Spine
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This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger. ⋯ The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. More research is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.
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Case Reports
Circumferential vertebrectomy with reconstruction for holocervical aneurysmal bone cyst at C4 in a 15-year-old girl.
The authors describe the unique case of a 15-year-old girl with a holovertebral aneurysmal bone cyst at C4, causing anterolisthesis and kyphosis, who underwent circumferential vertebrectomy with reconstruction and rigid fusion. ⋯ Spinal aneurysmal bone cyst in children presents diverse challenges. These lesions should be treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality. One-year followup demonstrated a stable construct, and the patient remains neurologically at her baseline.
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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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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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Pedicle screw fixation (PSF) has been used for the setting of a lumbar interbody fusion. ⋯ Geometric constraints caused by PSF will reduce substantially the bone stress level and the relative motion, and therefore be more likely to allow bone ingrowth at the bone-cage interface, compared with the stand-alone ALIF. The use of pedicle screw stabilization would have significant beneficial effects on the rate of interbody fusion, regardless of whether ALIF or PLIF was used.