Spine
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At the end of lumbar microdiscectomy, we administered an emulsion of low-dose epidural morphine and vaseline sterile-oil as carrier for morphine delivery. ⋯ Epidural application of morphine-vaseline sterile-oil compound after lumbar microdiscectomy proved to be safe and effective, improving postoperative pain control and return to function. At clinical and neuroradiological follow-up epidural fibrosis was acceptable. To confirm the efficacy of the compound, large prospective studies are warranted.
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Preoperative review of a prospective study, single institution, consecutive series. OBJECTIVE.: To analyze the intermediate-term follow-up of consecutive adolescent idiopathic scoliosis (AIS) patients treated with pedicle screw constructs. ⋯ This is the largest (N = 114), consecutive series of North American patients with AIS treated with pedicle screws having a minimum of 3-year follow-up. The average curve correction was 68% for the main thoracic, 50% for the proximal thoracic, and 66% for the thoracolumbar/lumbar curve at final follow-up.
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Animal experiment using transcranial motor-evoked potentials (tcMEPs) in a pig model. ⋯ Our results validate monitoring of tcMEPs in multiple myotomes to detect nerve root injury in pigs. This model may be used for further study of the use of tcMEPs to detect predictors and risk factors of nerve root injury during spinal surgery.
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Clinical, biochemical, and histologic analysis was performed after in vivo delivery of cDNA encoding various anabolic cytokines and marker genes to the lumbar epidural space of New Zealand white rabbits, using both adenoviral and adeno-associated viral vectors. ⋯ Properly dosed and directed gene therapy seems to be both safe and potentially efficacious. This study suggests that side effects of gene therapy may be due to a combination of dosing, transgene product, and vector choice, and that newer AAV vectors may reduce these side-effects and decrease the risk of this technology.
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Closing-opening wedge osteotomy (COWO) had been performed by the senior author (K.C.) since 1998. A study had been conducted to evaluate the efficacy of COWO since 2000. ⋯ COWO is a useful procedure for patients with sagittal imbalance requiring more than 35 degrees lordotic correction through the osteotomy site. A worse clinical result is associated with increasing patient comorbidities, pseudarthrosis in lumbosacral fusion, and junctional kyphosis.