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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There is no generally accepted scientific theory for the etiology of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. ⋯ While the findings of Professor Cheng and his colleagues have added MRI data to the field of relative anterior spinal overgrowth in AIS their interpretation engenders controversy. Three new hypotheses are proposed to interpret their findings: (1) hypoplasia of articular processes as a risk factor for AIS; (2) selection from the normal population to AIS involves anomalous vertebral morphology and soft tissue factors--this hypothesis may also apply to certain types of secondary scoliosis; and (3) a new method to predict the natural history of AIS curves by evaluating cerebro-spinal fluid (CSF) motion at the cranio-cervical junction. What is not controversial is the need for whole spine MRI research on subjects with non-idiopathic scoliosis.
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We report the updated results for a previously evaluated surgical treatment for adult low-grade isthmic spondylolisthesis. In 12 patients a decompressive laminectomy was performed followed by a circumferential fusion using posterior pedicle screw instrumented reduction and staged anterior cage-assisted interbody fusion. Average time to follow-up was 5.6 (range 4.9-6.6) years. ⋯ The average VAS score for back pain at last follow-up was 2.3 compared to 2.8 at 2.1-year follow-up. Ten patients had resumed their pre-symptom work status. This study demonstrates maintenance of the good clinical and radiological 2.1-year outcome after 5.6-year follow-up with no deterioration of back-pain scores.
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Spinal posture and the resultant changes during the entire pubertal growth period have not been reported previously. No cohort study has focused on the development of spinal posture during both the ascending and the descending phase of peak growth of the spine. The growth and development of a population-based cohort of 1060 children was followed up for a period of 11 years. ⋯ Women were more lordotic at all ages. Thoracic hyperkyphosis of > or =45 degrees was as prevalent in boys as girls at 14 years, but significantly (P<0.0001) more prevalent in men (9.6%) than in women (0.9%) at 22 years. The degree of mean thoracic kyphosis and the prevalence of hyperkyphosis increased in men during the descending phase of peak growth of the spine, but decreased in women.
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Proximal screw pullout is a well-recognized problem in anterior scoliosis surgery, with a rate of pseudarthrosis or screw pullout ranging from 15 to 30%. To prevent screw pullout at the top of the construct, the authors have devised the concept of a claw for the top instrumented vertebra. The claw consists of a classic anterior vertebral body screw inserted parallel to the inferior end-plate and in the posterior portion of the vertebral body 8 mm in front of the spine canal. ⋯ This concept can also be extended in the case of early revision for a proximal screw pullout, where it is possible to revise the instrumentation with an offset connector linking the rod to the superior portion of the pedicle where the suprapedicule hook has been inserted. We report two cases where a suprapedicle claw was successfully used in anterior scoliosis correction of a right thoracic curve. Such a concept may represent the solution to proximal screw pullout in anterior scoliosis correction.
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Randomized Controlled Trial Comparative Study
A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results.
The literature reports on the safety and efficacy of titanium cages (TCs) with additional posterior fixation for anterior lumbar interbody fusion. However, these papers are limited to prospective cohort studies. The introduction of TCs for spinal fusion has resulted in increased costs, without evidence of superiority over the established practice. ⋯ Revision procedures and complications were similar in both groups. In conclusion, this prospective, randomised controlled clinical trial shows the use of FRA in circumferential lumbar fusion to be associated with superior clinical outcomes when compared to those observed following the use of TCs. The use of TCs for circumferential lumbar spinal fusion is not justified on the basis of inferior clinical outcome and the tenfold increase in cost.