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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Posterior vertebral column resection (PVCR) is an effective technique for treating severe rigid spinal deformities, and no other osteotomy is capable for such an excellent corrective effects. The purpose of this study was to discuss the correction mechanisms of PVCR. ⋯ In conclusion, the middle segment offered the highest contribution rate to the deformity correction of the major curve, but at the same time the spinal cord was angulated in this segment. So, it is dangerous to gain too much deformity correction in the middle segment. Because spine would shorten and the tension in spinal cord would decrease after vertebral column resection, a better correction effect could be gained in upper and lower segments at a low risk of spinal cord injury. But it was actually too hard for such rigid spinal deformity. It could gain a better corrective effect and stability by placing more pedicle screws at major curve, especially at the upper and lower vertebras adjacent to the resected vertebra, but sometimes it was difficult to place enough pedicle screws in severe rigid spinal deformities.
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The sagittal profile of conventionally and surgically treated scoliotic spines is usually analyzed via lateral views of whole-spine X-rays in an upright position. Due to a more hypokyphotic configuration of scoliotic spines, the view onto the upper thoracic vertebrae is often difficult. We investigated whether additional supine MRI measurement supports valid kyphosis angle measurement. ⋯ Thoracal kyphosis measurement of postoperative spines in MRI is a valid diagnostic tool with reliability comparable to that of X-ray. These results cannot be transferred to lumbar lordosis measurement and transferred only partly to coronal COBB angle measurement.
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Surgery has not been proven to be a better treatment option than non-operative management for limb paresis due to lumbar disc herniation. For the patients it will still be a concern, whether they will regain full strength after the operation or not. ⋯ The majority of patients with paresis were fully recovered 1 year after microdiscectomy for lumbar disc herniation. If the paresis was severe at baseline, there was a four times higher risk for non-recovery. Patients who did not recover had significantly worse outcomes.
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The conventional open pedicle screw fusion (PSF) requires an extensive detachment of the paraspinal muscle from the posterior aspect of the lumbar spine, which can cause muscle injury and subsequently lead to "approach-related morbidity". The spinous process-splitting (SPS) approach for decompression, unilateral laminotomy for bilateral decompression, and the Wiltse approach for pedicle screw insertion are considered to be less invasive to the paraspinal musculature. We investigated whether SPS open PSF combined with the abovementioned techniques attenuates the paraspinal muscle damage and yields favorable clinical results, including alleviation in the low back discomfort, in comparison to the conventional open PSF. ⋯ In conclusion, SPS open PSF was less damaging to the paraspinal muscle than the conventional open PSF and had a significant clinical effect, reducing low back discomfort over 1 year after the surgery.
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Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option. ⋯ Thoracoscopic microdiscectomy for single level symptomatic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate.