Journal of neurosurgery. Spine
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The authors report their experience with 14 children in whom acute torticollis or a fixed flexion neck deformity developed. Other than neck deformity, there was no other significant functional or neurological symptom. Although several possible pathogenetic factors have been speculated, the exact cause remains unknown. ⋯ In all cases recovery from neck deformity was significant immediately after surgery. The deformity resolution was sustained during a mean follow-up period of 23 months (range 3-52 months), although the range of neck movements remained marginally restricted. The craniovertebral realignment is demonstrated by images and clinical photographs.
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Review
Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease. A review.
This systematic review assesses the efficacy of epidural steroids on adults undergoing lumbar spine surgery for degenerative spinal disease. ⋯ There is evidence that epidural steroids decrease pain in the short term and shorten length of stay in adults undergoing lumbar spinal surgery for degenerative spinal disease. Most of the evidence comes from studies without validated outcomes and that selectively report positive results. More research is required before establishing perioperative epidural steroids as an effective adjunct to surgery for reducing pain in the long term.
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Randomized Controlled Trial
Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article.
Cervical total disc replacement (TDR) was developed to address some of the shortcomings associated with anterior cervical discectomy and fusion (ACDF) by preserving motion at the treated level. To establish an evidence-based rationale for cervical TDR to serve as a viable alternative to ACDF, cervical arthroplasty must establish equivalent or superior clinical outcomes while maintaining motion. The authors report on 98 patients from a single investigational site involved in 3 separate prospective, randomized, controlled investigational device exemption multicenter trials comparing cervical arthroplasty to ACDF with a 2-6-year follow-up. ⋯ The prospective, intermediate-term (average follow-up > 3 years) results of cervical TDR at the authors' site are encouraging. Patients treated with the artificial discs showed significantly better clinical results, maintained motion at the treated level, and trended toward less adjacent-level disease.
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Early-onset, nonidiopathic spine deformities are frequently caused by intraspinal anomalies necessitating both neurosurgical and orthopedic intervention. The clinical tradition at most treatment units is to perform neurosurgical and orthopedic procedures separately. Sometimes the deformity correction surgery is also done in stages, which leads to several periods of hospitalization, increased use of health care resources, and a long rehabilitation time for the patient. The purpose of this project was to perform an outcome survey for major spine surgery in high-risk patients, and to analyze whether an additional neurosurgical intervention during the same session increased the risk of complications. ⋯ One-stage major spine surgery, even when neurosurgery is included, is safe and does not increase the risk of complications. The increase in hospital and ICU stays is marginal.
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The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure. ⋯ The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.