SciCombinator

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Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

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The purpose of this study is to review our operative experience of congenital kyphosis or kyphoscoliosis undergoing either pedicle subtraction osteotomy (PSO) or posterior vertebral column resection (pVCR) according to certain criteria we have established.

Concepts: Vertebral column, Scoliosis, According to Jim, Vertebra, Skeletal disorders, Lordosis, Kyphosis, Kyphoscoliosis

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INTRODUCTION: Many studies regarding spinal sagittal alignment were focused mainly on above-hip structures, not considering the knee joint. Knee-spine syndrome was proposed earlier, but the mechanism of this phenomenon has not been revealed. The aim of the study was to demonstrate how spinopelvic alignment and sagittal balance change in response to simulated knee flexion in normal non-diseased population. METHODS: Thirty young male were enrolled in the study cohort. Two motion-controlled knee braces were used to simulate knee flexion of 0°, 15°, and 30° settings. Whole spine and lower extremity lateral radiographs were taken at each knee setting of 0°, 15°, and 30° flexion. Spinal and pelvic parameters were measured, including two angular parameters, femoropelvic angle (FPA) and femoral tilt angle (FTA). RESULTS: The following equation can be made; PT (pelvic tilt) = FPA + FTA. The mean values of FPA and lumbar lordosis decreased significantly at 15° and 30° knee settings compared to the parameters at the 0° knee setting, while the mean values of pelvic tilt and sacral slope rarely changed. Results also showed FTA was not correlated with PT, but strongly correlated with FPA (R = -0.83, p < 0.01). CONCLUSIONS: The knee flexion resulted in decrease of lumbar lordosis without a significant change of pelvic posture in non-diseased population group.

Concepts: Vertebral column, Knee, Joint, Sartorius muscle, Flexion, Extension, Semimembranosus muscle, Popliteus muscle

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Raloxifene is the first selective estrogen receptor modulator that has been approved for the treatment and prevention of osteoporosis in postmenopausal women in Europe and in the US. Although raloxifene reduces the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer, it is approved in that indication in the US but not in the EU. The aim was to characterize the clinical profiles of postmenopausal women expected to benefit most from therapy with raloxifene based on published scientific evidence to date.

Concepts: Osteoporosis, Breast cancer, European Union, Menopause, Estrogen, Estrogen receptor, Tamoxifen, Selective estrogen receptor modulator

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PURPOSE: Currently degeneration of the intervertebral disc and joint in the degenerative process of the lumbar spine has mainly attracted the attention, however, there are very few literatures focusing on the height of the spinous process. Our objective was to examine in what generation the change in spinous process height occurs and how the change is involved in the degenerative process of the lumbar spine. METHODS: CT or CT myelography of 1,015 patients, 536 males and 579 females were measured in 6 items, including the heights of the L4 and L5 vertebral bodies, the L4 and L5 spinous processes, the L4/5 intervertebral disc, and the L5/S1 intervertebral disc. All data of the 6 items were analyzed and compared between gender in 5 age groups (40s, 50s, 60s, 70s and 80s). RESULTS: The results indicated a significant increase in the height of the L4 and L5 spinous process (P < 0.01) in the 60- to 70-year-old group for both genders, and also showed that the L4 and L5 vertebral body height was significantly decreased in the 50- to 60-year-old group (P < 0.01 in males, P < 0.001 in females). CONCLUSIONS: Changes in the spinous process morphology followed degenerative changes of the intervertebral disc and vertebral body in the degenerative process of the lumbar spine. This result may suggest that the morphological change of an increase in the height of the spinous process may be a kind of biological defense reaction to stabilize the intervertebral portion.

Concepts: Male, Lumbar vertebrae, Vertebral column, Gender, Vertebra, Intervertebral disc, Bones of the torso, Spinous process

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INTRODUCTION: The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. METHODS: Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. RESULTS: Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P < 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P < 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4° achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. CONCLUSIONS: Intravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

Concepts: Osteoporosis, Hospital, Vertebral column, Compression fracture, Vertebra, Intervertebral disc, Kyphoplasty, Vertebroplasty

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PURPOSE: In our article, we would like to introduce a new auxiliary implant called the CAB hook, for use in posterior approach scoliosis surgery. METHODS: Since 2007, we operated 42 patients with the CAB hook with an average preoperative Cobb angle of 59.3° (28°-92°). In three cases, the posterior approach was preceded by ventral release and Halo traction. In four cases, besides the CAB hooks, SCS hooks and pedicular screws, in three cases both CAB and SCS hooks, in nine cases CAB hooks with SCS pedicular screws, and in 23 cases, only CAB were used. The average follow-up time was 21.6 month (2-51). RESULTS: All the patients are satisfied with the results. No reoperation was needed due to the loss of correction, pain, implant failure, or infection. The average postoperative Cobb angle decreased to 24.7° (4°-60°). Based on this we calculated the Cincinnati Correction Index (CCI), which was 1.53 (0.7-4.8), which means that our correction exceeded the flexibility of the spine based on the lateral bending X-ray by 53 %. CONCLUSION: As with all new surgical techniques and implants after the short learning curve, we were able to improve the degree of correction and decrease the time of surgery. One of the advantages of the CAB hook is that besides a few implant-specific instruments, no special instrumentation is required for insertion, and image intensifier need not be used.

Concepts: Surgery, Scoliosis, The Loss, Curve, Learning curve, Image intensifier, The Spine, Hooks

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PURPOSE: We aimed to describe the morphological changes in the thoracic cage and spinal column induced in New Zealand White (NZW) prepubertal rabbits subjected to dorsal arthrodesis and observed at skeletal maturity by computed tomography (CT) scans. This was done to evaluate the plasticity of the thoracic cage of rabbits with non-deformed spine, by highlighting its modifications after spinal arthrodesis. Emogas data analysis, echocardiographic assessment and cardio-pulmonary measurements completed the evaluation. METHODS: Surgery was performed in 16 female rabbits, 6 weeks old. Nine were subjected to T1-T12 dorsal arthrodesis, while seven were sham-operated. Surgery involved the implant of two C-shaped stainless steel bars and heterologous bone graft. CT scans were performed before surgery, 2, 6 and 12 months after surgery. One week after the last CT scan, echocardiographic and emogas evaluations were performed. RESULTS: Chest depth (8 %), thoracic kyphosis (ThK) (23 %), dorsal and ventral length of the thoracic spine (11 %) and sternal length (7 %) were significantly reduced in operated compared to sham-operated rabbits. Mean values ± standard deviation (SD) of PaCO(2), PaO(2) and sO(2) were not significantly different. Mean values ± SD of echocardiographic measurements were not significantly different between the two groups of rabbits, except for thickness of the interventricular septum in systole, contractile capacity of the left ventricle and ejection fraction. CONCLUSIONS: T1-T12 dorsal arthrodesis in prepubertal NZW rabbits with non-deformed spine induced changes of the thoracic cage morphology. However, those changes are source of cardio-pulmonary complications not severe enough to reproduce a clinical picture comparable to thoracic insufficiency syndrome in humans.

Concepts: Heart, Medical imaging, Vertebral column, Scoliosis, Tomographic reconstruction, Ventricle, Thoracic vertebrae

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Surgical site infections represent a major complication of spinal surgery. The application of lyophilised vancomycin into the wound is reported to significantly decrease infection rates. As concentrations applied locally can exceed the minimal bacterial inhibitory concentration for more than a 1000-fold, toxic side effects on local tissue may be possible.

Concepts: Immune system, Infection, Anesthesia, Antiseptic

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Lateral transpsoas lumbar interbody fusion (LTIF) is an accepted treatment for degenerative lumbar disc disease. Bilateral percutaneous transfacet (TF) fixation is a promising option for stabilization following LTIF. Here, we describe our experience with this technique and assess the clinical outcomes and efficacy.

Concepts: Evaluation methods, Degenerative disc disease