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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Conjoined lumbosacral nerve roots (CLNR) are the most common anomalies involving the lumbar nerve structures which can be one of the origins of failed back syndromes. They can cause sciatica even without the presence of a additional compressive impingement (such as disc herniation, spondylolisthesis or lateral recess stenosis), and often congenital lumbosacral spine anomalies (such as bony defects) are present at the "conjoined sheaths". ⋯ We present five typical cases of conjoined nerve roots observed during a 1 year period, equivalent to 6% of our out-patients without a history of surgical treatment on the lumbar spine. In all cases with suspicious radiological findings MRI or lumbar myelography combined with CT and multiplanar reconstructions is recommended.
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"Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion. Instrumentation and surgical techniques have been modified in order to prevent spontaneous posterior fusion from occurring in children. ⋯ No statistical difference between the two treatments was found in cartilage, bone surface density, osteoid surfaces or osteoclast-covered surfaces in any zone. We conclude that ADCON-L gel mixed into autogenous bone graft can delay or decrease bone formation at spinal arthrodesis sites, thus influencing the extent of spinal fusion. This accords with our hypothesis that the use of ADCON-L gel can prevent not only the occurrence of spontaneous fusion in very young scoliosis patients after instrumentation without fusion, but also re-ossification of a decompressed spinal canal.
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Comparative Study Clinical Trial
A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature.
There is an increasing awareness of the risks and dangers of exposure to radiation associated with repeated radiographic assessment of spinal curvature and spinal movements. As such, attempts are continuously being made to develop skin-surface devices for use in examining the progression and response to treatment of various spinal disorders. However, the reliability and validity of measurements recorded with such devices must be established before they can be recommended for use in the research or clinical environment. ⋯ As might be expected for the smaller angles being measured, the segmental ranges of flexion showed lower reliability. Their usefulness with regard to the interpretation of individual results and the detection of 'real change' on an individual basis thus remains questionable. Nonetheless, the group mean values showed few between-day differences, suggesting that the device may still be of use in providing clinically interesting data on segmental motion when examining groups of individuals with a given spinal pathology or undergoing some type of intervention.
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The surgical management of post-traumatic thoracolumbar kyphosis remains controversial. The need for combined procedures is subject to debate, especially for post-traumatic kyphosis after simple type A fractures. The aim of this retrospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome after mono-segmental surgical treatment using an anterior procedure alone (group 1, n = 10 patients) and using a one-stage combined anterior and posterior procedure (group 2, n = 15 patients) for post-traumatic thoracolumbar kyphosis after simple type A fractures. ⋯ In all these cases the dorsal instrumentation was removed. Statistical analysis in this series of ten patients with anterior spondylodesis compared with 15 patients with combined one-stage spondylodesis did not reveal objective advantages of the combined procedure as far as the outcome of radiographic correction of kyphosis or patient outcome is concerned. It is therefore concluded that in cases of post-traumatic thoracolumbar kyphosis after simple type A fractures, mono-segmental correction using an anterior procedure alone, with spondylodesis, is the surgical procedure of choice.
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Clinical Trial
One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis.
There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudative stage of throracolumbar spinal tuberculosis. Twenty-three patients, including two children (9 and 15 years old, respectively) and 21 adults with thoracolumbar spinal tuberculosis were treated surgically. ⋯ Except for the early loosening of one screw in two cases (which did not affect the reconstruction of spinal stability), no other complications associated with this procedure were found during follow-up. Early reconstruction of spinal stability plays an important role in the surgical management of spinal tuberculosis. One-stage anterior interbody autografting and instrumentation in the surgical management of the exudative stage of spinal tuberculosis show more advantages in selected patients, but supplementary posterior fusion should be considered to prevent postoperative kyphosis when this procedure is performed in children.