The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2003
Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance.
Fixed sagittal imbalance (a syndrome in which the patient is only able to stand with the weight-bearing line in front of the sacrum) has many etiologies. The most commonly reported technique for correction is the Smith-Petersen osteotomy. Few reports on pedicle subtraction procedures (resection of the posterior elements, pedicles, and vertebral body through a posterior approach) are available in the peer-reviewed literature. We are aware of no report involving a substantial number of patients with coexistent scoliosis who underwent pedicle/vertebral body subtraction for the treatment of fixed sagittal imbalance. ⋯ Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Mar 2003
Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty.
Children with congenital thoracic scoliosis associated with fused ribs with a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably have curve progression without treatment. Surgery has been thought to have a negligible growth-inhibition effect on the thoracic spine in such patients because it has been assumed that the concave side of the curve and the unilateral unsegmented bar do not grow, but we are unaware of any conclusive studies regarding this assumption. ⋯ Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Mar 2003
Femoral anteversion in children with cerebral palsy. Assessment with two and three-dimensional computed tomography scans.
Assessment of femoral anteversion in children with cerebral palsy with two or three-dimensional computed tomography scans may be limited by both positional and anatomic variables. Three-dimensional computed tomography techniques are considered to be more accurate than two-dimensional imaging when the femur is not optimally positioned in the gantry or when the neck-shaft angle is increased. ⋯ When adequate alignment of the femur in the computed tomography scanner was possible, a simple two-dimensional technique exhibited excellent intraobserver and interobserver reliability and clinically acceptable accuracy within the relevant ranges of anatomic variability tested (neck-shaft angles of 120 degrees to 160 degrees and femoral anteversion of 20 degrees to 60 degrees). When optimal alignment of the femur in the scanner was not possible, neither two-dimensional nor three-dimensional techniques exhibited clinically acceptable accuracy for the measurement of femoral anteversion.