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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Multicenter Study Controlled Clinical Trial
A prospective clinical and radiographic 12-month outcome study of patients undergoing single-level anterior cervical discectomy and fusion for symptomatic cervical degenerative disc disease utilizing a novel viable allogeneic, cancellous, bone matrix (trinity evolution™) with a comparison to historical controls.
This multicenter clinical study was performed to assess the safety and effectiveness of Trinity Evolution(®) (TE), a viable cellular bone allograft, in combination with a PEEK interbody spacer and supplemental anterior fixation in patients undergoing anterior cervical discectomy and fusion (ACDF). ⋯ Patients undergoing single-level ACDF with TE in combination with a PEEK interbody spacer and supplemental anterior fixation had a high rate of fusion success without serious allograft-related adverse events.
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Review Comparative Study
C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy.
C5 palsy is a well-known complication of cervical spine decompression surgery. The complication develops in both posterior and anterior approaches. We aimed to review reports regarding postoperative C5 palsy in hopes for better prevention and treatment of this morbidity. ⋯ Some studies conclude that anterior procedure is more safe. Of all anterior procedures, the multilevel ACDF had the lowest incidence of C5 palsy. The hybrid technique can be chosen for more than two-vertebra corpectomy. In term of posterior procedures, laminectomy is safer. To prevent C5 palsy, electromyography can be used as a sensitive predictor and selective foraminotomy can be performed.
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Case Reports
Intraspinal canal rod migration causing late-onset paraparesis 8 years after scoliosis surgery.
Complete intraspinal canal rod migration with posterior bone reconstitution has never been described in the adolescent idiopathic scoliosis (AIS) population. We present an unusual but significant delayed neurological complication after spinal instrumentation surgery. ⋯ We opine that the progressive laminar erosion with intra-canal rod migration resulted from mechanical and infectious-related factors. The very low virulence of the strain of Propionibacterium acnes is probably involved in this particular presentation where the rod was trapped in the canal, owing to the quite extensive laminar reconstitution.
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Recent studies suggest that cervical lordosis is influenced by thoracic kyphosis and that T1 slope is a key factor determining cervical sagittal alignment. However, no previous study has investigated the influence of cervical kyphosis correction on the remaining spinopelvic balance. The purpose of this study is to assess the effect of surgical correction of cervical kyphosis on thoraco-lumbo-pelvic alignment. ⋯ Surgical correction of cervical kyphosis affects T1 slope and thoracic kyphosis, but not lumbo-pelvic alignment. These results indicate that the compensatory mechanisms to minimize positive sagittal malalignment of the head may occur mainly in the thoracic, and not in the lumbosacral spine.
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Most cervical fusion cages imperfectly mimic the anatomy of the intervertebral disc space. The production of individualized cages might be the next step to further improve spinal implants due to their enhanced load-bearing surface. ⋯ Preconditions for the manufacturing of individualized cervical fusion cages using specific patient data are given. The implantation is uncomplicated. The improved load-bearing surface will lower the rate of implant dislocation and subsidence. The production of individualized cages at a reasonable price has to be evaluated by spine surgeons and the industry.