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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The purpose was to investigate the median sacral artery (MSA) anatomical pathway in terms of its relationship to the lumbosacral spine. ⋯ The MSA anatomy is important for prevention of intra-operative bleeding. For anterior lumbosacral surgery, the MSA should be identified and controlled before proceeding with the spinal surgery. For posterior bicortical sacral screw placement, the screw tip should be fluoroscopically checked to avoid inserting the screw tip into the mid sacral promontory. By first approaching the anterior sacral promontory, the surgeon will find the MSA within the middle one-third zone, and 2.47-2.99 cm cephalad to this, the iliac vessels. Knowledge of the MSA helps the surgeon to operate more safely.
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Cell-based therapies such as concentrated bone marrow aspirate (BMA) with allograft and demineralized bone matrix (DBM) have been developed as a potential alternative to iliac crest bone graft (ICBG) in spinal fusion. BMA contains mesenchymal stem cells (MSCs) and growth factors that confer osteogenic and osteoinductive potential to osteoconductive scaffolds like allograft and DBM. It is well established that there is an age-related decline in bone marrow MSC population and efficacy. This might be problematic in spine arthrodesis when utilizing BMA derived from elderly patients as a fusion aide. The goal of this study was to describe the outcomes of concentrated BMA with allograft and DBM in elderly patients undergoing posterolateral and interbody lumbar fusion. ⋯ Despite the concerns of reduced fusion potential in elderly patients, autologous concentrated BMA mixed with allograft and DBM in posterolateral and interbody fusions can achieve successful fusion rates with good clinical outcomes and low complication rates.
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To assess whether patients undergoing lumbar spine surgery for the first time (Group 1) had different expectations from those undergoing lumbar spine surgery for a failed previous procedure (Group 2). ⋯ Patients' expectations remained very high despite having had a failed previous surgery for the same procedure.
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To evaluate the role of apparent diffusion coefficient (ADC) as a quantitative means to assess the degree of intervertebral disc (IVD) degeneration contextually within the framework of a widely used Pfirrmann classification rather than in a direct correlation with Pfirrmann grades. ⋯ This study demonstrates that previously perceived as an overlap in ADC value existing between different degenerative categories based on a visual inspection can be viewed as a quantitative role of ADC in assessment of disc degeneration. This reinforces the Pfirrmann classification system but also proceeds beyond mere qualitatively determining morphologic states.
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To evaluate the entry zone of iliac screw fixation to maintain proper entry width and screw length. ⋯ The iliac screw fixation entry zone to maintain proper screw length and entry width is outlined from 20 mm superiorly to 10 mm inferiorly from the PSIS and is located more medially from the prominence of the posterior iliac spine.