Spine
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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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A three-dimensional, nonlinear finite element analysis was performed to predict the in situ contact interaction of prosthesis components of the Prodisc-L in a multisegmental lumbar model following total disc replacement (TDR). ⋯ The in situ function of the TDR prosthesis was highly dependent on how well the device could incorporate itself into the mechanical environment in the disc space, which has been determined by the rest of the spinal structures, including the retained disc anulus, articular facets, ligaments, vertebrae, and muscular stabilizers. The different contact interaction of the artificial disc components revealed here could be attributed to the violation of this mechanical environment which, in turn, may bring adverse effects to those spinal elements.
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A long-term, population based, retrospective follow-up study. ⋯ Brace treatment does not prevent progression of the spinal deformity in patients with DD. Anteroposterior surgery is indicated in patients with severe spinal deformities. The risk for major complications is high especially in patients with marked kyphosis.
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Retrospective review. ⋯ There is a significant learning curve associated with thoracic pedicle screw placement in AIS. We describe several technical steps that can be taken to increase the safety of screw placement at the beginning of the learning curve. Inexperienced surgeons should expect a gradual improvement over time in radiographic and clinical outcomes.
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Case series. ⋯ Notwithstanding high sensitivities, specificities, and negative predictive values for cervical spine imaging and "clearance" mechanisms, 4 cases that illustrate the potential for undetected unstable cervical spine injuries are presented. Tremendous advancements in medical imaging have been made. However, radiograph, CT, and MR imaging may still fail to accurately translate the anatomic and dynamic complexity of the cervical spine into digital images that accurately guide clinical practice. A full understanding of and keen appreciation for the fact that no imaging technique, classification method, or clearance protocol can produce 100% sensitivity at all times is essential. These case reports cumulatively demonstrate a 0.04% to 0.2% incidence of undetected cervical injury requiring surgical stabilization. Removing cervical collar immobilization as quickly as possible based on negative interpretation of imaging data may prove harmful in a measurable percentage of patients and must be undertaken with caution only after clinical correlation and strict follow-up is established.