Neurosurgery
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To describe the technique and indications of a Smith-Petersen osteotomy in spinal deformity surgery. ⋯ A Smith-Petersen osteotomy is a safe and effective surgical technique to obtain correction of spinal deformity in both the sagittal and coronal planes.
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Bracing is the oldest treatment known for scoliotic spinal deformity. The relative advantages to the use of bracing have been directly related to the etiology of the deformity and the flexibility of the spine at the time that a decision is made regarding the use of a brace. In skeletally immature patients with adolescent idiopathic scoliosis, the advantages to bracing are clear. ⋯ Likewise, infantile and congenital scoliosis routinely requires surgical correction to prevent curve progression. Lastly, although many surgeons use bracing in the postoperative management of patients with spinal deformity, the benefits of postoperative bracing remain debatable. By far, the best indication for bracing is treatment of the skeletally immature adolescent patient with an idiopathic flexible curve of less than 45 degrees magnitude.
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Arteriovenous malformations of the basal ganglia and thalamus are often managed with radiosurgery or observation, without consideration of microsurgery. Given the devastating effects of hemorrhage from these lesions, the accumulating evidence that they bleed more frequently than their lobar counterparts should prompt more creative thinking regarding their management. ⋯ Given an appropriate surgical corridor of access, often afforded by incident hemorrhage, arteriovenous malformations of the basal ganglia and thalamus should be considered for microsurgical extirpation with preoperative embolization. In experienced hands, this approach presents an expeditious and definitive opportunity to eliminate the risk of subsequent hemorrhage and resultant morbidity and mortality.
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Review Case Reports Comparative Study
Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity.
Minimally invasive and interbody and instrumented fusion techniques are increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar spine. Advocates of minimal access spinal approaches list certain advantages over open procedures, including decreased postoperative pain and narcotic requirements, shorter hospital stays, less blood loss, and smaller incisions. The minimally invasive anterolateral approach allows access to the lumbar spine through the retroperitoneal space. ⋯ One patient had additional posterior segmental instrumentation placed. Mean Cobb angles in the coronal plane were 28.5 degrees preoperatively and 18.3 degrees postoperatively (P < 0.05). We also present a historical perspective on retroperitoneal spine surgery, a regional anatomic description of the lumbosacral plexus and surrounding structures, and a description of the surgical technique as related to treatment of lumbar deformity.
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To review current classification systems for adolescent and adult scoliosis. ⋯ The importance of scoliosis classification schemes lies in their ability to standardize communication among health care providers. With regard to the classification of adolescent scoliosis, the Lenke system has addressed many of the significant limitations of the King system and is now the standard classification scheme. Classification schemes for adult scoliosis have been reported only recently, and each offers specific advantages (the simple pathogenesis-based system of Aebi, the strong clinical relevance of the Schwab system, and the richly descriptive Scoliosis Research Society system). This article highlights the salient features of currently used scoliosis classification systems.