Spine
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Case Reports
Cauda equina compression after trauma: an unusual presentation of spinal epidural lipoma.
A case report is presented. ⋯ Previously asymptomatic epidural masses such as lipomas can present with neurologic deficit after trauma. Appropriate imaging can help in the diagnosis and management of such cases.
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A new surgical technique for en bloc resection of posterior mediastinum tumors invading the spine is described. ⋯ Even though a learning curve is necessary to achieve this extreme type of surgery, selective preoperative screening of patients is mandatory. Interesting results today confirm the feasibility of possible treatment of tumors still considered unresectable.
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Comparative Study
Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis.
A retrospective comparison of three different types of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. ⋯ Fusion rates were comparable for GroupA (ICBG) and Group C (composite graft of autologous bone marrow and demineralized bone matrix). The composite graft is our preferred graft for fusions in adolescent idiopathic scoliosis.
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Retrospective chart and radiologic analysis. ⋯ In patients without myelomeningocele or congenital scoliosis, but with Arnold-Chiari malformation and syringomyelia, suboccipital craniectomy gave the best chance for syrinx reduction and scoliosis improvement, particularly in children younger than 10 years. Syrinx shunting improved none of the scolioses. For syrinxes in patients with congenital scoliosis or myelomeningocele, neither neurosurgical procedure resulted in curve improvement, as other causes of scoliosis (vertebra anomalies, paralysis) remained untreated. Patients with myelomeningocele require a multipronged surgical approach to address all causes of syrinx, thus minimizing the potential need for repeat neurosurgery. Scoliosis correction without prior syrinx decompression carries a high neurologic risk.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion.
A prospective, randomized, double-blind clinical trial was conducted. ⋯ Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, although the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system.