Spine
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Randomized Controlled Trial Comparative Study
Allograft versus no graft with a posterior multisegmented hook system for the treatment of idiopathic scoliosis.
A prospective, randomized study. ⋯ Our results suggest that a PSF using newer-generation multisegmented hook-screw and rod systems can be successful with allograft and/or local bonegraft without the use of supplemental autogenous bone graft (from the iliac crest or ribs) in patients with AIS.
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A retrospective, comparative follow-up study. ⋯ Circumferential fusion provided significantly better long-term clinical, radiographic, and SRS total score than posterolateral or anterior fusion for high-grade isthmic spondylolisthesis.
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Comment Comparative Study
A review of the 2001 Volvo Award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group.
The current debate over the efficacy of lumbar fusion for low back pain has not been settled. Fritzell et al published a landmark paper entitled "Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group." Their goal was to provide objective evidence supporting lumbar fusion. While it was well designed and important to our knowledge base, it has limitations. ⋯ From technical and study design perspectives, Fritzell et al were able to validate the use of lumbar fusion for the treatment of low back pain. However, their use of "usual nonoperative" care and nonspecific definition of low back pain precluded a truly genuine comparison of operative and nonoperative groups. We commend the Swedish lumbar spine study group and their remarkable efforts; they elevated the sophistication of spine research and spawned many more excellent works to help settle the ongoing controversy on the ideal treatment of low back pain.
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Comparative Study
An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws.
A surgical simulation study in human cadaver spine specimens was conducted to evaluate the accuracy of 3 different surgical navigation systems compared to standard fluoroscopy in the percutaneous placement of iliosacral screws. ⋯ Computer-assisted fluoroscopy based image navigation appears to be more accurate than standard fluoroscopy in placing these screws. However, errors may occur with all techniques. Further refinement in registration procedures may highly improve the accuracy of percutaneous screw placement in a variety of spinopelvic procedures.
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Comparative Study
MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents: a clinical and biomechanical study.
Clinical review of pediatric patients with lumbar spondylolysis and biomechanical analysis using finite-element lumbar spine model. ⋯ The correlation between the high stresses in the pedicle and the corresponding HSC suggest that signal changes in MRI could be used as an indicator for early diagnosis of spondylolysis. The HSC of the pedicle provided useful information to diagnose early stage spondylolysis. Furthermore, the HSC may be a good indicator as to whether a bony union will result from conservative treatment.