Neurosurgery clinics of North America
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The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. ⋯ The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes.
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Various osteotomies are useful in making a rigid deformity flexible enough for realignment in coronal and sagittal plane. This article defines the osteotomies and their usefulness in treatment of specific rigid deformities. The pedicle subtraction osteotomy and vertebral column resection used in treating rigid deformities are described in detail.
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Neurosurg. Clin. N. Am. · Apr 2013
ReviewClassifications for adult spinal deformity and use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification.
Adult spinal deformity (ASD) is a complex disease state that pathologically alters standing upright posture and is associated with substantial pain and disability. This article provides an overview of classification systems for spinal deformity, clarifies the need to differentiate between pediatric and adult classifications, and provides an explanation on the use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification (SRS-Schwab ASD Classification). This information allows surgeons, researchers, and health care providers to (1) identify sources of pain and disability in patients with ASD and (2) accurately use the SRSeSchwab ASD Classification to evaluate patients with ASD.
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Neurosurg. Clin. N. Am. · Apr 2013
Review Case ReportsUse of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation.
Over the past 3 decades the sagittal plane has received increasing attention from the scientific community and spine surgeons alike. There remains a lack of clear and concise methods for incorporating surgical techniques and radiographic parameters to achieve the best possible outcome on a patient-specific level. This article proposes a new method for a treatment approach to sagittal malalignment by incorporating new digital tools for surgical planning. This technique offers a consistent approach to adult spinal deformity with sagittal-plane components, and can permit optimization in consistently achieving proper postoperative spinopelvic alignment.