While early analysis (four years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically.
Although patient outcomes are similar, anterior fusion and instrumentation for thoracolumbar burst fractures may present fewer complications or additional surgeries.
Lumbar decompression surgery results in a 58% incidence of asymptomatic compressive postoperative epidural hematoma. Adjacent level compression by hematoma occurs in 28% of patients. Advanced age, multilevel procedures, and international normalized ratio are independently associated with postoperative hematoma volume.
Sagittal spinal and global balance was strongly related to the ODI in adults with scoliosis. The observed correlation coefficients were higher than those reported in the only previous study suggesting the detrimental association of positive sagittal balance on ODI in adult spinal deformity. Coronal spinal and global balance did not influence the ODI in the current study cohort. Thisstudy underlines the relevance of C7 plumbline and gravity line in the evaluation of spinal and global balance, and lends further support to the philosophy of achieving adequate sagittal balance in the management of adult spinal deformity, especially in patients older than 50 years old with degenerative scoliosis.
Reduced lumbar lordosis and increased lumbosacral scoliosis can affect the general health status of older patients with de novo degenerative scoliosis. Lateral olisthesis, mainly, and anteroposterior olisthesis are important elements of rotatory subluxation in the lumbar curves, which are important radiographic parameters, predicting symptomatology and health status of patients with de novo degenerative scoliosis.
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