Spine
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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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Prospective cohort study. ⋯ Larger anular defects and less disc removal increased the risk of reherniation. Greater volumes of disc removal were associated with accelerated disc height loss. In the setting of larger anular defects or less aggressive disc removal, concern for recurrent herniation should be increased during outpatient follow-up. In this situation effective anular repair may be helpful.
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Randomized Controlled Trial Multicenter Study Comparative Study
Sagittal cervical alignment after cervical disc arthroplasty and anterior cervical discectomy and fusion: results of a prospective, randomized, controlled trial.
Radiographic results of a multicenter, prospective randomized study comparing 1-level cervical total disc replacement (TDR-C) with anterior cervical discectomy and fusion (ACDF). ⋯ In both TDR-C and ACDF, lordosis increased at the device-level, cranial adjacent level, and in total cervical lordosis, while lordosis decreased at the caudal adjacent level. Although ACDF facilitated a greater increase in device level lordosis (+1.25 degrees ) and less loss of lordosis at the caudal adjacent level compared with TDR-C (-0.39 degrees ), the clinical relevance of the small differences remain unknown.