Spine
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A retrospective review of the long-term clinical and radiographic outcomes of anterior spinal fusion with instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis (AIS). ⋯ The anterior approach in the treatment of thoracolumbar and lumbar curves in AIS offers good long-term functional outcomes for patients. Despite expected degenerative changes, patients scored well on the SRS and Oswestry tests, and were able to pursue careers and family activities.
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Randomized, double-blinded, placebo controlled animal study. ⋯ Our results suggest that teriparatide enhances spinal fusion while calcitonin has a neutral effect. The teriparatide group had the best histologic fusion rate and Emery scores, while the calcitonin group was similar to the saline controls. Although not significant, the teriparatide group had a strong trend towards superior radiographic fusion over the calcitonin group.
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Comparative Study
Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls.
Retrospective, observational study. ⋯ The aprotinin treatment group lost significantly less blood and received significantly fewer blood transfusions than both the tranexamic acid and control groups without significant differences in intra- and postoperative complications. These results may justify further study of aprotinin and other antifibrinolytics for this specific indication (3-column lumbar osteotomies in the adult spinal deformity population). A multicenter randomized comparative analysis would be ideal.
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A retrospective study. ⋯ Dynamic stabilization with pedicle screws in addition to decompressive laminectomy resulted a safe procedure in elderly patients with degenerative lumbar scoliosis; it was able to maintain enough stability to prevent progression of scoliosis and instability, enabling a wide laminectomy in cases of associated lumbar stenosis. This nonfusion stabilization technique was less aggressive than instrumented fusion and obtained a statistically significant improvement of the clinical outcome at last follow-up.
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Comparative Study
Usefulness of electromyography compared to computed tomography scans in pedicle screw placement.
This is a retrospective analysis of 30 pediatric deformity surgeries. ⋯ Thoracic and lumbar pedicle screws are safe surgical options in the treatment of pediatric scoliosis. Comparison of electromyography potentials and postoperative computed tomography scans showed no statistically significant difference for all classes of screws. The likelihood ratio for electromyography testing was more clinically significant in the lumbar spine. A triggered electromyography value greater than or equal to 6 mA has a high likelihood of that screw being in the "safe zone." However, there is no true electromyography cut-off value that guarantees accurate placement and avoidance of neurologic injury.