The spine journal : official journal of the North American Spine Society
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Meta Analysis
The fragility of statistically significant findings from randomized trials in spine surgery: a systematic survey.
Randomized controlled trials (RCTs) are the most trustworthy source for evaluating treatment effects, but RCTs of spine surgery interventions often produce discordant results. The Fragility Index is a novel metric to inform about the robustness of statistically significant results. ⋯ Statistically significant results in spine surgery RCTs are frequently fragile. The addition of only a small number of outcome events can completely eliminate significance. Surgeons, researchers, and other evidence users should exercise caution when interpreting the findings from RCTs with low Fragility Index values and applying these results to patient care.
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Proximal junctional failure (PJF) is a recognized complication of spinal deformity surgery. Acute PJF (APJF) has recently been demonstrated to be 5.6% in the adult spinal deformity (ASD) population. The incidence and rate of return to the operating room for APJF have not been specifically investigated in individuals with sagittal imbalance. ⋯ Acute PJF is more common in patients with preoperative sagittal imbalance (35%) than the general adult deformity patient population, and 37% of those with APJF require revision. It is least common when the UIV is in the UT spine, compared with the LT or L spine. Sagittal balance correction to an SVA 50 mm or less was a significant risk factor in patients with preoperative sagittal imbalance.
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The options available for treatment of Irreducible Atlantoaxial Dislocation (IAAD) with basilar invagination are odontoidectomy, posterior decompression, posterior atlanto-axial joint distraction. In 2006 Wang et al described that most IAAD can be reduced following anterior release of contracted soft tissues. Anterior release may be done by transoral (TO) or retropharyngeal (RP) approach. Posterior instrumented fusion provides stability and helps in achieving further reduction. ⋯ This series reinforces the safety and efficacy of both trans-oral and retro-pharyngeal anterior release for reduction of Irreducible AAD. Posterior fixation helps in achieving further reduction and provides stability. Anterior release followed by instrumented posterior fusion is a safe and effective modality of treatment for irreducible AAD associated with basilar invagination.