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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Review Meta Analysis
Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws.
A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. ⋯ The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.
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A classification of injuries is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been proposed, the most frequently used is the Denis classification. The problem of this classification system is that it is based on an assumption, which is anatomically unidentifiable: the so-called middle column. ⋯ There is an increasing severity from A to C, and within each group, the severity usually increases within the subgroups from .1, .2, .3. All these pathomorphologies are supported by a mechanism of injury, which is responsible for the extent of the injury. The type of injury with its groups and subgroups is able to suggest the treatment modality.
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This article reviews the basic principles of management of cervical trauma. The technique and critical importance of careful assessment is described. ⋯ Early reduction and stabilisation techniques are described, and the indications, and approach for surgery reviewed. The importance of the role of post-injury rehabilitation is identified.
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Indications for correction of post-traumatic kyphotic deformity of the spine and technical aspects of the surgical procedure are reviewed. Surgical correction of post-traumatic deformity of the spine should be considered in patients presenting a local excess of kyphosis in the fractured area superior to 20 degrees with poor functional tolerance. Severe pain, explained by objective factors such as canal or neuroforamen compromise with or without peripheral symptoms, angular deformity, non-union, focal instability, adjacent painful compensatory deformity such as lumbar hyper-lordosis or thoracic hypo-kyphosis or lordosis is a further argument for surgery. ⋯ Complications do occur and lead to the need of re-intervention in up to 10% of our cases. However, significant complications with lasting consequences did not occur in our experience. The more severe is the deformity, the better are the chances to improve the patient, as long as the surgical goals are fulfilled.
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Review Case Reports
Endoscopic surgery on the thoracolumbar junction of the spine.
The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load bearing spinal column and post-traumatic deformity represent the most frequent indications for surgery. ⋯ The particular position of this section of the spine, which lies in the border area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the operation site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique and instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.