The spine journal : official journal of the North American Spine Society
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Treatment of unstable burst fractures in the dorsolumbar spine still remains controversial. Surgical stabilization has been aimed to prevent long-term back pain and progression of deformity. ⋯ There is a progressive loss of correction of the angle of kyphosis after posterior stabilization with instrumentation even without implant removal that mainly corresponds to the decrease in the anterior segment height of the fractured vertebral body.
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Anterior corpectomy and reconstruction with bone graft and a rigid screw-plate construct is an established procedure for treatment of cervical neural compression. Despite its reliability in relieving symptoms, there is a high rate of construct failure, especially in multilevel cases. ⋯ This study suggests that screw divergence from the end plates not only increases load transmission to the graft but also predisposes the screws to higher shear forces after corpectomy reconstruction. In particular, the inferior screw demonstrated larger stress than the upper-level screws. In the proposed hybrid fusion model, lower stresses on the bone graft, end plates, and bone-screw interface were recorded, inferring lower construct failure (end-plate fractures and screw pullout) potential at the inferior construct end.
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Although several authors have already reported on the high local recurrence rate of sacral chordomas after surgical resection, there are no reports on the risk factors for recurrence after resection when combined with preoperative tumor-related blood vessel embolism by digital subtraction angiography (DSA) technique. ⋯ Higher tumor location and higher expressions of PCNA and bFGF will lead to a shorter CDFS. Resecting the tumor as completely as possible will decrease the chances of local recurrence of sacral chordomas.