The spine journal : official journal of the North American Spine Society
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Comparative Study
Effectiveness of cross-linking posterior segmental instrumentation in adolescent idiopathic scoliosis: a 2-year follow-up comparative study.
Surgeons continue to debate the need for a cross-link (CL) in posterior spinal instrumentation constructs with segmental pedicle screws in adolescent idiopathic scoliosis (AIS). Advantage of CLs is increased stiffness of the construct, and disadvantages include added expense and risk of late operative-site pain and pseudarthrosis. ⋯ We observed no differences in maintenance of correction, SRS scores, and complications with or without cross-linking posterior segmental instrumentation in AIS patients over 2-year follow-up. Further follow-up is necessary.
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Case Reports
Rectal perforation after AxiaLIF instrumentation: case report and review of the literature.
Bowel perforation is an uncommon complication of posterior spinal surgery. The AxiaLIF transsacral instrumentation system has been used for the treatment of L5-S1 spondylolisthesis and degenerative disc disease since its introduction in 2005 as a potentially less invasive alternative to traditional anterior or posterior interbody fusion. ⋯ Delayed presentation of rectal perforation with a subsequent anaerobic sepsis is a potential complication of the presacral approach to the L5-S1 disc space. Recognition and treatment with fecal diversion and long-term intravenous antibiotics is an alternative to device removal and sacral reconstruction.
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Comparative Study
C1 lateral mass screw placement via the posterior arch: a technique comparison and anatomic analysis.
Instrumentation of C1 is becoming increasingly common. Starting points initially described for C1 lateral mass screws at the lateral mass/posterior arch junction are technically challenging. Recently, a number of techniques have evolved advocating varying starting points and trajectories. Despite being technically easier, there are new safety concerns. Insufficient evidence exists for optimal C1 lateral mass screw placement with starting points in the posterior arch. ⋯ C1 lateral mass screws could be virtually placed bilaterally in each of 100 clinical cases without violating critical structures. However, none of the previously described approaches worked in every case because of significant anatomic variability. The vertical starting point was particularly critical, and vertebral groove height was the most limiting variable. Although a reliable safe zone could be found in every case, preoperative planning is essential to avoid critical structures.
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Case Reports
"Artifactual fracture-subluxation" of cervical spine in computed tomography screening sans plain radiographs.
Computed tomography (CT) has become the sole modality of screening for cervical injury in polytrauma because of the high sensitivity, speed, and convenience, thereby eliminating the need for plain radiographs. ⋯ Motion artifact in cervical CT screening can lead to a misdiagnosis of fracture subluxation. Duplication of soft tissue is highly suggestive of this motion artifact, and an additional single lateral plain radiograph may avert this pitfall.
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Randomized Controlled Trial Comparative Study
Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.
Chronic low back pain (cLBP) represents a major challenge to our health care systems. The relative efficacy of surgery over nonoperative treatment for the treatment of cLBP remains controversial, and little is known of the long-term comparative outcomes. ⋯ After an average of 11 years follow-up, there was no difference in patient self-rated outcomes between fusion and multidisciplinary cognitive-behavioral and exercise rehabilitation for cLBP. The results suggest that, given the increased risks of surgery and the lack of deterioration in nonoperative outcomes over time, the use of lumbar fusion in cLBP patients should not be favored in health care systems where multidisciplinary cognitive-behavioral and exercise rehabilitation programmes are available.