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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Global alignment analysis is of upmost importance in adult spinal deformity patients (ASD). Numerous parameters exist in the literature to measure global alignment based upon C7 or T1. One common limitation of these parameters is that they neglect the cervical segment which is essential in spinal compensatory mechanisms and in horizontal gaze preservation. A recent stereoradiography analysis of asymptomatic subjects introduced a new 3D parameter (ODHA), defined as the angle between the vertical reference line and the line joining the odontoid tip (OD) to hip axis center (HA). Thus, the goal of this study was to analyze 3D global alignment of ASD patients using the new parameter odontoid hip axis angle and its relationship to other spinal parameters. ⋯ Extreme values of ODHA are observed in significantly older patients with significant functional impairment. In addition, in these patients with sagittal malalignment with loss of lumbar lordosis, who recruit compensatory mechanisms such as pelvic retroversion, the cervical area is also involved with a posture in cervical hyperlordosis to maintain the head over the pelvis. Thus, ODHA is an interesting parameter allowing a more comprehensive alignment measurement taking into account the mechanisms of compensation of the cervical spine to the pelvis.
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To evaluate changes in the sagittal parameters of the occipito-atlantoaxial complex after three-level anterior cervical decompression and fusion (ACDF) and identify the influential factors by comparing ACDF with a zero-profile anchored spacer (ACDF-Z) versus a cage-plate construct (ACDF-P). ⋯ The Cobb angle decreased and ROM increased significantly as compensatory changes of the atlantooccipital or atlantoaxial joint after both types of ACDF, which may accelerate degeneration. The zero-profile anchored spacer had less impact on the occipito-atlantoaxial complex but was worse at maintaining the alignment restoration, which were contrary to the cage-plate construct. Surgeons should be aware of the impact of multi-level ACDFs on the occipito-atlantoaxial complex.
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The modification of cervical lordosis (CL) after adolescent idiopathic scoliosis (AIS) surgery is influenced by the correction of thoracic hypokyphosis. The quantification of the increase of CL as a function of the increase of thoracic kyphosis (TK) has never been calculated. ⋯ 60% of the TK gain was transferred to DCL gain. Correlations reflect the geometrical equivalence between PTK and DCL. The use of sagittal global measurements shows that DCL is equivalent to PTK and can be expressed as a function of pelvic parameters (DCL = PT + LL-PI). DCL must be considered to optimize the postoperative sagittal alignment of the spine.
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Navigation and robotic-guided systems are being used more often to facilitate efficient and accurate placement of hardware during spinal surgeries. Preoperative surgical planning is a key step in the safe use of these tools. No studies have yet investigated the predictive accuracy of surgical planning using a robotic guidance system. ⋯ This study indicates that the predictive accuracy of the use of preoperative planning software and robotic guidance to facilitate the surgical plan is within 6° and 9° in the coronal and sagittal planes, respectively.
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Anterior (ALIF) and lateral (LLIF) lumbar interbody fusion is associated with significant postoperative pain, opioid consumption and length of stay. Transversus abdominis plane (TAP) blocks improve these outcomes in other surgical subtypes but have not been applied to spine surgery. A retrospective study of 250 patients was performed to describe associations between TAP block and outcomes after ALIF/LLIF. ⋯ TAP block may represent an effective addition to pain management and opioid-reducing strategies and improve outcomes after ALIF/LLIF. Prospective trials are warranted to further explore these associations.