Journal of spinal disorders
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The importance of spinal cord monitoring during corrective scoliosis surgery is widely acknowledged. However, for patients with preoperative neurologic deficits, its use is technically difficult. ⋯ In each patient, eight muscle groups were recorded and stable responses were obtained in all patients. We conclude that TCE-MEP permits monitoring of the spinal cord in patients with disturbed motor function.
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Several studies describe sagittal realignment for flat back and related kyphotic decompensation. Official guidelines for sagittal and the frontal realignment have not been developed. In this retrospective study, the authors examined 10 patients with flat back syndrome and treated a related kyphotic decompensation syndrome by posterior wedge osteotomy. ⋯ One-level lumbar osteotomy is a safe procedure to correct sagittal unbalance. Peroperative lordosis correction allows reliable correction planning. The remaining problem is planning for frontal balance correction.
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The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.
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The sagittal profiles of the cervical and lumbar spine have not been studied in Scheuermann kyphosis. The purpose of this study was to investigate these profiles. Standing lateral radiographs of the spine in 34 children with Scheuermann kyphosis were reviewed. ⋯ Correlations were noted between cervical lordosis and lumbar lordosis (r2 = 0.17, Cobb angle; r2 = 0.16, PVBA) and between cervical lordosis and the residual sagittal difference (thoracic kyphosis minus lumbar lordosis; r2 = 0.32, p = 0.001 [Cobb angle], and r2 = 0.19, p = 0.01 [PVBA]). In Scheuermann kyphosis, the flexible cervical and lumbar spine is linked by the intermediate rigid thoracic segment. As the residual sagittal difference becomes more kyphotic, lordosis of the cervical spine increases as the patient strives to maintain a forward visual gaze.
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Review Case Reports
Sudden sensorineural hearing loss after spinal surgery under general anesthesia.
Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. ⋯ Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.