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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Surgical management for lumbar stenosis is generally safe and provides significant improvements in pain, disability, and function. Successful lumbar decompression hinges on removing an appropriate amount of lamina and other compressive pathology in the lateral recess. Too little bony decompression can result in persistent pain and disability, while over resection of the pars and/or facets may jeopardize spinal stability. ⋯ All attempts during a lumbar decompression should be made to prevent iatrogenic pars fractures, as they may result in severe sagittal imbalance, neurologic compromise, and persistent disability. Iatrogenic, high-grade L5-S1 spondylolisthesis can be successfully treated with reduction using circumferential fusion of the lumbosacral junction.
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Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed. ⋯ The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.
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Pelvic balance is a version of the pelvis defined by pelvic orientation parameters of PT and SS. Two distinct versions of pelvis are defined: (1) balanced characterized by a relatively low PT and high SS, and (2) unbalanced with relatively high PT and low SS meaning excessive retroversion of the pelvis. It was proved for patients with a high-grade spondylolisthesis that rebalancing of the pelvis can positively affect clinical outcomes. Little is known about the impact of such rebalancing in low-grade isthmic spondylolisthesis. ⋯ Radiological improvement of pelvic balance after surgical correction of mid- and low-grade isthmic spondylolisthesis did not correlate with clinical outcomes.
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Vertebral augmentation is an established treatment for patients with pathological vertebral compression fractures. These procedures typically employ a PMMA-based bone cement, which possesses a high compressive stiffness. Because of the increased risk of subsequent fractures after vertebral augmentations, there is a desire for reducing this stiffness. The goal of our study was to examine the influence of adding isotonic saline on the biomechanical properties of PMMA vertebroplasty cement. ⋯ The compressive stiffness of PMMA-based vertebroplasty cement can be reduced to almost a third by the addition of saline. The probable explanation is an increase in microporosity. Future simulator experiments will show whether the achieved reduction in stiffness is large enough to reduce the rate of subsequent vertebral fractures.
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Balloon kyphoplasty (BK) has emerged as a popular method for treating osteoporosis vertebral compression fractures (OVCFs). In response to several shortcomings of BK, alternative methods have been introduced, among which is radiofrequency kyphoplasty (RFK). Biomechanical comparisons of BK and RFK are very sparse. The purpose of this study was to perform a biomechanical study in which BK and RFK are compared. ⋯ BK and RFK achieved similar results for fracture stabilization and restoration of the height of the fractured VB. RFK involved shorter cement augmentation time and less damage to the trabecular bone.