Spine
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Clinical and radiologic assessment derived from a prospective multicenter data base of adolescent idiopathic scoliosis (AIS) patients. ⋯ Major curve correction at 2 years correlates most with the implant density that is correction increases with the number of implants used within the measured Cobb levels. Although the absolute number of screws used did not correlate with correction, there was an advantage in lumbar and thoracic curves to using screws compared to hooks. Sagittal contour in the thoracic spine became less kyphotic than the higher the implant density.
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Retrospective review. ⋯ There is a significant learning curve associated with thoracic pedicle screw placement in AIS. We describe several technical steps that can be taken to increase the safety of screw placement at the beginning of the learning curve. Inexperienced surgeons should expect a gradual improvement over time in radiographic and clinical outcomes.
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Comparative Study
Long adult spinal deformity fusion to the sacrum using rhBMP-2 versus autogenous iliac crest bone graft.
Comparative study. ⋯ The pseudarthrosis rate in the BMP group compares favorably to pseudarthrosis rate in ICBG group, suggesting that the use of rhBMP-2 without iliac harvesting leads to a competitive fusion rate in long adult spinal deformity surgery, while avoiding ICBG harvest site morbidity.
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Retrospective case series. ⋯ This study documented a 3.9% overall reoperation rate at our medical center, a 3-fold lower reoperation rate than the previously reported 12.9%. The most common reoperations were for infections (34%), pseudarthroses (26%), and postoperative curve progression of the adjacent unfused spine (17%).
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Retrospective case review at a single center. ⋯ The incidence of PJK can be minimized by the appropriate selection of the upper end vertebra to be fused and avoiding disruption of the junctional ligamentum flavum. The development of DJK can be minimized by incorporation of the first lordotic disc into the fusion construct.