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 detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence.
To compare the clinical and radiological outcomes in patients with congenital scoliosis (CS) and tethered cord syndrome (TCS) undergoing deformity correction with (NI group) versus without (NNI group) prior neurosurgical intervention aimed at detethering the cord. ⋯ Deformity correction and fusion surgery may be performed safely and effectively in CS with TCS patients without the need of a prior detethering procedure.
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Multicenter Study
Minimally invasive surgery versus standard posterior approach for Lenke Type 1-4 adolescent idiopathic scoliosis: a multicenter, retrospective study.
To compare the safety and efficacy of posterior minimally invasive surgery (MIS) to standard posterior spinal fusion (PSF) surgery for Lenke Type 1-4 adolescent idiopathic scoliosis (AIS). ⋯ Posterior MIS is a safe and effective alternative to standard open approach for Lenke Type 1-4 AIS patients with curves < 70° and reasonable flexibility. Mid-term results showed MIS had the advantages of less blood loss and pain with more fusion segments.
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Surgical correction for AIS has evolved from all hooks to hybrids or all screw constructs. Limited literature exists reporting outcomes using PHDS for posterior spinal fusion (PSF). This is the largest series in evaluating results of PHDS technique. ⋯ The PHDS demonstrates the potential for additional shoulder balance improvement. Extension of fusion to structural proximal thoracic spine is the key to success for shoulder balance. It remains to be seen whether these improvements will translate into improved clinical outcomes in the longer term.
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Although being standard for scoliosis curve size estimation, COBB angle measurement is well known to be inaccurate, due to a high interobserver variance in end vertebra selection and end plate contour delineation. We propose a stepwise improvement by using a spline constructed from vertebra centroids to resemble spinal curve characteristics more closely. To enhance precision even further, a neural net was trained to detect the centroids automatically. ⋯ In conclusion, our data suggest an advantage of spline-based automated measuring systems, so further investigations are warranted to abandon manual COBB measurements.