Recombinant human bone morphogenetic protein-2 in spine surgery: recommendations for use and alternative bone substitutes-a narrative review.

Background And Objective: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been extensively studied in preclinical, animal, and human studies and has been used widely in spine fusion surgery. Evidence demonstrates that fusion rates with rhBMP-2 are similar to or higher than those achieved with autologous bone graft. However, there have been concerns regarding the cost, optimal dosage, and potential complications of rhBMP-2 use in spine surgery.

Long-term outcomes following lumbar total disc replacement with M6-L.

Background: The motion preserving benefits of lumbar total disc replacement (LTDR) are well established. There is a paucity of long-term follow-up data on the M6-L prosthesis. The aim was to evaluate the clinical and radiographic outcomes of patients undergoing LTDR with M6-L and make comment about its effectiveness and durability.

Can Central Sensitization After Injury Persist as an Autonomous Pain Generator? A Comprehensive Search for Evidence.

Objective: To conduct a comprehensive search for evidence with regard to whether central sensitization after an injury can act as a persistent autonomous pain generator after the inducing injury has healed.

Methods: We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full-text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence.

Bone Morphogenetic Proteins in Spinal Surgery: What Is the Fusion Rate and Do They Cause Cancer?

Study Design: A retrospective cohort study.

Objective: The aim of this study was to determine the fusion rate using recombinant human bone morphogenetic protein (rhBMP) in spinal surgery and to estimate the risk of cancer subsequent to their use.

Summary Of Background Data: rhBMP may obviate the need for iliac crest bone graft harvest and provides similar or higher fusion rates than autologous bone graft.

Co-registration of isotope bone scan with CT scan and MRI in the investigation of spinal pathology.

Image fusion software enables technetium(99m)-methylene diphosphonate (Tc(99m)-MDP) bone scan images to be co-registered with CT scan or MRI, allowing greater anatomical discrimination. We examined the role of bone scan images co-registered with CT scan or MRI in the investigation of patients presenting with axial spinal pain and/or limb pain. One hundred and thirty-nine consecutive patients were examined, and thereafter investigated with CT scan, MRI, and/or dynamic plain films.

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up.

Lumbar plexus schwannoma causing recurrent syncope.

Retroperitoneal schwannomas are rare and present non-specifically. They usually manifest secondary to their compressive effects on adjacent structures. We describe a patient who presented with recurrent syncope resulting from a large retroperitoneal schwannoma stretching the inferior vena cava and compromising venous return.

Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis: analysis of outcome with long-term follow-up and interview by independent physician.

Study Design: A retrospective study of 73 consecutive patients who underwent cervical corpectomy and anterior strut fixation over 3 or more disc levels between July 1989 and May 1999.

Objective: To compare the efficacy of cervical spine fixation by autologous strut graft from iliac crest or fibula versus a titanium prosthesis without bone graft.

Summary Of Background Data: Strut grafting after multilevel anterior cervical corpectomy remains a challenging procedure, with published dislocation rates from 0% to 71%, and nonunion from 0% to 54%.

The major trauma management study: an analysis of the efficacy of current trauma care.

Background: An audit of the management and outcome of major trauma patients was carried out to determine ways in which the system of care may be improved.

Methods: The Major Trauma Management Study (MTMS) collected data prospectively on all consecutively admitted major trauma patients at eight major hospitals during a 12-month period. Outcome was studied using trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) analyses, as well as a preventable outcome analysis, which looked at survivors with complications or with a Glasgow Coma Score < 15 on discharge from hospital, as well as studying deaths.

Perfusion patterns during temporal lobe seizures: relationship to surgical outcome.

We sought to determine whether patterns of ictal hyperfusion demonstrated using [99mTC]HMPAO (hexamethylpropylene amine oxime) single photon emission computed tomography (SPECT) predict outcome of temporal lobectomy; in particular, whether the more extensive patterns of ictal hyperperfusion are associated with poor outcome. We studied 63 patients who had ictal SPECT studies prior to temporal lobectomy. Hyperperfusion on ictal SPECT scans was lateralized, and classified into: (i) 'typical', (ii) 'typical with posterior extension', (iii) 'bilateral' and (iv) 'atypical' patterns.

Temporal lobectomy for epilepsy - complicationsin 200 patients.

At the Austin Hospital, Melbourne, Australia, 200 consecutive temporal lobectomies were performed for refractorycomplex partial seizures between 1969 and 1991 as part of its Comprehensive Epilepsy Program. The complications of this retrospective series are reported. There were no 30-day postoperative deaths but there were 6 late deaths.

Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis.

We used actuarial methods to study outcome after temporal lobectomy in 135 consecutive patients classified into subgroups according to preoperative MRI findings. Sixty months after surgery, 69% of patients with foreign tissue lesions, 50% with hippocampal sclerosis, and 21% with normal MRIs had no postoperative seizures. An eventual seizure-free state of 2 years or more, whether the patient was seizure-free since surgery or not, was achieved by 80% of patients with foreign tissue lesions, 62% of those with hippocampal sclerosis, and 36% of those with normal MRIs.

Concurrent adjacent meningioma and astrocytoma: a report of three cases and review of the literature.

Three patients presenting with an adjacent meningioma and astrocytoma are described. A review of the literature discusses several modes of neuroimaging and the difficulties in diagnosing simultaneous adjacent tumors. Aspects of the pathology and etiology of these tumors are also reviewed.

The effectiveness of bicyclist helmets: a study of 1710 casualties.

During the 1980s, a sustained campaign increased the rates of helmet use of Victorian bicyclists. The efficacy of helmet use was evaluated by comparison of crashes and injuries (AIS-1985) in 366 helmeted (261 Australian Standard approved and 105 non-approved) and 1344 unhelmeted casualties treated from 1987 through 1989 at Melbourne and Geelong hospitals or dying before hospitalization. Head injury (HI) occurred in 21.

Craniotomy and thoracotomy for non-small cell carcinoma of the lung with cerebral metastasis.

Twenty patients with non-small cell carcinoma of the lung who had cerebral metastasis, were treated by craniotomy and thoracotomy. Eighteen of these patients had a solitary metastasis and all were treated as curable. Ten patients presented with synchronous lung and brain disease.

Systemic hypovolemia after subarachnoid hemorrhage.

Two patients who had suffered subrachnoid hemorrhage were subjected to intensive monitoring of parameters of circulating blood flow, cardiovascular dynamics, and fluid and electrolyte balance. Among the parameters studied were red cell volume, plasma volume, and total blood volume, cardiac output, and central venous and pulmonary capillary wedge pressures. Both patients experienced acute neurological deterioration during the study.

Intraventricular infusion of Dopamine in Parkinson's disease.

A patient with severe end-stage Parkinson's disease and troublesome fluctuations in motor function was treated with a long-term intraventricular infusion of dopamine. There was modest improvement in speech and mentation and there was smoother control of motor symptoms that was superior to that achieved by conventional oral medications.

The radionuclide assessment of a system for slow intrathecal infusion of drugs.

The authors describe a new radionuclide method for assessing the functional integrity of slow intrathecal infusion devices. Approximately 11 mCi (400 MBq) of Tc-99m DTPA is injected into the pump chamber. Early and delayed imaging of the pump, tubing, and spinal cerebrospinal fluid space is performed on a digital large-field-of-view gamma camera.

Timing of surgery for cerebral aneurysms: a plea for early referral.

Two groups of patients with aneurysmal subarachnoid haemorrhages--111 patients who underwent surgery within three days of haemorrhage, and 203 patients who underwent operations four or more days after the haemorrhage--were compared. No significant differences were found in outcome between the two groups. This indicates that early operation, which has the advantage of minimizing the risk of recurrent haemorrhage, is safe.

Long term intrathecal administration of morphine: a comparison of bolus injection via reservoir with continuous infusion by implanted pump.

Twenty-six cases of chronic intrathecal morphine administration are described: 19 cases utilizing the Spinalgesic injectable subcutaneous reservoir and 7 cases utilizing the Infusaid implanted infusion pump. In 25 cases, the morphine was delivered into the spinal subarachnoid space, and in 1 case of thalamic pain it was delivered into the temporal horn of the ipsilateral cerebral ventricle. The average duration of usage of the system was 132 days.

Achievement levels and mental health in medical students: a Monash University study.

An extensive battery of multi-choice psychology tests was administered to Monash Unversity medical students in 1975. Respondents were classified by sex, year and achievement level. Significant differences in parameters of psychological adaptation were detected when students in the three different achievement groups were compared.