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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To establish to what extent neurosurgeons subscribe to the lumbosacral radicular syndrome (LRS) guideline, and to evaluate their current management of patients with LRS against the guideline. All active neurosurgeons in the Netherlands (n=92) were mailed a questionnaire about the guideline and data from 66 responders were analysed. Patients were recruited via seven of the participating neurosurgeons and were interviewed once by telephone. ⋯ Three of these seven propositions may need updating based on "new evidence". The time between the onset of the LRS episode and the actual moment of surgery was considerably longer than that recommended in the guideline. Based on their current management of LRS patients, the neurosurgeons largely adhere with the LRS guideline.
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Although the causes and progression of adolescent idiopathic scoliosis (AIS) are still unclear, a recent extensive review has indicated a number of possible aetiological factors. Previous investigations, employing gait measurements, have indicated asymmetries in the ground reaction forces and suggest a relationship between these asymmetries, neurological dysfunction and spinal deformity. Using a strain-gauge force platform, the present study has examined the time-domain parameters of various components of the ground reaction force together with impulse. ⋯ The results show that the patients with a left compensatory curve had a greater SI for a left-side impulse, whilst subjects with little or no compensation had a greater right-side impulse. This indicates that a possible gait compensation is occurring, so that the subjects compensate on the opposite pelvis/lower limb to that of the curve. While indicating the asymmetries between left and right, the results also serve to highlight the value of using kinetic parameters in developing the understanding of the pathogenesis and aetiology of scoliosis.
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Comparative Study
Is there a need for anterior release for 70-90 degrees masculine thoracic curves in adolescent scoliosis?
Large and stiff thoracic scoliotic curves in the adolescent represent a classic indication of anterior release followed by posterior instrumentation. However, third-generation segmental spinal instrumentations have shown increased correction of thoracic curves. Indication for an anterior release may therefore not be required even in large and stiff thoracic curves. ⋯ All patients reported satisfactory results except the patient with an adding-on phenomena. In the literature, most of the results of anterior thoracoscopic release and posterior surgery give a percentage of Cobb angle correction similar or inferior to our series for an average initial Cobb angle of less magnitude. Therefore, with adequate posterior release, and the use of third-generation segmental instrumentation there is no need for anterior release even for curves in the 70-90 degrees range.
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The natural history of uncomplicated hematogenous pyogenic spondylodiscitis is self-limiting healing. However, a variable degree of bone destruction frequently occurs, predisposing the spine to painful kyphosis. Delayed treatment may result in serious neurologic complications. ⋯ The immediate success rate after surgery for unselected patients in this combined series of 34 patients was 76%. This technique can be impressively effective and the results sustained when applied in the early stages of uncomplicated spondylodiscitis and contraindicated in the presence of instability, kyphosis from bone destruction, and neurological deficit. The special point of this procedure is a minimally invasive technique with high diagnostic and therapeutic effectiveness.
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There is evidence that a fall in nutrient supply leads to disc degeneration but little understanding of the effects of nutrient deprivation on the physiology of disc cells which govern the composition of the disc. We examined the effects of changes in glucose and oxygen concentration and pH on the viability and metabolism of cells from bovine nucleus pulposus. Cells isolated from bovine discs and embedded in alginate beads were cultured under oxygen and glucose concentrations from zero to physiological levels and maintained at pH 7.4, pH 6.7, or pH 6.2 for up to 3 days. ⋯ Glucose, rather than oxygen, appears to be the nutrient critical for maintaining disc cell viability. However, in an avascular tissue such as the disc, it is unlikely that glucose deprivation will occur alone; it will almost certainly correlate with a fall in oxygen concentration and pH. These results indicate that the combined nutrient and metabolite environment, rather than concentrations of any single nutrient, should be considered when studying cellular physiology in the disc.