The spine journal : official journal of the North American Spine Society
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Surgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown. ⋯ The HRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment.
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Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. ⋯ Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.
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The normal spine is not a symmetrical structure. In recent studies, we demonstrated the presence of an axial rotational pattern that is similar to what is seen in the most prevalent curve patterns in idiopathic scoliosis at different ages. This suggests that if the spine starts to decompensate into scoliosis, it follows this preexistent rotational pattern. In scoliosis, the neurocentral junctions (NCJs) close asymmetrically, which leads to a different pedicle morphology in the convexity and concavity of the curve. The present study aimed to establish at which age the NCJ closes in different regions of the spine, whether it closes asymmetrically in the nonscoliotic spine as well and whether the closure pattern is related to the earlier demonstrated preexistent rotation. ⋯ This study focuses on the asymmetry and the regional pattern of closure of the NCJs at different ages. It suggests that preexistent rotation of the spine is related to the asymmetrical closure of the NCJs. Whether the asymmetry is the cause of or is caused by the preexistent rotation cannot be derived from this study.
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The intervertebral disc (IVD) possesses a minimal capability for self-repair and regeneration. Changes in the differentiation of resident progenitor cells can represent diminished tissue regeneration and a loss of homeostasis. We previously showed that progenitor cells reside in the nucleus pulposus (NP). The effect of the degenerative process on these cells remains unclear. ⋯ Based on these findings, we conclude that IVD degeneration has a meaningful effect on the cells in the NP. D-NP cells clearly go through the regenerative process; however, this process is not powerful enough to facilitate full regeneration of the disc and reverse the degenerative course. These findings facilitate deeper understanding of the IVD degeneration process and trigger further studies that will contribute to development of novel therapies for IVD degeneration.
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To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral artery and/or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. ⋯ Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent high-riding vertebral artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral artery injury.