Spine
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Multicenter Study Comparative Study Clinical Trial
Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5.
A retrospective review of 42 patients treated at three major medical centers for burst fractures of L3, L4, and L5. This is the largest low lumbar (L3-L5) burst fracture study in the literature to date. The study was designed to assess both radiographic and clinical outcomes in a cohort of patients treated during a 16-year period. ⋯ The results of nonoperative treatment of low lumbar burst fractures were comparable with those of operative treatment. The rate of repeat surgery (41%) and absence of a clearly definable long-term functional or radiographic benefit in patients without neurologic compromise may make surgery less appealing.
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Comparative Study
The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population.
The Short Form Health Survey (SF-36) was administered to patients with chronic spinal disorders both before and after tertiary rehabilitation. The association of the SF-36 with various socioeconomic outcomes was then examined. ⋯ The large number of associations between SF-36 scores and outcome variables highlights the importance of assessing the health-related quality of life of patients, and supports the use of the SF-36 in accomplishing this task. Among the findings, perhaps the most significant was the value of assessing health-related quality of life, particularly the subjective physical components, after completion of a functional restoration program. Prediction of long-term socioeconomic outcomes is likely to be improved if assessment is conducted at the end of the treatment process. SF-36 is recommended for assessing general health status, and more spine-specific measures are recommended for assessing spinal pain and disability variables.
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Comparative Study
Laparoscopic approach to L4-L5 for interbody fusion using BAK cages: experience in the first 58 cases.
Operative reports were reviewed for patients who underwent laparoscopic fusion at the L4-L5 level and information regarding the mobilization of the vessels was recorded. ⋯ Laparoscopic transperitoneal approach to L4-L5 for insertion of threaded fusion cages is feasible. The laparoscopic L4-L5 procedure can be accomplished with few complications, provided a dedicated team of collaborative surgeons with experience in laparoscopic spine techniques is employed. Variations in vascular anatomy did not prevent successful insertion of two threaded fusion cages.
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Comparative Study
Revision strategies for salvaging or improving failed cylindrical cages.
This is a review of 20 patients who experienced failure of threaded interbody fusion cages and underwent surgical correction. ⋯ All 20 cages failed because of surgical technique rather than an intrinsic defect in fusion cage technology. The factors associated with failure of the original insertion procedure were failure to achieve adequate distraction of the anulus fibrosis; undersized cages, especially when placed through the posterior interbody lumbar fusion approach; cerebrospinal fluid leakage or pseudomeningocele; Type 2 diabetes mellitus; the use of local bone graft rather than iliac crest inside the cage; anterior insertion in an excessively lateral position resulting in symptoms of a far lateral disc herniation; and failure to identify the spinal midline during an anterior approach.
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Comparative Study
In vivo evaluation of coralline hydroxyapatite and direct current electrical stimulation in lumbar spinal fusion.
An animal model of posterolateral intertransverse process lumbar spinal fusion using autologous bone, coralline hydroxyapatite, and/or direct current electrical stimulation. ⋯ Direct-current electrical stimulation increased fusion rates in a dose-dependent manner in a rabbit spinal fusion model. Coralline hydroxyapatite is an osteoconductive bone graft substitute, and thus requires an osteoinductive stimulus to ensure reliable fusion rates. Furthermore, coralline hydroxyapatite and direct current electrical stimulation can be used together to increase fusion rates in a rabbit spinal fusion model while avoiding the morbidity associated with harvesting iliac crest bone.