Risk of adjacent segment disease after 'topping-off' multi-level lumbar fusions with posterior dynamic stabilisers: an observational cohort study.

Purpose: To determine whether 'topping-off' lumbar fusions, using posterior dynamic stabilising devices (PDSs) with specific biomechanical parameters, reduces the risk of adjacent segment disease (ASD).

Methods: Survival analysis of two non-randomised cohorts, with or without 'topping-off' (T/O or NoT/O), compared the risk of further surgery for ASD following multi-level posterior lumbar interbody fusion (PLIF). The study sample comprised consecutive patients, aged 55 + years, with degenerative pathology at 2, 3 or 4 levels.

Monitoring image guidance system accuracy during spinal surgery with mini-screw fiducials: technical note.

Study Design: A technical note.

Objective: To describe a technique for measuring accuracy of intraoperative image guidance systems in spine surgery.

Summary Of Background Data: Image guidance may be of use when performing complex procedures on the spine.

Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats.

Introduction: The two main methodologies described for the assessment of spinal sagittal alignment are the pelvic radius (PR) technique and that based on measures of the Pelvic Incidence (PI) and Spino-Sacral Angle (SSA). Both methods stress the fundamental relationship between the anatomical position and orientation of the sacrum within the pelvis and the spinal curves above. The aim of the current study was to assess the strengths and potential weaknesses of the PR technique.

Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis.

Background Context: Adjacent segment disease (ASD) after lumbar spinal fusion has been an important reason behind the development of nonfusion stabilization technology. However, the incidence, prevalence, and factors contributing to adjacent segment degeneration in the lumbar spine remain unclear. A range of prevalence rates for ASD have been reported in the lumbar spinal literature, but the annual incidence has not been widely studied in this region.

Health-related quality of life: a comparison of outcomes after lumbar fusion for degenerative spondylolisthesis with large joint replacement surgery and population norms.

Background Context: Degenerative spine disease will become an increasing health problem, and a significant number of patients will be considered for surgery. Spinal surgeries have evolved since the last decades, and there is a positive impact on the clinical outcomes. Few works in the literature have reviewed the outcome compared with large joint replacement surgery, which is considered a benchmark for operative restoration of patients' quality of life.

Atlantoaxial stabilization using multiaxial C-1 posterior arch screws.

The authors present a novel technique of atlantoaxial fixation using multiaxial C-1 posterior arch screws. The technique involves the insertion of bilateral multiaxial C-1 posterior arch screws, which are connected by crosslinked rods to bilateral multiaxial C-2 pars screws. The clinical results are presented in 3 patients in whom anomalies of the vertebral arteries, C-1 lateral masses, and/or posterior arch of C-1 presented difficulty using existing fixation techniques with transarticular screws, C-1 lateral mass screws, or posterior wiring.

Segmental malalignment with the Bryan cervical disc prosthesis--contributing factors.

Part 1 of the current study found that use of the Bryan Cervical Disc prosthesis resulted in a median loss of 2 degrees in functional spinal unit (FSU) lordosis when compared with preoperative imaging (P<0.0001, range: 8-degree loss to 5-degree gain). The observed changes were generally small but varied among both the patients and the surgeons, suggesting that variables may exist which affect postoperative sagittal alignment.

Segmental malalignment with the Bryan Cervical Disc prosthesis--does it occur?

The early clinical results with the Bryan Cervical Disc prosthesis are encouraging but 2 recent small published series have noted postoperative radiologic kyphosis of the functional spinal unit (FSU) of 4 and 6 degrees. The current study was undertaken to accurately assess the extent of any sagittal deformity after the use of this prosthesis in a substantial, multisurgeon case series. The neutral, erect x-rays of 67 consecutive patients (88 disc levels) operated by one of 3 surgeons, were examined using manual and digital image analysis techniques for FSU sagittal angulation (lordosis), prosthesis shell angulation, segmental olisthesis, and overall cervical alignment.

Complications with cervical arthroplasty.

Object: Spinal arthroplasty is becoming more widely performed in the treatment of degenerative cervical disc disease. Although this new technology may offer benefits over arthrodesis, it also requires that the surgeon acquire new operative techniques, and new potential complications are introduced. To determine the incidence and distribution of perioperative complications, the authors analyzed their early data obtained in a series of patients treated with the Bryan Cervical Disc prosthesis.

Effects of a cervical disc prosthesis on segmental and cervical spine alignment.

Object: Cervical arthroplasty offers the promise of maintaining motion of the functional spinal unit (FSU) after anterior cervical discectomy. The impact of cervical arthroplasty on sagittal alignment of the FSU needs to be addressed, together with its effect on overall sagittal balance of the cervical spine.

Methods: The authors prospectively reviewed radiographic and clinical outcomes in 14 patients who received the Bryan Cervical Disc prosthesis (Medtronic Sofamor Danek, Memphis, TN), for whom early (< 6 months) and late (6-24 months) follow-up data were available.

Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice.

Study Design: Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad.

Objectives: To determine similarities and differences in the treatment of spinal trauma.

Summary Of Background Data: Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training.

Use of the ophthalmic phacoemulsification instrument for tumors of the spinal cord: report of seven cases.

In this retrospective cohort study, we examined the safety, efficacy, and benefits of utilizing the readily available ophthalmic phacoemulsification instrument for the surgery of seven intramedullary spinal cord tumors. Historically, the conventional neurosurgical ultrasonic aspirator was an adaptation of the original Cavitron Phaco-Emulsifier aspirator used in cataract surgery. The ophthalmic instrument has a 1.