Anterior Spinal Fusion for Thoraco-Lumbar Idiopathic Scoliosis Comparing Less Invasive Concave versus Traditional Convex Approach: A Pilot Study.

: Anterior spinal fusion for primary thoracolumbar or lumbar (TL/L) adolescent idiopathic scoliosis, AIS, has advantages over posterior fusion, particularly in saving motion segments below the fusion construct. Traditionally, the approach is anterolaterally from the convexity. In adult degenerative scoliosis, the lateral or anterolateral approach may be performed from the traditional or from the concave approach which is less invasive and gives comparable outcomes.

Allograft-Reconstructed Iliac Bone Graft Donor Site Remodels to Viable Bone and Its Feasibility for Revision Fusion.

Background: Bone autograft options may be limited in revision spinal fusion cases. Reconstruction of the iliac bone graft (IBG) donor site with cancellous bone allograft allows for reharvest for patients who subsequently have another fusion. This study examined viability of the reconstructed IBG (RIBG) donor sites.

Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report.

Objective: The purpose of this case study is to describe chiropractic care of the cervical spine for a patient who previously underwent cervical total disk replacement (CTDR) of the C5-6 and C6-7 disks.

Clinical Features: A 42-year-old female veteran of the U.S.

Postoperative Care Pathways Following Lumbar Total Disc Replacement: Results of a Modified Delphi Approach.

Study Design: A modified Delphi method was used to establish consensus. Subject matter experts were invited to participate as the expert panel. Best practice statements were distributed to the panel.

Value of single-level circumferential fusion: a 10-year prospective outcomes and cost-effectiveness analysis comparing posterior facet versus pedicle screw fixation.

Purpose: To compare the clinical and economic outcomes of facet versus pedicle screw instrumentation for single-level circumferential lumbar spinal fusion.

Methods: Outcomes included self-assessment of back and leg pain, pain drawing, ODI, pain medication usage, and procedure success. The CEA was based on the 10-year data collected, and the base-case was from a US payer perspective.

Five-year Results of a Randomized Controlled Trial for Lumbar Artificial Discs in Single-level Degenerative Disc Disease.

Study Design: A prospective, multicenter, randomized, controlled, investigational device exemption (IDE) noninferiority trial.

Objective: The aim of this study was to compare the 5-year safety and effectiveness of the activL Artificial Disc with Control Total Disc Replacement (TDR) systems (ProDisc-L or Charité) in the treatment of patients with symptomatic single-level lumbar degenerative disc disease (DDD).

Summary Of Background Data: The activL Artificial Disc received Food and Drug Administration approval in 2015 based on 2-year follow-up data.

Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings.

Background: Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for 1-level cervical disc arthroplasty (CDA). The purpose of this analysis is to compare the safety and efficiency of 1-level and 2-level CDA performed in an ambulatory surgery center (ASC) and in a hospital setting.

Methods: The study was a retrospective collection and analysis of data from consecutive CDA patients treated in ASCs compared to a historical control group of patients treated in hospital settings who were classified as outpatient (0 or 1-night stay) or inpatient (2 or more nights).

Defining the Ideal Lumbar Total Disc Replacement Patient and Standard of Care.

: Lumbar total disc replacement, now in use since 2004, was determined by the panel to be a standard of care for the treatment of symptomatic single-level lumbar degenerative disc disease in the active patient subpopulation as outlined by the investigational device exemption study criteria. The large body of evidence supporting this statement, including surgeons' experiences, was presented and discussed. Consensus statements focusing on decision-making criteria reflected that efficacy, long-term safety, clinical outcomes with validated measures, and cost-effectiveness should form the basis of decision-making by payers.

Foreword: Proceedings From the First Annual Lumbar Total Disc Replacement Summit.

: This publication focuses on proceedings from the First Annual Lumbar Total Disc Replacement Summit, held October 25, 2016 in Boston, MA. The Summit brought together 17 thought leading surgeons who employed a modified-Delphi method to determine where consensus existed pertaining to the utilization of lumbar total disc replacement as a standard of care for a subpopulation of patients suffering from degenerative disc disease.

Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study.

Study Design: Prospective cohort study with >10-year follow-up.

Objective: To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), number of levels treated, and preexisting adjacent level degeneration.

Summary Of Background Data: ACDF is a proven treatment for patients with stenosis and disc herniation and results in significantly improved short- and intermediate-term outcomes.

Morphologic and biomechanical comparison of spinous processes and ligaments from scoliotic and kyphotic patients.

The spinous processes and supraspinous and interspinous ligaments (SSL and ISL, respectively) limit flexion and may relate to spinal curvature. Spinous process angles and mechanical properties of explanted human thoracic posterior SSL/ISL complexes were compared for scoliosis (n=14) vs. kyphosis (n=8) patients.

Lumbar Total Disc Replacement for Discogenic Low Back Pain: Two-year Outcomes of the activL Multicenter Randomized Controlled IDE Clinical Trial.

Study Design: A prospective, multicenter, randomized, controlled, investigational device exemption (IDE) noninferiority trial.

Objective: The aim of this study was to evaluate the comparative safety and effectiveness of lumbar total disc replacement (TDR) in the treatment of patients with symptomatic degenerative disc disease (DDD) who are unresponsive to nonsurgical therapy.

Summary Of Background Data: Lumbar TDR has been used to alleviate discogenic pain and dysfunction while preserving segmental range of motion and restoring stability.

Flexibility and fatigue evaluation of oblique as compared with anterior lumbar interbody cages with integrated endplate fixation.

Objective: This study was undertaken to quantify the in vitro range of motion (ROM) of oblique as compared with anterior lumbar interbody devices, pullout resistance, and subsidence in fatigue.

Methods: Anterior and oblique cages with integrated plate fixation (IPF) were tested using lumbar motion segments. Flexibility tests were conducted on the intact segments, cage, cage + IPF, and cage + IPF + pedicle screws (6 anterior, 7 oblique).

Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years.

Background: Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented.

Methods: From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis).

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study.

Purpose: To compare single-level circumferential spinal fusion using pedicle (n = 27) versus low-profile minimally invasive facet screw (n = 35) posterior instrumentation.

Method: A prospective two-arm cohort study with 5-year outcomes as follow-up was conducted. Assessment included back and leg pain, pain drawing, Oswestry disability index (ODI), pain medication usage, self-assessment of procedure success, and >1-year postoperative lumbar magnetic resonance imaging.

Two-Level Circumferential Lumbar Fusion Comparing Midline and Paraspinal Posterior Approach: 5-Year Interim Outcomes of a Randomized, Blinded, Prospective Study.

Study Design: A prospective randomized and blinded comparative study of 2 patient groups with >5-year follow-up.

Objective: To compare the clinical outcomes and postoperative posterior muscle changes in patients with advanced degenerative disk disease undergoing 2-level circumferential spinal fusion using a posterior midline versus a paraspinal approach.

Summary Of Background Data: Lumbar spinal fusion is often performed using a circumferential (anterior and posterior) technique.

Compressive properties of fibrous repair tissue compared to nucleus and annulus.

The wound healing process includes filling the void between implant and tissue edges by collagenous connective repair tissue. This fibrous repair tissue may load share or stabilize implants such as spinal disc replacements. The objective of this study was the biomechanical characterization of human fibrous tissue compared to annulus fibrosus and nucleus pulposus.

Feasibility of the runt cow for in vivo testing of a spinal interbody prosthesis with preliminary results.

Background: The optimal lumbar spinal disc prosthesis has yet to be developed. Failures of clinical device studies may be minimized by appropriate large animal preclinical studies. The lumbar spine of the mature "runt" cow, Corrientes breed, has been shown to have a number of desirable characteristics to the human.

Percutaneous vertebral body cement augmentation for back pain related to occult osteomyelitis/diskitis.

Although complications related to vertebroplasty or kyphoplasty are few, we treated 2 patients with vertebroplasty or kyphoplasty for pain, presumed to be due to vertebral compression fractures, which were subsequently found to be due to occult osteomyelitis/diskitis. The onset of their infections appeared to have preceded their vertebral body augmentation procedures and was possibly due to prior interventional procedures for histories of back pain.An 86-year-old woman had had 3 prior kyphoplasty procedures for fractures at T10, T11, and L1.

In vitro biomechanics of an expandable vertebral body replacement with self-adjusting end plates.

Background Context: Unstable burst fractures of the thoracolumbar spine may be treated surgically. Vertebral body replacements (VBRs) give anterior column support and, when used with supplemental fixation, impart rigidity to the injured segments. Although some VBRs are expandable, device congruity to the vertebral end plates is imprecise and may lead to stress risers and device subsidence.

Biomechanical characterization of an annulus-sparing spinal disc prosthesis.

Background Context: Current spine arthroplasty devices require disruption of the annulus fibrosus for implantation. Preliminary studies of a unique annulus-sparing intervertebral prosthetic disc (IPD) found that preservation of the annulus resulted in load sharing of the annulus with the prosthesis.

Purpose: Determine flexibility of the IPD versus fusion constructs in normal and degenerated human spines.

Interbody device endplate engagement effects on motion segment biomechanics.

Background Context: Stand-alone nonbiologic interbody fusion devices for the lumbar spine have been used for interbody fusion since the early 1990s. However, most devices lack the stability found in clinically successful circumferential fusion constructs. Stability results from cage geometry and device/vertebral endplate interface integrity.

In vitro disc pressure profiles below scoliosis fusion constructs.

Study Design: Biomechanical human cadaveric study comparing straight and scoliotic spines with healthy and degenerated L4/5 discs.

Objective: To describe the biomechanical environment of discs under various spinal alignments by measuring the coronal intradiscal pressure profiles.

Summary Of Background Data: Abnormal loading of the lumbar discs in the concavity of scoliotic curves may accelerate disc degeneration, which may be related to pain.