Spine
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The applicability of using video assisted thoracoscopic surgery (VATS) to resect thoracic discs was investigated. A laboratory study was conducted using two human cadavers and three live pigs as surgical specimens. A total of nine thoracic levels were decompressed. ⋯ VATS provides a useful means of performing thoracic discectomies using a small thoracotomy incision. The decrease in invasiveness provided by this new technology may reduce operative morbidity, hospitalization time, and costs. More work is needed, especially in the design of instrumentation, before this becomes a viable alternative to current surgical procedures.
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The first clinical implementation of a microsurgical endoscopic technique for removal of thoracic disc herniation is described. ⋯ The microsurgical endoscopic technique allows spinal cord decompression with a substantial reduction in surgical trauma. It may shorten bed confinement and allow early return to active life. Application of this technique in other areas is being studied.
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Although the extent of injury after cervical spine fracture can be visualized by imaging, the deformations that occur in the spinal canal during injury are unknown. ⋯ Two potential spinal cord injury-causing mechanisms in axial bursting injuries of the cervical spine are occlusion and shortening of the canal. Post-injury radiographic measurements significantly underestimate the actual transient injury that occurs during impact.
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Four cases in which, during standard laminectomies, knife blades broke deep into the disc space are reported. ⋯ Because of the potential hazards of late intraabdominal visceral or vascular injuries, removal of sharp retained fragments at another session is recommended.
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The ability of hydroxyapatite (HA) materials to enhance the fixation strength of posterior spinal instrumentation was examined in 19 adult mongrel dogs. ⋯ The strength of poorly inserted transpedicular screws was significantly enhanced in vivo by the resorbable HA-grout material. The lower strength of HA-coated screws was attributed to screw geometry changes resulting from the coating process, and modifications of screw coating are recommended.