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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Our objective was to report on the clinical and radiological outcome from a cohort of patients with neuromuscular scoliosis who underwent selective anterior single rod instrumentation for correction of thoraco-lumbar and lumbar scoliosis. Traditionally combined anterior release with long posterior instrumentation has been advocated for the treatment of neuromuscular scoliosis. Neuromuscular curves tend to be long and may have significant pelvic obliquity. ⋯ The mean pre-operative compensatory curve of 31 degrees (range 20-42) spontaneously corrected to 18 degrees (range 14-24) at 3 months and was maintained at 18 degrees (range 10-26) at final follow up. The mean pre-operative pelvic obliquity of 7 degrees (range 0-14) corrected to 4 degrees (range 0-8) at 3 months and was 3 degrees (range 0-8) at final follow up. Selective anterior instrumentation and fusion in carefully selected patients with neuromuscular scoliosis (short flexible curves, minimal pelvic obliquity, pre-operative walkers, slow or non-progressive pathology) appears to have satisfactory clinical and radiological outcome at least in the short-term.
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Comparative Study
Variability of spinal instrumentation configurations in adolescent idiopathic scoliosis.
Surgical instrumentation for the correction of adolescent idiopathic scoliosis (AIS) is a complex procedure involving many difficult decisions (i.e. spinal segment to instrument, type/location/number of hooks or screws, rod diameter/length/shape, implant attachment order, amount of rod rotation, etc.). Recent advances in instrumentation technology have brought a large increase in the number of options. Despite numerous clinical publications, there is still no consensus on the optimal surgical plan for each curve type. ⋯ In conclusion, a large variability of instrumentation strategy in AIS was documented within a small experienced group of spinal deformity surgeons. The exact cause of this large variability is unclear but warrants further investigation with multicenter outcome studies as well as experimental and computer simulation studies. We hypothesize that this variability may be attributed to different objectives for correction, to surgeon's personal preferences based on their previous experience, to the known inter-observer variability of current classification systems and to the current lack of clearly defined strategies or rational rules based on the validated biomechanical studies with modern multi-segmental instrumentation systems.
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This morphometric and experimental study was designed to assess the dimensions and axes of the subaxial cervical pedicles and to compare the accuracy of two different techniques for subaxial cervical pedicle screw (CPS) placement using newly designed aiming devices. Transpedicular fixation is increasingly used for stabilizing the subaxial cervical spine. Development of the demanding technique is based on morphometric studies of the pedicle anatomy. ⋯ Because of the variability of cervical pedicles preoperative CT evaluation with multiplanar reconstructions of the pedicle anatomy is essential for transpedicular screw placement in the cervical spine. Cadaver studies remain mandatory to develop safer and technically less demanding procedures. A similar study is projected to further develop the technique of CPS fixation with regard to safety and clinical practicability.
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Low back and pelvic pain (LBPP) is prevalent during pregnancy and also post-partum. The aetiology is poorly understood. The aim of this study was to investigate possible associations between epidural or spinal anaesthesia and caesarean section (CS) with persistent LBPP half a year after pregnancy. ⋯ Epidural or spinal anaesthesia was not associated with risk of persistent LBPP. Elective CS was associated with an increased risk of persistent LBPP. However, the results must be interpreted with caution because of a relatively small study sample.
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Clinical Trial
Interobservational variation in determining fusion rates in anterior cervical discectomy and fusion procedures.
The fusion rate represents one of the most commonly used criteria for evaluating the efficacy of spinal surgical techniques and the effectiveness of newly developed instrumentation and spinal implants. Reported fusion rates are not frequently supported by adequate information regarding by whom and how fusion was defined. In our prospective study we examined the fusion rate in patients undergoing first time anterior cervical discectomy and fusion for degenerative disease. ⋯ Our findings confirm the necessity of defining and describing criteria for fusion whenever this rate is reported in clinical series. The lack of widely accepted, well-defined criteria makes comparison of these results difficult. The development of a well organized, prospective clinical study in which fusion and outcome will be assessed by both clinical and radiographic parameters could significantly contribute to a more accurate evaluation of overall outcome of cervical spinal procedures.