Spine
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Taking a product from concept to commercialization requires careful navigation of the regulatory pathway through a series of steps: (A) moving the idea through proof of concept and beyond; (B) evaluating new technologies that may provide added value to the idea; (C) designing appropriate test strategies and protocols; and (D) evaluating and mitigating risks. Moving an idea from the napkin stage of development to the final product requires a team effort. When finished, the product rarely resembles the original design, but careful steps throughout the product life cycle ensure that the product meets the vision.
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In the debate regarding whether rigid or semirigid fixation is better for proximal junctional kyphosis (PJK)/adult spinal deformity (ASD) correction, this presentation posits that semirigid fixation is the better approach. For ASD correction, might is not right, and a rigid approach does not solve the problems associated with PJK.
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When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation?
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Spinal cord injury (SCI) has occurred in 2.5 million people worldwide, and 130,000 new cases are reported each year. SCI most commonly consists of a compression injury with hemorrhage into gray matter and loss of neurons, oligodendroglia, and astrocytes, followed by invasion of lymphocytes and macrophages; cavitation of the cord follows, then Wallerian degeneration of ascending and descending tracts and loss of neuronal circuitry, culminating in glial scar perpendicular to the direction of the axon. Onset of necrosis occurs within 24 hours. Spontaneous repair is incomplete and involves limited sprouting of axons and new spinal circuits that bypass the lesion and move into descending tracts, resulting in indirect connections with lumbar motor neurons.