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 assess clinical and radiological outcomes at 2-year follow-up of one-level minimally invasive transforaminal interbody fusion with unilateral pedicle screw fixation (UNILIF) in the treatment of stable lumbar degenerative diseases. ⋯ One-level UNILIF constitutes an effective alternative for management of stable lumbar degenerative diseases. These slides can be retrieved under Electronic Supplementary Material.
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Hybrid stabilization with a dynamic implant has been suggested to avoid adjacent segment disease by creating a smoother transition zone from the instrumented segments to the untreated levels above. This study aims to characterize the transition zones of two-level posterior instrumentation strategies for elucidating biomechanical differences between rigid fixation and the hybrid stabilization approach with a pedicle screw-based dynamic implant. ⋯ Regardless of the implant, two-level posterior instrumentation was accompanied by a considerable amount of compensatory movement in the cranial untreated segments under the hybrid protocol. Hybrid stabilization, however, showed a significant reduction of this compensatory movement in comparison to rigid fixation. These results could support the surgical strategy of hybrid stabilization, whereas the concept of topping-off, including a healthy segment, is discouraged.
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The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion. ⋯ Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material.
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Cervical laminectomy is an effective treatment for multilevel cervical compressive myelopathy. Symptomatic spinal cord compression (SSCC) by paraspinal musculature (PSM) following cervical laminectomy is rarely reported. The aim of this study was to evaluate the frequency and pathogenesis of this complication after cervical laminectomy. ⋯ SSCC by PSM is a rare but devastating complication following cervical laminectomy, especially in those patients with preoperative kyphosis, prior antiplatelet treatment, and decompression with prone position. MRI is an ideal tool to identify this complication. Rapid cervical cord decompression and avoidance of recurrent compressive events can achieve a good clinical outcome. These slides can be retrieved under Electronic Supplementary Material.
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Major concern during surgery for high-grade spondylolisthesis (HGS) is to reduce lumbosacral kyphosis and restore sagittal alignment. Despite the numerous methods described, lumbosacral fixation in HGS is a challenging technique associated with high complication rate. Few series have described outcomes and most of the results are limited to lumbosacral correction without global sagittal alignment analysis. This study aims at analyzing clinical and radiological outcomes of HGS patients treated with intrasacral rods on full spine radiographs. ⋯ Intrasacral rod fixation appears to be an effective technique to correct LSA kyphosis, compensatory hyperlordosis and restore global sagittal alignment with a postoperative T1SPi corresponding to the value of the asymptomatic subject and achieve fusion. However, it remains a demanding technique with high risk of transient neurologic complications.