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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Randomized Controlled Trial
Cervical orthosis does not improve postoperative pain following posterior cervical fusion: a randomized controlled trial.
To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis. ⋯ Pain scores over the first 4 weeks after surgery were equivalent for patients undergoing multi-level PCF treated with or without a cervical orthosis. Our findings do not support the routine use of a postoperative cervical orthosis for postoperative pain control. Clinical Trials Registration Number NCT04308122, April 22, 2020.
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Cervical hemivertebrae (C3-6) causing significant osseous torticollis, head tilt and facial asymmetry are rare and complicated. Cervical hemivertebrectomy (CHVE) by a posterior-only approach was never reported because it is highly risky and its efficacy remains controversial. This study is to evaluate the feasibility and preliminary clinical outcomes of posterior-only approach for CHVE and torticollis correction in young children. ⋯ CHVE by a posterior-only approach was a feasible alternative option for the treatment of congenital cervical scoliosis. It could resect the CHV effectively and achieve satisfactory torticollis correction without additional anterior access surgery. Successful CPS placement in this child population was essentially important to enable reliable osteotomy closure and firm posterior instrumentation.
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Low-grade isthmic and degenerative spondylolisthesis (DS) of the lumbar spine are distinct pathologies but both can be treated with lumbar decompression with fusion. In a very large cohort, we compared patient-reported outcome in relation to the pathology and chief complaint at baseline. ⋯ Regardless of the type of spondylolisthesis, all groups experienced an improvement in COMI score after surgery. Patients with DS and LP as their chief complaint appear to benefit more than other patients. These results are the first to show that the type of the spondylolisthesis and its chief complaint have an impact on surgical outcome. They will be informative for the consent process prior to surgery and can be used to build predictive models for individual outcome.
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Early-stage spondylolysis (ESS) is a common cause of acute low back pain (LBP) in adolescents. When treating patients with ESS, early diagnosis is essential, yet difficult without magnetic resonance imaging. This study evaluates a self-reported questionnaire for detecting ESS. ⋯ Exercise frequency, training time, pain-provoking situations, and gender could be important factors to detect ESS within this questionnaire.
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To identify the clinical phenotypes associated with the rate of progression while waiting for surgery and propose a classification scheme for identifying subgroups of patients to prioritize for surgery when long surgical delays are expected. ⋯ We present an evidence-based surgical prioritization algorithm for pediatric idiopathic scoliosis that can easily be implemented in clinical practice when long surgical delays are expected.