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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Review Meta Analysis
Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis.
Despite an increasing implantation rate of interspinous process distraction (IPD) devices in the treatment of intermittent neurogenic claudication (INC), definitive evidence on the clinical effectiveness of implants is lacking. The main objective of this review was to perform a meta-analysis of all systematic reviews, randomized clinical trials and prospective cohort series to quantify the effectiveness of IPDs and to evaluate the potential side-effects. ⋯ As the evidence is relatively low and the costs are high, more thorough (cost-) effectiveness studies should be performed before worldwide implementation is introduced.
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Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. ⋯ Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.
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There have been several reports on hemivertebra resection via a posterior-only procedure. However, the number of reported cases is small, and various types of instrumentation have been used. In our study, we retrospectively investigated 56 consecutive cases of congenital scoliosis that were treated by posterior hemivertebra resection with transpedicular instrumentation. ⋯ Our results show that one-stage posterior hemivertebra resection with transpedicular instrumentation can achieve excellent correction, 360° decompression and short fusion without neurological complications. Pedicle cutting still remains a challenge in younger children when using bisegmental instrumentation. In addition, the radiolucent gaps in the residual space require further investigation.
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In patients with scoliosis, the morphology of the pedicles differs from those in normal spines. Preoperative three-dimensional information of these complex anatomic situations means a great advantage for the surgeon in order to assess which pedicles can be instrumented safely avoiding screw misplacement and for the decisions in choosing the appropriate screw size. The objective of this study was to measure pedicle dimensions in scoliotic spines on three-dimensional computed tomographic (CT) scans and to determine the intra- and interobserver reliability of the method. Additionally, the pedicles that cannot be instrumented safely by available screws were identified. ⋯ Measurement of pedicle dimensions on three-dimensional CT scans is a reliable but time-consuming procedure to assess pedicle dimensions. CT measuring should be reserved for special cases, where the anatomic situation remains unclear despite X-ray. In scoliotic spines, one-third of the mid-thoracic pedicles cannot be instrumented safely with pedicle screws.
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We evaluated the reliability and validity of an adapted Korean version of the Scoliosis Research Society-22 (SRS-22) questionnaire. ⋯ The adapted Korean version of the SRS-22 questionnaire was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for treatment outcome assessments in the Korean-speaking patients with idiopathic scoliosis.