Spine
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Comparative Study
Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis.
Radiographic outcome analysis following thoracic fusion of Lenke Type I adolescent idiopathic scoliosis (AIS) curves with segmental pedicle screw fixation. ⋯ Both monaxial and multiaxial thoracic pedicle screws provide excellent coronal deformity correction for thoracic fusion of main thoracic AIS. Monaxial screws provide superior derotation and restoration of thoracic symmetry as noted by significantly greater correction of the AVB-R, RH, and ARSD.
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Comparative Study
Long-term outcome in neuromuscular scoliosis fused only to lumbar 5.
Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. ⋯ Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion.
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This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N = 352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index. ⋯ This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.
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Axial computed tomography scans (CT) in 20 consecutive patients with idiopathic right thoracic scoliosis and anterior correction and fusion with a dual rod dual screw system. ⋯ Anterior instrumentation and correction of thoracic scoliosis with a dual rod dual screw system enable a correct and safe screw placement using a standard open approach. Excessive bicortical screw perforation should be avoided in order not to endanger the thoracic aorta.
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Comparative Study
Value of dermatomal somatosensory evoked potentials in detecting acute nerve root injury: an experimental study with special emphasis on stimulus intensity.
Dermatomal somatosensory-evoked potentials (D-SSEPs) in rats were recorded at the spinal level after L2-, L4-, and L5-dermatome stimulation. Pre- and post-transection patterns and rates of change of corresponding nerve roots were compared to determine accuracy. ⋯ D-SSEP is valuable for detecting acute single nerve root injury. In clinical settings, submaximal dermatomal stimulation identifies conduction abnormalities more consistently and with fewer false negatives and false positives than does supramaximal stimulation. We recommend submaximal stimulation.