Spine
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The authors examined a case series of patients younger than 16 years who had sustained a traumatic spine injury. ⋯ In children and adolescents, conservative treatment is an available option for stable fractures without neurologic lesion. Early surgical treatment (instrumentation and fusion) is mandatory for unstable fractures and injuries associated with spinal cord lesion. In children, a traumatic spinal cord lesion may develop a deformity that is mainly scoliotic, kyphotic, or lordotic in >90% of the cases.
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The current study was undertaken to determine if the presence of titanium wear particulate deleteriously influences early osseointegration of posterolateral bone graft or disrupts an established posterolateral fusion mass. ⋯ Titanium particulate debris introduced at the level of a spinal arthrodesis elicits a cytokine-mediated particulate-induced response favoring pro-inflammatory infiltrates, increased expression of intracellular tumor necrosis factor-alpha, increased osteoclastic activity, and cellular apoptosis. The presence of titanium particulate debris, secondary to motion between spinal implants, may serve as the impetus for late-onset inflammatory-infectious complications and long-term osteolysis of an established posterolateral fusion mass in the clinical setting.
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An extensive outcome questionnaire using a visual analog scale, the North American Spine Society Satisfaction Questionnaire, a Modified Roland and Morris disability index, and a modified Oswestry Disability Index was used to assess the outcome of anterior cervical discectomy and fusion for those with neck pain. ⋯ Properly selected patients who present with a primary indication of chronic neck pain report a high percentage of change in their self-perceived level of pain and function when treated with anterior cervical discectomy and fusion. Patients' self-expressed improvement with surgical management, as compared with their preoperative dissatisfaction because of their neck condition, documents that this surgical treatment is a reasonable option.