Spine
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Proximal junctional kyphosis (PJK) and adjacent segment degeneration (ASD) are important causes of reoperation for adult spinal deformity (). Reducing junctional complications can improve outcomes and cost-effectiveness of treatment. ⋯ In lumbar degeneration, semirigid fixation has been associated with implant loosening, nonunion, and revision surgery. Rigid fixation is more reliable than semirigid fixation for management of spinal deformity.
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The Uppsala Cryoplaning Technique has been used for over 30 years to study normal spinal anatomy and pathologies such as trauma, degenerative conditions, tumors, and metastases (SDC Figure 1, http://links.lww.com/BRS/B105). A heavy-duty sledge cryomicrotome creates authentic anatomical images of slices from the surface of in situ fresh-frozen specimens at submillimeter intervals. This presentation is intended to improve understanding of anatomical structures of the spine among spine surgeons.
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In the debate regarding whether rigid or semirigid fixation is better for proximal junctional kyphosis (PJK)/adult spinal deformity (ASD) correction, this presentation posits that semirigid fixation is the better approach. For ASD correction, might is not right, and a rigid approach does not solve the problems associated with PJK.
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Tethered cord syndrome (TCS) occurs as a constellation of neurologic signs and symptoms resulting from longitudinal traction on the spinal cord between fixed points. This condition involves a tug-of-war between ascent and inhibition of ascent of intrathecal nervous tissue within the vertebral canal during growth. ⋯ Patients report low back, lower extremity, and perineal pain; lower extremity sensory and motor deficits; urinary and bowel incontinence; and sexual dysfunction. When not treated early or adequately, TCS can lead to neurologic devastation.