Spine
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This is a retrospective analysis of 23 patients with severe neuromuscular spinal deformity treated with posterior instrumentation and fusion ending in the lumbar spine. ⋯ Posterior instrumentation and arthrodesis using lumbar lower instrumented vertebra pedicle screw anchorage can be performed safely and effectively, in selected patients patients with scoliosis and minimal pelvic obliquity.
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Comparative Study
A comparison of the effects of patient-controlled analgesia with intravenous opioids versus Epidural analgesia on recovery after surgery for idiopathic scoliosis.
Epidural infusion was compared with standard patient-controlled analgesia (PCA) in 50 patients after surgical correction of adolescent idiopathic scoliosis with respect to certain postoperative parameters. ⋯ Epidural infusion of opioids with bupivacaine is safe and effective for controlling postoperative pain after PSIF without an increased complication rate when compared with PCA. In the current study, patients tolerated a full diet and were discharged from the hospital an average of 0.5 days earlier than PCA-treated patients.
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A retrospective study. ⋯ Idiopathic thoracic scoliosis with a proximal thoracic curve of more than 25 degrees and level or elevated left shoulder should be considered a double thoracic curve pattern and should be treated by fusing both the proximal and the distal curves when using segmental instrumentation.
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Retrospective review of a defined Marfan population with traditional indications for bracing. ⋯ The success rate for brace treatment of Marfan scoliosis is 17%, which is lower than that reported for idiopathic scoliosis. Possible reasons include increased progressive forces, altered transmission of corrective pressure to the spine, and younger age at inception of bracing. Because there was no control group, it is unknown whether bracing slowed curve progression. Physicians should understand that most patients with Marfan syndrome who have a curve of more than 25 degrees and a Risser sign of 2 or less will reach the surgical range, even with brace treatment.