Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic Pain.

This study investigates the use of magnetic resonance spectroscopy (MRS) to identify the intervertebral disc (IVD) as a pain generator, explore the pathophysiology of the biochemical and structural components of discogenic low back pain (DLBP), and present potential evidence of physiological responses to spinal manipulation therapy (SMT). A 29-year-old male presented with uncomplicated low back pain (LBP). The non-specific presentation and clinical examination findings were consistent with an initial working diagnosis of non-specific LBP with the clinician suspecting IVD as a likely pain generator.

Allogeneic Disc Progenitor Cells Safely Increase Disc Volume and Improve Pain, Disability, and Quality of Life in Patients With Lumbar Disc Degeneration-Results of an FDA-Approved Biologic Therapy Randomized Clinical Trial.

Background: Progenitor cells derived from intervertebral disc tissue demonstrated immunomodulatory and regenerative properties in preclinical studies. We report the safety and efficacy results of a US Food and Drug Administration-approved clinical trial of these cells for the treatment of symptomatic degenerative disc disease.

Methods: Sixty patients with symptomatic single-level lumbar degenerative disc disease (mean age 37.

Impact of Cervical Disc Arthroplasty vs Anterior Cervical Discectomy and Fusion on Driving Disability: Post Hoc Analysis of a Randomized Controlled Trial With 10-Year Follow-Up.

Background: Driving an automobile requires the ability to turn the neck laterally. Anecdotally, patients with multilevel fusions often complain about restricted turning motion. The purpose of this study was to compare the effectiveness of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) on driving disability improvement at 10-year follow-up after a 2-level procedure.

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels.

Background: Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1- and 2-level cervical pathology, with established long-term safety and effectiveness.

Surgical Treatment of Meniscal Extrusion: A Biomechanical Study on the Role of the Medial Meniscotibial Ligaments With Early Clinical Validation.

Background: Meniscal extrusion refers to meniscal displacement out of the joint space and over the tibial margin, altering knee mechanics and increasing the risk of osteoarthritis. The meniscotibial ligaments have been shown to have an important role in meniscal stability. However, it remains unclear whether an isolated lesion of the medial meniscotibial ligaments will result in meniscal extrusion and whether repairing the detached ligament will reduce extrusion.

Repair and InternalBrace Augmentation of the Medial Ulnar Collateral Ligament.

"For more than 4 decades, reconstruction of the ulnar collateral ligament (UCL) using some type of autograft tissue has been the standard of care for UCL-injured athletes. This article reviews the history of UCL repair including the rationale for the revival of interest in primary repair of the UCL as an option for the treatment of select athletes as well as the early clinical results indicating the short-term successful outcomes of the procedure in properly selected athletes."

Treatment of Cervical Myelopathy: Long-term Outcomes of Arthroplasty for Myelopathy Versus Radiculopathy, And Arthroplasty Versus Arthrodesis for Myelopathy.

Study Design: Analysis of 2- and 7-year outcomes from a clinical trial comparing 2-level cervical disk arthroplasty (CDA) to anterior cervical discectomy and fusion (ACDF) in 287 patients with radiculopathy alone, and 110 patients with myelopathy alone or myelopathy with radiculopathy.

Objective: To compare the long-term safety and effectiveness of CDA for myelopathy versus radiculopathy.

Summary Of Background Data: CDA for myelopathy is safe and effective in short term.

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.

Long-term clinical and radiographic outcomes of the Prestige LP artificial cervical disc replacement at 2 levels: results from a prospective randomized controlled clinical trial.

OBJECTIVE The aim of this study was to assess long-term clinical safety and effectiveness in patients undergoing anterior cervical surgery using the Prestige LP artificial disc replacement (ADR) prosthesis to treat degenerative cervical spine disease at 2 adjacent levels compared with anterior cervical discectomy and fusion (ACDF). METHODS A prospective, randomized, controlled, multicenter FDA-approved clinical trial was conducted at 30 US centers, comparing the low-profile titanium ceramic composite-based Prestige LP ADR (n = 209) at 2 levels with ACDF (n = 188). Clinical and radiographic evaluations were completed preoperatively, intraoperatively, and at regular postoperative intervals to 84 months.

Cervical disc arthroplasty with the Prestige LP disc versus anterior cervical discectomy and fusion, at 2 levels: results of a prospective, multicenter randomized controlled clinical trial at 24 months.

OBJECTIVE The authors compared the efficacy and safety of arthroplasty using the Prestige LP cervical disc with those of anterior cervical discectomy and fusion (ACDF) for the treatment of degenerative disc disease (DDD) at 2 adjacent levels. METHODS Patients from 30 investigational sites were randomized to 1 of 2 groups: investigational patients (209) underwent arthroplasty using a Prestige LP artificial disc, and control patients (188) underwent ACDF with a cortical ring allograft and anterior cervical plate. Patients were evaluated preoperatively, intraoperatively, and at 1.

Cervical Disc Arthroplasty with Prestige LP Disc Versus Anterior Cervical Discectomy and Fusion: Seven-Year Outcomes.

Background: Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of cervical pathologies. Studies are on-going to assess the long term outcomes of CDA. This study assessed the safety and efficacy of the Prestige(®) LP Disc at 84-months follow up.

Observational Study of Depression in Patients Undergoing Cervical Disc Arthroplasty: Evidence of a Correlation between Pain Relief and Resolution of Depression.

Background: Depression has been associated with inferior outcomes following lumbar spine surgery. Our purpose was to investigate the prevalence of depression and its impact on the outcomes of a large sample of cervical disc arthroplasty patients and to examine the change in depression occurring in conjunction with changes in disability and pain.

Methods: A cohort of 271 patients who underwent single or multi-level cervical disc arthroplasty at a single orthopedic center filled out the Neck Disability Index, Medical Outcomes Study SF-36, numerical rating scales for neck pain and arm pain, preoperatively and 12-month postoperatively.

The Effect of Workers' Compensation Status on Outcomes of Cervical Disc Arthroplasty: A Prospective, Comparative, Observational Study.

Background: Receiving Workers' Compensation benefits has been associated with inferior outcomes after lumbar fusion. The purpose of our study was to compare the outcomes of cervical disc arthroplasty between patients receiving and those not receiving Workers' Compensation.

Methods: Patient-reported outcomes, reoperations, complications, and return-to-work status were analyzed at one year after surgery in an observational cohort of consecutive patients who underwent single-level or multilevel cervical disc arthroplasty for symptomatic cervical disc conditions, including radiculopathy or discogenic pain with or without radiculopathy, exclusive of myelopathy.

Cervical disc arthroplasty with PRESTIGE LP disc versus anterior cervical discectomy and fusion: a prospective, multicenter investigational device exemption study.

OBJECT This study compared the safety and efficacy of treatment with the PRESTIGE LP cervical disc versus a historical control anterior cervical discectomy and fusion (ACDF). METHODS Prospectively collected PRESTIGE LP data from 20 investigational sites were compared with data from 265 historical control ACDF patients in the initial PRESTIGE Cervical Disc IDE study. The 280 investigational patients with single-level cervical disc disease with radiculopathy and/or myelopathy underwent arthroplasty with a low-profile artificial disc.

Optimizing success with lumbar disc arthroplasty.

Purpose: This study aimed at determining the variables that may prove useful in predicting clinical outcomes following lumbar disc arthroplasty.

Methods: Pre- and post-operative imaging assessments were obtained for 99 single-level lumbar disc arthroplasty patients from a prospective IDE study. The assessments and patient demographics were tested to identify variables that were significantly associated with clinical outcomes.

Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty.

Purpose: Metal-on-metal total disc replacement is a recent alternative treatment for degenerative disc disease. Wear and corrosion of these implants can lead to local and systemic transport of metal debris. This prospective longitudinal study examined the serum chromium and cobalt levels in 24 patients with cobalt-chromium alloy metal-on-metal lumbar disc replacements.

Biomechanical assessment of a PEEK rod system for semi-rigid fixation of lumbar fusion constructs.

The concept of semi-rigid fixation (SRF) has driven the development of spinal implants that utilize nonmetallic materials and novel rod geometries in an effort to promote fusion via a balance of stability, intra- and inter-level load sharing, and durability. The purpose of this study was to characterize the mechanical and biomechanical properties of a pedicle screw-based polyetheretherketone (PEEK) SRF system for the lumbar spine to compare its kinematic, structural, and durability performance profile against that of traditional lumbar fusion systems. Performance of the SRF system was characterized using a validated spectrum of experimental, computational, and in vitro testing.

Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial.

Study Design: Randomized, controlled, multicenter, investigational device exemption trial.

Objective: To investigate the safety and effectiveness of the first two-piece, metal-on-metal lumbar disc prosthesis for treating patients with single-level degenerative disc disease.

Summary Of Background Data: For patients with degenerative disc disease unresponsive to conservative measures, lumbar disc arthroplasty provides an alternative to fusion designed to relieve persistent discogenic pain and maintain motion.