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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Appendicular skeleton markers are commonly used for maturity assessment for Adolescent Idiopathic Scoliosis (AIS) patients. Traditionally, Risser has been a standard skeletal maturity assessment method. More recently, Sanders classification (SSMS), as a more comprehensive system, became popular, especially in decision-making for Vertebral Body Tethering (VBT). Thumb-Ossification Composite Index (TOCI), using ossification of thumb epiphyses, has been claimed to more accurately stage patients around their peak height velocity. However, growth peaks may occur separately at lower limbs and trunk. Hence, Cervical Vertebral Maturity (CVM), using cervical spine morphology, possesses a potential to better estimate spinal growth as it uses axial skeleton markers instead of appendicular skeleton markers. The aim of the study was to compare various axial and appendicular skeletal maturity assessment methods for longitudinal growth and curve modulation after VBT. ⋯ Risser score provided considerably less information for all three outcome variables. TOCI and SSMS provided substantial information regarding remaining leg-length assessments, while in terms of assessment of total height gain and curve modulation after surgery, CVM and TOCI offered substantial information and SSMS offered strong information. Mutual use of axial and appendicular markers may provide valuable insight concerning timing of surgery and magnitude of surgical correction.
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To evaluate effects of spinal and rib osteotomies on the resulting spinal flexibility for surgical correction of thoracic scoliosis and to explore effects of posterior fixation on thoracolumbar segmental range of motion and lumbar intervertebral disc loading. ⋯ Low effects of Schwab grade 1 and 2 osteotomies question the impact of isolated posterior spinal releases for surgical correction maneuvers in adolescent idiopathic scoliosis, in contrast to additional concave rib osteotomies. High effects of posterior fixation potentially explain frequently reported complications such as adjacent segment disease or proximal junctional kyphosis.
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This study was performed to assess the impact of cervical kyphosis on the locations of average center of rotation (COR) of each level preoperatively and to investigate whether uncorrected cervical kyphosis increases the incidence of symptomatic adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). ⋯ Cervical kyphosis can impact the locations of COR and increase the incidence of symptomatic ASD. Kyphosis correction is needed during ACDF in patients with cervical kyphosis.
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To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment. ⋯ After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.
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Cervical total disc arthroplasty (TDA) is a motion-preserving alternative to anterior cervical discectomy and fusion that has gained popularity among spine surgeons. Although generally effective, TDA has been associated with rare cases of progressive osteolysis, a complication whose natural history and impact on clinical outcomes are not well understood. This case report aims to present a case of progressive osteolysis following cervical TDA with the SpinalKinetics® M6-C Artificial Cervical Disc and to discuss the clinical approach and implications for patient management. ⋯ This case highlights the potential for progressive osteolysis as a complication following cervical TDA, emphasizing the importance of ongoing surveillance and increased awareness among spine surgeons. Early identification and monitoring of osteolysis may mitigate the risk of severe outcomes and guide timely intervention.