Spine
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The issue of progression of congenital basilar invagination is evaluated on the basis of 3 clinical cases. The rationale of treatment of basilar invagination in general and, particularly, in the complex clinical situation encountered in the presented cases, by the authors' technique of atlantoaxial joint distraction, reduction of basilar invagination, and direct lateral mass plate and screw fixation is discussed. ⋯ The probable cause of basilar invagination and its progression is a congenital malformation ofalignment of the facets of the atlantoaxial joint. Distraction of the facets and direct interarticular atlantoaxial fixation presents a unique opportunity of reduction of the basilar invagination and fixation of the region.
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Retrospective review of current literature regarding neuroprotection and axonal regeneration therapies for acute spinal cord injury. ⋯ The initiation of human clinical trials for spinal cord-injured patients heralds great hope that effective therapies will be forthcoming, although a great deal remains to be learned. Clinicians must provide leadership in the epidemiologic design and rigor of these initial forays into human evaluation.
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Multicenter Study
Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study.
A retrospective case review of children treated with dual growing rod technique at our institutions. Patients included had no previous surgery and a minimum of 2 years follow-up from initial surgery. ⋯ The dual growing rod technique is safe and effective. It maintains correction obtained at initial surgery while allowing spinal growth to continue. It provides adequate stability, increases the duration of treatment period, and has an acceptable rate of complication compared with previous reports using the single rod technique.
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Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) in patients with combined spine and chest wall deformity with scoliosis and fused ribs. ⋯ Expansion thoracostomy and VEPTR insertion with serial lengthening may be the preferred treatment for young children with chest wall deformity and scoliosis associated with fused ribs but requires multidisciplinary care and attention to details of soft tissue management. When indicated, surgical intervention with VEPTR can be considered early in growth, before deformity is severe, since spinal growth will continue with treatment.
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An in vivo rat model of transient cervical nerve root compression. ⋯ Results imply a force threshold exists less than 10 gf for persistent pain symptoms following transient cervical nerve root compression. Findings also suggest that spinal glial activation may be related to behavioral sensitivity and may modulate cervical nerve root mediated pain.