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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Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression. ⋯ The aims of treatment for cervical spondylolisthesis are spinal cord decompression (ventral, dorsal or both), correction and fusion. The used procedure should depend on the severity of the cervical deformity, degree and side of the spinal cord compression, and the possibility of correction by extension and positioning.
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Although the causes and progression of adolescent idiopathic scoliosis (AIS) are still unclear, a recent extensive review has indicated a number of possible aetiological factors. Previous investigations, employing gait measurements, have indicated asymmetries in the ground reaction forces and suggest a relationship between these asymmetries, neurological dysfunction and spinal deformity. Using a strain-gauge force platform, the present study has examined the time-domain parameters of various components of the ground reaction force together with impulse. ⋯ The results show that the patients with a left compensatory curve had a greater SI for a left-side impulse, whilst subjects with little or no compensation had a greater right-side impulse. This indicates that a possible gait compensation is occurring, so that the subjects compensate on the opposite pelvis/lower limb to that of the curve. While indicating the asymmetries between left and right, the results also serve to highlight the value of using kinetic parameters in developing the understanding of the pathogenesis and aetiology of scoliosis.
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Clinical Trial
Correlation between inter-vertebral disc morphology and the results in patients undergoing Graf ligament stabilisation.
Previous studies have shown Graf ligament stabilisation procedure to give mixed results in the short to medium term. The aim of this study was to correlate the pre-operative state of the disc, multifidus muscles, age of the patient, levels operated and the clinical outcome after a mean follow-up of 47 months. ⋯ The indications of Graf ligament stabilisation procedure are not clear. Further work is necessary to clearly identify the indication for the procedure.
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Comparative Study
Is there a need for anterior release for 70-90 degrees masculine thoracic curves in adolescent scoliosis?
Large and stiff thoracic scoliotic curves in the adolescent represent a classic indication of anterior release followed by posterior instrumentation. However, third-generation segmental spinal instrumentations have shown increased correction of thoracic curves. Indication for an anterior release may therefore not be required even in large and stiff thoracic curves. ⋯ All patients reported satisfactory results except the patient with an adding-on phenomena. In the literature, most of the results of anterior thoracoscopic release and posterior surgery give a percentage of Cobb angle correction similar or inferior to our series for an average initial Cobb angle of less magnitude. Therefore, with adequate posterior release, and the use of third-generation segmental instrumentation there is no need for anterior release even for curves in the 70-90 degrees range.
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Spinal cord injury (SCI) results in the loss of function below the lesion. Secondary injury following the primary impact includes a number of biochemical and cellular alterations leading to tissue necrosis and cell death. Methylprednisolone (MP), by reducing edema and protecting the cell membrane against peroxidation, is the only pharmacological agent with a proven clinically beneficial effect on SCI. ⋯ Although combined treatment was significantly more effective on lipid peroxidation than melatonin or MP treatments alone, at the 10th day, neurobehavioral, electrophysiological, and ultrastructural recovery were at the same level. In conclusion, MP, melatonin, and MP and melatonin combined treatment modalities improved functional recovery at the same level. Future studies involving different doses of melatonin and different dose combinations with MP could promise better results since each drug has a different anti-oxidative mechanism of action.