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
Advances in the diagnosis of degenerated lumbar discs and their possible clinical application.
One possible source of chronic low back pain is a degenerated intervertebral disc. In this review, various diagnostic methods for the assessment of the presence of degenerative changes are described. These include clinical MRI, a number of novel MRI techniques and nuclear magnetic resonance spectroscopy. ⋯ A reliable diagnostic tool that could help a clinician to determine if a disc is the source of the pain in patients with chronic LBP is still not available. New MRI techniques are under investigation that could result in a significant improvement over current methods, particularly as they can allow monitoring, not only of morphological but also of biochemical changes.
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In recent years, authors have described novel derotation techniques for surgery in adolescent idiopathic scoliosis. These methods include direct vertebral body derotation (DVD) and vertebral coplanar alignment (VCA). By improved derotation it is hoped that there is further reduction in rib hump prominence and corresponding improvement in patients' quality of life. This paper aims to evaluate studies reporting outcomes from DVD and VCA techniques to assess if these methods lead to superior radiographic vertebral derotation, rib hump correction on surface measurements or patient-reported outcomes compared to traditional derotation manoeuvres using similar instrumentation. ⋯ There is little evidence to recommend the widespread adoption of DVD/VCA techniques. Whilst there is some weak evidence to suggest that novel techniques may improve radiographic measures, there is little to suggest that they offer patients improved correction of clinical rib hump or quality of life compared to established techniques. Further well-designed prospective studies are needed in this area.
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Comparative Study
Calculation of corrected body height in idiopathic scoliosis: comparison of four methods.
The aim of the study was to analyze four radiographic methods of calculating the loss of body height associated with scoliosis. ⋯ There existed no overall agreement between the four methods of calculation of the loss of body height associated with scoliosis. Calculations based on the Cobb angle produced inaccuracy and could be supplemented with data considering trunk size.
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Comparative Study
Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis.
This study aimed to compare efficacy, safety, and cost between staged vertebral column resection (VCR) and anterior release with internal distraction in treating severe and rigid idiopathic scoliosis. ⋯ Anterior release with posterior internal distraction produces better corrective effects than anterior and posterior VCR, though hospital stay and costs are greater.