Spine
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Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Congenital scoliosis (CS) is a spinal deformity resulting from underlying spinal malformations with an incidence of 0.5–1/1000 births.
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CS makes up 10% of scoliotic deformities, of which 25% do not progress, 25% progress mildly and 50% need treatment depending on the age, curve characteristics and magnitude and type of anomaly.
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CS is associated with non-vertebral anomalies (genitourinary, musculoskeletal, cardiac, ribs anomalies, etc.) and intraspinal anomalies (syrinx and tethered cord).
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Imaging should include whole spine X-rays, CT scanner with reconstruction to better delineate the vertebral anomalies and MRI to visualize the neural elements.
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Treatment of CS in the majority of cases is non-surgical and relies on fusion techniques (in situ fusion and hemiepiphysiodeis), resection techniques (hemiverterba resection), and growth-friendly techniques (distraction and instrumentation without fusion).
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The aim of the study was to conduct a literature review on growth hormone therapy in short-stature patients with kyphoscoliosis.
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The search strategy was performed in which all the relevant papers published in 20 years were included on Pub Med, Central, and Google scholar by using keywords short stature, growth hormones, adverse events of growth hormones in kyphoscoliosis, safety.
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The study investigation supports the idea that giving human growth hormone (HGH) to a diverse population of short-statured children does not enhance the occurrence of scoliosis.
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Patients on HGH therapy for progressing scoliosis had syndromes in which scoliosis was more prevalent in an age-matched group. Short stature attributed to progressive growth failure is prevalent in all mucopolysaccharidosis (MPS) disorders, as per the existing research on growth and growth hormone in MPS.
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MPS should be explored in children who are being tested for short stature since growth failure might be the presenting symptom.
These authors contributed equally to this work and should be considered co-first authors
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These authors contributed equally to this work and should be considered co-first authors
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Anterior cervical surgery (ACS) owes its development to various pioneering individuals whose revolutionary works form key advances and guide current medical decisions. This bibliometric study aimed to identify, analyse and visualize the main features of the most-cited papers in ACS.
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The citation count for the top 100 most-cited articles ranged from 148 to 1,197, and citations per year ranged from 3.1 to 89.8. The articles were published from 1958 to 2016, with the 2000s being the most active decade. There was an inverse correlation between the average citations per year since publication and article age.
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The oldest as well as most-cited two articles were both published in 1958 by Smith and Robinson, and Cloward, respectively. In their studies, the authors individually described the technique of anterior cervical discectomy with fusion (ACDF).
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The most popular keywords were: ‘fusion’ (22), ‘spine’ (20), ‘cervical spine’ (16), ‘complications’ (15), ‘arthrodesis’ (13), ‘interbody fusion’ (13), ‘bone morphogenetic protein’ (13), and ‘radiculopathy’ (12).
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ACDF was the most frequent surgical procedure (80%), while cervical disc arthroplasty is of gradual greater impact.
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The surgical techniques of ACDF have remained unaltered for over 60 years. More attempts are needed to promote its development.
Cite this article: EFORT Open Rev 2021;6:1203-1213. DOI: 10.1302/2058-5241.6.210074
Hospital del Trabajador, Santiago, Chile
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Hospital del Trabajador, Santiago, Chile
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Hospital Roberto del Río, Santiago, Chile
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Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease.
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Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology.
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This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient.
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SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making.
Cite this article: EFORT Open Rev 2021;6:1193-1202. DOI: 10.1302/2058-5241.6.210062
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Adjacent segment pathology (ASP) is a major cause of disability, and the recognition of the surgical risk factors associated with the development of this condition is essential for its prevention.
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Different surgical approaches, from decompression without fusion to non-instrumented and instrumented fusion, have distinct contributions to the development of ASP.
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Although motion-preservation procedures could reduce the prevalence of ASP, these are also associated with a higher percentage of complications.
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Several risk factors associated with previous surgery, namely the chosen surgical approach and anatomical dissection, the choice of interbody fusion, the increment and length of the fusion, and the restoration of sagittal alignment, may influence the development of ASP.
Cite this article: EFORT Open Rev 2021;6:966-972. DOI: 10.1302/2058-5241.6.210050
Centre for Spinal Surgery, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, UK
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In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level.
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In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications.
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In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure.
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In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care.
Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020
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Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.
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More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.
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As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.
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Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.
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This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients’ outcomes.
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The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas.
Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130
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Over the years, a number of authors have used different working definitions of instability in tuberculosis of the spine (TB spine). However, no clear consensus exists to define instability in TB spine. The current systematic review addresses the question ‘What defines instability in TB spine’?
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A comprehensive medical literature search was carried out to identify all the studies which defined instability in the setting of spinal TB. The extracted data included the clinical, X-ray and CT or MRI-based definitions.
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The current review identified lesser age, junctional region of the spine, mechanical pain and ‘instability catch’, kyphotic deformity above 40 degrees, pan-vertebral or bilateral facetal involvement and multifocal contiguous disease involving more than three vertebrae as predictors for spinal instability in the dorso-lumbar spine.
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Cervical kyphosis more than 30 degrees and facetal or pan-vertebral involvement were found to be the factors used to define instability in subaxial cervical spine.
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With respect to C1–C2 TB spine, migration of the tip of the odontoid above the McRae or McGregor line or anterior translation of C1 over C2 were considered as determinants for instability.
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Although definitive conclusions could not be drawn due to lack of adequate evidence, the authors identified factors which may contribute towards instability in TB spine.
Cite this article: EFORT Open Rev 2021;6:202-210. DOI: 10.1302/2058-5241.6.200113
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In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology.
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The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis.
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An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language.
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We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients.
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Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection.
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Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46–100%) with a complication rate of 8% (range 0–15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing ‘self-neuromonitoring’ by allowing patients to respond to cord and/or nerve stimuli.
Cite this article: EFORT Open Rev 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080
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Management of scoliosis in young children needs a comprehensive approach because of its complexity. There are many debatable points; however, only serial casting, growing rods (including traditional and magnetically controlled) and anterior vertebral body tethering will be discussed in this article.
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Serial casting is a time-gaining method for postponing surgical interventions in early onset scoliosis, despite the fact that it has some adverse effects which should be considered and discussed with the family beforehand.
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Use of growing rods is a growth-friendly surgical technique for the treatment of early onset spine deformity which allows chest growth and lung development. Magnetically controlled growing rods are effective in selected cases although they sometimes have a high number of unplanned revisions.
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Anterior vertebral body tethering seems to be a promising novel technique for the treatment of idiopathic scoliosis in immature cases. It provides substantial correction and continuous curve control while maintaining mobility between spinal segments. However, long-term results, adverse effects and their prevention should be clarified by future studies.
Cite this article: EFORT Open Rev 2020;5:753-762. DOI: 10.1302/2058-5241.5.190087