TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 77

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 77. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 754 Section Spinal Deformities and Malformations Operation times are longer and complication rates are higher Table 7 than with the other two approaches. Kwon and Albert 44 point out that solid fusion does not always correlate with clinical success in other degenerative disorders of the spine. While comparative objective radiographic measurements of the spine after PLIF vs. PLF for lytic spondylolisthesis in adults show better results for PLIF clinical outcomes were not reported to be markedly different 47 55 105 . It is therefore valid to at least critically question whether the benefits engendered by performing a combined approach stand in correlation to the longer technically more demanding and from a hardware standpoint usually more expensive procedure with a higher risk for complications. Fusion to L4 Reduction is facilitated by instrumenting to L4 In adults the L4 5 disc is often degenerated and requires inclusion in the fusion In children with severe developmental spondylolisthesis at L5 S1 Meyerding Grades III-V reduction can be extremely tedious and may be facilitated by instrumentation to L4 Case Study 2 Fig. 7 . This technique allows to distract between L4 and S1 which facilitates the reduction. In selected cases the L4 screws can be removed at the end of the operation or alternatively 12 weeks later which leaves the motion segment L4 5 intact 87 . However the lateral process of L5 is often dysplastic in children and does not allow for a reliable fusion. Therefore a fusion to L4 is recommended. This is particularly valid if no interbody fusion is added. In adults with marked slips of L5 S1 the adjacent L4 5 segment frequently exhibits significant degenerative changes. In these cases a fusion of L4 to S1 is indicated because the L4 5 segment often rapidly decompensates after the L5 S1 fusion. Vertebrectomy for a high-grade slip is prone to complications Vertebrectomy To achieve good spine realignment surgical treatment of spondyloptosis which almost only

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