The spine journal : official journal of the North American Spine Society
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As the biomechanical foundation of the spine, the pelvis was found to display rotation in the transverse plane in adolescent idiopathic scoliosis (AIS). However, the possible factors influencing the pelvic axial rotation (PAR) and its mechanism in patients with AIS remain unclear. ⋯ The majority of AIS patients with right MT or left major TL/L curves were found to have PAR to the right, in the same direction as the thoracic curve. The lumbar flexibility and apex rotation significantly influenced the PAR direction and magnitude. Moreover, the pelvis might be involved in compensation for the MT deformity through its connection with the lumbar spine.
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Recent rise in fraudulent disability claims in the United States has resulted in psychologists being increasingly called upon to use psychological tests to determine whether disability claims based on psychological or somatic/pain complaints are legitimate. ⋯ The results suggest that both the MSPQ and PDI are useful to screen for pain malingering in forensic evaluations, especially the MSPQ, which performed the best in differentiating between the groups.
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Comparative Study
Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure.
Adolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear. ⋯ Significant differences exist in the total radiation exposure in scoliosis patients with different treatment regimens, with operative patients receiving approximately 8 to 14 times more radiation than braced patients or those undergoing observation alone, respectively. Operative patients also receive more than twice the radiation per year than braced or observed patients. Almost 78% of the annual radiation exposure for operative patients occurs intraoperatively. Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of present imaging methods and a search for newer imaging methods with limited ionizing radiation should be undertaken.
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Minimally invasive transforaminal lumbar fusion (MIS-TLIF) has demonstrated efficacy in the treatment of lumbar degenerative diseases. The reported incidence of perioperative complications associated with MIS-TLIF surgery is highly variable. Studies concerning perioperative complications in broad patient populations are quite rare. This study analyzes a retrospectively collected database of patients who underwent an MIS-TLIF surgery at a single center. ⋯ Minimally invasive transforaminal lumbar fusion has gained popularity as a procedure for the treatment of lumbar instability or spondylolisthesis, with similar complications as in the open surgery. Transient sensory disturbance was the most common complication in this series.
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Surgical treatment of degenerative disc disease remains a controversial subject. Lumbar fusion has been associated with a potential risk of segmental junctional disease and sagittal balance misalignment. Motion preservation devices have been developed as an alternative to fusion. The LP-ESP disc is a one-piece deformable device achieving 6 df, including shock absorption and elastic return. This is the first clinical report on its use. ⋯ Results from the 2-year follow-up indicate that LP-ESP prosthesis recreates lumbar spine function similar to that of the healthy disc in terms of ROM, quality of movement, effect on sagittal balance, and absence of modification in the kinematics of the upper adjacent level.