Spine
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Thoracolumbar rotation was measured by a noninvasive method in 135 patients with ankylosing spondylitis. The mean of the total rotation from the level of the xiphisternum to S1 was 45.2 degrees, which is approximately half of that in healthy subjects measured by comparable methods. ⋯ Reproducibility of the method was good. Measurement of thoracolumbar rotation is seldom used in the assessment of ankylosing spondylitis, and merits further evaluation.
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Twenty-two adolescent patients with severe (more than 50%) slip were surgically treated. Eleven were reduced with Magerl/Dick transpedicular screw devices and fused posteriorly from L4 to S1, and 2 weeks later anteriorly L5-S1; the other 11 were fused in situ L4-S1 (6 patients) or L5-S1 (5 patients) using a circumferential (6 patients), anterior (4 patients) or posterolateral (1 patient) technique without instrumentation. The two groups were comparable as to age at operation, age at follow-up, follow-up time, and preoperative radiologic measurement of the slip, lumbosacral kyphosis, and clinical findings. ⋯ Reduction procedures were also associated with a higher number of complications and reoperations. No neurologic complications, however, occurred in the reduction group. Based on this study, in situ fusions are to be preferred in adolescents with severe spondylolisthesis.