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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Endoscopic surgery of the thoracic spine has up to now been considered as an experimental procedure. Reports published in recent years have shown that the results achieved with this technique are as good as, or for some indications superior to, those reported for classic open approaches. A review of the indications, limitations, advantages and disadvantages is presented. Although there is still resistance to acknowledging the effectiveness of this procedure, experience has shown that the results are as good, complications are fewer and postoperative recovery is improved, thus shortening the total hospitalization time.
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Meta Analysis
Anterior thoracoscopic spine release in deformity surgery: a meta-analysis and review.
Videoassisted thoracoscopic surgery (VATS) allows the surgeon to perform an anterior thoracoscopic spine release for spinal deformities. It is an alternative to open thoracotomy. Several years after its introduction the present author gives an update on the indications, surgical techniques, results, and complications of this new technology. ⋯ The VATS procedure has been used with success in most series for pediatric curves (average Cobb angle of 65 degrees or kyphosis of 75 degrees). No report of the surgical outcome (balance, rate of fusion, rib hump correction, cosmetic correction, pain, and patient satisfaction) was available for any series. Further prospective study including these parameters will be required to determine the real benefit of such procedures to the patient, bearing in mind that the correction of spinal deformities is the result of the surgeon's experience, skill, and the available technology.
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Interbody cages in the lumbar spine have met with mixed success in clinical studies. This has led many investigators to supplement cages with posterior instrumentation. The objective of this literature review is to address the mechanics of interbody cage fixation in the lumbar spine with respect to three-dimensional stabilization and the strength of the cage-vertebra interface. ⋯ The axial compressive strength of this interface is highly dependent upon vertebral body bone density. Other factors such as preservation of the subchondral bony end-plate and cage design are clearly less important in the compressive strength. Supplementary posterior instrumentation does not enhance substantially the interface strength in axial compression.
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We report on a 15-year-old boy in whom a spontaneous remission of a symptomatic synovial cyst, possibly emanating from the L4-5 facet joint, was noted. The medical history suggested that sport-related overactivity and/or minor trauma was the underlying cause. Conservative treatment for several months may be one treatment option if the cyst wall is not calcified and the symptoms and signs related to radiculopathy show a gradual decrease.
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Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. ⋯ In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.