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
Three-dimensional measurement of wedged scoliotic vertebrae and intervertebral disks.
Idiopathic scoliosis involves complex spinal intrinsic deformations such as the wedging of vertebral bodies (VB) and intervertebral disks (ID), and it is obvious that the clinical evaluation obtained by the spinal projections on the two-dimensional (2D) radiographic planes do not give a full and accurate interpretation of scoliotic deformities. This paper presents a method that allows reconstruction in 3D of the vertebral body endplates and measurement of the 3D wedging angles. This approach was also used to verify whether 2D radiographic measurements could lead to a biased evaluation of scoliotic spine wedging. ⋯ There was no statistical relation between the 2D radiographic angles and the locations of the 3D intervertebral wedging angles. These results clearly indicate that VB and ID endplates are wedged in 3D, and that measurements on plain radiographs allow incomplete evaluation of spinal wedging. Clinicians should be aware of these limitations while using wedging measurements from plain radiographs for diagnosis and/or research on scoliotic deformities.
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Halm-Zielke instrumentation (HZI) was developed to eliminate the disadvantages of Zielke instrumentation (VDS) in terms of lack of primary stability and a kyphogenic effect. HZI is an anterior double-rod system. The system is composed of a lid-plate, which is fixed at the lateral aspect of the vertebral body with two screws, a sunk screw anteriorly and a VDS screw posteriorly. ⋯ All patients were treated without any additional external immobilization. In our opinion, HZI is a major improvement on the original Zielke VDS. It eliminates the kyphogenic effect and provides primary stability.
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The purpose of the study was to evaluate the efficiency of patient-controlled analgesia (PCA) combined with continuous epidural block in patients who underwent lumbar spine surgery. In group 1 (postoperative PCA group), 23 patients were administered postoperative continuous epidural block in combination with analgesics, which was self-regulated by the patient using a device. In contrast, the 22 patients in group 2 (control group) received suppositories or intramuscular injections of analgesics on request. ⋯ The time spent by nurses on pain management in group 1 was less than that in group 2. No patient had any serious complications in either group. In conclusion, the present patient-controlled method combined with postoperative continuous epidural block could decrease the intensity of postoperative pain and the amount of time spent by nurses on the administration of postoperative analgesics after lumbar spine surgery.