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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"Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion. Instrumentation and surgical techniques have been modified in order to prevent spontaneous posterior fusion from occurring in children. ⋯ No statistical difference between the two treatments was found in cartilage, bone surface density, osteoid surfaces or osteoclast-covered surfaces in any zone. We conclude that ADCON-L gel mixed into autogenous bone graft can delay or decrease bone formation at spinal arthrodesis sites, thus influencing the extent of spinal fusion. This accords with our hypothesis that the use of ADCON-L gel can prevent not only the occurrence of spontaneous fusion in very young scoliosis patients after instrumentation without fusion, but also re-ossification of a decompressed spinal canal.
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This study was designed to develop predictive models for surgical outcome based on information available prior to lumbar stenosis surgery. Forty patients underwent decompressive laminarthrectomy. Preop and 1-year postop evaluation included Waddell's nonorganic signs, CT scan, Waddell disability index, Oswestry low back pain disability questionnaire, low back outcome score (LBOS), visual analog scale (VAS) for pain intensity, and trunk strength testing. ⋯ Underlying subclinical vascular factors may be involved in the complaints of spinal stenosis patients. Those factors should be investigated more thoroughly, as they may account for some of the failures of surgical relief. The CHAID decision tree appears to be a novel and useful tool for predicting the results of spinal stenosis surgery
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Clinical Trial
Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine.
Posterior instrumentation of the cervical spine has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervico-thoracic junction, has led spine surgeons to use pedicle screws. The improved biomechanical stability of pedicle screws and transarticular C1/2 screws allows for shorter instrumentations and improves the repositioning possibilities. ⋯ The mean operation time was 144 min (90-240 min) and the mean blood loss was 234 ml (50-800 ml). C1/2 transarticular screws, as well as transpedicular screws in the cervical spine and the cervico-thoracic junction, can be applied safely and with high accuracy using a CAS system. Computer-assisted instrumentation is recommended especially for pedicle screws at C3-C6.