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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Comparative Study
Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system.
Minimally invasive techniques for spinal surgery are becoming more widespread as improved technologies are developed. Stabilization plays an important role in fracture treatment, but appropriate instrumentation systems for endoscopic circumstances are lacking. ⋯ With interbody graft and fixation the new system demonstrated higher stabilizing effects in flexion/extension and lateral bending and restored axial stability beyond the intact spine, as well as having comparable or improved effects compared with the current system. Because of this biomechanical characterization a clinical trial is warranted; the usefulness of the new system has already been demonstrated in 45 patients in our department and more than 300 cases in a multicenter study which is currently under way.
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We studied the effects of spondylodesis on spinal curvature, functional outcome, level of ambulation and perceived competence in 11 children with osteogenesis imperfecta (OI). Mean age at surgical intervention was 13.1 years (SD 2.5 years) and follow-up amounted to 3.4 years (SD 2.3 years). Spinal curvature was measured according to Cobb. ⋯ The amount of pain, fatigue and subjective dyspnea seemed to diminish after spinal surgery. Progression of scoliosis proceeded, as did development of spinal curvature at the junction of the spondylodesis. Therefore, oral or intravenous bisphosphonates before and after spinal surgery should be considered.
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Review
Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature.
Traumatic atlanto-occipital dislocation (AOD) is a rare cervical spine injury and in most cases fatal. Consequently, relatively few case reports of adult patients surviving this injury appeared in the literature. We retrospectively report four patients who survived AOD injury and were treated at our institution. ⋯ The last patient, a man involved in a working accident, survived without neurological deficit of the upper extremities. Rigid posterior fixation and complete reduction of the dislocation were applied in last two cases using Cervifix together with a cancellous bone grafting. Previously reported cases of patients surviving AOD are reviewed, and clinical features and operative stabilisation procedures are discussed.
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We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. ⋯ No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.
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A highly unusual case is presented of a patient affected by Behçet's disease and severe kyphosis in the thoracic spine, who had a history of traumatic spinal cord injury during childhood. A review of the literature is also presented. Magnetic resonance imaging showed spinal cord compression at the level of the apex of the kyphosis in the upper thoracic spine. Although there is no information indicating that the coexistence of post-traumatic spinal deformity with Behçet's disease is not just a coincidental finding, the possibility that it was the presence of Behçet's disease concomitant with the antecedent spinal trauma that may have triggered the severe kyphotic deformity cannot be ruled out.