Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
Surgery versus conservative management in adult isthmic spondylolisthesis--a prospective randomized study: part 1.
A prospective randomized study was performed. ⋯ Surgical management of adult isthmic spondylolisthesis improves function and relieves pain more efficiently than an exercise program.
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Randomized Controlled Trial Clinical Trial
Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis--a prospective randomized study: part 2.
A prospective randomized study was performed. ⋯ Lumbar posterolateral fusion performed in situ for adult isthmic spondylolisthesis relieves pain and improves function. The use of supplementary transpedicular instrumentation does not add to the fusion rate or improve the clinical outcome.
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Comparative Study
Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques.
This investigation was conducted in two parts. In the first part, a morphometric analysis of critical cervical pedicle dimensions were measured to create guidelines for cervical pedicle screw fixation based on posterior cervical topography. In the second part of the study, a human cadaver model was used to assess the accuracy and safety of transpedicular screw placement in the subaxial spine using three different surgical techniques: 1) using surface landmarks established in the first part of the study, 2) using supplemental visual and tactile cues provided by performing laminoforaminotomies, and 3) using a computer-assisted surgical guidance system. ⋯ On the basis of the morphometric data, guidelines for cervical spine pedicle screw placement at each subaxial level were derived. Although a statistical analysis of cadaveric morphometric data obtained from the cervical spine could provide guidelines for transpedicular screw placement based on topographic landmarks, sufficient variation exists to preclude safe instrumentation without additional anatomic data. Insufficient correlation between different surgeons' assessments of surface landmarks attests to the inadequacy of screw insertion techniques in the cervical spine based on such specific topographic guide
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Cross-sectional measurement of the sagittal geometry of adolescent idiopathic scoliosis patients. ⋯ The proposed technique appears to give more representative results than those presented in the literature. It has the advantage of being part of a global noninvasive postural evaluation. Using this approach in a systematic manner could help reduce radiograph exposure while keeping track of the spine sagittal curvatures.
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A finite-element model of the craniovertebral junction was developed and used to determine whether a biomechanical mechanism, in addition to inflammatory synovitis, is involved in the progression of rheumatoid arthritis in this region of the spine. ⋯ To the best of the authors' knowledge, this is the first report of a validated, three-dimensional model of the C0-C1-C2 complex with application to rheumatoid arthritis. The data indicate that there may be a mechanical component (in addition to enzymatic degradation) associated with the osseous resorption observed during rheumatoid arthritis. Specifically, erosion of the odontoid base may involve Wolff's law of unloading considerations. Changes through the lateral aspects of the atlas suggest that this same mechanism may be partially responsible for the erosive changes seen during progressive rheumatoid arthritis. Anterior and posterior atlantodental interval values indicate that complete destruction of the transverse ligament coupled with alar and/or capsular ligament compromise is requisite if advanced levels of atlantoaxial subluxation are present.