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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Paget's disease of bone (PDB) is the second most frequent metabolic bone disease with the spine being a common site of manifestation. Still, neither the disease's etiology nor reasons for its manifestation at preferred skeletal sites are understood. The aim of the current study was therefore to perform a histologic and histomorphometric analysis of PBD biopsies of the spine to achieve a more detailed understanding concerning PDB activity and characteristics. ⋯ Disease activity in terms of osteoblast and osteoclast number does not appear to be significantly associated with disease location when spinal and iliac bone biopsies are compared. However, a positive correlation between vertebral body height and density in skeletal-intact individuals and disease incidence was observed leading to the conclusion that vertebral body height and possibly at least the spine bone volume together with bone density might play an important role in the incidence of PDB.
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To assess if the evaluation of the spino-pelvic balance can be effective in the surgical decision making of the high-grade high dysplastic developmental spondylolisthesis (HDDS). ⋯ The analysis of the spino-pelvic sagittal balance allows to identify two types of HDDS: the balanced deformities, which do not need reduction, and the unbalanced deformities, in which correction is needed.
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Vertebroplasty and more recently kyphoplasty are recognized as techniques in the treatment of osteoporotic vertebral fractures and in case of pathological fracture like in secondary tumors. The recent introduction of calcium phosphate cement (CPC) that offers, at least theoretically, an osteointegrative capacity, absent in polymethyl methacrylate (PMMA), has generated interest for its use in the treatment of traumatic fractures (type A) even in young patients. ⋯ While kyphoplasty with the use of CPC in the treatment of type A traumatic fractures was effective in the treatment of pain, it has not been so far effective concerning the maintenance of the reduction obtained intra-operatively and its osteointegrative effect.
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To identify potential prognostic factors predicting functional outcome and survival after surgery followed by radiotherapy for metastatic spinal cord compression due to solid tumors. ⋯ The key element for successful treatment of MESCC is multidisciplinary care of the patient, which includes all of those prognostic factors that have been, until now, analyzed and compared. In our set of patients treated for vertebral metastases, PS, time to development of symptoms, and the presence of visceral metastases affected functional outcome and survival.
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Many degenerative phenomena frequently result into kyphotic lumbar and thoracic deformities or cause their progression combined with deformities on the frontal plane of the spine. In these patients, the progression of the sagittal imbalance may lead to a series of disabling functional and painful consequences. The analysis of the spinopelvic parameters biases the choice of the correction surgical strategy aimed at restoring a good tri-dimensional and sagittal balance of the spine. ⋯ In our experience, patients with sagittal imbalance and short fusion areas show a higher risk of correction loss; the arthrodesis area must include the thoracolumbar junction, and it is often necessary to include the whole thoracic spine in the arthrodesis area. This is to avoid any loss of correction, implants mobilization, and proximal hyperkyphosis.