Spine
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Comparative Study
Posterior fixation of thoracic and lumbar spine fractures using DC plates and pedicle screws.
A prospective investigation of internal fixation of acute thoracic and lumbar spine fractures using pedicle screws and dynamic compression plates was performed. This article details the results of 23 patients who were followed for an average of 20 months. The indications for the procedure were an unstable fracture--dislocation below the eighth thoracic vertebra or low lumbar fractures that would be difficult to treat with conventional spinal implants. ⋯ There was no increase in neurologic deficit. One patient developed an asymptomatic pseudarthrosis demonstrated by breakage of both plates through unfilled screw holes at the motion segment. Other complications included one wound infection, one case of arachnoiditis after an intradural bone fragment was excised, and one dural tear created by a Kirschner wire, which did not result in a neurologic deficit or a cerebrospinal fluid leak.(ABSTRACT TRUNCATED AT 250 WORDS)
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A multicentered prospective trial to investigate the usefulness of the AO spinal internal fixator for the treatment of thoracolumbar fractures and fracture-dislocations was undertaken. This pedicle screw-rod system was effective in stabilizing a variety of unstable fracture patterns. It was effective in decompressing the canal of retropulsed bony fragments associated with burst fractures. By the use of this implant, sagittal plane deformity was easily corrected.
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A recently developed simple device, the intervertebral body fixation dual-blade plate, was used in 88 cases of different spinal disorders. This patients in the first series were operated on from 1984 to 1986. The device is biomechanically simple and its application safe and easy. ⋯ The midterm results, covering a follow-up period of 24-49 months (mean, 32 months) were satisfactory; there were no serious complications directly related to the device. There were four cases of pseudarthrosis due to insufficient bone graft technique. Of these, there were three cases of failure of the dual-blade plate.
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The Syracuse I-Plate is a versatile neutralization plate for anterior spinal fixation following decompression for burst fractures and pathologic vertebral body destruction by tumor. In this article, the history, current use, and indications are discussed. The anterior approach and application of the I-plate to the lower thoracic and lumbar spine is presented, as well as a brief summary of a current clinical series of 34 patients. Fusion rates were high and hardware failure most frequent in patients with associated osteoporosis or extensive posterior disruption, such that the device was contraindicated in cases of extensive three-column injuries or significantly osteoporotic bone.
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Comparative Study
Hypotensive anesthesia for scoliosis surgery in Jehovah's Witnesses.
Hypotensive anesthesia has been advocated in spinal surgery for the purpose of diminishing operative blood loss. This study evaluated its effectiveness in 12 Jehovah's Witnesses undergoing Harrington instrumentation and fusion who refused transfusion. Previous series from this institute did not use deliberate hypotension because of routinely low blood loss. ⋯ The majority of blood losses in spinal instrumentation with fusion occurs with decortication. This rapid bleeding occurs at venous pressures which are unaffected by arterial blood pressure manipulation. The authors conclude that spinal surgery is possible in Jehovah's Witnesses without transfusion and that operative technique is the single most important determinant of blood loss.