Neurosurgery
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Pedicle subtraction osteotomy (PSO) is an effective tool for the correction of fixed sagittal plane deformity. However, there is potentially significant perioperative morbidity associated with this technique. We report our perioperative morbidity rate in recently performed PSO cases treated with our present surgical, anesthetic, and monitoring techniques and discuss complication-avoidance strategies. ⋯ In this series, most patients undergoing PSO had multiple previous spine surgeries and comorbidities. The risk of perioperative morbidity for revision cases undergoing PSO was in excess of 50%. We discuss complication-avoidance strategies.
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Comparative Study
Vertebral body replacement systems with expandable cages in the treatment of various spinal pathologies: a prospectively followed case series of 60 patients.
Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications. ⋯ Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.
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Comparative Study
Outcome of extratemporal epilepsy surgery experience of a single center.
Our aim was to determine the surgical outcome in adult patients with intractable extratemporal epilepsy and follow it over time. ⋯ Our results indicate that extratemporal epilepsy surgery at the Bethel Epilepsy Center has become more effective in the treatment of extratemporal epilepsy patients over the years, ensuring continuous improvement in outcome. This improvement can be attributed mainly to more restrictive patient selection.
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Significant advances have been made in the contemporary management of thoracolumbar spinal deformities, including improved segmental bony fixation, techniques for osteotomy, and mechanically powerful reduction maneuvers, which now allow the spinal surgeon to correct severe, complex, and rigid spinal deformities. However, one of the major limitations of surgical intervention has been the high complication rates associated with these surgical endeavors. ⋯ The open exposures for long-segment fixation result in additional blood loss, increased rates of infection, and prolonged immobilization caused by postoperative pain. Minimally invasive techniques attempt to overcome these drawbacks of the open exposures, and this report reviews preliminary experience in treating spinal deformities with long-segment minimally invasive internal fixation.
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Spinal deformity is the oldest disease known to humankind. The first record of correction of spinal deformity was documented in an Indian religious mythological book written between 3500 BC and 1800 BC. Initially, all spinal deformities were treated with the use of braces, traction, or casts. ⋯ This concept allowed surgeons to begin to achieve three-dimensional corrections by respecting both the sagittal and coronal curves simultaneously. The introduction of pedicle screws, throughout the thoracolumbar spine, has increased the ability of surgeons to achieve greater degrees of curve correction than had previously been possible. The history of spinal deformity is still maturing as newer procedures continue to be performed on a daily basis.