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
-
Patients with adolescent idiopathic scoliosis (AIS) often present with a disfiguring shoulder imbalance. Shoulder balance (Sh.B) is of significant importance to the patient's self-perception. Previous studies have correlated Sh.B with respect to only the clinical posterior view correlated with radiographs. It is important, however, to address Sh.B with respect to anterior view of the patients' shoulders as if patients were viewing in a mirror. In this study, we evaluated the anterior Sh.B and correlated it with posterior Sh.B clinically and radiographically in Lenke type 1 and 2 curves. ⋯ There is no strong correlation between anterior and posterior clinical Sh.B, and surgeons should evaluate both sides in planning deformity correction, especially in Lenke 2 curves. None of the radiographic measures showed strong correlation (R > 0.8) with anterior or posterior clinical Sh.B. A stronger correlation existed between radiographic measures and anterior Sh.B measurements compared with posterior clinical Sh.B measurements in Lenke 2 curves further necessitating anterior evaluation in this group.
-
Idiopathic scoliosis can lead to sagittal imbalance. The relationship between thoracic hyper- and hypo-kyphotic segments, vertebral rotation and coronal curve was determined. The effect of segmental sagittal correction by in situ contouring was analyzed. ⋯ Lenke 1 and 3 curves can show normal global kyphosis, divided in cranial hyperkyphosis and caudal hypokyphosis. The cranial end of hypokyphosis corresponds to maximal rotation. These vertebrae have most migrated anteriorly and laterally. The sagittal apex between segmental hypo- and hyper-kyphosis corresponds to the coronal thoracic apex. A segmental sagittal imbalance correction is achieved by in situ contouring. The concept of segmental imbalance is useful when determining the levels on which surgical detorsion may be focused.
-
The purpose of the study was to find out if transpedicular decancellation osteotomy (TDO) is recommendable for neurological recovery in patients with myelopathy due to tubercular rigid kyphosis. We have analyzed the pattern of recovery seen after the surgery and also made an effort to correlate the neurological recovery with preoperative clinical and radiological features. ⋯ TDO gives good results in delayed onset neurological deficits in caries spine with rigid kyphosis. At least, one grade improvement in the neurological status of patients with ASIA C and ASIA D can be expected. Maximum improvement in the neurology is seen in the first 3 months and up to 6 months from the date of surgery, without much improvement thereafter. Level of evidence Level IV.
-
One of the downsides of spinal correction surgery for adolescent idiopathic scoliosis (AIS) is the cessation of spinal longitudinal growth within the fused levels in growing children. However, the surgery itself has the potential to increase spinal longitudinal length by correcting the curvature. The purpose of this study was to evaluate the correlation between curve correction and increased spinal longitudinal length by corrective surgery for AIS. ⋯ Spinal longitudinal length was significantly increased after surgery in both the ASF and PSF groups. Correction of the Cobb angle and increase in T1-L5 length were highly correlated with each other, especially in the PSF group.
-
Clinical Trial
Efficacy of epidural administration of anti-interleukin-6 receptor antibody onto spinal nerve for treatment of sciatica.
Interleukin-6 (IL-6) is thought to play a crucial role in the radicular pain caused by lumbar spinal stenosis. However, efficacy of inhibition of IL-6 for sciatica in patients with lumbar spinal stenosis has not been clarified. The purpose of the current study was to examine the effect of the anti-IL-6 receptor monoclonal antibody, tocilizumab, on radicular pain by its epidural administration onto spinal nerves in patients with lumbar spinal stenosis. ⋯ Our results indicate that the epidural administration of an anti-IL-6 receptor monoclonal antibody, tocilizumab, onto the spinal nerve produced reduction of radicular leg pain, numbness, and low back pain without adverse event. IL-6 may be one of the inducers of pain caused by spinal stenosis in humans.