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 Meta Analysis
Is anterior release and cervical traction necessary for the treatment of irreducible atlantoaxial dislocation? A systematic review and meta-analysis.
To compare the clinical and radiographic outcomes of irreducible atlantoaxial dislocation (IAAD) treated with posterior fusion after anterior release and direct posterior reduction of the dislocation. ⋯ III. These slides can be retrieved under Electronic Supplementary Material.
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Review Case Reports
Treatment of cervical subaxial injury in the very young child.
Infant's cervical spine has serious differences compared to other pediatric age groups and adults. Anatomical and biomechanical constitution of an infant is unique, and the pediatric spine gradually begins to resemble the structure of the adult spine after age 10. In addition, clinical presentation of the cervical spinal traumas has many distinctions from birth to the end of adolescence. In young children, cervical spine traumas are mainly localized in the upper cervical region. Trauma localized in subaxial cervical region and fracture-dislocations are rare in infants. ⋯ Here, we present a case history of a 7-month-old infant with surgically treated severe subaxial flexion-distraction injury. Neurologic examination revealed complete loss of motor function below C5. A whole-body CT was taken and we observed that C5-6 dislocated anteriorly approximately one vertebra size and also unilateral facet joint was locked. The patient was intubated and closed reduction was attempted with fluoroscopy under general anesthesia, but it was unsuccessful. Whereupon C5-6 microdiscectomy was performed with the anterior approach and fixation was provided with the craniofacial miniplate. Despite anterior stabilization, exact posterior alignment could not been achieved so, posterior approach was added to the surgery. At 12 month follow-up, the patient improved from quadriparesis to paraparesis and we achieved a satisfactory radiological outcome.
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Comparative Study
Osteoporotic thoracolumbar compression fractures: long-term retrospective comparison between vertebroplasty and conservative treatment.
To compare long term clinical and radiographic outcomes in osteoporotic vertebral compression fractures of the thoracolumbar spine treated with conservative treatment and percutaneous vertebroplasty. ⋯ Percutaneous vertebroplasty represents a safe treatment for osteoporotic vertebral compression fractures, although it may be associated with a higher incidence of adjacent fractures and therefore worse thoracolumbar kyphosis and long-term follow-up than conservative treatment. These slides can be retrieved under Electronic Supplementary Material.
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Pyogenic spondylodiscitis (PS) is a potentially life-threatening infection burdened by high morbidity rates. Despite the rising incidence, the proper management of PS is still controversial. Aim of this study was to describe the clinical features of PS and to evaluate the prognostic factors and the long-term outcomes of a large population of patients. ⋯ The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge. These slides can be retrieved under Electronic Supplementary material.
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Morphology measures of the odontoid process in children under 12 years old were carried out to demonstrate the viability of anterior internal fixation in this population once their active profile may not be compatible with successful conservative treatment. ⋯ In both groups, the minimal transverse diameter of the odontoid process allowed for the use of one 3.5-4.5 mm screw for anterior internal fixation. These slides can be retrieved under Electronic Supplementary Material.