Diagnosis of spine pseudoarthrosis based on the biomechanical properties of bone.

Background Context: Failure to fuse following anterior cervical discectomy and fusion (ACDF) may result in symptomatic pseudoarthrosis. Traditional diagnosis involves computerized tomography to detect bridging bone and/or flexion-extension radiographs to assess whether segmental motion is above specific thresholds; however, there are currently no well-validated diagnostic tests. We propose a biomechanically rational approach to achieve a reliable diagnostic test for pseudoarthrosis.

Initial Validation of a Sacroiliac Joint-Specific Disability Questionnaire.

Low back pain is a multidimensional disorder that can originate from a variety of pain generators, including the sacroiliac (SI) joint. Although the Oswestry Disability Index (ODI) is often used in SI joint treatment studies, the effects of the SI joint on functional disability are likely different from those of other low back pain generators. Thus, we developed the Denver SI Joint Questionnaire (DSIJQ) and performed validation testing in patients (n=24) with SI joint-specific pain at baseline, +2 weeks, and +6 months.

Biomechanical evaluation of a novel repair strategy for intervertebral disc herniation in an ovine lumbar spine model.

Following herniation of the intervertebral disc, there is a need for advanced surgical strategies to protect the diseased tissue from further herniation and to minimize further degeneration. Accordingly, a novel tissue engineered implant for annulus fibrosus (AF) repair was fabricated three-dimensional fiber deposition and evaluated in a large animal model. Specifically, lumbar spine kinetics were assessed for eight (n = 8) cadaveric ovine lumbar spines in three pure moment loading settings (flexion-extension, lateral bending, and axial rotation) and three clinical conditions (intact, with a defect in the AF, and with the defect treated using the AF repair implant).

Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors.

Objective: There are few prior reports of acute pelvic instrumentation failure in spinal deformity surgery. The objective of this study was to determine if a previously identified mechanism and rate of pelvic fixation failure were present across multiple institutions, and to determine risk factors for these types of failures.

Methods: Thirteen academic medical centers performed a retrospective review of 18 months of consecutive adult spinal fusions extending 3 or more levels, which included new pelvic screws at the time of surgery.

Alternative Uses of O-Arm and Stealth Navigation Technology Over 10 Years: The University of Colorado Experience.

Intraoperative computed tomography scanning with O-arm and use of Stealth navigation can improve surgical outcomes in a variety of orthopedic subspecialties. In spine surgery, the accuracy, precision, and safety of pedicle screw and interbody implant placement has improved. This technology is now routinely used in percutaneous pedicle screw placement and minimally invasive sacroiliac joint fusion.

Minor Trauma Caused High-Grade Lumbosacral Spondylolisthesis After Short-Segment Lumbar Fusion: A Case Report.

Case: Ten days after L3-L5 instrumented posterior lumbar spinal fusion, an 85-year-old woman developed Grade 4 spondylolisthesis at L5-S1 after a minor fall. She underwent posterior open reduction and internal fixation with extension of fusion from L2 to the pelvis. The preexisting hardware at L5 caused partial laceration of the right L5 nerve root.

Blockade of Osteoclast-Mediated Bone Resorption With a RANKL-Inhibitor Enhances Bone Formation in a Rat Spinal Fusion Model.

Study Design: Rat spine fusion model.

Objective: The present study aimed to determine whether administration of osteoprotegerin (OPG) in a rat model of spinal fusion increases bone volume, bone density, and decreases osteoclasts in the fusion mass.

Summary Of Background Data: OPG is a soluble RANK-ligand inhibitor that blocks osteoclast differentiation and activation.

Three- and 4-Level Lumbar Arthrodesis Using Adjunctive Pulsed Electromagnetic Field Stimulation: A Multicenter Retrospective Evaluation of Fusion Rates and a Review of the Literature.

Background: The incidence of 3- and 4-level lumbar arthrodesis is rising due to an aging population, and fusion rates affect clinical success in this population. Pulsed electromagnetic field (PEMF) stimulation is used as an adjunct to increase fusion rates following multilevel arthrodesis. The purpose of the study was to evaluate the fusion rates for subjects who underwent 3- and 4-level lumbar interbody arthrodesis following PEMF treatment.

Validation of new shoulder periprosthetic joint infection criteria.

Background: A periprosthetic joint infection (PJI) in the shoulder can be difficult to diagnose. Many variables have been used to determine a PJI. Recently, the 2018 International Consensus Meeting (ICM) on orthopedic infections gave new criteria to help identify PJI in the shoulder.

Postoperative pelvic incidence (PI) change may impact sagittal spinopelvic alignment (SSA) after instrumented surgical correction of adult spine deformity (ASD).

Objectives: To study factors causing postoperative change of PI after surgical correction of ASD and to assess the effect of this variability on postoperative PI-LL mismatch.

Background: PI is used as an individual constant to define lumbar lordosis (LL) correction goal (PI-LL < 10). Postoperative changes of PI were shown but with opposite vectors.

Recombinant Human Bone Morphogenetic Protein-2 Improves Spine Fusion in a Vitamin D-Deficient Rat Model.

Background: The effects of vitamin D deficiency on spinal fusion are not well studied, nor are approaches to overcoming deficiency-related detrimental effects. The purpose of this study was to (1) evaluate the effects of vitamin D deficiency on spine fusion in a rat model, and (2) determine whether recombinant human bone morphogenetic protein-2 (rhBMP-2) can improve outcomes in deficient rats.

Methods: Sprague-Dawley rats were assigned to a vitamin D group: vitamin D sufficient (14), vitamin D deficient (16), vitamin D postoperative rescue (15).

Early results of reverse total shoulder arthroplasty using a patient-matched glenoid implant for severe glenoid bone deficiency.

Background: Reverse total shoulder arthroplasty (rTSA) in the presence of significant glenoid bone loss remains a challenge. This study presents preliminary clinical and radiographic outcomes of primary and revision rTSA using a patient-matched, 3-dimensionally printed custom metal glenoid implant to address severe glenoid bone deficiency.

Methods: Between September 2017 and November 2018, 19 patients with severe glenoid bone deficiency underwent primary (n = 9) or revision rTSA (n = 10) using the Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) at a single institution.

Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion.

Study Design: This is a retrospective, single-institution, cohort study.

Objectives: To evaluate the association of Mersilene tape use and risk of proximal junctional kyphosis (PJK), after surgical correction of adult spinal deformity (ASD) by posterior instrumented fusion (PIF). PJK, following long spinal PIF, is a complication which often requires reoperation.

Dynamically Crystalizing Liquid-Crystal Elastomers for an Expandable Endplate-Conforming Interbody Fusion Cage.

Degenerative disc disease (DDD) is the leading cause of low back pain and radiating leg pain. DDD is commonly treated surgically using spinal fusion techniques, but in many cases failure occurs due to insufficient immobilization of the vertebrae during fusion. The fabrication and demonstration of a 3D-printed semi-crystalline liquid crystal elastomer (LCE) spinal fusion cage that addresses these challenges in particular subsidence are described.

Transpedicular-Transdiscal Cement Augmentation Treatment of Thoracolumbar Fusion Proximal Junctional Failure.

Background: Long instrumented fusions for adult deformity have a proximal junction kyphosis rate between 20% and 40%. When symptomatic, proximal junctional failure (PJF) often requires revision surgery and is associated with significant morbidity. Vertebral cement augmentation (VCA) has been used for prophylaxis against PJF but has not been previously described as treatment after onset of PJF has occurred.

Long-Term Treatment Effect and Predictability of Spinopelvic Alignment After Surgical Correction of Adult Spine Deformity With Patient-Specific Spine Rods.

Study Design: Retrospective case series.

Objective: To evaluate the short- and long-term treatment effect (TE) of spinopelvic parameters after surgical correction of adult spine deformity (ASD) utilizing preoperative planning and patient-specific spine rods (PSSRs), and to assess the correspondence between planned and real outcomes.

Summary Of Background Data: PSSR have been used in ASD correction for the last decade.

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.

Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts.

Background: Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized.

Mini-open sacroiliac joint fusion with direct bone grafting and minimally invasive fixation using intraoperative navigation.

Background: Describe a novel technique for sacroiliac arthrodesis using intraoperative navigation, direct bone grafting, and minimally invasive implants. Report on the outcomes of the first cohort of these patients.

Methods: Institutional review board (IRB) approved, single center, two surgeon, retrospective study.

Interspinous Process Decompression Improves Quality of Life in Patients with Lumbar Spinal Stenosis.

Lumbar spinal stenosis has been shown to negatively impact health-related quality of life. Interspinous process decompression (IPD) is a minimally invasive procedure that utilizes a stand-alone spacer to serve as a joint extension blocker to relieve neural compression in patients with spinal stenosis. Using the 5-year results from an FDA randomized controlled trial of IPD, the quality of life in 189 patients treated with the Superion® spacer was evaluated with the SF-12.

Evaluation and Prediction of Human Lumbar Vertebrae Endplate Mechanical Properties Using Indentation and Computed Tomography.

Current implant materials and designs used in spinal fusion show high rates of subsidence. There is currently a need for a method to predict the mechanical properties of the endplate using clinically available tools. The purpose of this study was to develop a predictive model of the mechanical properties of the vertebral endplate at a scale relevant to the evaluation of current medical implant designs and materials.

Stand-alone Anterior Lumbar Interbody, Transforaminal Lumbar Interbody, and Anterior/Posterior Fusion: Analysis of Fusion Outcomes and Costs.

Fusion outcomes and costs of stand-alone anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) in association with posterior fusion, and anterior/posterior (A/P) fusion were compared using clinical, radiographic, and billing data. Adult patients with symptomatic 1- or 2-level degenerative disk disease in isolation or in association with a grade 1 or 2 degenerative or lytic spondylolisthesis and canal and/or foraminal stenosis who underwent elective stand-alone ALIF, TLIF, or A/P fusion were compared. The analysis focused primarily on fusion rates and costs and secondarily on radiographic and clinical parameters.