Spine deformity
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In recent years, there has been increasing appreciation of the need to treat scoliosis as a three-dimensional deformity. ⋯ The historical low-dose CT data set permitted detailed three-dimensional assessment of the deformity correction that is achieved using thoracoscopic anterior spinal fusion for progressive adolescent idiopathic scoliosis.
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Multicenter Study
Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis-The Pelvis and Other Considerations.
Prospective multicenter database study. ⋯ Level II.
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The aim of this study was to measure contributions of individual vertebra and disc wedging to coronal Cobb angle in the growing scoliotic spine using sequential magnetic resonance imaging (MRI). Clinically, the Cobb angle measures the overall curve in the coronal plane but does not measure individual vertebra and disc wedging. It was hypothesized that patients whose deformity progresses will have different patterns of coronal wedging in vertebrae and discs to those of patients whose deformities remain stable. ⋯ Sequential MRI data showed complex patterns of deformity progression. Changes to the wedging of individual vertebrae and discs may occur in patients who have no increase in Cobb angle; therefore, the Cobb method alone may be insufficient to capture the complex mechanisms of deformity progression.
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Longitudinal cohort. ⋯ Level II. Prospective cohort.
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Intraoperative neurophysiologic monitoring has become a standard tool for mitigating neurologic injury during spinal deformity surgery. Significant monitoring changes during deformity correction are relatively uncommon. This study characterizes precipitating factors for neurologic injury and relates significant events and postoperative neurologic prognosis. ⋯ Intraoperative signal changes were most frequently from traction or positioning. However, the most common cause of persistent neurologic deterioration and the only cause of postoperative neurologic deficit was the performance of osteotomies. Unlike traction- or instrument-related correction, osteotomies produce irreversible changes, from canal intrusion or sudden localized deformity change. The incidence of postoperative neurologic deficit is very low when the inciting cause is reversed; however, osteotomy-related events are irreversible, with a high incidence of associated lasting neurologic injury.