Spine
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The effects of Harrington instrumentation on the longitudinal axis rotation of the vertebra, the kyphosis-lordosis, and the rib-cage deformity were investigated by computer tomography in 33 patients. No significant derotation was achieved. ⋯ The rib hump was reduced significantly only with distraction rod instrumentation. The obtained results indicate that despite instrumentation, the spine preserves an almost unchanged peripheral position in the rib cage.
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A follow-up x-ray study of 554 subjects aged between 50 and 84 years has been carried out to determine the appearance, presence, and progression of scoliosis in the elderly and its relationship to osteoporosis and back pain. The subjects were chosen from a population group of 3600 subjects examined 7 to 13 years previously in the same investigators. Some degree of scoliosis was found in 70% of the subjects, and curves of 10 degrees or more in approximately 30%. ⋯ There was no direct relationship between the presence or progression of scoliosis and osteoporosis. There was no direct relationship between scoliosis and back pain or between scoliosis and degenerative changes in the spine. Since scoliosis in the elderly seldom becomes a clinical problem of significance, there would appear to be no valid reason for a more extensive study of the condition at this time.
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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.