European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Less invasiveness is the way forward for spinal surgery. Minimal disruption of tissue, preservation of muscle function, and restoration of normal spinal alignment are still the goals of most surgical procedures. ⋯ The autograft is harvested from the vertebral body, thus avoiding the morbidity associated with an iliac crest bone graft. The operative steps for the procedure are described.
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A 32-year-old woman, addicted to heroin, presented with a dorsal spondylodiscitis due to Candida albicans associated with epidural abscess. Antimycotic treatment was successful, and no neurosurgical decompression was necessary. To our knowledge, this is the first case of documented epidural involvement in candidal spondylodiscitis. The diagnosis of candidal spondylodiscitis should be considered in cases of para- or tetraplegia occurring in intravenous drug abusers.
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Eighty consecutive cases of suprafascial pedicle screw stabilization were reviewed. Intraoperative fluoroscopy aided the percutaneous screw placement after structural anterior interbody graft(s) were placed. During routine outpatient hardware removal, all intradiscal fusions were stressed via the Shanz screws under fluoroscopy. Anterior reconstruction via a mini open approach coupled with this minimally invasive posterior approach led to a 96% successful fusion rate.
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Restoring a stable anterior column is essential to achieve normal spinal biomechanics. A variety of mechanical spacers have been developed and advocated for both anterior and posterior approaches. The ability to radiographically assess the "biology" of bone incorporation in these mechanical (metal) spacers is an inherent limitation. ⋯ Additional posterior instrumentation may increase the stability of the motion segment, but the degree of stability necessary to achieve a biological union remains unclear. The incorporation of these biological cages can be monitored by conventional radiographic techniques. The method of insertion preserves the vertebral end-plates and can be performed by a minimally invasive or standard open procedure.
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Comparative Study
Early histologic changes in lower lumbar discs and facet joints and their correlation.
Biomechanical and histologic studies have highlighted the close functional relationship between lumbar discs and their associated facet joints, and it is conceivable that their degenerative changes are interdependent. However, separation of cause from effect remains controversial. Hitherto, no study in humans has correlated the changes histologically. ⋯ There was no correlation between changes in discs and the associated facet joints at either level. The results of the study showed that microscopic changes are seen in the disc and facet joints from an early age and can be quite marked in some individuals before the age of 40 years. A correlation of degenerative changes within the FSU could not be established.