Spine
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Radiographic analysis, outcomes analysis (pain scale, Oswestry, SRS-24), and accumulation of complications. Outcomes and complications collected prospectively. Radiographic analysis performed retrospectively. ⋯ The clinical result with pedicle subtraction osteotomy is reduced with pseudarthrosis in the thoracic or lumbar spine and subsequent breakdown adjacent to the fusion. For patients with a degenerative sagittal imbalance etiology the results were worse and the complications were higher. Central canal enlargement is critical.
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Retrospective analysis with prospective outcomes. ⋯ Staged posterior surgery can be performed safely with few surgical complications and no major medical complications, as well as excellent outcomes in a population known to be at high risk. Such staging can be useful in performing complex posterior revision and osteotomy surgery while limiting hemodynamic stresses.
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A retrospective clinical and radiographic analysis of long adult deformity fusions terminating at L5. ⋯ Subsequent L5-S1 DDD developed in 61% of patients after long adult fusions to L5 and was associated with a significant loss of sagittal alignment and an increased likelihood for or definite need for another operation. Loss of L5 implant fixation is not uncommon, especially in patients with a deep-seated L5 vertebra.
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Comparative Study
Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis.
A biomechanical study on cadaveric thoracic vertebrae using pullout strength, insertional torque, and bone mineral density to determine the optimal sagittal trajectory of thoracic pedicle screws. ⋯ The straight-forward technique results in a 39% increase in maximum insertional torque and a 27% increase in pullout strength compared to the anatomic technique. The maximum insertional torque at the neurocentral junction resulted in a 36% increase using the straight-forward technique versus the anatomic trajectory. Bone mineral density directly correlates with pullout strength for both techniques.
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Case report. ⋯ The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to hypotensive anesthesia, prone positioning on a Montreal mattress, or a combination of the two. Careful intraoperative positioning may reduce the risk of this occurring after spinal surgery. However, close postoperative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of early detection and treatment for this condition.