[Bilateral L3 spondylolysis. A case report and an overview of spondylolytic defect repair techniques].

The direct fusion methods for repair of spondylolytic defects of the lumbar spine have recently been replaced by transpedicular screw fixation of the affected segment, in combination with PLIF, TLIF or ALIF procedures. However, in clearly indicated cases, such as a younger patient with no intervertebral disc degeneration and only minimal or no displacement of the vertebra, the direct repair techniques have a great advantage over transpedicular fixation because they preserve segmental motion The paper reports on a patient with spondylolysis at L3 who underwent surgery combining the Tokuhashi and Matsuzaki and the Gillet and Petit techniques, which involved a system of transpedicular screws, rods and sublaminar hooks supplemented with a cross-connector to support the base of the spinous process. After surgery, the patient reported pain relief and return to normal activities and CT examination showed bony union of both spondylolytic defects.

Prevention of vertebral body-splitting fractures after multilevel ProDisc-L implantation.

Background: Prior studies of multilevel ProDisc-L (PD-L) implants (Synthes Spine, Inc., West Chester, Pennsylvania) using the standard US technique have used conventional radiography postoperatively. We found vertebral body-splitting fractures (VB-SFs) in interposed vertebral bodies after 5 sequential multilevel PD-L device implantations using the standard US technique.

ProDisc-C: an in vivo kinematic study.

Study Design: A prospective study of 22 patients with single-level cervical spondylosis.

Objective: To quantify the changes in the biomechanics of the cervical spine after the insertion of a ProDisc-C (Synthes Spine, Paoli, PA) artificial disc.

Summary Of Background Data: Cervical arthroplasty is designed to maintain cervical motion of the functional spinal unit (FSU) after cervical discectomy.

Augmentation improves human cadaveric vertebral body compression mechanics for lumbar total disc replacement.

Study Design: Cadaveric biomechanical study.

Objective: To quantify the effects of vertebral body augmentation on biomechanics under axial compression by a total disc replacement (TDR) implant.

Summary Of Background Data: TDR is a surgical alternative to lumbar spinal fusion to treat degenerative disc disease.

Sagittal balance influences range of motion: an in vivo study with the ProDisc-C.

Background Context: Cervical arthroplasty is designed to maintain cervical motion of the functional spinal unit after cervical discectomy. The impact of the ProDisc-C (Synthes Spine, Paoli, PA) on in vivo kinematics and sagittal alignment requires further assessment.

Purpose: The purpose of this study is to test the hypothesis that the ProDisc-C increases range of motion (ROM) in flexion and extension at the surgical level, and assess its impact on cervical alignment.

Does Vertebral Endplate Morphology Influence Outcomes in Lumbar Total Disc Arthroplasty? Part II: Clinical and Radiographic Results as Evaluated Utilizing the Vertebral Endplate Yue-Bertagnoli (VEYBR) Classification.

Study Design: This study was a prospective study with a minimum patient follow-up of 2 years. Objective The purpose of this study was to evaluate the clinical usefulness of a vertebral endplate classification system (VEYBR) in predicting outcomes following lumbar arthroplasty.

Background: In the present study, our previously described endplate classification system was evaluated to determine its clinical usefulness in patients undergoing lumbar arthroplasty.

Does vertebral endplate morphology influence outcomes in lumbar disc arthroplasty? Part I: an initial assessment of a novel classification system of lumbar endplate morphology.

Background: The influence of lumbar endplate morphology on the clinical and radiographic outcomes of lumbar disc arthroplasty has not been evaluated to the best of our knowledge.

Study Design And Objective: In this observational study of 80 patients, the objective was to formulate a reproducible and valid lumbar endplate classification system to be used in evaluating lumbar total disc replacement patients.

Methods: A novel vertebral endplate morphology classification system was formulated after review of data related to 80 patients enrolled in a prospective, randomized clinical trial in conjunction with an application for a US Food and Drug Administration investigational device exemption.

Disc arthroplasty design influences intervertebral kinematics and facet forces.

Background Context: Total disc replacement is a novel approach for dynamically stabilizing a painful intervertebral segment. While this approach is gaining popularity, and several types of implants are used, the effect of disc arthroplasty on lumbar biomechanics has not been widely reported. Consequently, beneficial or adverse effects of this procedure may not be fully realized, and data for kinematic optimization are unavailable.

Lumbar total disc arthroplasty utilizing the ProDisc prosthesis in smokers versus nonsmokers: a prospective study with 2-year minimum follow-up.

Study Design: Prospective nonrandomized clinical series.

Objectives: To evaluate the efficacy of ProDisc lumbar artificial disc replacement (ADR) in smokers versus nonsmokers.

Summary Of Background Data: Smoking is a negative predictor in fusion surgery.

Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up.

Object: The authors conducted a prospective longitudinal study to assess the efficacy of ProDisc arthroplasty in patients in whom symptomatic adjacent-segment degeneration has developed after remote lumbar fusion. The follow-up period was a minimum of 2 years.

Methods: The 20 patients in this study ranged in age from 18 to 67 years.

Lumbar total disc arthroplasty in patients older than 60 years of age: a prospective study of the ProDisc prosthesis with 2-year minimum follow-up period.

Object: The authors conducted a prospective longitudinal study to obtain outcome (minimum follow-up period 2 years) regarding the safety and efficacy of single-level lumbar disc (ProDisc prosthesis) replacement in patients 60 years of age or older.

Methods: This prospective analysis involved 22 patients treated in whom the lumbar ProDisc prosthesis was used for total disc arthroplasty. All patients presented with disabling discogenic low-back pain (LBP) with or without radicular pain.

Mechanical testing of a novel hydrogel nucleus replacement implant.

Background Context: Both total disc and nucleus replacement arthroplastic approaches are emerging as viable treatment modalities for discogenic pain resulting from degenerative disc disease. The results of the testing in this investigation show that this novel nucleus replacement implant exhibits physical and mechanical properties which make it uniquely suitable as a replacement to the degenerated nucleus pulposus.

Purpose: The purpose of this investigation was to evaluate key performance characteristics of a novel nucleus replacement device.

The treatment of disabling single-level lumbar discogenic low back pain with total disc arthroplasty utilizing the Prodisc prosthesis: a prospective study with 2-year minimum follow-up.

Study Design: Prospective, longitudinal minimum 2-year follow-up.

Objective: To assess the efficacy and safety of the Prodisc implant in patients with disabling single-level discogenic low back pain (LBP).

Summary Of Background Data: The treatment of debilitating discogenic LBP has been controversial and varied.

The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis: a prospective study with 2-year minimum follow-up.

Study Design: Prospective, longitudinal minimum 2-year follow-up.

Objective: To assess the efficacy and safety of the Prodisc implant in patients with disabling multilevel discogenic low back pain (LBP).

Summary Of Background Data: Few, if any, alternatives have been proposed to treat recalcitrant and debilitating multilevel lumbar discogenic low back pain.

Complications and strategies for revision surgery in total disc replacement.

Spinal arthroplasty is an acceptable alternative to fusion in many cases of disabling degenerative disc disease. Although arthroplasty has been demonstrated to be a safe and efficacious surgical option, complications related to the approach or the device may occur in few cases. Revision strategies for failed total disc arthroplasty can be planned as a posterior fusion, leaving the total disc replacement device in place, or by way of anterior removal with subsequent anterior fusion or revision replacement of the prosthesis.

Hybrid constructs.

Hybrid constructs can combine motion-preserving technologies with each other or motion-preserving technologies with fusion techniques. Hybrid constructs can be implanted in single-stage or multistage surgeries. Early results are promising.

Cervical total disc replacement, part two: clinical results.

This article focuses on the clinical results of three prostheses (the Bryan Cervical Disc, the Bristol Disc, and the ProDisc-C) for cervical total disc replacement. Background on the development, design, and biomechanical characteristics of each prosthesis is given and surgical indications and clinical results are summarized and analyzed.

Lumbar partial disc replacement.

On the basis of the anatomy of the disc, the nucleus as pain generator and the resulting treatment possibility using nucleus replacement technologies are reviewed. Various devices are presented, from the first historical steps to treatment possibilities in the future. Clinical experiences of the widely-used PDN prosthetic device are analyzed.

Standard and minimally invasive approaches to the spine.

With the advent of minimally invasive surgical approaches to the spine, the ability to adequately expose the desired anatomic structures while minimizing the disadvantages of excessive soft tissue stripping, dissection, and prolonged retraction has become increasingly popular. A minimally invasive one- or two-level posterior exposure of the spine is now safely attainable with the latest minimal-access systems that exploit the biomechanics of an adjustable blade retractor. As the clinical use of these developing systems escalates, more outcomes data will become available to determine the safety and value of these minimally invasive procedures.

Clinical results of an open prospective study of a bis-GMA composite in percutaneous vertebral augmentation.

In this open prospective trial, 53 patients with acute pain from osteoporotic vertebral fracture related to osteoporosis or malignancy underwent vertebral augmentation with a new bisphenol-a-glycidyl dimethacrylate (bis-GMA) resin (Cortoss, Orthovita, Malvern, Pa, USA). Treatment consisted of up to 8 ml of Cortoss injected into a given vertebra. The procedure encompassed single and multiple injections (including the contralateral hemivertebra, to a maximum of 3 vertebral levels).

Early results after ProDisc-C cervical disc replacement.

Object: Cervical anterior decompression and total-disc replacement is currently being investigated as an alternative treatment in patients with symptomatic intervertebral cervical spondylosis with and without radiculopathy. The authors prospectively investigated the safety and efficacy of using the ProDisc-C disc for cervical arthroplasty in the treatment of symptomatic cervical spondylosis.

Methods: Sixteen patients in whom a diagnosis of symptomatic cervical spondylosis had been established were prospectively treated with complete anterior cervical discectomy and ProDisc-C cervical disc arthroplasty.

Artificial intervertebral discs and beyond: a North American Spine Society Annual Meeting symposium.

Background Content: This is a synopsis of a symposium presented to the North American Spine Society Annual Meeting in Seattle, WA, 2001.

Purpose: To bring to the reader who may not have attended the symposium a distillation of the material presented on this frontier of spinal surgery.

Methods: Panel presentation.

The Anterolateral TransPsoatic Approach (ALPA): a new technique for implanting prosthetic disc-nucleus devices.

Prosthetic disc-nucleus devices have traditionally been implanted via the same posterior approach that is standard for lumbar decompression surgery. To avoid disrupting the posterior structures of the spine and to facilitate device implantation, the AnteroLateral transPsoatic Approach (ALPA) has been developed. With ALPA, an incision is made in the lateral region overlying the disc, and the lateroabdominal muscles are bluntly dissected.

Circumferential fusion of the lumbar and lumbosacral spine using a carbon fiber ALIF cage implant versus autogenous bone graft: a comparative study.

This study reports on 92 patients treated with circumferential lumbar fusions for degenerative conditions. The elected procedure was a circumferential fusion using transpedicular stabilization. Two groups were examined depending on whether they were stabilized anteriorly with autogenous bicortical iliac crest graft (n = 38) or with an ALIF carbon fiber cage implant (n = 54).