Spine
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A retrospective review of consecutive pediatric and adolescent patients who required posterior spinal fusion to correct scoliosis. ⋯ Using measures of efficacy similar to those reported in studies of adults, autologous blood was found to be more effective in meeting the transfusion needs of pediatric patients who required posterior spinal fusion than in meeting those needs in adult surgical patients in previous studies.
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Comparative Study
Revision of failed lumbar fusions. A comparison of anterior autograft and allograft.
The radiographic and clinical results of two different anterior structural grafts were compared in 38 patients who had combined anterior-posterior revision surgery for failed lumbar fusion. ⋯ Femoral ring allografts are as effective, clinically and radiographically, as tricortical iliac autografts when used as an anterior structural element in revision lumbar spine fusion in patients who have undergone multiple surgical procedures for pseudarthrosis or flatback deformity. The slightly greater improvement for the allograft group needs to be confirmed in a larger study.
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Randomized Controlled Trial Clinical Trial
Neurologic outcome of early versus late surgery for cervical spinal cord injury.
A prospective analysis evaluating neurologic outcome after early versus late surgery for cervical spinal cord trauma. ⋯ The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury (mean, 1.8 days) as opposed to waiting longer than 5 days (mean, 16.8 days).
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Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine.
To perform anatomic dissections and measurements of the recurrent laryngeal nerve between the inferior thyroid artery and superior border of the clavicle (mid-portion) on both sides. ⋯ The recurrent laryngeal nerve on the right side is highly vulnerable to injury if ligature of the inferior thyroid vessels is not performed as laterally as possible or if retraction of the midline structures along with the recurrent laryngeal nerve is not performed intermittently. Avoiding injury to the recurrent laryngeal nerve, especially on the right side, is a major consideration during an anterior approach to lower cervical spine.
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A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence. ⋯ Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.