The spine journal : official journal of the North American Spine Society
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Repeated cohort studies have consistently demonstrated a survival advantage after en bloc resection for locally aggressive primary tumors in the sacrum. A sacrectomy is often required to remove the tumor en bloc, which may necessitate the sacrifice of sacral nerves. This can potentially result in functional complications, including the impairment of gait, bowel function, or bladder function. ⋯ Preoperative bladder, bowel, and motor functions, level of sacral tumor involvement, and corresponding level of sacrectomy were the greatest predictors of long-term bladder, bowel, and motor functions. There were no statistically significant changes in bladder, bowel, or motor functions from pre-op to 6 months post-op, and therefore, pre-op functional status was predictive of long-term function.
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Traditional short-segment fixation of unstable thoracolumbar injuries can be associated with progressive kyphosis and implant failure. Load sharing classification (LSC) recommends supplemental anterior reconstruction for fractures of score 7 or greater. Posterior fixation including the fractured vertebra (PFFV) has biomechanical advantages over conventional short-segment fixation. However, its efficacy in severe thoracolumbar injuries (LSC≥7) has not been studied. ⋯ Reduction of unstable thoracolumbar injuries even with LSC≥7 can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction. In the current era of evolving concepts of fracture fixation, the relevance of LSC in the management of unstable burst fractures is questionable.
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Comparative Study
Radiologic and clinical outcomes comparison between single- and two-level pedicle subtraction osteotomies in correcting ankylosing spondylitis kyphosis.
Single pedicle subtraction osteotomy (PSO) has been used to correct ankylosing spondylitis (AS) kyphosis successfully, but this approach seems insufficient to correct severe kyphosis. Two-level PSO has been attempted to correct advanced kyphosis in recent years. However, studies have not yet compared outcomes between single and double PSOs, and the indications to perform two-level PSO are unclear. ⋯ Pedicle subtraction osteotomy is an effective method to correct kyphosis with AS. Most patients can be successfully treated by single PSO. In severe patients, two-level PSO may be preferable because its correction ability is greater and spine curvature is better than that of single-level PSO. However, two-level PSO requires an increased operating time and results in increased blood loss. Nevertheless, the complications were similar between the two groups.
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During quiet standing, the gravity line (GL) can be located according to the sum of the ground reaction forces (GRFs) measured with a force platform. C7 plumb line (C7PL) is an easy method to estimate sagittal trunk balance, but discordance between C7PL and the GL is widely recognized. However, the prevalence of occiput-trunk (O-T) discordance (GL-C7PL>3 cm) and the factors affecting this type of discordance have not yet been determined. ⋯ The prevalence of discordance between GL and C7PL in ASD patients was 24%, and thoracic kyphosis and global sagittal alignment were significantly correlated with this discordance. The concordance of GRF and GL and the discordance of GRF and C7PL highlight the importance and necessity of accounting for GL when considering surgical treatment.