Spine
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Multicenter Study
Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention.
This is a retrospective multicenter analysis of a subset of 375 patients with thoracic adolescent idiopathic scoliosis (AIS) treated with either anterior (238) or posterior (137) fusion with preoperative or postoperative distal junctional kyphosis (DJK) >or=10 degrees . ⋯ It appears that both posterior and anterior instrumentation for thoracic curves must include the junctional level to prevent postoperative DJK when postoperative DJK is present. The presence of increased kyphosis after surgery in the T10-L2 region seen in both anterior and posterior groups that had postoperative DJK develop constitutes a "risk factor" for the development of DJK.
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Comparative Study
Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis.
A retrospective matched cohort study. ⋯ Pedicle screw instrumentation offers a significantly better major curve correction and postoperative pulmonary function values without neurologic problems compared with hybrid constructs. Both instrumentation methods offer similar junctional change, lowest instrumented vertebra, operative time, and postoperative SRS-24 outcome scores in the operative treatment of AIS.
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Comparative Study
Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity.
Clinical radiographic and outcomes investigation. ⋯ For high-grade spondylolisthesis and long adult deformity fusions to the sacrum, a montage of bilateral S1 screws and iliac screws were effective in protecting the sacral screws from failure. Pseudarthrosis at L5-S1 was manifested by rod breakage at that level. We saw no evidence of a long-term effect of the iliac screws predisposing the sacroiliac joints to degeneration at follow-up ranging from 5 to 10 years.
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A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age with either distraction and fusion using Harrington rods (ST, n = 156; 145 females and 11 males) or with brace (BT, n = 127; 122 females and 5 males), were followed at least 20 years after completion of the treatment. ⋯ For both brace treated and surgically treated AIS patients, spinal mobility and muscle endurance were reduced more than 20 years after completed treatment. The physical function was not severely restricted.