.4° ± 3.0°), with improvements maintained throughout the 24-month follow-up period (p < 0.001). Similarly, anterior disc height (ADH), posterior disc height (PDH), and foraminal height (FH) each increased significantly from preoperative to immediate postoperative measurements, and these gains were maintained over the two-year follow-up (p < 0.001 each). Lumbar lordosis increased significantly from the preoperative value (41.9° ± 10.5°) to the immediate postoperative period (45.7° ± 10.8°); however, this improvement decreased slightly at the one- and two-year follow-ups. No revisions were required for cage-related complications. One patient experienced a surgical site infection, and two patients had mechanical complications (screw loosening and proximal junctional kyphosis). Conclusions: Expandable interbody cages enable excellent restoration and maintenance of disc height and segmental lordosis in a standard open TLIF procedures at two-year. Achieving these outcomes depends on several factors, including proper preparation of the vertebral endplates, accurate cage placement and expansion, posterior facet osteotomy, and the application of posterior compression prior to final fixation. These steps are essential to fully maximize the potential of expandable cage technology.

Familial dysautonomia (FD) is an inherited severe congenital disease and a rare syndrome associated with progressive neuronal degeneration throughout life. Among its orthopedic conditions, FD patients have an higher incidence of kyphoscoliosis and osteomyelitis. Due to the rarity of FD and the presence of multiple comorbidities, there are currently no established guidelines for the management of vertebral pathologies associated with FD. Hence, this highlights the importance of sharing the case of our patient. The purpose of our study is to report the case of a 45-year-old patient with FD who underwent multiple spinal surgeries at our clinic, to provide possible indications for the most effective management of this rare condition.