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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The aim of the study was to develop an insight into the impairments in spinal fracture patients, operatively treated with an internal fixator, and also into their ability to participate in daily living, return to work and quality of life as defined by the World Health Organization. Nineteen patients operated for a type A fracture of the thoracolumbar spine (T9-L4) between 1993 and 1998 in the University Hospital Groningen, the Netherlands, aged between 18 and 60 years, without neurological deficit were included in the study. Operative treatment consisted of fracture reduction and internal fixation using the Universal Spine System, combined with transpedicular cancellous bone grafting and dorsal spondylodesis. ⋯ In this matter, leg (muscle) performance seems a more important factor than overall condition (VO2-max). The results of the study indicate that patients with thoracolumbar spinal fractures without neurological deficit, treated with dorsal instrumentation, perform like healthy people 3-8 years after injury, according to the RMDQ, VAS Spine Score and SF36 results. Physical capacity tests reveal that leg (muscle) performance seems a more important factor in impairment than arm lift or overall condition.
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Degenerative cervical disorders predominantly lead to anterior spinal cord compression (by bony spurs at the posterior margin of the vertebral body or by degenerated disc), which may be central and/or foraminal. In a smaller percentage of cases, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or spinal cord. The aim of this work is to present a minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy. ⋯ Complete recovery of the preoperative neurological deficit was found in four patients, while the remaining eight patients showed improvement of the neurological symptoms during the follow-up period. There were no intra-operative or postoperative complications and no re-operation. The preliminary experience with this technique, and the good clinical outcome, seem to promise that this minimally invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine.
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Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. ⋯ There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.