European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This paper examines the following speculative hypothesis: "that in some patients with scoliosis there is disproportionate neuro-osseous growth--the longitudinal growth of the spinal cord fails to keep pace with the growth of the vertebral column and, as a consequence, the spine buckles into a scoliosis deformity". A literature review of the morphology and neurology of scoliosis does not deny the hypothesis. Several mechanisms are suggested as to why the spinal cord growth could become uncoupled from osseous growth.
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The short segmental pedicle screw device is widely used for the decompression of neural elements and reduction of normal anatomy. Many biomechanical studies concerning proper decompression are available. However, no study has determined the optimal device adjustment for reduction of the burst fracture to the normal anatomy. ⋯ With this adjustment, on average the spine became 0.9 mm compressed and 2.0 degrees lordotic, compared to the intact. The results of the study show that the device adjustments of axial translation and sagittal angulation can be applied in any sequence, with the same results. The combination of 5 mm distraction with 6 degrees extension was the device adjustment that produced the closest anatomical reduction.
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Randomized Controlled Trial Clinical Trial
The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burst fractures on canal remodeling.
Short-segment posterior instrumentation for the treatment of thoracolumbar burst fractures has been reported with a high rate of failure. Transpedicular intracorporeal grafting in combination with short-segment instrumentation has been offered as an alternative to prevent failure. However, concern still remains about the potential complication of further canal narrowing or failure of remodeling with this technique. ⋯ Spinal canal narrowing was 38.5+/-18.2% at presentation, 22.1+/-19.8% postoperatively, and it further improved to -2.5+/-16.7% at follow-up, similar for both groups. Our results demonstrate that transpedicular intracorporeal grafting in the treatment of burst fractures does not have a detectable effect on the rate of reconstruction of the canal area or on remodeling. Spinal canal remodeling was observed to occur in all patients regardless of grafting.
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Atlantooccipital dislocation (AOD) is a rare and usually fatal injury. In the current study, the authors reported an extremely rare case of posterior AOD with Jefferson fracture and fracture-dislocation of C6-C7. ⋯ To our knowledge, this is the first report of posterior AOD with two other non-contiguous cervical spine injuries. A high index of suspicion and careful examination of the upper cervical spine should be considered as the key to the diagnosis of AOD in cases that involve multiple or lower cervical spine injuries.