Anatomical relationship between the accessory process of the lumbar spine and the pedicle screw entry point.

Introduction: The vertebra accessory process (or tubercle) of the lumbar spine is an understated landmark which lies caudal to the mammillary process at the base of the transverse process. To our knowledge, no studies compare its relation to pedicle entry point for screw placement. We proposed to evaluate whether a valid and reliable relationship exists between the accessory process and the projected pedicle axis.

Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months.

Background: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months.

Methods: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed.

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation.

Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication.

Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.

Background Context: Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population.

Purpose: To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes.

Industry and evidence-based medicine: Believable or conflicted? A systematic review of the surgical literature.

Background: Over the last few decades medical research and development has come to depend more heavily on the financial support of industry. However, there is concern that financial relations between the medical community and medical industry could unduly influence medical research and therefore patient care. Our objective was to determine whether conflict of interest owing to authors'/investigators' financial affiliation with industry associated with their academic research has been identified in the surgical literature.

Comparative assessment of sacral screw loosening augmented with PMMA versus a calcium triglyceride bone cement.

Study Design: A calcium triglyceride bone cement (CTBC) was compared with the gold-standard polymethylmethacrylate (PMMA) to assess the stability of augmented sacral screw fixation under cyclic loading.

Objective: To determine whether CTBC augmentation of a pedicle screw would provide a similar level of fixation in the S1 pedicles compared with PMMA augmentation.

Summary Of Background Data: Numerous studies have shown the advantages of using PMMA to augment screw fixation; however, its biomechanical properties are not ideal.

Comparing the fixation of a novel hollow screw versus a conventional solid screw in human sacra under cyclic loading.

Study Design: The loosening rates of two monocortical pedicle screw designs (hollow and solid) were compared in a cadaveric sacrum model subjected to cyclic loading.

Objective: To determine if a hollow screw would be more resistant to loosening than a solid pedicle screw when placed into the pedicles of S1 and tested under stair-cased cyclic loading.

Summary Of Background Data: Screw loosening is a clinical problem for lumbosacral fusions.