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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Spinal deformity is the commonest orthopaedic manifestation in neurofibromatosis type-1 and is categorized into dystrophic and non-dystrophic types. Management should be based on a meticulous assessment of the spine with plain radiography and magnetic resonance imaging (MRI) to rule out the presence of dysplastic features that will determine prognosis and surgical planning. MRI of the whole spine should also be routinely obtained to reveal undetected intraspinal lesions that could threaten scheduled surgical interventions. ⋯ Bracing of dystrophic curves has been unsuccessful. Combined anterior/posterior spinal arthrodesis including the entire structural component of the deformity is indicated in most cases, particularly in the presence of associated sagittal imbalance. This should be performed using abundant autologous bone graft and segmental posterior instrumentation to minimize the risk of non-union and recurrence of the deformity.
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Comparative Study
Atlantoaxial fusion using anterior transarticular screw fixation of C1-C2: technical innovation and biomechanical study.
This study is an attempt to describe a new technique for anterior transarticular screw fixation of the atlantoaxial joints, and to compare the stability of this construct to posterior transarticular screw fixation with and without laminar cerclage wiring. Nine human cadaveric specimens were included in this study. The C1-C2 motion segment was instrumented using either anterior transarticular screws (group 1), posterior transarticular screws alone (group 2), or posterior screws with interlaminar cerclage wires (group 3). ⋯ Anterior transarticular screw fixation of the atlantoaxial spine has several advantages over posterior fixation techniques, and is as stable as posterior transarticular fixation in all clinically significant planes of motion. The addition of posterior interlaminar cerclage wiring further improves resistance to flexion-extension forces. Anterior transarticular screw fixation of the atlantoaxial joint is a useful technique for achieving C1-C2 stabilization.
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A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis. ⋯ In the present study with use of a motion-preserving Maverick prosthesis, it appears that the patient is able to maintain the preoperative sagittal balance. The prosthesis has enough freedom of motion to allow the patient to maintain the natural sagittal and spinopelvic balance needed to prevent potential undue stress on the muscles and the sacroiliac joint. Although the number of patients is small, this is the first study to our knowledge that evaluates the sagittal balance after motion-preserving total disc arthroplasty.
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One of the main limitations of vertebroplasty is the excessive pressure required to inject a sufficient amount of cement into a vertebral body. Based on previous work that shows that approximately 95% of the injection pressure is required to deliver the cement through the cannula, we proposed a new cannula design with a larger internal diameter in the proximal section. The objective of this study is to determine whether the new cannula geometry significantly reduces the delivery pressure and eases cement injection during vertebroplasty. ⋯ Specifically, when the internal diameter of the proximal section was increased by a factor of two, which is clinically feasible, the delivery pressure dropped by about 63%. The redesigned cannula appears to have the potential to improve vertebroplasty. The key benefits are that (1) it eases cement injection, (2) it can be easily integrated into the existing procedure, and (3) it is cost-effective.
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The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57 years, SD 9 years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57 years, SD 7 years), with no history of back pain requiring medical treatment. ⋯ The patients in the "poor" outcome group ("surgery didn't help"; 9%) had a significantly greater reduction in ROF(lumbar) post-surgery compared with the "good" outcome group ("surgery helped"; 91%) (p=0.04). In stepwise linear regression, the change in ROF(lumbar) was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion." In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery.