Spine
-
This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity. ⋯ This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters.
-
Multicenter Study
Validity of the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire.
A cross-sectional multicenter study was performed to validate the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire. ⋯ The Spanish version of the SRS-22 is valid. It has a factorial structure similar to that of the original questionnaire. Moreover, it relates to known severity characteristics of the disease, distinguishes among scoliosis patient groups, and shows concordant values with another valid instrument for measuring self-perceived health.
-
Comparative Study
Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques.
An anatomic and computed tomography (CT) study of the Roy-Camille and the Magerl techniques with quantitative comparison of the safety zones of the two surgical techniques. ⋯ The Roy-Camille technique demonstrated a progressive decrease of its safety zone from C3-C6. At C5 and C6 there is a great probability to have a transarticular screw with a Roy-Camille screw. A similar variation was not observed for the Magerl technique. These anatomic results seem to be in relation with the morphologic variability of lateral masses from C3-C6 as demonstrated by an increase of the height/thickness ratio at the lower part of the cervical spine. According to these anatomic considerations and previously published biomechanical data, Roy-Camille technique appears to be the best option at C3 and C4. On the opposite at C5 and C6, the choice is more difficult considering that there is no biomechanical difference between the two techniques and that the Magerl technique is safer but a more demanding procedure.
-
Retrospective outcome measurement after circumferential reconstructive surgery with lumbar fusion in patients with chronic discogenic low back pain. ⋯ When using strict patient selection criteria that include independent determination of pain generators via pressure-controlled diskography and completion of a preoperative conditioning program for improving general health status, the number of levels in reconstructive lumbar surgery may not significantly impact overall clinical outcome.
-
A retrospective review was performed on 21 adult patients surgically treated with high-grade spondylolisthesis (Grade III, IV, or V). Additionally, the natural history, classification, and surgical alternatives for high-grade spondylolisthesis in the adult are discussed through literature review. ⋯ Adult patients with high-grade spondylolisthesis not responding to nonoperative treatment can be stabilized in situ with posterior instrumentation from L4 to S1. The use of adjunctive fixation with iliac screws and/or transvertebral screws is recommended for the adult patient, particularly in revision or unstable cases. Reduction of the slipped vertebrae remains controversial for all grades of spondylolisthesis and more so for the adult patient. Partial reduction of the slip angle, decreasing the lumbosacral kyphosis, should be considered if significant sagittal malalignment is present or to improve arthrodesis success. Anterior column support should be performed, particularly when reduction has been obtained. Anterior column support can be performed, anteriorly or posteriorly, either by using inter vertebral body structural strut support or with a transsacral fibular dowel to improve stability and success of arthrodesis.