Spine
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The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity.
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The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity.
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SPO is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space. A mobile anterior disc is essential. SPO is best in patients with +6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm bone).
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PSO is a technique where the posterior elements and pedicles are removed. Then a triangular wedge through the pedicles is removed and the posterior spine is shortened using the anterior cortex as a hinge. The ideal candidates are patients with a severe sagittal imbalance. A single level osteotomy can produce 30° 40° of correction. A single level osteotomy may restore global sagittal balance by an average of 9 cm with an upper limit of 19 cm.
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BDBO is an osteotomy done above and below a disc level. A BDBO provides correction rates in the range of 35° to 60°. The main indications are deformities with the disc space as the apex and severe sagittal plane deformities.
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VCR is indicated for rigid multi-planar deformities, sharp angulated deformities, hemivertebra resections, resectable spinal tumours, post-traumatic deformities and spondyloptosis. The main indication for a VCR is fixed coronal plane deformity.
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The type of osteotomy must be chosen mainly according to the aetiology, type and apex of the deformity. One may start with SPOs and may gradually advance to complex osteotomies.
Cite this article: EFORT Open Rev 2017;2:73-82.
DOI: 10.1302/2058-5241.2.160069
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Universitat Autónoma de Barcelona, Spain
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An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined.
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This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature.
Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029
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Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population.
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Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment.
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A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined.
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The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis.
Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030.
Search for other papers by Emre Acaroglu in
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Adult spinal deformity (ASD) is a very diverse condition that affects the quality of life of the involved individuals deeply. There is an ongoing discussion as to whether treatment should be surgical (which is potentially dangerous) or non-surgical.
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In addition to a systematic review of literature on the surgical treatment of ASD with special emphasis on complications, a decision-analysis was performed using the patient information within a European multi-centric database of ASD.
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The probabilities of improvement and complications as well as associated disease burden (utility) were calculated at the baseline and at first-year follow-up.
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Decision-analysis suggests that the chances of clinical improvement are significantly higher with surgical treatment. Though surgical treatment is significantly more prone to complications, the likelihood of improvement remains higher than that offered by non-surgical treatment.
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Surgical treatment of ASD appears to be associated with a higher likelihood of clinical improvement. Future work needs to focus on refining the criteria for appropriate patient selection and decreasing the incidence of complications.
Cite this article: Acaroglu E, European Spine Study Group. Decision-making in the treatment of adult spinal deformity. EFORT Open Rev 2016;1:167-176. DOI: 10.1302/2058-5241.1.000013.