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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Numerous vertebral fracture patterns have been reported in the literature. We present the case of a patient who sustained severe trauma to the back that resulted in a very unusual and not previously reported rotational injury consisting in complete 180 degrees rotation of the T6 vertebral body along a vertical axis, with only limited anteroposterior and lateral displacement. ⋯ The aetiology of such displacement is unknown. The possibility of late vascular complications should be kept in mind while treating thoracic spine fractures with rotational displacement.
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The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. ⋯ In three cases, kyphosis reappeared cranial to the fused segments, requiring ventral stabilization. With respect to increasing kyphosis angle, an early intervention should be aimed at. A secondary operation can be necessary, if surgery is performed without taking care of the growth potential.
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The association between peridural scarring and recurrent pain after lumbar discectomy is much debated. A recently published study found that patients with extensive peridural fibrosis were 3.2 times more likely to experience recurrent radicular pain than those with less extensive scarring. This finding may lead to an overestimation of peridural fibrosis in clinical practice. ⋯ The amount of fibrosis was divided into four stages in each affected quadrant. We found no differences regarding the amount of peridural fibrosis between patients with radicular pain and patients with non-radicular pain. We conclude that the extent of peridural scarring as defined by MRI is of minor value in the differential diagnosis of recurrent back and leg pain after lumbar microdiscectomy.
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Although the structural changes occurring in the scoliotic spine have been reported as early as the 19th century, the descriptions and biomechanical explanations have not always been complete and consistent. In this study, three-dimensionally rendered CT images of two human skeletons with a scoliotic deformity and two patients with serious scoliosis were used to describe the intrinsic vertebral and rib deformities. The pattern of structural deformities was found to be consistent. ⋯ The rib deformities at the convex side of the scoliotic curve showed an increased angulation of the rib at the posterior angle, whereas the rib curve on the concave side was flattened. The observed vertebral deformities suggest that these are caused by bone remodelling processes due to forces in the anterior spinal column, which drive the apical vertebral body out of the midline, whereas forces of the musculo-ligamentous structures at the posterior side of the spinal column attempt to minimize the deviations and rotations of the vertebrae. The demonstrated rib deformities suggest an adaptation to forces imposed by the scoliotic spine.
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In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. ⋯ Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 c.c. at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.