Journal of spinal disorders & techniques
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J Spinal Disord Tech · Feb 2005
Structures at risk following anterior instrumented spinal fusion for thoracic adolescent idiopathic scoliosis.
With the increasing popularity of anterior instrumented spinal fusion for adolescent idiopathic scoliosis, there has also been a rising concern over the proximity of the descending aorta to the screw tips and the possibility of vessel wall erosion over time. This computed tomography (CT) study attempts to define the relative position of the thoracic aorta and other vital structures to the spine (preoperatively) and to the projected instrumentation (postoperatively) by level and curve magnitude in deformity patients. ⋯ The course of the thoracic aorta may vary in individuals; however, in deformity patients, it generally moves from a relatively anterolateral position proximally to a posteromedial position at the apex. Distally, it moves more anteriorly. Consequently, the aorta moves closer to the screw tips both at the apex and distally, whereas the distal screws are more frequently juxtaposed to the descending aorta (P < 0.05).
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J Spinal Disord Tech · Feb 2005
Multicenter StudyAnterior-only stabilization of three-column thoracolumbar injuries.
The optimal treatment of "unstable" thoracolumbar injuries remains controversial. Studies have shown the advantages of direct anterior decompression of thoracolumbar injuries along with supplemental posterior instrumentation as a combined or staged procedure. Others have also shown success in decompression as a single-stage anterior procedure, largely limited to two-column (anterior and middle) injuries. A retrospective review of all available clinical and radiographic data was used to classify unstable three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) classification system. This was conducted to evaluate the efficacy of stand-alone anterior decompression and reconstruction of unstable three-column thoracolumbar injuries, utilizing current-generation anterior spinal instrumentation. ⋯ Current types of anterior spinal instrumentation and reconstruction techniques can allow some types of unstable three-column thoracolumbar injuries to be treated in an anterior stand-alone fashion. This allows direct anterior decompression of neural elements, improvement in segmental angulation, and acceptable rates of arthrodesis without the need for supplemental posterior instrumentation.
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J Spinal Disord Tech · Feb 2005
Randomized Controlled Trial Comparative Study Clinical TrialAnterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study.
A prospective randomized study was conducted to determine whether there exist any differences in radiographic, clinical, or functional outcomes when individuals with stable burst fractures of the thoracolumbar junction without neurologic deficit are treated with either a posterior fusion with instrumentation or anterior reconstruction, fusion, and instrumentation. There exists relatively little literature evaluating the outcomes of individuals treated with anterior surgery, and no prospective randomized studies exist comparing the two treatment approaches. ⋯ Although patient outcomes are similar, anterior fusion and instrumentation for thoracolumbar burst fractures may present fewer complications or additional surgeries.
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J Spinal Disord Tech · Feb 2005
Comparative StudyRadiofrequency heating of painful annular disruptions: one-year outcomes.
Although several studies have reported on outcomes following heating of annular tears with a thermoresistive catheter (SpineCATH), no data are available on the efficacy of thermal treatment with a flexible radiofrequency electrode (discTRODE). A prospective case-control study was conducted to determine the efficacy of radiofrequency heating of painful annular tears in the lumbar spine. ⋯ Radiofrequency heating of annular tears can lead to an improvement in the pain of internal disc disruption. The improvement gained by this treatment method is significantly better than that obtained from conservative management.