Journal of neurosurgery. Spine
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Comparative Study
The impact of segmental and en bloc derotation maneuvers on scoliosis correction and rib prominence in adolescent idiopathic scoliosis.
Idiopathic scoliosis is a pathological process influencing the spinal column in 3 dimensions. Initial surgical treatment focused primarily on correction in the coronal plane, and with improved instrumentation, increasing attention has targeted balancing the sagittal profile. Newer surgical techniques now permit operative corrective forces to also directly address axial rotation. Although several technical variations of direct vertebral body derotation (DVBD) have been devised, no studies have compared outcomes from the differing techniques. The purpose of this study was to describe and compare the differences between segmental and en bloc DVBD. ⋯ Although each surgical technique of DBVD may have theoretical benefits and risks, no apparent difference in outcomes was observed between techniques. The concurrent use of both techniques was associated with increased blood loss and operative duration without any appreciable benefit. The surgeon should adopt the derotation technique with which he or she is most comfortable, but concurrent use of both does not appear to improve results.
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The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy. ⋯ Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.
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Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. ⋯ The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.
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The aim of this study was to identify potential risk factors for and determine the rate of vertebral compression fracture (VCF) after intensity-modulated, near-simultaneous, CT image-guided stereotactic body radiotherapy (SBRT) for spinal metastases. ⋯ Stereotactic body radiotherapy is associated with a significant risk (20%) of VCF. Risk factors for VCF include an age > 55 years, a preexisting fracture, and baseline pain. These risk factors may aid in the selection of which spinal SBRT patients should be considered for prophylactic vertebral stabilization or augmentation procedures. Clinical trial registration no.: NCT00508443.
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Unilateral contusions represent an increasingly popular model for studying the pathways and recovery mechanisms of spinal cord injury (SCI). Current studies rely heavily on motor behavior scoring and histological evidence to make assessments. Electrophysiology represents one way to reliably quantify the functionality of motor pathways. The authors sought to quantify the functional integrity of the bilateral motor and sensory pathways following unilateral SCI by using measurements of motor and somatosensory evoked potentials (MEPs and SSEPs, respectively). ⋯ Motor evoked potential recovery corresponded to the amount of spared CST in unilateral and midline injuries, but motor behavior consistently recovered independent of MEPs. These data support the idea that spared contralateral pathways aid in reducing the functional deficits of injured ipsilateral pathways and further support the idea of CNS plasticity.