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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Thoracic hyperkyphosis is a sagittal deformity that can cause back pain and neurological impairment, leading to difficulties in maintaining a straight gaze. Sagittal thoracic malalignment has different etiologies and different corrective strategies. ⋯ Ponte's is, together with Smith-Petersen osteotomy, a posterior column osteotomy. The magnitude of correction can reach 10° per level if intervertebral discs are still mobile.
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Traumatic central cord syndrome (TCCS) is the most commonly encountered type of incomplete spinal cord injury. TCCS typically occurs in patients over the age of 50 with a narrow spinal canal and follows an acute hyperextension injury of the cervical spine. Here, we report on the demographics of TCCS patients, their clinical course and outcomes, and the factors that may have influenced these outcomes. ⋯ The Groote Schuur Hospital patient population differs from the international norm, particularly with respect to age and mechanism of injury. The ASIA motor score and cervical spine canal diameter proved to be useful predictors of outcome. Within our patient group, timing of surgery did not appear to influence the outcome.
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Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical landmarks are missing. ⋯ PSO in the fixed fusion mass is technically demanding. Preoperative CT-scan and preoperative navigation allow us to push the limits when anatomical landmarks disappear. Bleeding and neurologic are the two major complications feared by the surgeon. The best way to avoid these revision surgeries is to restore a proper lumbar lordosis at the time of initial surgery by considering lumbo-pelvic indexes.
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Certain abnormal contact points, appearing like additional joints (pseudofacets) were observed between atlas and axis in a subset of patients with congenital atlantoaxial dislocation (CAAD). The origin, function and bearing on management of such pseudofacets remain largely undetermined. The object is to study 'pseudofacets'or 'accessory joints' in patients with CAAD and to analyze the possible genesis, role and bearing of these on surgery and fusion rates. ⋯ Pseudofacets may be a result of genetic aberration and nature's mechanism to restrict abnormal C1-2 mobility in CAAD by imparting some stability. Their presence hinders the visualization making it difficult to reach upto the true facets, thus a bane. They may require extensive drilling when direct posterior approach is used, thereby disrupting the natural restrictive mechanism. However, the flattened surfaces provide an increased area for postoperative bony fusion between C1 and 2, making their presence a 'boon'.
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Degenerative scoliosis is a three-dimensional deformity that can present in some instances with fixed sagittal and coronal imbalance. Pedicle subtraction osteotomy (PSO) is an effective technique that allows correction with a posterior approach. When a combined coronal and sagittal imbalance is present, asymmetric PSOs could be an optimal choice to correct deformity on both planes. ⋯ The few studies present in literature show good results in terms of correction, even if the difficulty of this technique is certain.