European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Telemeterized internal spinal fixation devices were implanted in ten patients. The loads acting on the fixators were compared for different body positions, including standing, sitting, and lying in a supine, prone, and lateral position. Implant loads differed considerably from patient to patient depending, for example, on the indication for surgery and the surgical procedure. ⋯ Flexion bending moments were significantly higher in upright than in lying body positions. Loads on the fixators were not higher for sitting than for standing. Patients who have undergone mono- or bisegmental spine stabilization should therefore be allowed to sit as soon as they can leave the bed.
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Case Reports
Free vascularized bone graft in spinal surgery: indications and outcome in eight cases.
In selected spinal deformities the use of a vascularized graft to establish fusion may be considered: compared to a non-vascularized graft it has superior mechanical properties, resulting in greater graft strength and stiffness, and greater effectiveness in facilitating union. Eight patients with a progressive spinal deformity (four cases) and malignancy (four cases) were treated with resection and/or correction and stabilization. To facilitate (multi)level fusion vascularized fibular grafts were used in two cervical and two thoracolumbar deformities. ⋯ One patient died 2.5 years after the intervention due to widespread metastases, while another patient died in the postoperative period due to unknown reasons. Vascularized bone graft in spinal surgery facilitates primary mechanical stability and rapid fusion, and it has higher resistance to infection. The variety of applications of a vascularized graft may extend the range of indications for the use of grafts in spinal surgery.
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The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. ⋯ The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.
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Forty-one patients with thoracic adolescent idiopathic scoliosis (AIS) treated with only a posterior spine fusion using specialized pedicle hooks (SPH) (hooks augmented with 3.2-mm screws) at the apex of the curve were reviewed in order to assess the effectiveness of this correction method. Inclusion in the study group required a minimum of 2 years' follow-up and the same strategy of correction where the apical vertebrae (3 or 4 vertebrae on the concave side) were instrumented with SPH. The mean preoperative Cobb angle was corrected from 55 degrees (42 degrees -80 degrees) to 18 degrees (67%) postoperatively and to 23 degrees (58%) at the last follow-up (28-50 months) for a flexibility index of 46%. ⋯ Three patients had to have their instrumentation removed because of pain. There was no complication related to the use of the SPH. The authors conclude that apical correction with SPH allows effective scoliosis correction without spinal distraction and does not require supra- or infralaminar hook in the spinal canal.
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Odontoid fractures are frequent in patients over 70 years of age, and in patients over 80 years of age they form the majority of spinal fractures. In a retrospective analysis of 23 geriatric (> 70 years) patients with a fracture of the odontoid, we compared some of the clinical features to a contemporary series of patients younger than 70 years of age. Whereas in the younger patients high-energy trauma accounted for the majority of the fractures, low-energy falls were the underlying cause in 90% of the odontoid fractures in the elderly. ⋯ Loss of reduction and non-union after non-operative treatment, a complicated postoperative course and complications due to associated injuries accounted primarily for this high complication rate. Elderly patients with a fracture of the odontoid are a high-risk group with a high morbidity and mortality rate. An aggressive diagnostic approach to detect unstable fractures and application of a halo device or early primary internal stabilisation of these fractures is recommended.