Spine
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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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Observational study of patients with scoliosis and matched controls. ⋯ Adult scoliosis has a significant and measurable impact on affected patients compared with controls. There is a poor correlation between radiographic parameters of outcome and patient self-assessment of health status. The SRS-22 is a reliable instrument in adults as demonstrated by a high degree of internal consistency and reproducibility. The SRS-22 is a valid instrument for use in adult deformity as demonstrated by the criterion validity assessment with the SF-36. The study supports the use of the SRS-22 in the adult spinal deformity population.
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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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A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment. ⋯ More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.
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Comparative Study
A comparison between the prone and lateral position for performing a thoracoscopic anterior release and fusion for pediatric spinal deformity.
Retrospective review of all patients who had a single stage thoracoscopic anterior release and spine fusion followed by a posterior spinal fusion with posterior instrumentation. ⋯ A thoracoscopic anterior spinal release and fusion in the prone position appears to achieve the same results as when performed in the lateral position for pediatric spinal deformity. The prone position saves time in the operating room due to decreasing the time needed by the anesthesiologists and the transition time between the anterior and posterior procedures. Potentially serious complications related to single-lung ventilation are avoided with bilateral-lung ventilation in the prone position.