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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Comparative Study Clinical Trial
Treatment of idiopathic scoliosis with side-shift therapy: an initial comparison with a brace treatment historical cohort.
A group of 44 patients with idiopathic scoliosis (mean age 13.6 years) with an initial Cobb angle between 20 degrees and 32 degrees received side-shift therapy (mean treatment duration 2.2 years). A group of 120 brace patients (mean age 13.6 years) with an initial Cobb angle in the same range (mean brace treatment 3.0 years) was the historical reference group. ⋯ The difference in the mean progression of the Cobb angle for the respective groups is small (for efficiency: 3 degrees vs -2 degrees, for efficacy: 2 degrees vs -1 degrees ). Side-shift therapy appears to be a promising additional treatment for idiopathic scoliosis in adolescents with an initial Cobb angle between 20 degrees and 32 degrees.
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The purpose of this combined study was to evaluate the stability and safety of a new monocortical screw-plate system for anterior cervical fusion and plating (ACFP) according to Caspar in comparison with classical bicortical fixation. In the biomechanical part of the study two groups, each comprising six fresh human cadaveric spines (C4-C7), matched for bone mineral density, additionally resulting in almost the same mean age, were used. Range of motion and neutral zone were analyzed in flexion-extension, rotation (left, right) and lateral bending (left, right) using pure moments of +/- 2.5 Nm for each specimen in the intact state, after discectomy at C5/6 and after discectomy at C 5/6 followed by bone grafting plus plating (Caspar plates), with either monocortical or bicortical screws. ⋯ Following these findings monocortical screw fixation can be recommended for the majority of anterior cervical fusion and plating procedures in degenerative disease, making the procedure quicker, easier, and safer. Bicortical screw fixation still has specific indications for multilevel stabilization, poor bone quality (osteoporosis, rheumatoid disease - as bicortical oversized rescue screw), unstable spines (trauma, tumour) and in particular for the realignment of kyphotic deformities (restoration of the normal lordotic curve). Due to the design of the study the results apply only to surgical treatment of monosegmental degenerative disc disease at the time.
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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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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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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.