We evaluated the efficacy of Escherichia
coli-derived recombinant human bone morphogenetic protein-2
(E-BMP-2) in a mini-pig model of spinal
1. At the present stage of our experience, when 150 patients have been analysed over a period of five years, the conclusion has been reached that
Introduction. Recently published results suggest insertion of shorter screws in L5/S1 stand-alone
Introduction. Iatrogenic spondylolisthesis occurs infrequently after posterior decompression. Posterior surgery is challenging due to altered anatomy and scarring. Anterior lumbar interbody fusion (ALIF) allows indirect decompression, restoration of lordosis and fusion. Material and Methods. Retrospective review of 6 patients (5 female, 1 male, mean age 64±5.8 years) with iatrogenic spondylolisthesis (5 L4/L5; 1 L4/L5) treated with stand-alone ALIF (Synfix, BMP2). Assessment of pelvic incidence, listhesis, pre- and post-operative ODI, VAS, global lumbar lordosis and segmental lordosis as outcome measurements. Results. The slippage was grade II at L4/L5 in 3 patients and grade I in 2 patients at L4/L5 and 1 patient at L5/S1. Average ODI dropped from 49±11% pre-operatively to 30±9% at 6 and to 25±6% at 12 months follow-up. VAS average dropped from 7±1 to 3±1 at 6 and 12 months follow-up. Average pelvic incidence was 54.6±8.0°. Global lordosis of 44.6±5.2° increased to 49.0±8.6°; Segmental lordosis in L4/5 was increased from 12.1±8.2° to 22.4±3.7° at 6 and 20.5±7.9° at 12 months. Cage migration due to severe osteoporosis occurred in 1 case after 5 months. Conclusion.
Introduction: The initial promise of stand-alone threaded
INTRODUCTION: The initial promise of stand-alone threaded
From April 2001 to January 2003, 60 patients were selected for a circumferential fusion with an ALIF Brantigan cage and posterior titanium instrumentation. The aim of this study was to analyse the complications and the effects of circumferential fusion on functional outcome and lumbar lordosis. Circumferential fusion restored lordosis, provided a higher fusion rate, and showed a tendency towards better functional outcome and reduced back and leg pain.
Aim: To determine the incidence of adjacent level osteophytes in patients who have had anterior cervical fusion using an anterior cervical plate as compared to those who are fused without an anterior cervical plate. Design: We retrospectively reviewed the lateral radiograms of sixty two patients who have had an anterior cervical fusion with a minimum follow up of twelve months. Materials and methods: We looked for the development of adjacent level osteophytes in these patients at their final follow up, which was generally at the time radiological fusion. There were 27 patients in the first group who had an anterior cervical plate used to fix the vertebrae in addition to the Cervios cage, while the 35 patients in the second group in whom only a Rabea cage was used for the fusion. The mean follow-up was 20.6 months (range 12–48). Results: 64.3% of the patients who had an anterior cervical plate developed adjacent level osteophytes while none of the patients who have had the fusion without the cage developed the osteophytes. Conclusion: We found the patients who had an
Anterior decompression and adequate spine fixation in patients with cervical radiculopathy and myelopathy are essential for functional restoration of cervical spine. In this study, we performed evaluation and comparative radiological assessment of several types of spinal implants in terms of bone block formation, sagittal alignment and effectiveness as a structural support.
Group1. Autograft – 91 patients Group 2. TiNi alloy cages – 74 patients. Group 3. Varilift expandable cages without plate fixation – 22 patients Group 4. Verilift cages with plate fixation – 8 patients Group 5. Bone substitute spacer and plate fixation – 3 patients.
Spines are often stabilised posteriorly by internal fixation and anteriorly by a bone graft. The effect of an autologous bone graft from the iliac crest on implant loads is unknown. We used an internal spinal fixation device with telemetry to measure implant loads for several body positions and activities in nine patients before and after
Purpose: To investigate the potential value of titanium anterior interbody cages compared to morselized rib graft for
Persistent back pain in the presence of an intact posterior fusion is commonly seen and is often regarded as being psychogenic in origin. This paper discusses five patients, all of whom were chronically disabled by such pain; all five had a confirmed posterior and/or lateral fusion. In each case lateral discography identified the disc within the fused segment as the source of symptoms and pain relief was obtained with an
A series of 123 patients suffering traumatic spondylolisthesis of the axis is reported. This lesion is associated with extension and axial loading injury, and there is a high incidence of injuries of the face or scalp and of associated fractures of the upper cervical spine. There is a low incidence of neurological injury, which seems paradoxical in the presence of what appears to be gross instability, but protection from extremes of flexion and extension may be adequate treatment. Union is usual regardless of displacement. Traction is a safe means of treatment, but early waking in a halo support reduces time in hospital without jeopardizing the result. Operation is needed only for chronic instability with or without pain, and
We present a study of 30 fusion operations in 26 rheumatoid arthritics with cervical spine instability. Atlanto-axial instability was present in 15, of whom 12 were fused; three had cord involvement and all made a partial or complete recovery following fusion. Cranial settling necessitated cranio-cervical fusion in four patients; all fused, and one with myelopathy was relieved. Subaxial instability required fusion in seven cases; two postoperative deaths followed the only two
Operative treatment was performed in nine patients with cervical spondylotic myelopathy complicating athetoid cerebral palsy. The first two patients were treated by laminectomy, and the other seven by
1. Anterior transperitoneal lumbar fusion is a successful method of stabilising painful mechanical derangements which have not responded to the usual conservative measures. 2. The operation in this series was done mainly for backache; it should not be contemplated if there is definite evidence of nerve root compression, because sequestrated disc material cannot be removed from the spinal canal from the anterior route. 3. Careful technique has resulted in few complications attributable to the operation. 4. This method is sometimes thought to be inapplicable in cases of spondylolisthesis with a displacement of more than one-third. However, in this series we have seen the block type of graft used with a good measure of clinical and radiological success. 5. There is no doubt that for those patients who have had previous unsuccessful laminectomies or posterior
It has been thought that lumbar intervertebral discs were innervated segmentally. We have previously shown that the L5-L6 intervertebral disc in the rat is innervated bilaterally from the L1 and L2 dorsal root ganglia through the paravertebral sympathetic trunks, but the pathways between the disc and the paravertebral sympathetic trunks were unknown. We have now studied the spines of 17 rats to elucidate the exact pathways. We examined serial sections of the lumbar spine using immunohistochemistry for calcitonin gene-related peptide, a sensory nerve marker. We showed that these nerve fibres from the intervertebral disc ran through the sinuvertebral nerve into the rami communicantes, not into the corresponding segmental spinal nerve. In the rat, sensory information from the lumbar intervertebral discs is conducted through rami communicantes. If this innervation pattern applies to man, simple decompression of the corresponding nerve root will not relieve discogenic pain.
Between 1978 and 1988 a total of 27 operations were performed on 26 patients for cervical myelopathy due to rheumatoid disease in the subaxial spine. Three different causes were recognised: the first group had cord compression due to subluxation of the cervical spine itself (6 patients); the second had cord compression occurring from in front, with rheumatoid lesions of vertebral bodies or discs (6); the third had compression from behind the cord due to granulation tissue within the epidural space (14). Group I was treated by closed reduction of the subluxation followed by surgical fusion either from in front or behind. Group II was decompressed by subtotal resection of the involved vertebral bodies and discs, followed by interbody fusion. The patients in group III were decompressed by laminectomy and excision of fibrous granulation tissue from the epidural space. Good recovery of neurological function was observed after 18 of the operations, fair recovery after five, poor recovery followed three, and one was worse. Myelopathy recurred in four patients, all of whom had had
Aims: Presentation and evaluation of clinical outcomes of patients with cervical degenerative disc disease treated by Smith – Robinson method with interbody fusion by Cornerstone Carbon Cage (CCS) in own clinical experience. Methods: We operated 37 patients by anterior cervical discectomy with interbody stabilisation by CCS in the last 11 months. 31 patients were operated for the first time. In 6 cases, patients were reoperated after surgical treatment in other hospitals. The Smith – Robinson cervical discectomy with
Introduction and Aims: Trans-laminar screw fixation is a popular method of posterior stabilisation when performing a 360-degree lumbar fusion, but many have concerns over the biomechanical stability of this construct. The objective of this paper is to compare the fusion rate and clinical outcome of this method with pedicle screw fixation. Method: During 2001, 31 patients underwent combined anterior and posterior fusion by the two senior surgeons for the treatment of discogenic low back pain.