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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This review provides an overview of the patent literature on posteriorly placed intrapedicular bone anchors. Conventional pedicle screws are the gold standard to create a fixation in the vertebra for spinal fusion surgery but may lack fixation strength, especially in osteoporotic bone. The ageing population demands new bone anchors that have an increased fixation strength, that can be placed safely, and, if necessary, can be removed without damaging the surrounding tissue. ⋯ This review provides insights into worldwide patented intrapedicular bone anchors that aim to increase the fixation strength compared to the conventional pedicle screw. The identified anchoring methods and their working principles can be used for clinical decision-making and as a source of inspiration when designing novel bone anchors.
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To compare instrumentation configurations consisting of bilateral single or double rods and additional interbody cages (IBCs) at different levels in terms of Range of Motion (ROM) and distribution of von Mises stress in rods. ⋯ Double rods and IBCs reduced global and segmental ROM as well as von Mises stress in rods. The results suggest a possible benefit in using both strategies to minimize pseudarthrosis and instrumentation failure. However, increased ROM in adjacent levels and the shift of maximal von Mises stress to adjacent areas might cause complications elsewhere.
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Correction surgeries for spinal malalignment showed good clinical outcomes; however, there were concerns including increased invasiveness, complications, and impact on medico-economics. Ideally, an early intervention is needed. To better understand the patho-mechanism and natural course of spinal alignment, the effect of factors such as muscle mass and strength on spinal sagittal imbalance were determined in a multicenter cross-sectional study. ⋯ Aging, obesity, low TM, and low GS are potential risk factors for spinal sagittal malalignment. Especially, low TM and low GS are potentially associated with more progressed spinal sagittal malalignment. Thus, early intervention for muscles, such as exercise therapy, is needed, while the spinal sagittal alignment is normal or mildly affected.
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To report on the phenomenon of body drift in neurofibromatosis scoliosis and discuss its implication on surgical safety. ⋯ The 'body drift' phenomenon was unique to neurofibromatosis scoliosis and was secondary to severe pedicle morphology changes. This was present even in curves less than 60° and could result in cord injury while instrumenting the concave pedicle. Therefore, a thorough preoperative assessment and planning by a 3D CT are mandatory.
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This study analyzes anatomical variations of the thoracic cage (TC) according to spinopelvic alignment, age and gender using stereoradiography in erect position. ⋯ This study demonstrates the correlation between TC anatomy and spinopelvic parameters, confirming its part of the spinopelvic chain of balance. Indeed, higher spinal curvatures were associated with lower SPI and higher TC thickness, TC volume and rib absolute sagittal angles.