Spine
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Case Reports
Late spontaneous hemothorax complicating anterior spinal instrumentation in adolescent idiopathic scoliosis.
Case report. ⋯ Late spontaneous HT in patients with anterior fusion and instrumentation for AIS is a rare but life-threatening complication.
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Prospective, sequential enrollment. ⋯ The SAQ is reliable, responsive to curve improvement, and shows strong evidence of validity. It provides more detail than the SRS in the appearance domain, and provides explanation of spinal deformity's concerns and improvements.
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Multicenter Study
Neural complications in the surgical treatment of adolescent idiopathic scoliosis.
Multicenter, prospective, consecutive clinical series. ⋯ The neural complication rate was 0.69%. Two thecal penetrations were due to medial placement of pedicle screws, and 1 was due to dissection during spine exposure. If these are eliminated, as they imply intraspinal entry but not direct neural injury, together with 1 positional neurapraxia, which is remote from the surgical field, our complication rate is 0.38%. This is consistent with other studies in the North American Literature, including multiple reports from the Scoliosis Research Society. Common themes are significant curve correction producing neural stretch and the use of sublaminar wires. None of the neural injuries was permanent. These results reaffirm that surgical treatment of adolescent idiopathic scoliosis has a low but real neural complication rate.
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A retrospective long-term follow-up study. ⋯ Advanced L5-S1 DDD developed in 69% of deformity patients after long fusions to L5 with 5 to 15 year follow-up. SAD frequently results in significant positive sagittal balance at a minimum 5-year follow-up. Long fusions to the upper thoracic spine down to L5 and circumferential fusion may further promote subsequent L5-S1 disc degeneration.
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Medical and radiographic review of 19 consecutive patients with spastic quadriplegia before and after intrathecal baclofen pump insertion with special attention paid to progression of scoliosis. ⋯ In published data, the rate of progression of scoliosis in skeletally immature nonambulatory patients with cerebral palsy was 4.5 degrees /year. In this study, the average rate of progression of the scoliosis for the immature was 9.02 degrees /year. For the skeletally mature bed-ridden patients, the worst-case natural history progression was 4.4 degrees /year. The comparable rate of change in skeletally mature (Risser 5) nonambulatory patients (n = 6) in this study was 28.4 degrees /year. This study demonstrates a significant increase in the rate of scoliotic curve progression after ITB pump placement when compared with published natural history data. The evidence of the beneficial effects of ITB on spasticity has been confirmed, and as larger, prospective randomized studies are conducted, the authors think that support for continued use of this treatment will increase. However, early bracing and spinal fusion may be warranted to prevent significant increases in spinal deformity if scoliosis is anticipated to progress more than 10 degrees /yr for patients with spastic quadriplegia and ITB pump. The authors are now performing spinal fusions for curves that exceed 40 degrees to 50 degrees in the presence of an ITB pump as recommended by previous reviews of scoliosis and accompanying quadriplegia.