Spine
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A retrospective study investigated the progression risk of juvenile scoliosis until skeletal maturity or spinal fusion. ⋯ Curve pattern, Cobb angle at onset of puberty, and curve progression velocity are strong predictive factors of curve progression. Juvenile scoliosis > 30 degrees increases rapidly and presents a 100% prognosis for surgery (curve > 40 degrees to 45 degrees ). Anticipation is necessary if the scoliosis progresses during the first year of puberty. The prediction is difficult for curves of 21 degrees to 30 degrees during the first 2 years of puberty. Curve pattern and curve progression velocity are useful to detect which curves are likely to progress. From this retrospective analysis, spinal fusion could have been indicated earlier sometimes. An earlier intervention is probably preferable to obtain better curve reduction on a supple spine, even if a perivertebral fusion is necessary. We use the 3 parameters for operative indications. If an early spinal fusion leads to better curve correction needs to be verified on prospective data.
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Prospective clinical study. ⋯ These findings are important for the operating room personnel, which is exposed daily to radiation intraoperatively, as well as the patients, when using CAS procedures.
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Prospective study analyzing midterm clinical results of total lumbar disc replacement (ProDisc II) for different indications. ⋯ Present data suggest beneficial clinical results of TDR for treatment of DDD in a highly selected group of patients. Better functional outcome was obtained in younger patients under 40 years of age and patients with degenerative disc disease in association with disc herniation. Multilevel disc replacement had significantly higher complication rate and inferior outcome. Results are significantly dependent on preoperative diagnosis and patient selection, number of replaced segments, and age of the patient at the time of operation. Because of significantly varying outcomes, indications for disc replacement must be defined precisely.
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A retrospective case series of surgically treated achondroplastic patients with severe thoracolumbar kyphosis. ⋯ Posterior spinal osteotomy with segmental instrumentation is a reasonable surgical option for thoracolumbar kyphosis in patients with achondroplasia. Modification of the surgical procedures depending on the presence or absence of the dysplastic changes of the apical vertebra is necessary to obtain optimal results.
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A retrospective review of neurophysiologic alerts during anterior cervical surgery. ⋯ Diagnosis of cervical spondylotic myelopathy or trauma and cervical corpectomy procedures increase the risk for having major intraoperative alerts. In case of persistent tceMEP/SSEP amplitude loss, consider delaying potentially harmful interventions, such as premature termination of the procedure or methylprednisolone infusion, until a new neurologic deficit is verified with an awake-clinical examination.