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.
-
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.
-
A review article. ⋯ Spino-pelvic balance in the sagittal plane can be considered as an open linear chain linking the head to the pelvis where the shape and orientation of each successive anatomic segment are closely related and influence the adjacent segment. Pelvic morphology and spino-pelvic balance are abnormal in developmental spondylolisthesis. These abnormalities should be quantified on lateral standing radiographs of the spine and pelvis and have important implications for the evaluation and treatment of this pathologic condition.
-
Mechanical testing of cadaveric motion segments. ⋯ IDET has a significant but inconsistent effect on compressive stresses within intervertebral discs. These results may partly explain the variable clinical success of IDET.
-
An anatomic study of the extraforaminal attachments of the lumbar spinal nerves was performed using human lumbar spinal columns. ⋯ Ligamentous connections exist between lumbar extraforaminal spinal nerves and nearby structures.