Journal of spinal disorders
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A retrospective review of 107 patients with cerebral palsy who had undergone a posterior spinal fusion with unit rod instrumentation by the same two surgeons was done to determine what factors cause complications that lead to delayed recovery time and a longer than average hospital stay. The operative risk score was developed with scores for the child's ability to walk and talk, oral feeding ability, cognitive ability, and medical problems within the year prior to surgery. Operative risk score is primarily a measure of degree of neurologic involvement. ⋯ Curves with deformity of >70 degrees had statistically significant high POCS (p = 0.03). Complications for patients having a posterior and an anterior surgery versus those who had a posterior fusion alone were not statistically different (p > 0.05). The factors that led to a greater rate of complications were the severity of neurologic involvement, severity of recent history of significant medical problems, and severity of scoliosis.
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Anatomical and biomechanical data have suggested that pedicle screw fixation at the sacrum is optimum in the anteromedial direction into the S1 vertebral body, yet the possibility of posterior iliac crest interference with this screw pathway has been considered but not defined. This study aimed to determine if the anteromedial direction of screw placement into the vertebral body is possible in all cases at S1 and to assess the limiting effect of the posterior iliac crest. Computed tomography scans of the upper sacrum at the S1 pedicle parallel to the sacral endplate were examined in 100 patients. ⋯ On only three occasions (1.5%) was the ideal screw corridor not possible because of posterior iliac crest overlap. In each case, this occurred only unilaterally and when the widest of the screw corridors (12.5 mm) was used. Both the distance between the posterior iliac crests and the space available for optimum screw placement are greater in females than males.
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Combinations of varying degrees of spondylosis and/or ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL) contribute to thoracic and lumbar neural compression in North Americans. Preoperative magnetic resonance and computed tomography examinations dictated the surgical approaches used to address spondylosis/OPLL in 11 patients, OYL in 12 patients, and spondylosis/OPLL and OYL in 3 patients. ⋯ Outcomes (Odom's criteria) after laminectomy (24 patients) and circumferential thoracic procedures (2 patients) were good to excellent in the 73% of patients with spondylosis/OPLL, in 83% with OYL, and excellent for all 3 with spondylosis/OPLL and OYL. Full recognition of thoracic or lumbar spondylosis/OPLL and OYL ensure optimal surgical planning and outcomes.