Spine
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Clinical and radiologic assessment derived from a prospective multicenter data base of adolescent idiopathic scoliosis (AIS) patients. ⋯ Major curve correction at 2 years correlates most with the implant density that is correction increases with the number of implants used within the measured Cobb levels. Although the absolute number of screws used did not correlate with correction, there was an advantage in lumbar and thoracic curves to using screws compared to hooks. Sagittal contour in the thoracic spine became less kyphotic than the higher the implant density.
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Retrospective clinical outcome study. ⋯ Despite the perioperative difficulties seen with CP patients, the majority of the patient/parents were satisfied with the results of the spinal deformity surgery. Functional improvements were limited but 8% to 40% of the patients still perceived the results as improved. The reason for less than optimal satisfaction appears to be due to less correction of the major curve, greater residual major Cobb angle, hyperlordosis of the lumbar spine after surgery, and late postoperative complications.
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Consecutive cohort study. ⋯ We found no evidence supporting the opinion that high-dose MPSS administration facilitates neurologic improvement in patients with spinal cord injury. We believe MPSS should be used under limited circumstances because of the high incidence of pulmonary complication.
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Multicenter Study Comparative Study
Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients.
Multi-center, retrospective review. ⋯ Counter to previous reports, age, comorbidities, and sagittal balance did not influence treatment modality for AS. Operative treatment for younger patients was driven by increased coronal plane deformity. Conversely, pain and disability mandated treatment for older patients, independent of radiographic measures. These findings suggest that AS patients do not become uniformly disabled with age, and that disability can not be solely predicted by radiographic findings. These data should be considered when considering treatment for AS.
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Comparative Study Clinical Trial
Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes.
Prospective, nonrandomized consecutive single surgeon series. ⋯ With current deformity correction techniques, both ALIF and TLIF are effective in DLS surgery. Anterior surgery is not routinely required to treat all cases of DLS.