Neurosurgery clinics of North America
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Chordomas are the most common primary malignant tumor of the mobile spine and of the sacrum. Although considered not to possess significant metastatic potential, such lesions are locally aggressive, leading to neurologic compromise and lytic destruction of bone. ⋯ Such radical resections may be associated with significant surgical morbidity, however. Although considered generally resistant to radiation therapy and chemotherapy, recent advances in photon and proton radiation therapy and use of monoclonal antibodies may provide improved outcomes for poor surgical candidates and for tumors that recur after surgery.
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Pediatric thoracolumbar spinal trauma is a relatively rare event. It is important to understand the unique mechanical, diagnostic, and management considerations of this patient population. Inadequate recognition of thoracolumbar spinal injuries or suboptimal management may lead to less than ideal clinical outcomes in a population of patients who otherwise would have had great potential for recovery.
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Neurosurg. Clin. N. Am. · Oct 2007
ReviewNewer technologies for the treatment of scoliosis in the growing spine.
Progressive scoliosis in the growing child poses a unique challenge. The surgeon aims to attain maximal curve correction while maintaining spinal and thoracic growth. Nonoperative treatments include bracing and serial casting. ⋯ These include growing rods, intervertebral body stapling, and the vertical expandable prosthetic titanium rib. Each of these offers unique advantages and disadvantages. In this article, the authors review these newer technologies for treatment of the growing spine.
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This article reviews current published literature regarding pediatric iatrogenic spinal deformity, with particular emphasis on the cervical spine. The results of published series reporting the incidence, etiology, age, risk factors, surgical techniques, and treatment options are summarized. Iatrogenic deformity resulting from radiation therapy and a variety of surgical procedures are addressed.
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The cervicothoracic junction (CTJ) represents a unique region in the spine because of its biomechanical properties. It is predisposed to various traumatic injuries, tumor, and iatrogenic instability. It is also a difficult region to access anteriorly because of the vital structures ventral to the CTJ. The development of new surgical techniques and new instrumentation has allowed better access and fixation to the CTJ.