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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Comparative Study
Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults.
Retrospective study of a prospective clinical and radiological database of subjects with adolescent (AIS) and adult (AS) idiopathic scoliosis undergoing surgical correction by posterior approach. ⋯ A decrease of cervical lordosis and thoracic kyphosis is commonly associated with AIS. The anterior unbalance frequently found in AIS does not seem to have the same significance of severity as in AS. In AIS PI does not change the balance criterions, while in AS the severity of unbalance is increased with higher PI. TLK seems to be a way of worsening the balance in elderly, mainly in lumbar and thoraco-lumbar scoliosis with low PI. Surgical correction of the thoracic and lumbar spine in AIS induces significant changes in the sagittal spino-pelvic profile. Changes in the cervical sagittal profile vary according to the pre-op sagittal profile of the thoracic kyphosis. Cervical lordosis and thoracic kyphosis are improved by surgical correction in subjects with pre-operative hypokyphosis, but a reverse effect is noted in those with normal pre-operative kyphosis. The clinical significance of these changes in sagittal shape remains to be determined. In AS, it appears easier to restore a good balance in the lower PI population than in those with less pre-operative unbalance.
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Percutaneous spine procedures may occasionally be difficult and subject to complications. Navigation using a dynamic reference base (DRB) may ease the procedure. Yet, besides other shortcomings, its fixation demands additional incisions and thereby defies the percutaneous character of the procedure. ⋯ Percutaneous spine interventions can be safely and accurately navigated using epiDRB with minimal trauma or radiation exposure and without additional skin incisions.
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Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. ⋯ Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.
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Posterior pedicle screw instrumented correction and fusion have become the gold standard in the surgical treatment of thoracic scoliosis. However, in thoracic Lenke type C curves selective posterior fusion of the thoracic curve may lead to spinal imbalance. The aim of the study was to analyse the radiological results of selective anterior thoracic fusion using a standard open dual rod technique with special respect to spontaneous lumbar curve correction (SLCC). ⋯ Selective anterior correction and fusion in primary thoracic curves with lumbar modifier type Lenke C resulted in a reliable and satisfactory SLCC. Advantages of anterior versus posterior techniques are the true segmental derotation with excellent rib hump correction and a superior restoration of thoracic kyphosis.
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The aim of this study was to explore the operative technique and effectiveness of triangular osteosynthesis for vertically unstable sacral fractures. ⋯ Triangular osteosynthesis is a relatively new fixation for vertical unstable sacral fractures, the fixation is rigid, permits early full weight-bearing, and nerve decompression can be performed, which facilitates function recovery.