Der Orthopäde
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Posttraumatic kyphosis (PTK) is a possible consequence of a missed fracture, a wrong indication for conservative therapy or an inadequate surgical technique but PTK can also be a complication after adequate surgery. Avoidance of PTK is of importance because subsequent surgical therapy can be extensive. ⋯ Knowledge of the principles of sagittal balance and spinopelvic parameters are indispensable in the treatment of PTK. Our experience and results from the literature show that a good long-term outcome with limited complications can only be achieved when considering the biomechanical principles as well as restoration of sagittal balance.
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Thoracic and thoracolumbar kyphosis is a common deformity in pediatric and adolescent populations. Kyphotic deformation of the spine is defined as a curve which shows an increase in the dorsal convex angulation. The most common causes of kyphosis in pediatric and adolescent populations are Scheuermann's disease, postural and congenital kyphosis. ⋯ Clinically significant sagittal deformities can lead to severe pain, substantial cosmetic alterations, spinal cord dysfunction, problems with swallowing, gastrointestinal and cardiopulmonary complications. When the kyphotic deformity exceeds a certain point and conservative therapy options are no longer sufficient surgical intervention is indicated. The available operative options for treatment of the various types of pediatric and adolescent thoracolumbar kyphosis include dorsal instrumentation and fusion combined with ventral fusion and purely ventral instrumentation and fusion.
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Review Comparative Study Controlled Clinical Trial
[Multiplan correction of a 3D deformity. Options and relevance of optimizing the thoracic kyphosis in reconstructive scoliosis surgery].
There is presently still no consensus on how to operatively treat adolescent idiopathic scoliosis (AIS), i.e. a clearly reduced thoracic kyphosis. For a long time the primary focus was mostly on correcting the coronal plane while neglecting the sagittal profile. Based on the current literature and own retrospective data a comprehensive review will be given on the optimal correction of the spine and how to avoid secondary complications. Different operative standard procedures are demonstrated with special attention to the sagittal balance and the special parameters sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sagittal slope (SSL) and pelvic incidence (PI). ⋯ Both the results from the literature and own data confirm that operative correction of AIS needs a careful planning including sagittal spinopelvic parameters. Rigid thoracic hypokyphosis require additional osteotomy.
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Review Case Reports
[Sagittal deformity. Basic principles of surgical strategies].
There is a large body of literature supporting the importance of restoring sagittal balance to the spine. The main message is this: regardless of the specific surgical strategy and treatment or pathology, rebalancing results in a positive patient outcome. Complex deformity patients need to be evaluated with attention to the global balance and the operative planning and strategy must be adapted accordingly. ⋯ The reason for the outcome may be sagittal imbalance and osteotomy techniques as well as fusion extension may be needed. The postoperative outcome can only be improved when the sagittal balance is already considered in the planning and treatment strategy during initial correction surgery. Concerning sagittal balance a paradigm shift seems to occur.
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We report on the results of 246 Bryan cervical discs, which were implanted between June 2002 and September 2010 in 146 patients. Of the patients 74 (128 prostheses) could be followed up for more than 1 year and the average follow-up period was 2.6 years. Of the patients 18 were operated on at one level (group 1), 77 prostheses were multilevel surgery (group 2) and with 33 patients arthroplasty was combined with fusion (hybrid, group 3). ⋯ The overall mobility improved in all 3 subgroups and 2 cases (group 3) fused. With 5 patients the prosthesis had to be removed and the segment had to be fused in the postoperative course. As a conclusion a meticulous preoperative planning as well as a subtle surgical technique is the main prerequisite for long-lasting mobility of the Bryan prosthesis.