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 AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine. ⋯ The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.
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The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed. ⋯ In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM.
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Case Reports
Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?
Recent literature shows that occult discoligamentous injuries still remain difficult to diagnose in the first instance. Thresholds as indicators for discoligamentous segmental instability were previously defined. But, since supine radiodiagnostic is prone to spontaneous reduction of a displaced injury, and even some highly unstable injuries reveal only slight radiographic displacement, these criteria might mislead in the traumatized patient. A highly accurate radiographic instrument to assess segmental motion is the computer-assisted quantitative motion analysis (QMA). The aim was to evaluate the applicability of the QMA in the setting of a traumatized patient. ⋯ Our data show a high rate of false negative results in cases of hidden discoligamentous injuries by using conventional radiographic analysis as well as QMA in plain lateral radiographs in a trauma setting. Despite the technical possibilities in a modern trauma center, our data and recent literature indicate a thorough clinical and radiographic follow-up of patients with cervical symptoms to avoid secondary complications from missed cervical spine injuries.
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The aim of the second part of the study was to investigate the influence of parameters that lead to increased facet joint contact or capsule tensile forces (disc height, lordosis, and sagittal misalignment) on the clinical outcome after total disc replacement (TDR) at the lumbosacral junction. ⋯ Parameters associated with increased facet joint capsule tensile forces lead to an inferior clinical outcome at mid-term follow-up. When performing TDR, we therefore suggest avoiding iatrogenic posterior translation and overdistraction (and consecutive lordosis).
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A possible complication after total disc replacement (TDR) is subsidence, presumably caused by asymmetric implantation, implant undersizing or reduced bone quality. This study aims to quantify the degree of subsidence of an SB Charité TDR, and investigate whether undersizing is related to subsidence. ⋯ A reproducible method to determine undersizing was developed. Thresholds were determined related to a reduced risk of subsidence.