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 Comparative Study
Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis.
Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior-posterior approach to posterior-only approach, we conducted a meta-analysis. ⋯ Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior-posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.
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In adult scoliosis surgery (AS) delineation of risk factors contributing to failure is important to improve patient care. Treatment goals include deformity correction resulting in a balanced spine and horizontal lowest instrumented vertebra (LIV) in fusions not ending at S1. Therefore, the study objectives were to determine predictors for deformity correction, complications, revision surgery, and outcomes as well as to determine predictors of postoperative evolution of the LIV-take-off angle (LIV-TO) and symptomatic adjacent segment disease (ASD). ⋯ In the current study, the magnitude of deformity correction in the sagittal and coronal planes was shown to have significant impact on radiographic and clinical outcomes as well as revision rates. Findings indicate that risks for complications might be reduced by restoration of sagittal balance, appropriate deformity correction and advanced lumbosacral fixation. The use of preoperative LIV-TO and LIV-TO on bending/traction-films were shown to be useful for surgical planning, selection of the LIV and prediction of follow-up-TO, respectively. Parameters of sagittal balance rather than coronal deformity predicted ASD.
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Different treatment methods including immediate mobilization with or without brace, bed rest or immobilization using thoracolumbosacral orthosis have been applied for stable compression fractures of the pediatric spine. The aim of this study was to evaluate the influence of bracing on the remodeling capacity of pediatric thoracolumbar type A 1.2 impaction fractures. Additionally, the prevalence of pain and functional disabilities were assessed. ⋯ A significant remodeling capacity of thoracolumbar vertebral impaction fractures sustained in childhood is demonstrated. Bracing does not seem to influence the long-term outcome of these injuries. More studies have to be performed to define the role of bracing in these fractures.
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Comparative Study
The validity and reliability of "Spinal Mouse" assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves.
Radiological measurement has been accepted as the gold standard for evaluating scoliosis for many years. However, exposure of children to X-ray constitutes a major limitation of the radiological methods. Spinal Mouse (SM) is a safe, practical and easy to perform measurement of curvature in scoliosis, but its validity and reliability have not been investigated. The aim of this study was to investigate the validity and reliability of Cobb angle and SM measurements in children with adolescent idiopathic scoliosis (AIS). ⋯ We conclude that SM can be used for research and patient follow-up in the clinic as a safe, reliable, quick, and easy to use method with no side effects although it cannot be the only factor to consider when determining the treatment plan of AIS patients.
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To characterize the sagittal alignment of each Lenke type and investigate the relationship between coronal and sagittal deformities in adolescent idiopathic scoliotic (AIS) patients. ⋯ The influence of coronal deformity on sagittal parameters was limited and mainly reflected in the deviation of TK. Most coronal and sagittal parameters were not significantly correlated, and the coronal deformity types did not change the global sagittal postural patterns.