Spine
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Retrospective review. ⋯ Pediatric sacral fractures are rare (0.16% of pediatric trauma). As is the case in adults, most fractures are not associated with neurologic injury. Diagnosing pediatric sacral fractures requires high clinical suspicion and thorough radiographic evaluation. Correlation of neurologic injury with certain fracture types may be possible, but will require larger studies to be confirmed.
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Patient age; localization, length, and magnitude of the curve; and sagittal plane alignment are reported to be the major determinants in the selection of patients for convex growth arrest. Although the existence of sagittal plane abnormality (kyphosis or lordosis) is accepted as a contraindication for convex growth arrest, this issue has not been discussed in detail. ⋯ Sagittal segmental abnormality does not have a negative effect on the control of scoliosis in the majority of the patients (11 of 13). If the coronal curve stabilizes or improves, then sagittal segmental abnormality could also be stabilized (in 7 of 11 patients).
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Retrospective chart review. ⋯ Reconstructive spine surgery in pediatric patients with severe restrictive lung disease and significant spinal deformity is well tolerated. Familiarity with different surgical techniques of salvage reconstruction and perioperative multidisciplinary management should be emphasized. Routine preoperative tracheostomy is not indicated.
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Retrospective clinical and radiographic review with functional outcome assessment. ⋯ Satisfactory results are achieved with selective thoracic fusion of properly selected C modifier lumbar curves. Correction of the lumbar curve results principally from a decrease in the tilt of its upper vertebrae, but not necessarily improved apical translation. Mild coronal imbalance was well tolerated and has not necessitated distal extension of the fusion.