Intervertebral disc and stem cells cocultured in biomimetic extracellular matrix stimulated by cyclic compression in perfusion bioreactor.

Background Context: Intervertebral disc (IVD) degeneration often causes back pain. Current treatments for disc degeneration, including both surgical and nonsurgical approaches, tend to compromise the disc movement and cannot fully restore functions of the IVD. Instead, cell-based IVD tissue engineering seems promising as an ultimate therapy for IVD degeneration.

Epidural anesthesia as a novel anesthetic technique for anterior lumbar interbody fusion.

Study Objective: To determine if epidural anesthesia is a reasonable technique for anterior lumbar interbody fusion.

Design: Retrospective chart review.

Setting: Academic university hospital.

Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery.

Study Design: A preintervention and postintervention design was used to examine a total of 200 patients.

Objective: After successful implementation at our institution of a perioperative oral multimodal analgesia protocol in major joint arthroplasty, a modified regimen was provided to patients undergoing spine procedures.

Summary Of Background Data: A proactive, multimodal approach is currently recommended for the management of acute postoperative pain.

Use of patella allograft for anterior cervical diskectomy and fusion.

Study Design: Retrospective cohort.

Objective: The purpose of this study is to determine the fusion rates of a consecutive series of anterior cervical decompressions and fusions with allograft patella using both static and dynamic plates.

Summary Of Background Data: Anterior cervical diskectomy and fusion (ACDF) has been shown to improve symptoms of radiculopathy and myelopathy.

Six-year outcomes of anterior lumbar interbody arthrodesis with use of interbody fusion cages and recombinant human bone morphogenetic protein-2.

Background: Twenty-four-month outcomes have been reported for patients with degenerative lumbar disc disease who were treated with stand-alone anterior lumbar interbody arthrodesis with use of dual tapered interbody fusion cages and recombinant human bone morphogenetic protein-2. This report represents an update of the clinical and radiographic results of this treatment at six years.

Methods: Two hundred and seventy-seven patients with single-level degenerative disc disease with up to grade-I spondylolisthesis were enrolled in two prospective, multicenter, U.

Sacral fractures.

Sacral fractures are a treatment challenge for the orthopaedic surgeon. The relative rarity of sacral fractures limits physician exposure to these injuries and has resulted in questions regarding their optimal treatment. Proper diagnosis and classification also are subjects of considerable debate.

Surgical treatment of thoracolumbar fractures.

Surgical management of a thoracolumbar fracture varies according to many factors. Fracture morphology, neurologic status, and surgeon preference play major roles in deciding on an anterior, a posterior, or a combined approach. The goal is to optimize neural decompression while providing stable internal fixation over the least number of spinal segments.

Nonsurgical treatment of thoracolumbar spinal fractures.

The transitional anatomy of the thoracolumbar spine makes it vulnerable to injury from high-energy vehicular crashes and falls. The definitive management of patients with thoracolumbar spinal fractures is dependent on the presence and extent of neurologic injury, the presence and magnitude of acute deformity, and an estimate concerning spinal stability. It is well established that neurologic deficits generally improve without surgery.

Emergency evaluation, imaging, and classification of thoracolumbar injuries.

Thoracolumbar injuries usually are the result of high-energy trauma and frequently are associated with multisystem concomitant injuries. Whenever a thoracolumbar injury is suspected, a prompt and thorough evaluation should be performed in the emergency department, using the guidelines of the American College of Surgeons and including full primary and secondary surveys as well as resuscitation. Protection of the spine and spinal cord is of paramount importance during the initial evaluation.

Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy.

Background: Although there have been case reports describing the use of cervical disc arthroplasty for the treatment of myelopathy, there is a concern that motion preservation may maintain microtrauma to the spinal cord, negatively affecting the clinical results. As we are not aware of any studies on the use of arthroplasty in this scenario, we performed a cross-sectional analysis of two large, prospective, randomized multicenter trials to evaluate the efficacy of cervical disc arthroplasty for the treatment of myelopathy.

Methods: The patients in the current study were a cohort of patients who were enrolled in the United States Food and Drug Administration Investigational Device Exemption studies of the Prestige ST and Bryan disc replacements (Medtronic, Memphis, Tennessee).

Counterpoint: physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed.

Study Design: Review of the nature of conflicts of interest in physician-industry relationships, with a focus on the efforts to ethically manage physician-industry relationships.

Objective: To illustrate the perspective that physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed.

Summary Of Background Data: The interest in considering the appropriateness of physician-industry relationships has recently become focused on spine surgery.

Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial.

Object: The authors report the results of a prospective randomized multicenter study in which the results of cervical disc arthroplasty were compared with anterior cervical discectomy and fusion (ACDF) in patients treated for symptomatic single-level cervical degenerative disc disease (DDD).

Methods: Five hundred forty-one patients with single-level cervical DDD and radiculopathy were enrolled at 32 sites and randomly assigned to one of two treatment groups: 276 patients in the investigational group underwent anterior cervical discectomy and decompression and arthroplasty with the PRESTIGE ST Cervical Disc System (Medtronic Sofamor Danek); 265 patients in the control group underwent decompressive ACDF. Eighty percent of the arthroplasty-treated patients (223 of 276) and 75% of the control patients (198 of 265) completed clinical and radiographic follow-up examinations at routine intervals for 2 years after surgery.

A quantitative analysis of strain at adjacent segments after segmental immobilization of the cervical spine.

Study Design: A biomechanical study on human cadaveric cervical spines with segmental fixation.

Objectives: To quantify the strains across all segments of the spine after simulated fusion.

Summary Of Background Data: Clinical evidence suggests that degenerative changes occur at adjacent levels after cervical fusion.

The correlation between preoperative disc space height and clinical outcomes after anterior lumbar interbody fusion.

Objective: To determine whether preoperative disc space height (DSH) influences the clinical outcomes of patients diagnosed with single-level symptomatic discogenic disease and treated with a stand-alone anterior lumbar interbody fusion with two tapered threaded fusion cages, we performed a retrospective analysis of 392 patients.

Methods: Preoperative radiographs were used to establish four study groups based on the patients' DSH: the tall disc group: DSH >15 mm; the intermediate tall group: DSH ranging from 10 to 15 mm; the intermediate collapsed group: DSH ranging from 5 to 10 mm; and the collapsed disc group: DSH <5 mm.

Results: All of the patient groups exhibited improvement in their clinical outcomes.

The effect of single-level, total disc arthroplasty on sagittal balance parameters: a prospective study.

A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis.

Design rationale and biomechanics of Maverick Total Disc arthroplasty with early clinical results.

This paper reviews the design criteria, biomechanical and biological (wear and safety) testing of this chrome cobalt metal-on-metal, ball and socket design prosthesis. The surgical technique and early clinical results of the initial implantations are also reviewed. Initial results of 7 Maverick implantations showed all 7 patients attaining a 15 point Oswestry improvement within 3 months after implantation.

The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation.

Study Design: A retrospective review of a consecutive series of patients with acute thoracolumbar burst fractures who were surgically treated with an anterior corpectomy and fusion with anterolateral Z-plate fixation.

Objectives: To evaluate the clinical and radiographic success of the management of acute thoracolumbar burst fractures by corpectomy, structural grafting, and anterolateral internal fixation.

Summary Of Background Data: Burst fractures are frequently associated with instability or neurologic deficit.

The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies.

In anterior lumbar spinal fusion, patients treated with rhBMP-2 on a collagen sponge carrier had statistically superior outcomes compared to patients treated with autogenous bone graft. A collagen sponge carrier should replace autogenous bone graft for this patient population.

Anterior lumbar interbody fusion for the management of chronic lower back pain: current strategies and concepts.

In a retrospective analysis of two large multicenter clinical studies, 321 patients with degenerative lumbar disc disease were divided into two groups who underwent anterior lumbar interbody fusion using two threaded titanium fusion cages. To determine whether differences in surgical procedures and cage design affect anterior and posterior annular distraction and clinical outcomes, the authors evaluated the clinical and radiographic outcomes of patients treated with a stand-alone ALIF procedure. End-plate preservation techniques were associated with improved anterior and posterior disc space distraction compared with standard end-plate preparation techniques.