The History of Spinal Deformity.

The description and history of the treatment of spinal disorders have evolved from very early Grecian and Hindu times through to today's complex techniques. An emphasis on renowned figures from throughout the world who have contributed greatly to our understanding and care of spinal deformities is provided. Knowledge of the past provides significant input to our understanding of the current problems and enhances the development of future modalities of care.

Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis.

Object: In this study, the authors compared outcomes and complications in patients with and without rheumatoid arthritis (RA) who underwent surgery for spinal deformity.

Methods: The authors searched the Johns Hopkins University database for patients with RA (Group RA) and without RA (Group NoRA) who underwent long spinal fusion for scoliosis by 3 surgeons at 1 institution from 2000 through 2012. Groups RA and NoRA each had 14 patients who were well matched with regard to sex (13 women/1 man and 12 women/2 men, respectively), age (mean 66.

Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery.

Study Design: : Randomized, placebo-controlled trial.

Objective: : To evaluate the efficacy of epsilon aminocaproic acid (EACA) to reduce the number of red-cell (RBC) transfusions in adult patients undergoing major spinal surgery.

Summary Of Background Data: : Reconstructive spinal surgery is associated with significant blood loss.

Short-term mortality and its association with independent risk factors in adult spinal deformity surgery.

Study Design: Retrospective review.

Objectives: To determine postoperative mortality after adult spinal deformity surgery. To determine whether independent risk factors can predict mortality.

Pulmonary embolism after adult spinal deformity surgery.

Study Design: Retrospective review.

Objective: To determine the incidence and identify the associated risk factors of pulmonary embolism (PE) in patients who receive pharmacologic thromboprophylaxis after adult spinal deformity surgery.

Summary Of Background Data: The risk of PE after adult spinal deformity surgery is reported to be as high as 2.

Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults: a radiographic analysis.

Study Design: Retrospective study.

Objective: To compare the radiographic lumbar curve correction between a posterior only and combined anterior-posterior approach in patients with adult spinal deformity.

Summary Of Background Data: In adolescent idiopathic scoliosis correction, posterior only has been compared with the combined anterior-posterior approach; however, there have been no corollary studies in adult scoliosis.

Physician-owned companies.

Study Design: The author relates his experience in the development of a spinal implant development company (K2M) that is significantly advised by physicians.

Objectives: To provide information about the development of a spinal implant company (K2M) advised by a group of professional spinal surgeons. To relate the federal laws (STARK and anti-kickback) as they pertain to surgeon-influenced companies.

Small intestinal submucosa as a potential bioscaffold for intervertebral disc regeneration.

Study Design: To evaluate the capacity of porcine small intestine submucosa to support the in vitro proliferation of human disc cells and the synthesis of extracellular matrix that could restore the biochemical properties of the disc.

Objective: To evaluate if porcine small intestine submucosa is a potential bioactive scaffold for rescuing degenerative disc cells.

Summary Of Background Data: Discogenic back pain is associated with alterations of the disc and abnormal turnover of the disc extracellular matrix.

In vivo evaluation of plasmid DNA encoding OP-1 protein for spine fusion.

Study Design: A posterolateral lumbar interbody arthrodesis animal model was selected to evaluate the percutaneous delivery of OP-1 plasmid DNA. OBJECTIVE.: To evaluate the feasibility of achieving ectopic bone formation using nonviral gene delivery with a minimally invasive technique, by coinjecting plasmid DNA encoding OP-1 with collagen into the paraspinal muscle.

Interaction of human mesenchymal stem cells with disc cells: changes in extracellular matrix biosynthesis.

Study Design: To evaluate the in vitro interactions between human mesenchymal stem cells (MSCs) and degenerative disc cells.

Objectives: To demonstrate the potential of MSCs in regulating the extracellular matrix synthesis of degenerative disc cells.

Summary Of Background Data: Culture of degenerative disc cells followed by their reinsertion into a disc can retard the degeneration process in an animal model.

Spinal fusion after revision surgery for pseudarthrosis in adult scoliosis.

Study Design: A retrospective study. OBJECTIVE.: To decipher the incidence, characteristics, functional outcomes, and complications of spinal fusion after revision surgery for recurrent pseudarthrosis in adult patients with scoliosis.

Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint.

Background Context: The sacroiliac joint is known to be a possible cause of chronic low back pain, but the diagnosis and treatment of disorders of the sacroiliac joint have been difficult and controversial.

Purpose: To describe the outcome of sacroiliac joint arthrodesis for sacroiliac joint disorders, with the hypothesis that sacroiliac arthrodesis leads to improved postoperative function.

Study Design/setting: Consecutive case series performed in an academic medical institution.

Temperature-responsive hydroxybutyl chitosan for the culture of mesenchymal stem cells and intervertebral disk cells.

Temperature-responsive polymers are attractive candidates for applications related to injectable delivery of biologically active therapeutics, such as stem cells. In this study, we evaluate the potential of thermosensitive hydroxybutyl chitosan (HBC) as a biomaterial for the culture of human mesenchymal stem cells (hMSC) and cells derived from the intervertebral disk, with the eventual goal of using the HBC polymer as an injectable matrix/cell therapeutic. Conjugation of hydroxybutyl groups to chitosan renders the polymer water soluble and thermally responsive.

Lumbar nerve root palsy after adult spinal deformity surgery.

Study Design: A retrospective study was conducted to investigate the incidence and prognosis of postoperative lumbar nerve root palsy after surgical treatment for adult spinal deformity.

Objective: To decipher the incidence of postoperative lumbar nerve root palsy and recovery in 361 adult spinal deformity patients who underwent 407 spinal fusion surgeries.

Summary Of Background Data: Although lumbar nerve root palsy is a known complication of spinal surgery, there are no large studies that have examined its incidence or prognosis.

Central cord syndrome after total hip arthroplasty: a patient report.

Study Design: Case report.

Objective: To present a patient with central cord syndrome injury after total hip arthroplasty performed under general endotracheal anesthesia.

Summary Of Background Data: Central cord syndrome, a common injury usually sustained as a result of an extension injury to the cervical spine, often occurs in geriatric patients with underlying spondylotic changes.

Concepts in nuclear replacement.

This article describes the pathogenesis of early nuclear failure and current philosophical approaches to artificial, biological, and bioartificial nucleus replacement. Necessary in this review is an overview of current approaches to nucleus replacement with prosthetics and various gel materials.

Complications and surgical revision for failed disc arthroplasty.

This review will outline the indications and options for revision of failed disc arthroplasty. Such indications may include implant loosening, malposition, displacement, early wear, and infection. Each indication will likely require different preoperative planning, testing, and strategies.

Evaluation of the biological response of wear debris.

Study Design: An animal study was conducted to evaluate the biological response to titanium particles from an artificial intervertebral disc in terms of serology and histologic changes.

Objectives: To determine the biological response to wear debris in the retroperitoneal and epidural space.

Summary Of Background Data: Few wear studies exist about mechanical artificial discs.

Sacral insufficiency fracture surgically treated by fibular allograft.

Sacral insufficiency fractures have been known to occur distally after long instrumentation to the sacrum. Most such fractures are treated nonoperatively, but surgery is indicated for patients who have nonunions, persistent pain, neurologic deficits, or gross displacement. The current report elucidates the potential complication of sacral fracture after long lumbar arthrodesis, reviews the pertinent literature, presents three patients with sacral fractures after long instrumented lumbar spinal arthrodesis to the sacrum, and describes a new surgical technique for stabilizing such fractures.