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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The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were treated with the X-Stop interspinous distraction device. ⋯ Finally, secondary surgical treatment by decompression with posterolateral fusion was performed in seven patients (58%) within 24 months. In conclusion, the X-Stop interspinous distraction device showed an extremely high failure rate, defined as surgical re-intervention, after short term follow-up in patients with spinal stenosis caused by degenerative spondylolisthesis. We do not recommend the X-Stop for the treatment of spinal stenosis complicating degenerative spondylolisthesis.
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A retrospective analysis of adults treated with long instrumented fusion for scoliosis from the thoracic spine proximally to L4 or L5. To evaluate the long-term clinical outcomes as well as radiological changes in distal unfused mobile segments and to evaluate factors that may predispose to distal disc degeneration and/or poor outcome. A total of 151 mobile segments in 85 patients (65 female), mean age 43.2 (range 21-68), were studied. ⋯ Disc degeneration does occur below an arthrodesis for scoliosis in adults which does not correlate with clinical outcome. The correlation of loss of sagittal balance with disc degeneration may be as a result of degeneration causing the loss of balance or vice versa, i.e. sagittal imbalance causing degeneration. Immediate post-operative imbalance correlates with degeneration of the L4/5 disc, which may imply the latter.
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Randomized Controlled Trial
The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11-13 year follow-up.
Few studies have investigated the long-term effect of posterolateral lumbar spinal fusion on functional outcome. ⋯ Improvement in functional outcome is preserved for 10 or more years after posterolateral lumbar spinal fusion. No difference between instrumented fusion and non-instrumented fusion was observed. Patients who have to retired due to low back pain have the smallest improvement.
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A prospective cohort study of skeletally immature idiopathic scoliotic patients treated with the TriaC brace. To determine if the TriaC brace is effective in preventing curve progression in immature adolescent idiopathic scoliotic patients with a very high risk of curve progression based on reported natural history data. The aim of the newly introduced TriaC brace is to reverse the pathologic transverse force pattern by externally applied and continuously present orthotic forces. ⋯ The current study demonstrates that treatment with the TriaC brace reduces the scoliosis, and that the achieved correction is maintained in some degree after skeletal maturity is reached and bracing is discontinued. It also prevents further progression of the Cobb angle in idiopathic scoliosis. The new brace does not differ from the conventional braces as far as maintaining the deformity is concerned.
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To study the effect of the degree of scoliosis, degree of hypokyphosis/lordosis and rotation of apical vertebra on individual lung volume (measured with CT scan) in asymptomatic adolescent idiopathic scoliosis (AIS) patients. Individual (right and left) lung volume, angle of kyphosis and rotation of apical vertebra, were measured in 77 asymptomatic AIS patients having right thoracic curve, using modern computed tomography (CT) scan. To compare, lung volumes were measured in 22 normal persons (control group). ⋯ A significant inverse correlation was found between the angle of kyphosis and right to left lung volume ratio, i.e., as the angle of kyphosis decreased the convex to concave lung volume ratio increased (P = 0.0109, r = -0.255). In asymptomatic, AIS patients, with increase in degree of curvature, and rotation of apical vertebra, the ratio of convex to concave side lung volume increases; indicating concave side lung volume is comparatively more affected (decreased) than convex side lung volume. On the other hand with decrease in the angle of kyphosis the convex to concave lung volume ratio increases indicating kyphotic angle has an inverse relation to convex to concave lung volume ratio.