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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Although the Roussouly classification of common variants in spinal sagittal alignment is well accepted, no studies have implemented it in an asymptomatic adult population. In addition, no study investigated the radiographic features of asymptomatic patients with an anteverted pelvis. The aim of this prospective radiographic study of 296 asymptomatic adults without spinal pathology was to investigate how the Roussouly classification could include the anteverted pelvis concept. ⋯ Although asymptomatic adults stood with stable global balance, the sagittal spinal alignment of healthy subjects, newly divided in 5 sagittal types, varied significantly. Type 3 AP appears as a new and unusual sagittal shape with low-grade PI, very low or negative PT, and hyperlordosis. Whereas most asymptomatic adults stood with C7PL behind the hip axis, a sizeable portion had C7 in front of the hip axis. This could be a new controversial aspect of ideal spinal balance.
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Case Reports
Slow correction of severe spastic hyperlordosis in an adult by means of magnetically expandable rods.
We describe a case of severe and progressive lumbar hyperlordosis (160°) in a 28-year-old female university student with cerebral palsy. Her main complaints were abdominal wall pain and increasing inability to sit in her custom wheelchair. ⋯ This is the first case published in which percutaneous magnetic distraction was successfully used in an adult patient.
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Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis. ⋯ No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.
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Review Case Reports
Management of a posterior gunshot injury with a floating pedicle and cerebrospinal fluid leak.
Gunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade. ⋯ Literature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.