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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To conduct a retrospective multicenter study to investigate the accuracy of pedicle screw (PS) placement in the cervical spine by freehand technique and the related complications in various pathological conditions including trauma, rheumatoid arthritis, degenerative conditions and others. ⋯ Malposition rate of PS placement in the cervical spine by freehand technique was high in rheumatoid patients even when being performed by experienced spine surgeons. Any guidance tools including navigation systems are recommended for placement of cervical PSs in patients with RA.
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Sagittal imbalance is an independent predictor of outcome in adult degenerative spinal deformity. Restoration of sagittal spinopelvic parameters correlates with a better postoperative outcome. Several methods of preoperative calculation for sagittal correction have been proposed, most of them are geometrical. A non-geometrical method, based on data of spinopelvic relationships in normal subjects that uses the patient's pelvic incidence and age to calculate target lumbar lordosis and thoracic kyphosis is proposed. The goal of this study is to describe and validate this non-geometrical method in terms of sensitivity and specificity to predict satisfactory spinopelvic alignment. ⋯ Calculation of the target lordosis and kyphosis based only in the value of PI and age is a reliable method that can predict good outcomes in terms of alignment. The rule LL = -(PI + 10°) is an easy to calculate and very effective method of planning for lumbar lordosis and good alignment can be expected with high confidence when the final lordosis is within 10° of undercorrection. Including TK in surgical planning can improve the results in terms of restoration of the less known "spinopelvic balance" parameter.
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Observational Study
Proportional lumbar spine inter-vertebral motion patterns: a comparison of patients with chronic, non-specific low back pain and healthy controls.
Identifying biomechanical subgroups in chronic, non-specific low back pain (CNSLBP) populations from inter-vertebral displacements has proven elusive. Quantitative fluoroscopy (QF) has excellent repeatability and provides continuous standardised inter-vertebral kinematic data from fluoroscopic sequences allowing assessment of mid-range motion. The aim of this study was to determine whether proportional continuous IV rotational patterns were different in patients and controls. A secondary aim was to update the repeatability of QF measurement of range of motion (RoM) for inter-vertebral (IV) rotation. ⋯ The variation in proportional motion between lumbar vertebrae during passive recumbent trunk motion was greater in patients with CNSLBP than in matched healthy controls, indicating that biomechanical factors in passive structures play a part.
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The intersomatic cage ROI-C one is a new promising system in anterior cervical discectomy with subsequent fusion. ⋯ This is the first prospective study on ROI-C cages. Although this is a preliminary assessment, the ROI-C cage may represent an excellent alternative to other devices or simple bone graft.
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For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing. ⋯ For the osteoporotic spine, screw injected augmentation showed the best biomechanical stability. Although pullout testing was more sensitive, the differences observed were not reflected in the more physiological fatigue testing, thus casting further doubt on the clinical relevance of pullout testing.