Neurosurgery clinics of North America
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Iatrogenic cervical deformity can develop after anterior or posterior procedures. Careful attention to detail can minimize the likelihood of creating a sagittal or coronal plane deformity. Strategies for the prevention and correction of postoperative cervical deformity are presented.
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Sagittal imbalance may be either segmental (type 1) or global (type 2). Careful preoperative evaluation is essential to determine the presence and extent of any inherent flexibility in the deformity. ⋯ More rigid or fixed sagittal plane deformities may be corrected with one or more osteotomies. Thorough planning and meticulous execution of osteotomies are essential to obtaining optimal surgical results.
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Idiopathic scoliosis in adolescents and adults presents many challenges to the spinal surgeon. Preoperative planning, intraoperative technique, and postoperative management all contribute to the ultimate outcome. Avoiding complications in the treatment of idiopathic scoliosis depends on a thorough knowledge of the fundamental principles of spinal deformity evaluation and treatment.
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The safe performance of complex spine surgery requires the close collaboration of the anesthesiology and surgical teams. The avoidance of medical and anesthetic complications depends on the appropriate preoperative medical evaluation, patient positioning, selection and administration of anesthetic agents, management of intraoperative fluid status, emergence from anesthesia, and administration of postoperative analgesia.
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In adults, symptomatic scoliosis is usually a de novo primary degenerative deformity that develops in the fifth or sixth decade or an unrecognized or untreated idiopathic deformity with superimposed degeneration. The evaluation and treatment of adult scoliosis must focus on addressing patient symptoms while limiting the consequences of the treatment. The presence of neurological deficits, the flexibility of the deformity, the coronal and sagittal balance, and status of spinal segments outside of the main deformity are all important considerations when planning surgery. The complication rate of deformity surgery in adults is potentially high; but excellent functional outcome and patient satisfaction can occur with thorough preoperative patient education and meticulous surgical technique.