Spine
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Comparative Study
Long-term outcome in neuromuscular scoliosis fused only to lumbar 5.
Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. ⋯ Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion.
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Comparative Study
Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study.
Retrospective analysis of patients treated with single and dual growing rods who had completed their course of treatment, had definitive fusion, and had a minimum of 2 years follow-up. ⋯ The use of growing rods is effective in controlling severe spinal deformities and allowing spinal growth. Dual rods are stronger than single rods and, therefore, provide better initial correction and maintenance of correction. The use of an apical fusion does not appear to be effective over the course of treatment.
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Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. ⋯ In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.
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Eighteen human torsos were used in three experiments (A, B, and C) to determine the changes in sagittal motion due to three different sequences of three surgical releases. ⋯ Sagittal plane motion in the thoracic spine is influenced by all three structures tested in this experiment. Overall, the radical discectomy provides the greatest increase in total ROM and in extension compared with the other two releases. The second most influential release is the combination of sternal osteotomy plus costosternal release (i.e., sternal release), particularly in extension (correction of kyphosis). When two releases are done in sequence, radical discectomy plus sternal release provides the greatest increase in total ROM and in extension. Overall, total facetectomy is the least effective release. These data have relevance for surgical strategies in the correction of thoracic kyphosis or lordosis and suggest a potential role for sternal osteotomy and costosternal release in severe and rigid upper thoracic kyphosis.
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A retrospective study. ⋯ The incidence of proximal junctional kyphosis at 7.3 years postoperation was 26% and did not progress significantly after 2 years postoperation. Risk factors for developing PJK were an associated thoracoplasty, hybrid instrumentation (proximal hooks and distal pedicle screws), and a preoperative larger sagittal thoracic Cobb angle (T5-T12 > 40 degrees). The SRS-24 outcome instrument was not affected by PJK.