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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Comparative Study
The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta.
In severe forms of osteogenesis imperfecta, multiple compression fractures of the spine, as well as vertebral height shortening could be responsible for an increased thoracic kyphosis or a diminished lumbar lordosis. Theses progressive changes in sagittal shapes of the trunk could be responsible for a global sagittal trunk imbalance. We compare the parameters of sagittal spinopelvic balance in young patients with OI to those parameters in a control group of healthy volunteers. ⋯ In OI patients, the T1T12 thoracic kyphosis was statistically higher than in control group and was not correlated with other shape (LL) or pelvic (SS, PT or PI) parameters. Because isolated T1T12 kyphosis increase without T4T12 significant modification, we suggest that vertebral deformations worsen in OI patients at the upper part of thoracic spine. Further studies are needed to precise the exact location of most frequent vertebral deformities.
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This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol based on POC and determine its efficacy. ⋯ No major graft-related complications occurred in multilevel groups. The better surgical outcome of anterior surgery in MCM may make a significant difference in surgical outcome in younger and fitter patients like those of POC III whose expectations out of surgery are more. Judicious choice of anterior or posterior approach should be made after individualizing each case.
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Recent basic science studies on discogenic low back pain have provided new knowledge about this condition. This paper reviews some of these results and presents an overview of the following findings. The rat lumbar intervertebral disk may be innervated non-segmentally through the paravertebral sympathetic nerve and segmentally through the sinuvertebral nerves, and also by dichotomizing sensory fibers. ⋯ Nerve growth factor (NGF)-sensitive neurons are predominant in the rat intervertebral disk, which indicates that hyperalgesic responses can be induced by inflammation. NGF in the NP may promote axonal growth. Lumbar fusion may inhibit nerve ingrowth into the degenerated disk and reduce the percentage of calcitonin gene related peptide (CGRP)-positive neurons.
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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. ⋯ Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve <90 degrees ) and 69% in group 2 (curve >90 degrees) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.