Spine
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Frontal plane geometry of postoperative curves was analyzed using a geometric model to investigate the relationship between coronal decompensation and postoperative apical shifts from the center sacral line for various thoracic and lumbar Cobb angles. ⋯ Decompensation does not appear to be caused by the relative magnitudes of the postoperative thoracic and lumbar curves, but is a result of inadequate relative distance between the thoracic and lumbar apical vertebrae in the postoperative geometry.
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The authors sought to measure the stiffness at the lumbosacral junction when it has been immobilized by means of two different posterior fixation systems in conjunction with three different anterior interbody fixation techniques. The information obtained provides a foundation for determining how methods of lumbosacral spinal fixation can maximize rigidity and improve fusion rates at this clinically important anatomic site. ⋯ The authors' data demonstrate that the threaded interbody fusion device may be an effective system for immobilization of the L5-S1 disc space. Rigidity of fixation at the lumbosacral junction may be enhanced by use of appropriate anterior interbody fusion techniques.
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This experimental study was designed to test the hypothesis that posterior spinal fusion and internal fixation, using a stiff transpedicular construct, would withstand additional anterior column growth without the need for an anterior procedure and would prevent the development of deformity secondary to asymmetric growth of the anterior column in the immature canine model. ⋯ The present study confirmed that in immature canines anterior column growth continues after posterior fusion without instrumentation. The magnitude of this growth, combined with a posterior tether, is sufficient to cause significant lordosis. The results are the first to document that a stiff posterior spinal instrumentation system is sufficient to overpower the residual anterior growth centers, even in the presence of a posterior tether (fusion mass). This technique creates a mechanical epiphysiodesis evidenced by arresting vertebral body length, narrowing disc space, and preventing lordosis, thus thwarting the deformity-producing mechanism without an additional anterior procedure.
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The authors developed a rat-tail model to investigate the hypothesis that vertebral wedging during growth in progressive spinal deformities results from asymmetric loading in a "vicious cycle." ⋯ The findings confirm that vertebral growth is modulated by loading, according to the Hueter-Volkmann principle. The quantification of this relationship will permit more rational design of conservative treatment of spinal deformity during the adolescent growth spurt.