Spine
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Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography. ⋯ Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.
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A histologic study of cerebrospinal fluid tracers in Sprague-Dawley rats undergoing lumboperitoneal shunt insertion in the excitotoxic animal model of posttraumatic syringomyelia (PTS). ⋯ Increasing caudal subarachnoid space compliance with a shunt does not affect local CSF flow into the spinal cord and syrinx. These results suggest that localized alterations in compliance, as opposed to obstruction from traumatic arachnoiditis, may act as an important factor in syrinx pathogenesis.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial.
Multicenter prospective randomized study of artificial disc replacement (ProDisc) versus circumferential fusion (standard of care) for one- and two-level degenerative disc disease. This is an interim analysis on patients seen at the Spine Institute Saint John's Health Center, Santa Monica, California. ⋯ Disc replacement patients reported significantly less pain (Visual Analogue Scale) and disability (Oswestry) in the early period following surgery compared to fusion patients. This difference disappeared by 6 months. When compared to fusion, the disc replacement allowed preservation of motion at L4-L5 with a similar trend at L5-S1.
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Clinical Trial
The feasibility, safety, and utility of vertebral wedge osteotomies for the fusionless treatment of paralytic scoliosis.
Before-after intervention study of a fusionless surgical technique to correct scoliosis secondary to spinal cord injury or myelodysplasia in children and adolescents. ⋯ The vertebral wedge osteotomy procedure appears to be a potential option for the treatment of paralytic scoliosis. The procedure was feasible and safely performed in these 14 patients, with spinal mobility maintained. There were no nonunions. The efficacy of the procedure is still not known, as is for which patients the procedure is indicated and timing of the operation. Long-term follow-up (to skeletal maturity) is needed. Only six of the patients are currently skeletally mature, and more numbers are needed to determine efficacy in this group.
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This in vitro biomechanical study was undertaken to quantify the multidirectional intervertebral kinematics following total disc replacement arthroplasty compared to conventional stabilization techniques. ⋯ Total disc arthroplasty serves as the next frontier in the surgical management of discogenic spinal pathology. The SB Charitè restored motion to the level of the intact segment in flexion-extension and lateral bending and increased motion in axial rotation. The anterior annular resection necessary for device implantation and unconstrained design of the prosthesis account for this change in rotation. The normal lumbar flexion-extension axis of rotation is an ellipse rather than a single point. Only disc replacement rather than pedicle instrumentation or BAK interbody instrumentation preserves the kinematic properties and normal mapping of segmental motion at the operative and adjacent intervertebral disc levels.