The spine journal : official journal of the North American Spine Society
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The single-stage posterior approach only for spinal tuberculosis (TB) has been reported by some surgeons recently, but few studies have reported single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in treatment of thoracic TB with kyphosis and spinal cord compression in patients older than 65 years. ⋯ Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion is an effective and safe method in treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals.
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Case Reports
Left ventricle thrombus after tranexamic acid for spine surgery in an HIV-positive patient.
Our case highlights the underappreciated thrombotic risks of tranexamic acid (TXA) use in non-cardiac surgery and emphasizes the need to elucidate these risks with appropriate clinical trials. ⋯ The thrombotic risks of TXA use in non-cardiac surgery have yet to be adequately studied in clinical trials. Hence, TXA use in this context is still an area of uncertainty, and its thrombogenic risks have yet to be studied as a primary outcome in any large prospective trial to date. Patients with any hypercoagulable risk factors, including HIV infection or any prior thrombotic history in which TXA use is being considered, should prompt a discussion among the perioperative physicians involved.
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Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. ⋯ The greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae.
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The incidence of osteoporotic and insufficiency fractures of the pelvic ring is increasing. Closed reduction and percutaneous fixation with cannulated sacroiliac screws is well-established in the operative treatment of osteoporotic posterior pelvic ring fractures. However, osteoporotic bone quality might lead to the risk of screw loosening. For this reason, cement augmentation of the iliosacral screws is more frequently performed and recommended. ⋯ Regarding iliosacral screw fixation in osteoporotic bone, the primary stability of techniques involving cement augmentation is significantly higher compared with screw fixation without cement augmentation. Perforated screws with the same primary stability as that of conventional screw fixation in combination with cement augmentation might be a promising alternative in reducing complications of cement leakage. These biomechanical results have to be transferred into clinical practice and prove their clinical value.
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Laminoplasty is a major surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Sometimes, patients with cervical OPLL demonstrate postoperative kyphosis despite sufficient preoperative lordosis. Recently, the impact of T1 slope has emerged as a predictor of kyphotic alignment change after laminoplasty. However, the relationship between T1 slope and postoperative cervical alignment change is not yet fully established. ⋯ Patients with higher T1 slope had more lordotic curvature before surgery and demonstrated more LCL at 2-year follow-up. Cervical alignment was compromised after laminoplasty, and the degree of LCL was correlated with preoperative T1 slope. After laminoplasty for cervical OPLL, patients with higher T1 slope tended to exhibit a greater LCL yet did not drift into frank postoperative kyphosis.