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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Case Reports
Keyhole decompression surgery for holospinal epidural abscess: a novel approach for spinal stability preservation.
Spinal epidural abscesses are rare yet serious conditions, often necessitating emergency surgical intervention. Holospinal epidural abscesses (HEA) extending from the cervical to the lumbosacral spine are even rarer and present significant challenges in management. This report aims to describe a case of HEA with both ventrally-located cervical and dorsally-located thoracolumbar epidural abscesses treated with a combination of anterior keyhole decompression and posterior skip decompression surgeries. ⋯ Management of HEA poses significant challenges, particularly in cases with ventrally-located cervical epidural abscesses. Our case highlights the efficacy of a combined surgical approach involving anterior keyhole decompression and posterior skip decompression in achieving abscess drainage and preserving spinal stability. This novel technique offers advantages over existing methods by preserving intervertebral motion and minimizing the risk of postoperative kyphosis. Further studies are warranted to validate the long-term outcomes and generalizability of this approach.
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Observational Study
Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study.
To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. ⋯ Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.
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Plentiful evidence points to a significant correlation between paravertebral muscles and spinal diseases. Yet, no reports are available detailing the association between paravertebral muscle status and diffuse idiopathic skeletal hyperostosis (DISH). The purpose of this retrospective study was to assess the link between paravertebral muscle area as well as fat infiltration and DISH based on computer tomography. ⋯ In conclusion, the fat infiltration of the paravertebral muscles was significantly associated with DISH.
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Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles. ⋯ No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position.
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Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. In routine clinical practice, SC changes are well depicted using conventional MRI, especially T2-weighted imaging. However, this modality usually fails to provide satisfactory clinico-radiological correlations. In this context we assessed the potential value of quantitative changes measured with a T1 MP2RAGE sequence. ⋯ T1-MP2RAGE mapping in patients with DCM demonstrated both focal and diffuse cervical SC alteration. It could thus be a biomarker for patients with DCM managed surgically.