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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Case Reports
Kyphoscoliosis associated with congenital neuromuscular disease with uniform type 1 fibers.
To report the first case of surgical treatment for severe kyphoscoliosis associated with respiratory disorder in a patient with congenital neuromuscular disease with uniform type 1 fibers (CNMDU1), including management of the possible onset of malignant hyperthermia (MH) in general anesthesia. CNMDU1 is rare among congenital neuromuscular diseases, and surgery for spinal deformity in CNMDU1 has not been described. Onset of MH in general anesthesia is a concern in this disease. ⋯ Spinal deformity in CNMDU1 has a risk of severe progression, which makes early diagnosis by biopsy important. The surgery may be recommended before severe progression of spinal deformity and respiratory disorder. Perioperative MH is a concern, but can be managed by appropriate procedures.
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A 47-year-old male with a history of recurrent low-back pain presented with acute left radiculopathy. ⋯ Intradural disc herniation is a rare condition and requires durotomy to remove the pathology. Therefore an actual high resolution MRI is mandatory in all cases of intraspinal space occupying lesions.
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Despite the advantages of modern instrumentation techniques, the treatment of severe rigid idiopathic scoliosis could be very demanding. Traction can provide better, safer correction and minimize complications related to forceful intra-operative maneuvers; however, several side effects are associated with prolonged periods of traction. The aim of this work is to review the clinical and radiographic results of limited perioperative halo-gravity traction in severe rigid curves analyzing its efficacy, advantages and possible complications and comparing it to classic two staged corrections performed without traction. ⋯ Limited halo-gravity traction is an efficient, safe modality in the treatment of severe rigid adolescent scoliosis. The application of gradual traction over a limited period of 2 weeks led to better correction, shorter operative time with no significant complications.
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The indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis (AIS) have not been established, with some studies suggesting that rates of spinal cord abnormalities are low and question the use of the routine MRI in AIS. ⋯ Our audit demonstrates that neither coronal nor sagittal misbalance should be used as an indicator of neural axis abnormalities.
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Comparative Study
Diffusion-weighted MR imaging in differentiation between osteoporotic and neoplastic vertebral fractures.
To assess the usefulness of magnetic resonance imaging (MRI) with spin-echo echo-planar diffusion-weighted imaging (SE-EPI-DWI) in differentiation between vertebral osteoporotic fractures and pathological neoplastic fractures. ⋯ DWI provides reliable information to support MRI diagnosis of neoplastic versus osteoporotic fractures. ADC value appears as a useful adjunctive parameter.