Spine
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Seventeen patients with progressive neuromuscular spinal deformity were critically analyzed. All patients were surgically managed by employing segmental spinal instrumentation with Luque rods accompanied by posterior spinal fusion to sacrum. Satisfactory correction of scoliosis, kyphosis, and lordosis was achieved. ⋯ Respiratory complications in this high-risk group were minimal. Partial postoperative immobilization with bivalved thoraco-lumbosacral orthoses (TLSO) was employed in the majority of patients. Segmental spinal instrumentation provides significant benefits to justify its continued use and development.
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Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This study of 165 cases demonstrates the various spectra of injury, called phylogenies, and develops a classification based on the mechanism of injury. ⋯ The probability of an associated neurologic lesion relates directly to the type and severity of cervical spine injury. With use of the classification, it is possible to formulate a rational treatment plan for injuries to the cervical spine.
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The correlation between the lateral curve, the location and the length of the curve, and the longitudinal axis rotation of the apical vertebra has been studied in 65 patients with idiopathic scoliosis using computer-assisted tomography. This method provides the opportunity to describe the relationship between the rib hump, the longitudinal axis rotation, the lateral curve, and the kyphosis-lordosis with exceedingly small radiation doses. The vertebral rotation was found to be correlated to the lateral curve but not to the location of the length of the curve. The longitudinal axis rotation of the vertebrae is the most important factor for the development of the rib hump which is further accentuated by increased lordosis.
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To analyze the effect of the Harrington compression system on the rib hump in thoracic idiopathic scoliosis, intraoperative measurements were made on 21 cases during correction with the distraction system and after addition of the compression system. The data show that the compression system makes a major contribution to the correction of total rib deformity in over two-thirds of the patients, and the correction of the rib valley is much more significant than correction of the rib hump. Analysis of postoperative spine roentgenograms seems to indicate that the extent of the rib correction does not correlate with spine derotation as measured by the system of Nash and Moe. The improvement in rib correction achieved by addition of the compression system appears to result from changes centered about the costovertebral joints.
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Computer tomography (CT) presents a method of determining longitudinal axis vertebral rotation and vertebral, spinal, and rib case deformity. Different rotation angles, distances, and indexes are defined and discussed. ⋯ This accuracy was lost if the vertebrae were tilted 20 degrees in both the frontal and the sagittal plane. Computer tomography can be used for evaluation of the vertebral rotation in the frontal plane.