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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Spinal pseudomeningoceles (SPM) are extradural collections of CSF (cerebrospinal fluid); a frequent association with upper cervical injuries (UCI) has been observed. We propose a possible etiopathogenetic mechanism supporting the formation of cervical SPM based on some considerations. ⋯ The dural layer at C0-C2 level is adherent to the thick ligamentous apparatus, as opposed to the segments below where it is solely covered by the posterior longitudinal ligament. A "transitional zone" of dura exists between the C0-C2 region and subaxial segment of the cervical spine. This watershed area constitutes a point of minor resistance. Lacerations of the meningeal layers, caused by severe UCI at the "transitional zone", drain CSF into the anterior epidural space and form SPM.
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The posterior transpedicular fixation technique is a standard procedure for stabilizing the injured thoracolumbar spine but the long-term results of this approach are controversial. Clear guidelines are missing and the literature shows complete disagreement regarding indications, approaches, surgical techniques, and type of fixation. ⋯ Results show that, at the follow-up, the SI remains almost stable after the surgical correction, while the SPK (which describes the eventual injury of the affected intervertebral disc) decreases indicating a progressive regional kyphotic deformity. Thus, in some cases posterior fixation alone is not sufficient for long-term spinal stabilization and often can be not effective to prevent the late kyphotic deformity.
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The clinical outcome of polytrauma patients underwent spine fixation was analyzed and correlated both to surgical time (early versus delayed) and to fixation type (open versus percutaneous). ⋯ In polytrauma patients an early spine fixation improves clinical outcome. Patients underwent percutaneous screw fixation showed a better outcome compared to open surgery group obtained despite worst clinical conditions.
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Observational Study
Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery?
The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis. ⋯ Conservative treatment with Chêneau brace and physiotherapy was effective in our hands for halting scoliosis progression in 100 % of patients.
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The surgical treatment of adult scoliosis still presents many points of discussion. Decision-making on the type of treatment is mandatory to evaluate all the possible alternatives to surgery. ⋯ After an average term of 8 years (5-10) we record 8 (23 %) excellent cases, 10 (29 %) good, 12 (34 %) satisfactory, 5 (14 %) bad. The VAS in the pre-operative period had a value of 7 (5-9) passed in the post-operative period of 3 (0-6). 13 reoperations were performed (36 %).