Spine
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A retrospective study of the effectiveness of Amicar (epsilon aminocaproic acid). ⋯ Amicar was highly effective in decreasing total perioperative blood loss and transfusion requirements in same-day ASF and PSF with SSI for idiopathic scoliosis. It results in less preoperative autologous blood donation, perioperative blood transfusion, costs, and potential transfusion-related complications. It was most effective in decreasing intraoperative estimated PSF with SSI blood loss. It had no significant effect during the ASF, postoperative chest tube, or PSF wound suction drainage. We now recommend that it be used for the PSF with SSI procedure only.
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Multicenter Study Comparative Study Clinical Trial
Return of shoulder girdle function after anterior versus posterior adolescent idiopathic scoliosis surgery.
Multicenter, prospective, cohort study. ⋯ Approach-related differences in shoulder morbidity do exist in the treatment of primary thoracic curves in AIS. Specifically, OASF imparts a significantly greater magnitude and duration of postoperative shoulder dysfunction than do the TASF or PSF approaches. Nonetheless, these negative effects are transient as shoulder function in those patients treated via an open thoracotomy normalized by the 1-year postoperative time-point at the latest. Accordingly, viewed in isolation, shoulder morbidity should not deter surgeons from using an open anterior approach in the surgical treatment of AIS.
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Comparative Study
Comparison between 4.0-mm stainless steel and 4.75-mm titanium alloy single-rod spinal instrumentation for anterior thoracoscopic scoliosis surgery.
Retrospective review of a consecutive, single surgeon case series. ⋯ Although the average follow-up in the Ti group was significantly shorter than in the SS group, the 4.75-mm titanium alloy construct resulted in improved maintenance of deformity correction at 2-years postop and a lower incidence of instrumentation-related complications (pseudarthrosis, rod breakage, and surgical revisions) compared to the 4.0-mm stainless steel construct. Improved outcomes with the titanium alloy construct are likely because of the mechanical properties of the implant, refined patient selection criteria, and greater surgical experience gained with time.
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Clinical Trial
Selection of fusion levels in adolescent idiopathic scoliosis using fulcrum bending prediction: a prospective study.
A prospective study of 50 consecutive patients undergoing selective thoracic fusion for idiopathic scoliosis with minimum 2 year follow-up. ⋯ The new objective strategy for determining fusion levels using FB radiographs is safe and effective. With considering the flexibility of the curve, we are able to save levels distally in over 60% of patients. This strategy takes into account the power of modern instrumentation.
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In vitro biomechanical investigation of lumbosacropelvic spinal instrumentation. ⋯ There were no biomechanical differences between bilateral and unilateral iliac screw fixation. Intervertebral cage with full discectomy was significantly less stiff than intact. This study provides biomechanical data to correlate with improved clinical outcomes using unilateral iliac screw fixation, and evidence contraindicating full discectomy with intervertebral cage placement.