Spine
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Open surgical procedures have been the mainstay of spinal surgery for decades, but minimally invasive spinal surgery (MIS) has recently gained traction. Translaterally placed cages permit insertion of large cages and promote skeletal realignment and fusion. ⋯ MIS and open surgical procedures are reported to have similar outcomes at 1 year; in the first 6 weeks, patients undergoing open surgery often need blood transfusion, develop infection, and use more narcotics. Spine surgery has been associated with modulus mismatch between osteoporotic bone and titanium and the need for multiple painful and traumatic surgical procedures, and spine surgeons continue the quest to find better ways to do things.
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Numerous health care resources are utilized to treat low back pain (LBP) resulting from degenerative disc disease (DDD). Most patients with disc degeneration remain asymptomatic, and the degree of disc degeneration does not correlate with pain severity, making diagnosis and effective treatment challenging.
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Improving spinal fusion by optimizing scaffold and surface engineering is a topic of interest for both surgeons and researchers. Concerns regarding patient safety with off-label use of bone morphogenetic protein (BMP) have increased, and patients are choosing minimally invasive spine surgery to lessen morbidity by avoiding harvest of bone graft. These trends may be driving studies on how surgeons can avoid issues associated with biologics (e.g., cost, morbidity), while achieving efficacious and safe bone fusion.
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Prospective, nonrandomized cohort. ⋯ NA.
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Biologics in the appropriate biomechanical environment provide viable bone graft substitutes for repair of injured bone while promoting bone formation and osseointegration. Surgeons must recall the basics of bone structure, the principles of Wolff's law, and the components and steps of new bone formation to optimize the fusion environment and to maximize patient outcomes.