The spine journal : official journal of the North American Spine Society
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Evidence demonstrating the biomechanical effects of the Hueter-Volkmann principle on vertebral body growth in spinal deformities is lacking. Bracing a scoliotic curve should, in theory, unload the growth plates on the concave side of the vertebral bodies near the curve's apex. Growth stimulation, leading to structural remodeling of the vertebral bodies, on the curve's concave side may explain the improvement or lack of curve progression, as measured by Cobb angles, reported with successful brace management of adolescent idiopathic scoliosis (AIS). ⋯ Brace application results in immediate positional derotations of the spine in patients with AIS. These positional derotations were maintained only in patients with flexible curves, at final follow-up. Brace treatment was not recommended in patients whose curves did not correct at least 20% in a TLSO.
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Biochemical treatment options including attempts at intervertebral disc restoration are desirable for the physiologic treatment of degenerative disc disease. ⋯ The results of this pilot study suggest that intradiscal injection therapy with glucosamine, chondroitin sulfate, hypertonic dextrose and DMSO warrants further evaluation with randomized controlled trials.
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Clinicians have long hypothesized that gender may be a risk factor in treatment outcomes of patients with chronic disability associated with musculoskeletal disorders. Although the scientific literature shows a higher prevalence of occupational low back injury in men, and a higher rate of repetitive motion and neck injuries in women, few studies have comprehensively investigated the role of gender regarding cost-related outcome variables of significance after work-related injuries. ⋯ The present study represents the first large-scale examination of the relationship between gender and treatment outcomes for a population with CDSD after work injuries. There was a pattern of moderately better 1-year posttreatment socioeconomic outcome for men. On psychosocial measures, men showed lower disability and depression scores than women, with higher levels of physical functioning both before and after treatment. Overall, male patients with CDSD appeared to show somewhat better biopsychosocial outcomes. This leaves the question of identifying gender-specific risk factors to explain these differences.
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Previous clinical studies of interbody fusion cages have generally failed to report sagittal plane alignment. In some cases, parallel-sided cages have contributed to loss of lumbar lordosis. A wedged-shaped carbon-fiber-reinforced polymer (CFRP) cage implant filled with autologous bone was designed to allow surgeons to more easily achieve normal sagittal plane alignment in posterior lumbar interbody fusion (PLIF). ⋯ The wedged CFRP cage with pedicle screw fixation allows surgeons to maintain normal sagittal plane alignment. These devices are safe and effective for treatment of spondylolisthesis and are FDA approved in the United States.
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Review Historical Article
A surgical revisitation of Pott distemper of the spine.
Pott disease and tuberculosis have been with humans for countless millennia. Before the mid-twentieth century, the treatment of tuberculous spondylitis was primarily supportive and typically resulted in dismal neurological, functional and cosmetic outcomes. The contemporary development of effective antituberculous medications, imaging modalities, anesthesia, operative techniques and spinal instrumentation resulted in quantum improvements in the diagnosis, management and outcome of spinal tuberculosis. With the successful treatment of tuberculosis worldwide, interest in Pott disease has faded from the surgical forefront over the last 20 years. With the recent unchecked global pandemic of human immunodeficiency virus, the number of tuberculosis and secondary spondylitis cases is again increasing at an alarming rate. A surgical revisitation of Pott disease is thus essential to prepare spinal surgeons for this impending resurgence of tuberculosis. ⋯ Unlike historical times, effective medical and surgical management of tuberculous spondyitis is now possible. Proper selection of drug therapy and operative modalities, however, is needed to optimize functional outcomes for each individual case of Pott disease.