Spine
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This is a retrospective study of 50 patients with adolescent idiopathic scoliosis with curves measuring 35 degrees to 45 degrees who were treated with a Boston brace. ⋯ These long-term data confirm that the Boston brace when used 18 or more hours per day is effective in preventing progression of large curves at a mean of 9.8 years after bracing is discontinued.
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Three types of anterior thoracolumbar multisegmental fixation were biomechanically compared in construct stiffness and rod-screw strain. ⋯ For single-rod fixation, increased rod diameter neither markedly improved construct stiffness nor affected rod-screw strain, indicating the limitations of a single-rod system. In thoracolumbar anterior multisegmental instrumentation, the dual-rod fixation provides higher construct stiffness and less rod-screw strain compared with single-rod fixation.
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Comparative Study
A comparison of the effects of patient-controlled analgesia with intravenous opioids versus Epidural analgesia on recovery after surgery for idiopathic scoliosis.
Epidural infusion was compared with standard patient-controlled analgesia (PCA) in 50 patients after surgical correction of adolescent idiopathic scoliosis with respect to certain postoperative parameters. ⋯ Epidural infusion of opioids with bupivacaine is safe and effective for controlling postoperative pain after PSIF without an increased complication rate when compared with PCA. In the current study, patients tolerated a full diet and were discharged from the hospital an average of 0.5 days earlier than PCA-treated patients.
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Retrospective review of a defined Marfan population with traditional indications for bracing. ⋯ The success rate for brace treatment of Marfan scoliosis is 17%, which is lower than that reported for idiopathic scoliosis. Possible reasons include increased progressive forces, altered transmission of corrective pressure to the spine, and younger age at inception of bracing. Because there was no control group, it is unknown whether bracing slowed curve progression. Physicians should understand that most patients with Marfan syndrome who have a curve of more than 25 degrees and a Risser sign of 2 or less will reach the surgical range, even with brace treatment.
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Prospective study. ⋯ Pulmonary function following thoracotomy with ASF with instrumentation demonstrated a significant decline of 3-month postoperative PFT values, but returned to preoperative baseline absolute values (L) by the 2-year follow-up visit. The percent predicted values returned to within 95% of baseline 2 years postoperatively. Scoliosis surgeons should be aware of these findings when deciding upon the approach (anterior versus posterior) utilized for thoracic AIS.