Spine
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Since the advent of single, stiff rod anterior instrumentation, and now dual rod anterior instrumentation, most thoracolumbar-lumbar scoliosis is treated with an anterior approach. We have previously reported a retrospective comparison of patients with single torsion thoracolumbar-lumbar scoliosis treated with either anterior or posterior instrumented fusion. The purpose of this study is to examine the patient-based outcomes in this cohort of patients at an average of 5 years (anterior instrumentation) and 9 years (posterior instrumentation). ⋯ At an average of 9 years of follow-up, patients treated with posterior transpedicular instrumentation have equivalent patient-based outcomes to patients treated with anterior single solid rod instrumentation at an average of 5 years of follow-up.
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Comparative Study
Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation.
Radiographic analysis of anterior and posterior instrumentation for adolescent idiopathic scoliosis. ⋯ Anterior and posterior instrumentation had differential effects on the sagittal plane in patients with adolescent idiopathic scoliosis. However, the overall magnitude of the differences was small. Properly performed, both approaches can result in acceptable sagittal profiles.
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Outcomes of transpedicular decompression and/or osteotomy were analyzed retrospectively. ⋯ Overall, the results suggest that the "eggshell" procedure is a reliable and safe technique to achieve anterior decompression of the spinal canal and posterior stabilization through a single approach.
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A retrospective evaluation of radiographs in patients with idiopathic scoliosis was undertaken to assess predictors of flexibility. ⋯ We have shown that curve magnitude and patient age are the main predictors of structural flexibility. Every 10 degrees increase in curve magnitude over 40 degrees results in a 10% decrease in flexibility; every 10-year increase in age decreases flexibility of the structural curve by 5% and the lumbosacral fractional curve by 10%. Curve magnitude and age of the patients are significant predictors of curve flexibility. The demonstration of this association offers useful information in estimating how surgical options for deformity correction may change over time.
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Biomechanical evaluation of lumbosacral fixation using a porcine model. ⋯ Iliac screw constructs reduced lumbosacral flexibility levels in three of four loading methods (axial rotation, flexion-extension, and lateral bending) compared with pedicle screw reconstructions. The addition of interbody cages decreased lumbosacral motion for the iliac screw treatments under flexion-extension loading and pedicle screw constructs under axial rotation but did not protect the sacral screws in destructive testing as the iliac screws did. Based on evaluation using an porcine model, both iliac screws and interbody cages effectively reduce the multidirectional flexibility properties of the lumbosacral junction; however, iliac screws are more restrictive of motion (at the lumbosacral joint) and protective of the S1 screws.