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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When a deformity involves more than one area of the spine, it becomes a multifocal deformity; such a deformity could either be extending on two adjacent segments, or be two separated deformities on two non-adjacent segments. ⋯ All these questions about the management of multifocal deformities will be discussed and answered with technical details and concrete examples of the different situations that may be encountered.
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Multicenter Study
Pedicle subtraction osteotomy in the thoracic spine and thoracolumbar junction: a retrospective series of 28 cases.
Pedicle subtraction osteotomy is a well-described surgical technique for treatment of kyphotic deformity in the spine. It is not widely used for treatment of thoracic kyphosis. We present the first documented series of 28 patients who underwent this procedure in 3 international centers. These patients presented with severe deformity with a wide range of aetiologies. ⋯ Global sagittal balance was statistically improved in this series as demonstrated by FBI and C7 SVA correction.
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Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. This phenomenon is often treated with operative modalities, such as osteotomies, though even with surgery, only one-third of patients may reach neutral alignment. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. ⋯ Finally, given the importance of sagittal alignment and the role of osteotomies in treatment for deformity, the need for future research becomes apparent. Novel intraoperative measurement techniques and three-dimensional analysis of the spine may allow for vastly improved operative correction. Furthermore, awareness of the relationship between alignment and balance, the soft tissue envelope, and compensatory mechanisms will provide a more comprehensive conception of the nature of spinal deformity and the modalities with which it is treated.
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To evaluate and compare early radiographic and clinical outcomes of lower cervical and upper thoracic three-column osteotomies (3CO) for cervicothoracic kyphosis correction. ⋯ Three-column posterior osteotomies at the cervicothoracic junction restored regional sagittal alignment and improved quality of life in this series of patients with rigid cervicothoracic deformity, albeit with high complication rates. Lower cervical osteotomies provided greater cervical SVA correction and were shorter operations, although they were associated with more complications and longer hospital and ICU stays compared to upper thoracic osteotomies.
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Comparative Study Clinical Trial
Does whole-spine lateral radiograph with clavicle positioning reflect the correct cervical sagittal alignment?
To evaluate the differences of cervical alignment between standing cervical lateral radiograph and whole-spine lateral radiograph with clavicle position. ⋯ Clavicle position during whole-spine radiograph caused a substantial decrease in the T1-slope; head position posteriorly translated followed by the cervical sagittal alignment became more hypo-lordotic, with slight downward gazing in comparison with the cervical radiograph.