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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Review
MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics.
Over the past decade, the minimally disruptive lateral transpsoas approach for lumbar interbody fusion (MI-LIF) is increasingly being used as an alternative to conventional surgical approaches. The purpose of this review was to evaluate four primary questions as they relate to MI-LIF: (1) Is there an anatomical justification for MI-LIF at L4-5? (2) What are the complication and outcome profiles of MI-LIF and are they acceptable with respect to conventional approaches? (3) Given technical and neuromonitoring differences between various MI-LIF procedures, are there any published clinical differences? And, (4) are modern minimally disruptive procedures (e.g., MI-LIF) economically viable? ⋯ There is considerable published evidence to support MI-LIF in spinal fusion and advanced applications, though the results of some reports, especially concerning complications, vary greatly depending on technique and instrumentation used. Additional cost-effectiveness analyses would assist in fully understanding the long-term implications of MI-LIF.
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Clinical Trial
Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation.
The purpose of this study was to assess the mid-term clinical and radiological results as well as patient safety in terms of complication and reoperation rates in patients treated with a novel anterior stand-alone fusion (ASAF) device (Synfix-LR, DePuy Synthes, West Chester, PA, USA) in a cohort of patients with predominant and intractable low back pain originating from monosegmental degenerative disc disease at the lumbosacral junction. ⋯ The current study delineates satisfactory clinical results following ASAF at the lumbosacral junction. Patient safety was demonstrated with acceptable complication and low reoperation rates. Radiological data demonstrated a significant reconstruction of lordosis at the lumbosacral junction. Solid interbody fusion was achieved in 97.3 % of all cases in a highly selected cohort with optimal predisposition for fusion. ASAF may serve to avoid a variety of negative side effects for a considerable number of patients which, otherwise, would have been candidates for posterior instrumented fusion techniques.
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Dynamic implants have been developed to address potential adjacent level effects due to rigid instrumentation. Rates of revision surgeries may be reduced by using improved implants in the primary surgery. Prior to clinical use, implants should be rigorously tested ex vivo. The objective of our study was to characterize the load-sharing and kinematic behavior of a novel low-stiffness spinal implant. ⋯ The novel implant behaved similarly to the medium-stiffness implant in both load-sharing and translation despite having a different design and stiffness. Complex implant design and specimen-implant interaction necessitate pre-clinical testing of novel implants. Further in vitro testing in axial rotation and flexion-extension is recommended as they are highly relevant loading directions for non-rigid implants.
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The aim of this study was to evaluate the radiographic characteristics of polyetheretherketone (PEEK) cages packed with adjacent vertebral autograft material in lumbar anterior lumbar interbody fusion (ALIF) in spinal deformity long fusion surgeries. ⋯ The use of lumbar ALIF with PEEK cages and adjacent vertebral autografts in spinal deformity long fusion surgeries is an effective and safe procedure. The allograft filler is safe and effective in maintaining the shape of harvested vertebrae. Additional long-term follow-up studies are needed to further justify its use.
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The presence of degeneration alters the stress within that particular degenerated disc. Therefore, the state of degeneration of the disc at the level adjacent to a single level fusion would influence the rate of subsequent further degeneration of that same adjacent disc. Therefore, the purpose of this study was to investigate the biomechanical effect of the disc degeneration at the adjacent segment on the stress of the corresponding segment after one segment lumbar fusion using validated finite element (FE) models. ⋯ The present study demonstrates disc degeneration per se and fusion can cause the increase of disc stress at the adjacent segment. However, they seem not to act synergistically. Therefore, the proper decision of fusion extent needs comprehensive individual considerations about the degree of facet degeneration, canal stenosis and patient's activity.