Spine
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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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Retrospective chart review. ⋯ Current or previous osteomyelitis or discogenic infection, previous anterior spinal surgery, spondylolisthesis, osteophyte formation, transitional lumbosacral vertebra and anterior migration of interbody device point to an increased risk of vascular injury during anterior lumbar spinal surgery. Careful handling of the vascular structures and liberal use of topical hemostatic agents can lead to control of hemorrhage and preservation of vascular patency. Routine postoperative surveillance for proximal deep vein thrombosis, by magnetic resonance venography of the pelvic veins and inferior vena cava, should be performed after venorrhaphy.
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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.
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Comparative Study
Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss.
Parallel group design. ⋯ IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.
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Comparative Study
Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion.
Biomechanical in vitro human cadaveric lumbar flexibility testing with 6 sequential treatments. ⋯ ROM at the superior adjacent level (L2-L3) demonstrated no significant difference between intact, destabilized, one-level posterior fixation, and one-level circumferential fusion at the index level (L3-L4) when comparing posterior dynamic stabilization to rigid rod fixation. However, ROM at the superior adjacent level (L2-L3) was significantly greater for lateral bending and axial rotation when both levels (L2-L3 and L3-L4) were stabilized with a dynamic stabilization system. When the functional spinal units were instrumented with a two-level hybrid construct, two-level posterior instrumentation (L2-L3 and L3-L4) with a cage at the index level (L3-L4), all bending modes generated significantly greater ROM for the dynamic stabilization group at L2-L3 compared with rigid rod fixation.