Spine
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Clinical Trial
Expansive laminoplasty as a method for managing cervical multilevel spondylotic myelopathy.
This study evaluated 12 patients with multilevel cervical spondylotic myelopathy who underwent Kurokawa's procedure using hydroxyapatite spacers and performed with T-saw thread wire. ⋯ Laminoplasty with the T-saw technique appears to be a good method for managing multilevel cervical spondylotic myelopathy. This method is associated with a low rate of complications that also allows marked functional improvement in most patients. It can be used as a complement to anterior surgery.
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Henry William Meyerding is best known for his spondylolisthesis classification system, but he achieved much more while working at the Mayo Clinic, Minnesota, during the first half of the 20th century. A brief biography is presented, as well as some personal insights into the character of H. W. Meyerding.
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Comparative Study
Video-assisted versus open anterior lumbar spine fusion surgery: a comparison of four techniques and complications in 135 patients.
A retrospective review involved 135 patients undergoing anterior interbody fusion using four different approaches: transperitoneal video-assisted surgery with insufflation, retroperitoneal endoscopic video-assisted surgery, minilaparotomy retroperitoneal surgery, and traditional oblique muscle-splinting retroperitoneal surgery. ⋯ A comparative analysis of four techniques for approaching the lower lumbar spine to perform arthrodesis in 135 patients showed an incidence of complications consistent with the literature for video-assisted techniques, but higher than for open techniques. For these and other reasons, the video-assisted approaches have been abandoned by the surgeons of this report.
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A retrospective review was performed. ⋯ Autogenous tibial strut grafts provide physical advantages over commonly used iliac crest, rib, and fibula grafts. The tibia provides dense cortical bone with ample length and mechanical strength, although the actual strength of each strut was not measured directly. In this study, adequate correction was maintained throughout an average follow-up period of 3.9 years, and solid fusion was obtained in all cases. The results indicate that this technique offers a reliable means of providing anterior support in the management of severe kyphosis with virtually no donor-site morbidity. Although the number of patients in this review was limited, the authors believe that anterior autogenous tibial struts are an excellent alternative for the treatment of severe kyphosis and kyphoscoliosis.
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Multicenter Study
Selective anterior fusion of thoracolumbar/lumbar curves in adolescents: when can the associated thoracic curve be left unfused?
A retrospective multicenter study was conducted to investigate patients with a major thoracolumbar/lumbar adolescent idiopathic scoliosis and an associated minor thoracic curve treated with an anterior instrumentation and fusion of the lower curve. ⋯ Statistical analysis showed that a successful surgical outcome was dependent on both the structural changes in the thoracic curve and the patient's maturity. The thoracolumbar/lumbar-thoracic (TL/L:T) Cobb ratio in combination with the degree of the thoracic curve on lateral bending was the best predictor among the structural indexes. Of 44 patients with a TL/L:T Cobb ratio of 1.25 or greater and/or a thoracic curve, which bent out to 20 degrees or less, 42 had a satisfactory result. The best predictor among the maturity indexes was closure of the triradiate cartilages. Of 43 patients in whom the triradiate cartilages were closed, 42 had satisfactory results. When this data is combined, the outcome for the thoracic curve can be reasonably predicted.