Spine
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Descriptive anatomy. OBJECTIVE.: To describe the anatomy associated with the extensive transmuscular paraspinal approach required to perform multiple intercosto-lumbar neurotizations. ⋯ Multiple lumbar roots neurotizations with lower intercostal nerves already have been proposed by other authors. In this strategy, the use of the spinal cord and intercostal nerves above the spinal cord lesion avoids the axonal regrowth required via the injured central nervous system. Rerouting intercostals nerves down to the lumbar roots at their exit from the intervertebral foraminae is less invasive that the same procedure performed down to the vertebral canal at the level of the cauda equina as we used in previous protocols. Our anatomic study confirms the advantage of the paraspinal sacrospinalis splitting approach in multiple intercosto-lumbar neurotizations. The approach is quick and easy and allows a good exposure of the nerve roots at the thoracic and lumbar levels. The L2, L3, and L4 roots could be satisfactorily neurotized with this procedure.
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Randomized Controlled Trial
Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain.
Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. ⋯ Circumferential fusion is dominant over instrumented posterolateral fusion, that is, both being significantly cheaper and significantly better in a long-term, societal perspective.
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Retrospective morphometric population study. ⋯ Achondroplastic pedicle morphology differs markedly from those of the normal spine: chord lengths are substantially shorter, pedicles are inclined cranially, pedicle starting points diverge progressively in the lumbar spine, and pedicle shape transitions from vertically to horizontally oriented ellipsoids along the lumbar spine. Consideration of this variation could maximize the effectiveness and safety of pedicle instrumentation.
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Observational cohort study. ⋯ Stable vertebral fractures in childhood with no neurologic deficits at injury do not render more degenerative changes than can be expected according to age, but they are associated with more Schmorl's nodes at adjacent disc levels.
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Randomized Controlled Trial
Effect of low-dose ketamine on voltage requirement for transcranial electrical motor evoked potentials in children.
Randomized controlled trial. OBJECTIVE.: To determine the effect of low-dose ketamine on the voltage needed to elicit maximal amplitude of the motor-evoked response to transcranial electrical stimulation during propofol/remifentanil anesthesia in children undergoing scoliosis surgery. ⋯ Addition of low-dose ketamine to propofol/remifentanil anesthesia does not significantly reduce the voltage needed to elicit maximum amplitude of the motor-evoked response to transcranial electrical stimulation.