Spine
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Comparative Study
Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance.
Clinical, radiographic, and outcomes assessment comparing two surgical techniques. Clinical data were collected prospectively. The radiographic analysis was done retrospectively. ⋯ When comparing three or more SPOs (14 patients) to one pedicle subtraction procedure (41 patients), the correction in kyphosis was nearly identical. There was a significantly greater likelihood of decompensating the patient to the concavity with three or more SPOs than with a single PSO (P < 0.02). The blood loss was substantially greater with the PSO group (P < 0.001).
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Eighteen human torsos were used in three experiments (A, B, and C) to determine the changes in sagittal motion due to three different sequences of three surgical releases. ⋯ Sagittal plane motion in the thoracic spine is influenced by all three structures tested in this experiment. Overall, the radical discectomy provides the greatest increase in total ROM and in extension compared with the other two releases. The second most influential release is the combination of sternal osteotomy plus costosternal release (i.e., sternal release), particularly in extension (correction of kyphosis). When two releases are done in sequence, radical discectomy plus sternal release provides the greatest increase in total ROM and in extension. Overall, total facetectomy is the least effective release. These data have relevance for surgical strategies in the correction of thoracic kyphosis or lordosis and suggest a potential role for sternal osteotomy and costosternal release in severe and rigid upper thoracic kyphosis.
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Literature review. ⋯ Optimal inclusion criteria for future adolescent idiopathic scoliosis brace studies consist of: age is 10 years or older when brace is prescribed, Risser 0-2, primary curve angles 25 degrees -40 degrees , no prior treatment, and, if female, either premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness should include: (1) the percentage of patients who have < or =5 degrees curve progression and the percentage of patients who have > or =6 degrees progression at maturity, (2) the percentage of patients with curves exceeding 45 degrees at maturity and the percentage who have had surgery recommended/undertaken, and (3) 2-year follow-up beyond maturity to determine the percentage of patients who subsequently undergo surgery. All patients, regardless of subjective reports on compliance, should be included in the results (intent to treat). Every study should provide results stratified by curve type and size grouping.
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Comparative Study
Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography.
A retrospective study. ⋯ Intraoperative plain radiographs alone using 3 radiographic criteria were very sensitive to detect lateral wall pedicle screw violations, specific for assessing for medial wall violations, and highly accurate for both. This result confirms the ability of careful intraoperative plain radiographic assessment after pedicle screw insertion to detect malpositioned screws, to allow for possible revision during the index operation.
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A retrospective study. ⋯ The incidence of proximal junctional kyphosis at 7.3 years postoperation was 26% and did not progress significantly after 2 years postoperation. Risk factors for developing PJK were an associated thoracoplasty, hybrid instrumentation (proximal hooks and distal pedicle screws), and a preoperative larger sagittal thoracic Cobb angle (T5-T12 > 40 degrees). The SRS-24 outcome instrument was not affected by PJK.