Spine
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A prospective study of 19 adolescents and seven adults with idiopathic scoliosis undergoing posterior spinal fusion with segmental spinal instrumentation and a concomitant thoracoplasty had pulmonary function evaluation before surgery and at selected time points up to a minimum 2 years after surgery. ⋯ We reserve the thoracoplasty procedure for adolescents and adults with preoperative pulmonary function values that will tolerate the morbidity associated with the rib resection. Adolescent patients appear to normalize their pulmonary function tests by 2 years follow-up, whereas long-term pulmonary function in the adult patient remains a concern.
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A radiographic evaluation of 100 adult volunteers over age 40 and without a history of significant spinal abnormality was done to determine indices of sagittal spinal alignment. ⋯ The majority of asymptomatic individuals are able to maintain their sagittal alignment despite advancing age. Loss of distal lumbar lordosis is most responsible for sagittal imbalance in those individuals who do not maintain sagittal alignment. Spinal fusion for deformity should take into account the anticipated loss of lordosis that may occur with age.
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The effect of intraoperative positioning on lumbar lordosis was retrospectively studied by radiographic analysis of 40 patients under general anesthesia. ⋯ The "90-90" position on the Hastings frame was associated with significant reduction of total and segmental lordosis in the middle and lower lumbar spine. Positioning prone on a Jackson table maintained standing lumbar lordosis and increased lumbosacral lordosis.
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Historical Article
The history of the discovery of the sciatica stretching phenomenon.
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Randomized Controlled Trial Clinical Trial
Interobserver and intraobserver variability in interpretation of lumbar disc abnormalities. A comparison of two nomenclatures.
A double-blind prospective study was used to measure interobserver and intraobserver variability when interpreting lumbar spine magnetic resonance imaging studies of disc abnormalities. ⋯ Experienced readers using standardized nomenclature showed moderate to substantial agreement with interpreting disc extension beyond the interspace on magnetic resonance imaging.