Pelvic fixation is still associated with a very high rate of mechanical failure. Major risk factors appear to be age and type of fixation. Although could not be shown to be statistically significant, failure to restore the optimal sagittal balance may be a contributing factor as well. So in conclusion, in cases with suboptimal sagittal plane correction, S2AI with polyaxial screws seem to have higher risk of short-term acute failure compared to IwL.
Scoliosis refers to curves exceeding 10 degrees observed through posterioanterior direct radiography. In fact, the diagnosis for idiopathic scoliosis is accepted to exclude already available causes. The aim of this paper was to review the etiopathogenesis, classification systems and the treatment management of idiopathic scoliosis. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' was performed. For the literature review, papers concerning the etiopathogenesis, classification and treatment were selected among these articles. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' yielded 4518 articles published between 1947 and 2013. The main hypothesis put forward included genetic factors, hormonal factors, bone and connective tissue anomalies. King, Lenke, Coonrad and Peking Union Medical College (PUMC) classifications were the main classification systems for idiopathic scoliosis. Exercise, bracing and anterior, posterior or combined surgery when indicated are the choices for the treatment. Every idiopathic scoliosis case has to be managed to its own characteristics. It is the post-operative appearance that the surgeons are perhaps the least interested but the adolescent patients the most interested in. The aim of scoliosis surgery is to restore the spine without neurological deficit.
AIM:The term kyphosis is used to describe the spinal curve that results in an abnormally rounded back. Kyphosis may develop due to trauma, developmental anomalies, degenerative disc disease, inflammatory diseases, and infectious diseases and also iatrogenic. The aim of this paper is to review the etiopathognesis and the treatment management of kyphosis. METHODS:A search in the National Library of Medicine (Pubmed) database using key word 'kyphosis' and was made. For the literature review, papers concerning etiopathogenesis, classification and treatment were selected among these papers. RESULTS:A search in the National Library of Medicine (Pubmed) database using key word 'kyphosis' yielded 7506 papers published between 1916 and 2013. The main papers about kyphosis were congenital, Scheuermann, tumour related, neuromuscular, posttraumatic, infectionrelated, iatrogenic kyphosis. CONCLUSIONS:Every patient with kyphosis should be treated based on her/his current state and needs. It should always be remembered that the patients with negative sagittal balance can compensate it with the hip flexion but it is far more difficult to compensate the positive sagittal balance. The main goal of surgery to treat the kyphotic patients is to correct the sagittal curve and also restore a spinal balance within an acceptable range above the hips and knees.
AIm: Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. mATErIAl and mEThOds: 258 cervical spondylotic myelopathy (CSM) cases were scanned by conventional magnetic resonance imaging (MRI) and additionally dynamic MRI. Contributions of dynamic cervical MRI to the surgical plans and results were evaluated. rEsulTs:We had sagittal and axial T2W MR scans at flexion and extension, in addition to the neutral cervical MR imaging. We found that the AP diameter of spinal canal is increased 14.9 % in flexion and decreased 13.4 % in extension relative to the neutral MR imaging. CONClusION:The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.KEywOrds: Cervical, Cervical spondylotic myelopthy, Dynamic, MRI ÖZ AmAÇ: Servikal vertebra omurganın en hareketli bölümüdür. Radyolojik incelemeler omurga yapısı hakkında bilgi verse de fonksiyonel olarak herhangi bir veri sağlamamaktadır. Fleksiyon duruşunda omurilik gerilir ve ön tarafta yer alan osteofitik değişikliklerin basısı artmaktadır. Ekstansiyon duruşunda ise spinal kanal daralmakta, omurilik kısalmakta ve genişlemekte ve arka tarafta yer alan posterior ligamentlerin basısı artmaktadır. yÖNTEm ve GErEÇlEr: 258 servikal spondilopatik miyelopati hastası klasik MR görüntülerine ek olarak dinamik MR görüntüleri ile incelendi. Dinamik servikal MR görüntülemeleri ile cerrahi planlama ve sonuçları incelendi. BulGulAr:Hastaların fleksiyon ve ekstansiyon duruşunda T2 ağırlıklı sagital ve aksiyel kesitlerine ek olarak nötr duruşta servikal MR görüntüleri elde edildi. Hastaların ön-arka spinal kanal çapı nötral duruşla karşılaştırıldığında fleksiyon duruşunda %14,9 artarken, ekstansiyon duruşunda %13.4 azalmaktadır. sONuÇ: Spinal hastalıklarda spinal kord basısındaki değişiklikler ve spinal kanalın transvers alanındaki değişiklikler prognostik önem taşımaktadır. Spinal kord ve subaraknoid alan ölçümleri dinamik MRG ile elde edilen aksiyel kesitlerden elde edilebilir. Dinamik manyetik rezonans görüntülemeleri servikal spondilopatik miyelopatinin cerrahi kararını vermede yardımcı olmaktadır.
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