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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This review summarizes the experience with the vertical expandable prosthetic titanium rib (VEPTR) device, which enables five new procedures to treat complex spine and chest wall abnormalities in pediatric patients, which cause thoracic insufficiency syndrome, the inability of the thorax to support normal respiration or lung growth. ⋯ VEPTR and its principles of use have become an important first step toward improving the quality of life and longevity of children with thoracic insufficiency syndrome, but much work remains to advance both its design and its use.
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The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. ⋯ Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.
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To determine whether preliminary evidence supports X-STOP implants as an effective treatment for lumbar radiculopathy secondary to foraminal stenosis, and if larger formal trials are warranted. ⋯ In this small study, X-STOP appeared safe and effective. It is less invasive than other established surgical procedures, but does not jeopardise other options in the event of failure. Large scale clinical trials are justified but floor and ceiling effects suggest that the ODI and SF-36 may not be the best choice of outcome measures for those studies.
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Comparative Study
Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults.
Retrospective study of a prospective clinical and radiological database of subjects with adolescent (AIS) and adult (AS) idiopathic scoliosis undergoing surgical correction by posterior approach. ⋯ A decrease of cervical lordosis and thoracic kyphosis is commonly associated with AIS. The anterior unbalance frequently found in AIS does not seem to have the same significance of severity as in AS. In AIS PI does not change the balance criterions, while in AS the severity of unbalance is increased with higher PI. TLK seems to be a way of worsening the balance in elderly, mainly in lumbar and thoraco-lumbar scoliosis with low PI. Surgical correction of the thoracic and lumbar spine in AIS induces significant changes in the sagittal spino-pelvic profile. Changes in the cervical sagittal profile vary according to the pre-op sagittal profile of the thoracic kyphosis. Cervical lordosis and thoracic kyphosis are improved by surgical correction in subjects with pre-operative hypokyphosis, but a reverse effect is noted in those with normal pre-operative kyphosis. The clinical significance of these changes in sagittal shape remains to be determined. In AS, it appears easier to restore a good balance in the lower PI population than in those with less pre-operative unbalance.
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Percutaneous spine procedures may occasionally be difficult and subject to complications. Navigation using a dynamic reference base (DRB) may ease the procedure. Yet, besides other shortcomings, its fixation demands additional incisions and thereby defies the percutaneous character of the procedure. ⋯ Percutaneous spine interventions can be safely and accurately navigated using epiDRB with minimal trauma or radiation exposure and without additional skin incisions.