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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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.
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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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Multicenter Study Clinical Trial
Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study.
Prospective observational cohort study with matched and unmatched comparisons. Level II evidence. ⋯ It would appear from this study that common nonoperative treatments do not change the QOL in patients with ASLS at 2-year follow-up. However, operative treatment does significantly improve the QOL for this group of patients. Our conclusions are limited by the fact that we were only able to follow-up 45% of the nonoperative group to 2-year follow-up, in spite of extensive efforts on our part to accomplish such.
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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.