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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Randomized Controlled Trial
An analysis of the safety and efficacy of dexmedetomidine in posterior spinal fusion surgery for adolescent idiopathic scoliosis: a prospective randomized study.
To evaluate whether use of dexmedetomidine, a centrally acting α2 adrenergic agonist, reduces opioid consumption in PSF. ⋯ Dexmedetomidine provided analgesia comparable to morphine with lower PONV scores. It also reduced the opioid requirements in the PSF patients without additional complications and can therefore be incorporated in pain management protocols.
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Meta Analysis
Comparison of a dual-surgeon versus single-surgeon approach for scoliosis surgery: a systematic review and meta-analysis.
Corrective surgery for scoliosis is a complex and challenging prospect for experienced spine surgeons due to the prolonged duration of surgery and the significant level of technical skill and expertise required. Traditionally, shorter operative time and lower blood loss have correlated well with improved outcomes and as such, efforts have been made to affect these metrics including the use of two attending surgeons for major cases in preference to one. This systematic review and meta-analysis assessed the available literature to further clarify the potential benefit that adopting a dual-surgeon approach offers over single-surgeon operations. ⋯ III.
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Multicenter Study
Surgeons lack of agreement on determining preoperative radiographic and clinical shoulder balance in adolescent and adult idiopathic scoliosis patients.
Preoperative shoulder balance is an important factor in determining the upper instrumented vertebrae (UIV). In adolescent and adult idiopathic scoliosis (AIS/AdIS) patients, we studied the intraobserver and interobserver reliability of spinal surgeons' assessment of preoperative shoulder balance using X-rays (XR) and anterior/posterior photographs. ⋯ Though surgeons' ability to agree with themselves was moderate to substantial, surgeons' ability to agree with each other was fair to moderate. Combined measures to assess preoperative shoulder balance are needed for UIV selection.
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Adolescent idiopathic scoliosis (AIS) is a common type of idiopathic scoliosis. Previous studies reported that the incidence of intraspinal abnormalities among the presumed idiopathic scoliosis was 13-43%. Intraspinal abnormalities were also considered increasing the risks of progressing of scoliosis and neurological complications following scoliosis corrective surgery. The surgical strategy of presumed adolescent idiopathic scoliosis (PAIS) associated with intraspinal abnormalities remains controversial. The purpose of this study was to investigate whether one-stage posterior surgery safe and effective for the PAIS patients associated with intraspinal abnormalities. ⋯ One-stage posterior corrective surgery is safe and effective in PAIS patients associated with intraspinal abnormalities without preoperative neurological symptoms. Surgical guidelines of AIS are appropriate for the treatment of PAIS patients associated with intraspinal abnormalities.
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The coronal Cobb angle is commonly used for assessing the adolescent idiopathic scoliosis (AIS); however, it may underestimate the severity of AIS while the plane of maximum curvature (PMC) could be a promising descriptor for three-dimensional assessment of AIS. This study aimed to develop a computational method (CM) for estimating the PMC based on the coronal and sagittal images of the spine, and to verify the results with computed tomography (CT). ⋯ III.