Spine
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In this anatomic study, the safety and accuracy of C1-C2 transarticular screw placement was tested in a normal anatomic situation in cadaver specimens using a specially designed aiming device. ⋯ This anatomic study demonstrates that C1-C2 transarticular screw fixation can be performed safely in a normal anatomic situation by surgeons who are familiar with the pertinent anatomy. The aiming device allowed safe instrumentation in all patients. In case of an irregular anatomic situation (e.g., congenital abnormalities or trauma), computed tomographic scan with sagittal reconstruction is recommended-in particular, to obtain information about the course of the vertebral artery.
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A retrospective clinical review of 20 children seen during a 7-year period who had atlantoaxial rotatory subluxation. ⋯ Optimal management of atlantoaxial rotatory subluxation entails early diagnosis with plain cervical radiographs and dynamic computed tomography. Closed reduction with cervical traction followed by rigid immobilization accomplished reduction in 15 of 16 patients (94%) and was curative in 10 of 16 patients (63%). Although reduction was achieved more rapidly and effectively with traction than with a collar, there may be a role for simple immobilization without reduction in patients with a short duration of symptoms. There does not appear to be a correlation between cause of atlantoaxial rotatory subluxation, age, or sex and the likelihood of recurrence.
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This study assessed the value of using lateral radiographs in evaluating the optimal screw length in transarticular C1-C2 screw fixation. ⋯ This results in this study indicate that a lateral radiograph may not be reliable in determining the optimal screw length, although it is valuable in directing accurate screw angle in the sagittal plane. Preoperative computed tomographic evaluation of the C1-C2 region may be helpful in estimating the location of the screw tip on the lateral radiograph during surgery.
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A retrospective review was completed on 21 patients who had a "least invasive" (one or two level) microdecompression and uninstrumented single-segment lumbar fusion for spinal canal stenosis with degenerative spondylolisthesis. ⋯ In this retrospective study, a "least invasive" surgical approach to lumbar degenerative spondylolisthesis with spinal canal stenosis causing claudicant leg pain produced acceptable results.
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Radiologic and operative findings of intravertebral cleft in the osteoporotic spine were investigated and the pathomechanism discussed. ⋯ The unstable cleft in the affected vertebral body of the osteoporotic spine with magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a false joint lined by fibrocartilaginous tissue with notable movement consistent with pseudarthrosis.