The spine journal : official journal of the North American Spine Society
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Transarticular C1-2 screws are widely used in posterior cervical spine instrumentation. Injury to the vertebral artery during insertion of transarticular Cl-2 screw remains a serious complication. Use of a computer-assisted surgery system decreases this complication considerably. However, this system encounters problems in ensuring complete accuracy because of positional variations during preoperative and intraoperative imaging generation. Therefore, intraoperative fluoroscopy still is one of the commonly used methods to guide insertion of transarticular Cl-2 screw. Evaluation of a true lateral radiographic view of the C2 pedicle for screw trajectory during C1-2 transarticular screw insertion may help to minimize this potential complication. ⋯ True lateral radiographic views of the pedicles provide useful information for defining screw trajectory intraoperatively. Using this view along with AP and lateral view of cervical spine and preoperative three-dimensional CT scan may narrow the margin of error in this delicate area.
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Acute onset of radicular symptoms has been reported following hemorrhage into lumbar synovial cysts after trauma or in cases of spinal instability. No previous cases have been linked to anticoagulation therapy. ⋯ This is the first reported case of symptomatic hemorrhagic lumbar facet cyst associated with anticoagulation therapy.
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In adolescents with idiopathic scoliosis (AIS), several studies have shown that the pelvis is structurally changed by the spinal disorder. In fact, a significant correlation has been observed between the three-dimensional changes in the lumbar curve and the reduction in pelvic displacement in the three spatial planes during gait. However, the impact of this pelvic disorder on the walking mechanism has not been established. ⋯ The scoliosis affected the structural bones of the pelvis with no effect on the 3D pelvis position during standing. During walking, normal 3D pelvic displacements could be explained by the prolonged duration of activation of the erector spinae and quadratum lumborum muscles bilaterally allowing the equilibrium of the pelvis to be maintained. This excessive muscular activity caused a failure of the locomotor mechanism as shown by an increase in the muscular external work.