Journal of neurosurgery. Spine
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Significant numbers of patients with spinal tuberculosis (TB), especially in developing countries, still present late after disease onset with severe neurological deficits. The authors conducted a study to assess the outcome in these patients. ⋯ A significant proportion of patients with spinal TB and severe motor deficits experience remarkable improvement after surgical decompression and hence should undergo surgery even though they may be suffering from paraplegia of considerable duration.
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Anterior cervical discectomy (ACD), ACD with interbody fusion (ACDF), ACDF with placement of an anterior plate system (ACDFP), corpectomy, and corpectomy with plate placement are used to fuse the cervical spine. The authors conducted a metaanalysis of studies published after 1990 in which fusion rates achieved with each procedure were reported for patients with degenerative disease at one, two, and three disc levels. ⋯ The anticipated fusion rate is one of several factors that may guide surgical decision making. Anterior cervical decompression and fusion results in high fusion rates. The results of the authors' study show that regardless of the number of levels fused, the use of an anterior cervical plate system significantly increases the fusion rate. For two-disc-level disease, there was no significant difference between ACD with a plate system or corpectomy with a plate system. For three-disc-level disease, however, the evidence suggests that corpectomy with plate placement is associated with higher fusion rates than discectomy with plate placement.
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The authors describe the use of sacral pedicle subtraction osteotomy (PSO) with multiple sacral alar osteotomies for the correction of sacral kyphosis and pelvic incidence and for achieving sagittal balance correction in cases of fixed sagittal deformity after a sacral fracture. In this paper, the authors report on a novel technique using a series of sacral osteotomies and a sacral PSO to correct a fixed sagittal deformity in a patient with a sacral fracture that had healed in a kyphotic position. The patient sustained this fracture after a previous surgery for multilevel instrumented fusion. ⋯ Experts agree that the pelvic incidence is a fixed parameter that dictates the morphological characteristics of the pelvis and affects spinopelvic orientation and sagittal spinal alignment. An increased pelvic incidence is associated with a higher degree of spondylolisthesis in the lumbosacral junction, and increased shear forces across this junction. The authors demonstrate that the pelvic incidence can be altered and corrected with a series of sacral osteotomies to improve sacral kyphosis, compensatory lumbar hyperlordosis, and sagittal balance.
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Clinical Trial
Treatment of painful osteoporotic compression and burst fractures using kyphoplasty: a prospective observational design.
The aim of this study was to test the hypothesis that kyphoplasty is an effective treatment in painful osteoporotic vertebral fractures, even with involvement of the posterior cortical wall. ⋯ Kyphoplasty is effective in the treatment of painful osteoporotic vertebral compression and burst fractures, at least under medium-term conditions. The potential complication of procedure-related secondary narrowing of the spinal canal by the retropulsed posterior wall in burst fractures appears to be more of a theoretical than an actual risk.