Spine
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The treatment of unstable thoracic spine fractures remains controversial. Theoretical biomechanical advantages of transpedicular screw fixation include three-column control of vertebral segments and fixation of a vertebral segment in the absence of intact posterior elements. Additionally, pedicle screw constructs may obviate the need for neural canal dissection and potential neural element impingement by intracanal instrumentation. A 3-year consecutive series was performed to evaluate the use of transpedicular screw fixation in the treatment of unstable thoracic spine injuries. ⋯ In carefully selected instances, pedicle screw fixation of upper, middle, and lower thoracic and upper thoracolumbar spinal injuries is a reliable and safe method of posterior spinal stabilization. Transpedicular screw fixation may offer superior three-column control in the absence of posterior element integrity and obviates the need for intracanal placement of hardware. Transpedicular instrumentation provides rigid fixation for upper, middle, and lower unstable thoracic spine injuries and produces early pain-free fusion results. These results provide evidence that with appropriate preoperative radiographic evaluation of pedicular size and orientation using computed tomography as well as radiograph assessment, transpedicular instrumentation is a safe and effective alternative in the treatment of unstable thoracic (T2-L1) spinal injuries.
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A retrospective report of three cases outlining upper intestinal obstruction as a rare complication following surgery for scoliosis. ⋯ Vomiting following surgery for scoliosis should be investigated thoroughly, as superior mesenteric artery syndrome carries significant morbidity, protracted hospital stay, and potential mortality.
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Assessment of qualitative and quantitative changes in the microcirculation of nerve roots, such as the diameter of blood vessels and the low rate of erythrocytes, was observed during lumbar interbody fusion. ⋯ A contact endoscope was used to observe the microhemodynamics of nerve roots before and after retraction of the nerve root during lumbar interbody fusion surgery, and a decrease in the flow rate of erythrocytes was observed.
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A retrospective review of medical records and imaging studies of children diagnosed with spinal cord injury without radiographic abnormality (SCIWORA) or SCIWORA-like symptoms at Children's Hospital of Pittsburgh between 1965 and 1999 was undertaken. ⋯ We identified no cases of serious, recurrent SCIWORA at our institution from 1965 to 1999. A case-by-case evaluation is required for the treatment of spinal cord injury without apparent spinal column injury, and bracing is not uniformly indicated.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies.
A prospective randomized clinical study was conducted. ⋯ Consistently, rhBMP-2 with the biphasic calcium phosphate granules induced radiographic posterolateral lumbar spine fusion with or without internal fixation in patients whose spondylolisthesis did not exceed Grade 1. Statistically greater and quicker improvement in patient-derived clinical outcome was measured in the rhBMP-2 groups.