Spine
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A retrospective review of the case records and radiographs of 133 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation between 1986 and 1992. ⋯ Performance of a thoracoplasty was the only risk factor for postoperative pulmonary complications in patients undergoing posterior spinal fusion. There was no correlation between deterioration of preoperative pulmonary function and the risk of postoperative pulmonary complications. It appears that performance of preoperative pulmonary function tests in patients with moderate adolescent idiopathic scoliosis-scheduled for posterior spinal fusion is not necessary.
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Biomechanical testing with human cadaveric lumbar vertebral bodies was used to determine the utility of an injectable carbonated apatite cancellous bone cement for improving the structural performance of pedicle screws subjected to axial pull-out or transverse cyclic loading. ⋯ The data suggest that augmentation with this carbonated apatite cancellous bone cement can enhance immediate screw fixation.
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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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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.
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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.