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[PMID]: 29523203
[Au] Autor:Cirovic S; Lloyd R; Jovanovik J; Volk HA; Rusbridge C
[Ad] Address:The Centre for Biomedical Engineering, University of Surrey, Guildford, GU2 7XH, UK. s.cirovic@surrey.ac.uk.
[Ti] Title:Computer simulation of syringomyelia in dogs.
[So] Source:BMC Vet Res;14(1):82, 2018 Mar 09.
[Is] ISSN:1746-6148
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Syringomyelia is a pathological condition in which fluid-filled cavities (syringes) form and expand in the spinal cord. Syringomyelia is often linked with obstruction of the craniocervical junction and a Chiari malformation, which is similar in both humans and animals. Some brachycephalic toy breed dogs such as Cavalier King Charles Spaniels (CKCS) are particularly predisposed. The exact mechanism of the formation of syringomyelia is undetermined and consequently with the lack of clinical explanation, engineers and mathematicians have resorted to computer models to identify possible physical mechanisms that can lead to syringes. We developed a computer model of the spinal cavity of a CKCS suffering from a large syrinx. The model was excited at the cranial end to simulate the movement of the cerebrospinal fluid (CSF) and the spinal cord due to the shift of blood volume in the cranium related to the cardiac cycle. To simulate the normal condition, the movement was prescribed to the CSF. To simulate the pathological condition, the movement of CSF was blocked. RESULTS: For normal conditions the pressure in the SAS was approximately 400 Pa and the same applied to all stress components in the spinal cord. The stress was uniformly distributed along the length of the spinal cord. When the blockage between the cranial and spinal CSF spaces forced the cord to move with the cardiac cycle, shear and axial normal stresses in the cord increased significantly. The sites where the elevated stress was most pronounced coincided with the axial locations where the syringes typically form, but they were at the perimeter rather than in the central portion of the cord. This elevated stress originated from the bending of the cord at the locations where its curvature was high. CONCLUSIONS: The results suggest that it is possible that repetitive stressing of the spinal cord caused by its exaggerated movement could be a cause for the formation of initial syringes. Further consideration of factors such as cord tethering and the difference in mechanical properties of white and grey matter is needed to fully explore this possibility.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process
[do] DOI:10.1186/s12917-018-1410-7

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[PMID]: 29317358
[Au] Autor:Klekamp J
[Ad] Address:Christliches Krankenhaus Quakenbrück, Department of Neurosurgery, Quakenbrück, Germany. Electronic address: j.klekamp@ckq-gmbh.de.
[Ti] Title:How Should Syringomyelia be Defined and Diagnosed?
[So] Source:World Neurosurg;111:e729-e745, 2018 Mar.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Syringomyelia is considered as a fluid-filled cavitation inside the spinal cord. However, there is no agreement whether a dilated central canal should be included under this heading or how glioependymal cysts, myelomalacias, or cystic tumors should be distinguished from syringomyelia. This article provides a definition of syringomyelia and guidelines for its diagnosis. METHODS: Between 1991 and 2015, of 3206 patients with spinal cord pathologies 2276 demonstrated cystic features. All patients underwent magnetic resonance imaging. Syringomyelia was differentiated from cystic intramedullary tumors, glioependymal cysts, myelomalacias, and dilatations of the central canal by clinical and radiologic criteria. RESULTS: A total of 1535 patients were diagnosed with syringomyelia, 635 with dilatations of the central canal, 52 with glioependymal cysts, 52 with mylomalacias, and 2 with cystic intramedullary spinal cord tumors. Additional neuroradiologic studies revealed the causes of syringomyelia. As a result 604 patients showed pathologies at the craniocervical junction leading to disturbances of cerebrospinal fluid (CSF) flow. The commonest was a Chiari I malformation in 543 patients. Nine hundred thirty-one patients presented with pathologies in the spinal canal. The commonest causes were spinal arachnopathies, leading to CSF flow obstructions in 533 patients, intramedullary tumors in 152 patients, and tethered cord syndromes in 69 patients. CONCLUSIONS: The diagnosis of syringomyelia should be reserved for patients with a fluid-filled cavity in the spinal cord related to either a disturbance of CSF flow, spinal cord tethering, or an intramedullary tumor. For patients in whom such a relation cannot be established, the diagnosis of syringomyelia should be withheld.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:In-Data-Review

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[PMID]: 29294396
[Au] Autor:Goel A; Gore S; Shah A; Dharurkar P; Vutha R; Patil A
[Ad] Address:Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; Lilavati Hospital and Research Centre, Bandra, Mumbai. Electronic address: atulgoel62@hotmail.com.
[Ti] Title:Atlantoaxial Fixation for Chiari 1 Formation in Pediatric Age-Group Patients: Report of Treatment in 33 Patients.
[So] Source:World Neurosurg;111:e668-e677, 2018 Mar.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The role of atlantoaxial instability in the pathogenesis of Chiari 1 formation (Chiari formation) in pediatric age-group patients is evaluated. MATERIAL AND METHODS: During the period of January 2010 to June 2017, 33 pediatric patients having Chiari formation were treated with atlantoaxial fixation. Twenty-four patients had basilar invagination, and 9 patients had no bone abnormality at the craniovertebral junction. Sixteen patients had syringomyelia, and 9 patients had both basilar invagination and syringomyelia. Considering the type of facet alignment and atlantoaxial instability, the patients were divided into 3 groups. Type 1 dislocation (13 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type 2 dislocation (5 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type 3 dislocation (15 patients) was the absence of demonstrable facet malalignment. Type 2 and 3 atlantoaxial facet instability were labeled as central atlantoaxial dislocation. In 14 patients, dynamic images showed mobile and at least partially reducible vertical atlantoaxial dislocation. RESULTS: All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. All patients had gratifying and sustained clinical improvement. CONCLUSIONS: The outcome further confirms the cause-effect relationship of Chiari formation and atlantoaxial instability.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:In-Data-Review

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[PMID]: 29294392
[Au] Autor:Shtaya A; Sadek AR; Nicoll JAR; Nader-Sepahi A
[Ad] Address:Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom; Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom. Electronic address: ashtaya@sgul.ac.uk.
[Ti] Title:Choroid Plexus in the Central Canal of the Spinal Cord Causing Recurrent Syringomyelia.
[So] Source:World Neurosurg;111:275-278, 2018 Mar.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Syringomyelia is a fluid-filled cavitation within the substance of the spinal cord. This condition usually follows a primary pathology that disrupts the normal cerebrospinal fluid circulation or disturbs the microcirculation and cytoarchitecture of the spinal cord parenchyma. However, an etiology of recurrent syringomyelia resulting from an ectopic choroid plexus (CP) has not been discussed. Ectopic CP rests may be found within the central nervous system. Although there has been a single report, describing ectopic intramedullary spinal cord CP, to our knowledge, extra-cranial nonmalignant CP in the central canal of the spinal cord has not been reported. CASE DESCRIPTION: We report CP in the central canal of the spinal cord in a 23-year-old male patient who had developmental delay and diabetes mellitus type I who presented with dissociated sensory changes and muscle wastage predominantly on the right upper and lower limbs. Magnetic resonance imaging demonstrated a multiloculated spinal cord syringomyelia stretching from cervical (C3) to the conus medullaris causing recurrent neurologic deficits. A biopsy of the central canal spinal cord lesion revealed CP. Decompression and syringosubarachnoid shunt insertion stabilized the patient's neurology. CONCLUSIONS: Our illustrative case reveals the presence of CP in the central canal of the spinal cord that may suggest a role in the etiology of recurrent syringomyelia. Although management poses a challenge to neurosurgeons, prompt decompression and shunting of the syringomyelia remains a favorable approach with acceptable outcomes. Further investigation into the pathophysiology of central canal CP ectopic causing recurrent syringomyelia and its correlation with spinal cord development may help future treatments.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:In-Data-Review

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[PMID]: 29390355
[Au] Autor:Zhu C; Huang S; Zhou C; Yang X; Wang L; Ling T; Liu L; Song Y
[Ad] Address:Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
[Ti] Title:A case report of congenital scoliosis associated with situs inversus totalis.
[So] Source:Medicine (Baltimore);96(50):e9239, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Situs inversus totalis is a rare anomaly disease in which the organs in the chest and abdomen are positioned in a mirror image reversal of normal positions. Although this has been confirmed to be associated with spinal abnormalities, reports about situs inversus totalis with congenital scoliosis remain limited. PATIENT CONCERNS: We present a 9-year-old girl having congenital scoliosis associated with situs inversus totalis. DIAGNOSES: She also had other associated anomalies: ventricular septal defect, mild restrictive ventilatory dysfunction, hydronephrosis, and syringomyelia. Her preoperative Cobb angle (T11-L3) was 78°. INTERVENTIONS: She received single growing rods treatment and subsequent posterior spinal fusion correction surgery for her scoliosis. OUTCOMES: The coronal Cobb angle of the main curve was corrected to 20° postoperatively and no obvious loss of spinal corrective angle was identified 1 year after the correction surgery. LESSONS: Growing rods technique could be a safe and effective alternative for the treatment of scoliosis associated with situs inversus totalis. In the correction of left-sided lumbar curve of this kind of patients, the risks of aorta impingements should not be neglected when placing pedicle screws on the concave sides.
[Mh] MeSH terms primary: Scoliosis/congenital
Scoliosis/surgery
Situs Inversus
[Mh] MeSH terms secundary: Abnormalities, Multiple
Child
Female
Humans
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009239

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[PMID]: 28743389
[Au] Autor:Nagashima H; Mizukawa K; Taniguchi M; Yamamoto Y; Kohmura E
[Ad] Address:Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan. Electronic address: hn0628hn@med.kobe-u.ac.jp.
[Ti] Title:Cerebrospinal fluid leakage and Chiari I malformation with Gorham's disease of the skull base: A case report.
[So] Source:Neurol Neurochir Pol;51(5):427-431, 2017 Sep - Oct.
[Is] ISSN:0028-3843
[Cp] Country of publication:Poland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Gorham's syndrome is a rare bone disorder characterized by massive osteolysis of unknown etiology. There are no reports of comorbidity involving cerebrospinal fluid (CSF) leakage and Chiari I malformation with Gorham's syndrome. Here, we report an unusual case of an acute presyrinx state complicated by bacterial meningitis due to CSF leakage and Chiari I malformation associated with Gorham's disease of the skull base. CASE PRESENTATION: A 25-year-old woman with Chiari I malformation associated with Gorham's syndrome presented with aggressive paresthesia following bacterial meningitis. Axial magnetic resonance imaging (MRI) and computed tomography (CT) cisternography revealed CSF leakage in the right petrous apex. A presyrinx state was diagnosed based on the clinical symptoms and MRI findings. With resolution of the bacterial meningitis, the spinal edema and tonsillar ectopia also improved. Surgical repair of the CSF leakage was performed by an endoscopic endonasal transsphenoidal approach to prevent recurrence of meningitis. The postoperative course was uneventful. CONCLUSION: Skull base osteolysis in Gorham's syndrome may induce Chiari I malformation and CSF leakage. We should pay attention to acute progression of clinical symptoms because Gorham's syndrome may predispose to development of Chiari I malformation and may be complicated by CSF leakage.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:In-Process

  7 / 3964 MEDLINE  
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[PMID]: 29485364
[Au] Autor:Mousele C; Georgiopoulos M; Constantoyannis C
[Ad] Address:a Department of Neurosurgery, University Hospital of Patras, Faculty of Medicine , University of Patras , Patras , Greece.
[Ti] Title:Syringobulbia: A delayed complication following spinal cord injury - case report.
[So] Source:J Spinal Cord Med;:1-8, 2018 Feb 27.
[Is] ISSN:2045-7723
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:CONTEXT: Syringobulbia is a very rare progressive disorder of central nervous system, with several possible underlying conditions. Rarely, it is also encountered as a late complication of syringomyelia. FINDINGS: In the present manuscript, a case of a paraplegic patient, due to traumatic spinal cord injury (thoracolumbar fracture), presenting after years progressively developing symptoms of the lower cranial nerves and upper extremities, owed to syringomyelia and syringobulbia, the surgical treatment applied and its outcomes are described. We performed a syringo-peritoneal shunting procedure using a T-tube. The patient's symptoms resolved postoperatively and the cavity's size was reduced to a great degree. CONCLUSION/CLINICAL RELEVANCE: The late appearance of cranial nerve deficits or symptoms-signs of the upper extremities in a patient with traumatic thoracic spinal cord injury should raise suspicion that post-traumatic syringomyelia or syringobulbia has occurred. In such cases, radiologic evaluation and early surgical drainage of the cyst as a means of preventing significant delayed neurologic deficit is advocated.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher
[do] DOI:10.1080/10790268.2018.1439437

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[PMID]: 29482005
[Au] Autor:Chai Z; Xue X; Fan H; Sun L; Cai H; Ma Y; Ma C; Zhou R
[Ad] Address:Basic Medical College, "2011"Collaborative Innovation Center, Neurobiology Research Center, Shanxi University of Traditional Chinese Medicine, Jinzhong 030619, China.
[Ti] Title:Efficacy of posterior fossa decompression with duraplasty for patients with Chiari malformation type I: a systematic review and meta-analysis.
[So] Source:World Neurosurg;, 2018 Feb 23.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:This study aimed to quantitatively assess and compare the effect and safety of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression (PFD) in treating patients with Chiari malformation type I (CM1). PubMed, Embase, and Cochrane Library were searched through May 2017. Fourteen cohort studies, involving a total of 3666 patients with CM1, were included. Studies were pooled, and the relative risk (RR) and its corresponding 95% confidence interval (CI) were calculated. The decrease in syringomyelia was better for patients in the PFDD group than for patients in the PFD group (RR=1.57, 95%CI=1.07-2.32, P =0.042, I =56.6%). The incidence of cerebrospinal fluid leak (RR=5.23, 95%CI=2.61-10.51, P =0.830, I =0%) and aseptic meningitis (RR=4.02, 95%CI=1.46-11.03, P =0.960, I =0%) significantly increased among patients in the PFDD group compared with those in the PFD group. On stratifying by age, a significantly reduced risk in the reoperation rate was observed in the adult group. However, the clinical improvement and the incidence of wound infection were not significantly different between the two groups. This study confirmed that the decrease in syringomyelia was better for patients treated with PFDD than for those treated with PFD alone. However, no significant difference was found in the clinical improvement and the reoperation rate between the two groups.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:Publisher

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[PMID]: 29470234
[Au] Autor:Faloon M; Sahai N; Pierce TP; Dunn CJ; Sinha K; Hwang KS; Emami A
[Ad] Address:Michael Faloon MD, Nikhil Sahai MD, MPH, Todd P. Pierce MD, Conor J. Dunn MD, Kumar Sinha MD, Ki Soo Hwang MD, Arash Emami MD, Seton Hall University, School of Medicine, St Joseph's Regional Medical Center, Department of Orthopaedic Surgery, Paterson, NJ, USA.
[Ti] Title:Incidence of Neuraxial Abnormalities Is Approximately 8% Among Patients With Adolescent Idiopathic Scoliosis: A Meta-analysis.
[So] Source:Clin Orthop Relat Res;, 2018 Feb 21.
[Is] ISSN:1528-1132
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Several studies have sought to address the role of routine preoperative MRI in patients with adolescent idiopathic scoliosis (AIS) undergoing deformity correction. Despite similar results regarding the prevalence of neuraxial anomalies detected on MRI, published conclusions conflict and give opposing recommendations. Lack of consensus has led to important variations in use of MRI before spinal surgery for patients with AIS. QUESTIONS/PURPOSES: This systematic review and meta-analysis of studies about patients with AIS evaluated (1) the overall proportion of neuraxial abnormalities; (2) the patient factors and curve characteristics that may be associated with abnormalities; and (3) the proportion of patients who underwent neurosurgical intervention before scoliosis surgery and the kinds of neuraxial lesions that were identified. METHODS: We performed a search of four electronic databases (PubMed, EMBASE, CINAHL Plus, and SCOPUS) utilizing search terms related to routine MRI and AIS, yielding 206 articles. Studies included had at least 20 participants, patients with ages 11 to 21 years, and a Methodological Index for Non-Randomized Studies (MINORS) study quality score of 8 and 16 points for noncomparative and comparative studies, respectively. Non-English manuscripts, animal studies, and those that did not include patients with AIS solely were excluded. Eighteen articles with 4746 patients were included for analysis of the overall proportion of neuraxial abnormalities, 12 articles with 3028 patients for analysis by sex, eight articles with 1603 patients for right main thoracic curve, eight articles with 665 patients for a left main thoracic curve, and 13 articles with 3063 patients and 230 (7.5%) abnormalities for number of neurosurgical interventions before scoliosis correction. The mean MINORS score for studies included was 14 (range, 10-20). Each study was analyzed for the proportion of patients identified with neuraxial abnormalities and associations with specific demographics. We determined the proportion of patients who underwent surgical interventions before scoliosis surgery as well as the types of neuraxial lesions identified. The articles were assessed for heterogeneity and publication bias. Because all groups were determined to be heterogeneous, a random-effects model was used for each group in this meta-analysis; with this analysis, an overlap of 95% confidence intervals suggests no difference at the p < 0.05 level, but this analytic approach does not provide p values. RESULTS: The pooled proportion of neuraxial abnormalities detected on MRI was 8% (95% confidence interval [CI], 6%-12%). With the numbers available, we found no difference in the proportion of male and female patients with neuraxial abnormalities (18% [95% CI, 11%-29%] versus 9% [95% CI, 6%-12%], respectively). Likewise, there was no difference in the proportion of pooled neuraxial abnormalities in right and left curves (9% [95% CI, 6%-14%] versus 15% [95% CI, 5%-35%], respectively). In the subset of abnormalities analyzed for number of neurosurgical interventions before scoliosis correction, the pooled proportion showed that 33% (95% CI, 24%-43%) underwent neurosurgical intervention before deformity correction. The most common abnormalities of the 367 found on MRI were syringomyelia in 127 patients (35%), Arnold-Chiari Type 1 malformation with syrinx in 103 patients (28%), and isolated Arnold-Chiari Type 1 malformation in 91 patients (25%). CONCLUSIONS: The proportion of patients with AIS who have neuraxial abnormalities is high (8%) and a large number undergo surgical intervention before scoliosis reconstruction. We did not find any particular demographic variables that indicated an increased risk of abnormality. Clinicians should consider advanced imaging before surgical intervention in the treatment of a patient with an idiopathic diagnosis. Preventable variables need to be identified by future studies to establish a better working treatment protocol for these patients. LEVEL OF EVIDENCE: Level III, diagnostic study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:Publisher
[do] DOI:10.1007/s11999.0000000000000196

  10 / 3964 MEDLINE  
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[PMID]: 29191468
[Au] Autor:Mazel C; Ajavon L
[Ad] Address:Department of orthopedics and spine, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France. Electronic address: christian.mazel@imm.fr.
[Ti] Title:Malunion of post-traumatic thoracolumbar fractures.
[So] Source:Orthop Traumatol Surg Res;104(1S):S55-S62, 2018 Feb.
[Is] ISSN:1877-0568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:Thoracolumbar malunion is the result of loss of correction, insufficient correction or even no correction (both in the frontal and sagittal planes) of a thoracolumbar fracture. The main causes are incorrect assessment of the fracture's complexity (burst fracture), its potential progression to kyphosis and associated disc or ligament damage. It can also be the result of a poorly conducted initial treatment. The types of malunion have changed over the years because of the introduction of vertebroplasty and kyphoplasty. The malunion can be well tolerated if there is only a moderate deformity. However, the functional and pain-related limitations can be severe with large deformities. Functional limitation is mainly related to sagittal imbalance, but also to sequelae associated with the injury in various ways (non-union, disc degeneration, spinal cord compression, syringomyelia, etc.). The deformity and its consequences are evaluated globally using full-body standing radiographs (EOS), CT scan and MRI. Comparison of MRI images taken in a lying position to weight bearing views or even dynamic ones is an additional means to evaluate whether the lesions are reducible. Differences in spine morphology and compensatory mechanisms to combat the sagittal imbalance induced by the deformity must also be analyzed. These provide more complete information about the consequences of the malunion and help to establish the best corrective strategy. These compensatory mechanisms consist of accentuation of lumbar lordosis along with reduction of thoracic kyphosis. As a last resort, the pelvis and femur contribute to this compensation when there is a large deformity or a stiff spine due to preexisting osteoarthritis. Treatment strategies are fairly well standardized. When the deformity is reducible, a two-stage surgery is indicated. When the deformity is not reducible, posterior transpedicular closed wedge osteotomy is the gold standard. Nevertheless, the best way to treat thoracolumbar malunion is to prevent it.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1712
[Cu] Class update date: 180218
[Lr] Last revision date:180218
[St] Status:In-Data-Review


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