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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Bone bruising associated with long bone injury is a defined entity with known radiological, pathologic and clinical features. Vertebral bone bruise (VBB) has been described through magnetic resonance imaging (MRI) of the injured spine, but to date the consequences of this entity are unknown. The objective of this retrospective study was to describe the plain radiographic outcome of MRI-defined VBB associated with thoracic and lumbar spine fracture in adults, and to assess whether VBBs caused abnormalities of the bone-implant interface at instrumented levels. ⋯ A total of 12 out of 30 (40%) bruised levels were instrumented in 13 out of 18 (72%) operated patients. No bone--implant interface failure was observed at these levels. It is concluded that VBB associated with thoracic and lumbar vertebral fracture in adult patients does not appear to cause significant progressive vertebral deformity or bone--implant interface failure.
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Clinical Trial
Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients.
The treatment of neurologically intact patients with thoracolumbar burst fractures is still controversial. This study was designed to evaluate the role of nonoperative treatment for 29 neurologically intact patients with two- or three-column-injured thoracolumbar burst fractures. Neurologically intact patients with types A, B and C burst fractures were treated conservatively and divided into groups GI and GII, according to their column involvement, with two and three injured columns, respectively. ⋯ None of the patients had neurological deterioration. Most of the functional results were satisfactory. As a result, it was concluded that nonoperative treatment could be an alternative method for neurologically intact two- and three-column-injured Denis-types A, B and C thoracolumbar burst fractures.
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Spinal deformity is the commonest orthopaedic manifestation in neurofibromatosis type-1 and is categorized into dystrophic and non-dystrophic types. Management should be based on a meticulous assessment of the spine with plain radiography and magnetic resonance imaging (MRI) to rule out the presence of dysplastic features that will determine prognosis and surgical planning. MRI of the whole spine should also be routinely obtained to reveal undetected intraspinal lesions that could threaten scheduled surgical interventions. ⋯ Bracing of dystrophic curves has been unsuccessful. Combined anterior/posterior spinal arthrodesis including the entire structural component of the deformity is indicated in most cases, particularly in the presence of associated sagittal imbalance. This should be performed using abundant autologous bone graft and segmental posterior instrumentation to minimize the risk of non-union and recurrence of the deformity.
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Comparative Study
Atlantoaxial fusion using anterior transarticular screw fixation of C1-C2: technical innovation and biomechanical study.
This study is an attempt to describe a new technique for anterior transarticular screw fixation of the atlantoaxial joints, and to compare the stability of this construct to posterior transarticular screw fixation with and without laminar cerclage wiring. Nine human cadaveric specimens were included in this study. The C1-C2 motion segment was instrumented using either anterior transarticular screws (group 1), posterior transarticular screws alone (group 2), or posterior screws with interlaminar cerclage wires (group 3). ⋯ Anterior transarticular screw fixation of the atlantoaxial spine has several advantages over posterior fixation techniques, and is as stable as posterior transarticular fixation in all clinically significant planes of motion. The addition of posterior interlaminar cerclage wiring further improves resistance to flexion-extension forces. Anterior transarticular screw fixation of the atlantoaxial joint is a useful technique for achieving C1-C2 stabilization.
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A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis. ⋯ In the present study with use of a motion-preserving Maverick prosthesis, it appears that the patient is able to maintain the preoperative sagittal balance. The prosthesis has enough freedom of motion to allow the patient to maintain the natural sagittal and spinopelvic balance needed to prevent potential undue stress on the muscles and the sacroiliac joint. Although the number of patients is small, this is the first study to our knowledge that evaluates the sagittal balance after motion-preserving total disc arthroplasty.