Spine
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A recently developed simple device, the intervertebral body fixation dual-blade plate, was used in 88 cases of different spinal disorders. This patients in the first series were operated on from 1984 to 1986. The device is biomechanically simple and its application safe and easy. ⋯ The midterm results, covering a follow-up period of 24-49 months (mean, 32 months) were satisfactory; there were no serious complications directly related to the device. There were four cases of pseudarthrosis due to insufficient bone graft technique. Of these, there were three cases of failure of the dual-blade plate.
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The Syracuse I-Plate is a versatile neutralization plate for anterior spinal fixation following decompression for burst fractures and pathologic vertebral body destruction by tumor. In this article, the history, current use, and indications are discussed. The anterior approach and application of the I-plate to the lower thoracic and lumbar spine is presented, as well as a brief summary of a current clinical series of 34 patients. Fusion rates were high and hardware failure most frequent in patients with associated osteoporosis or extensive posterior disruption, such that the device was contraindicated in cases of extensive three-column injuries or significantly osteoporotic bone.
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Comparative Study
Hypotensive anesthesia for scoliosis surgery in Jehovah's Witnesses.
Hypotensive anesthesia has been advocated in spinal surgery for the purpose of diminishing operative blood loss. This study evaluated its effectiveness in 12 Jehovah's Witnesses undergoing Harrington instrumentation and fusion who refused transfusion. Previous series from this institute did not use deliberate hypotension because of routinely low blood loss. ⋯ The majority of blood losses in spinal instrumentation with fusion occurs with decortication. This rapid bleeding occurs at venous pressures which are unaffected by arterial blood pressure manipulation. The authors conclude that spinal surgery is possible in Jehovah's Witnesses without transfusion and that operative technique is the single most important determinant of blood loss.
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The hypothesis for the mechanism of production of scoliosis, advanced on the basis of morphometric and morphologic studies in human thoracic skeleton, finds further support in the results of an experimental study in rabbits described herein. The removal of transverse processes alone resulted in the production of scoliosis and lordosis. When both transverse processes and facet joints were removed, scoliosis developed rapidly and was considerable. ⋯ The convexity of the curve was always toward the operated side, and the apex was almost always at the lowest operated segment. Lordosis was limited to within the operated area. The results of the experiment indicate that scoliosis resulted because of the asymmetry in load transmission through the ribs to the vertebral column in rabbits.