Spine
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A retrospective study of postoperative pain management with intrathecal morphine. ⋯ Intrathecal morphine in the moderate dose range of 9 to 19 microg/kg (mean 14 microg/kg), provides safe and effective postoperative analgesia in the immediate postoperative period for patients with idiopathic scoliosis undergoing PSF and SSI. Higher doses did not result in significantly better analgesia and had a greater frequency of respiratory depression requiring PICU admission.
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Clinical Trial
Selection of fusion levels in adolescent idiopathic scoliosis using fulcrum bending prediction: a prospective study.
A prospective study of 50 consecutive patients undergoing selective thoracic fusion for idiopathic scoliosis with minimum 2 year follow-up. ⋯ The new objective strategy for determining fusion levels using FB radiographs is safe and effective. With considering the flexibility of the curve, we are able to save levels distally in over 60% of patients. This strategy takes into account the power of modern instrumentation.
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Comparative Study
Comparison between 4.0-mm stainless steel and 4.75-mm titanium alloy single-rod spinal instrumentation for anterior thoracoscopic scoliosis surgery.
Retrospective review of a consecutive, single surgeon case series. ⋯ Although the average follow-up in the Ti group was significantly shorter than in the SS group, the 4.75-mm titanium alloy construct resulted in improved maintenance of deformity correction at 2-years postop and a lower incidence of instrumentation-related complications (pseudarthrosis, rod breakage, and surgical revisions) compared to the 4.0-mm stainless steel construct. Improved outcomes with the titanium alloy construct are likely because of the mechanical properties of the implant, refined patient selection criteria, and greater surgical experience gained with time.
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Multicenter Study Comparative Study Clinical Trial
Return of shoulder girdle function after anterior versus posterior adolescent idiopathic scoliosis surgery.
Multicenter, prospective, cohort study. ⋯ Approach-related differences in shoulder morbidity do exist in the treatment of primary thoracic curves in AIS. Specifically, OASF imparts a significantly greater magnitude and duration of postoperative shoulder dysfunction than do the TASF or PSF approaches. Nonetheless, these negative effects are transient as shoulder function in those patients treated via an open thoracotomy normalized by the 1-year postoperative time-point at the latest. Accordingly, viewed in isolation, shoulder morbidity should not deter surgeons from using an open anterior approach in the surgical treatment of AIS.
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Multicenter Study Comparative Study
Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific?
Prospective, observational study. ⋯ Our findings confirm the SRS instrument has excellent discriminate validity in the adult population. It appears to be disease-specific in the domains of pain, appearance and activity in adult spinal deformity patients who have not had prior surgery.