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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In 1959, Harmon was the first to implant a vitallium sphere into the intervertebral disc space in order to preserve mobility and maintain disc height in patients with back pain secondary to degenerative disc disease. Fernstrom reported good results after implantation of stainless steel spheres. However, a reduction in disc height frequently occurred secondary to sphere subsidence into the endplates. This often led to revision surgery, and the concept was abandoned. ⋯ To the best of our knowledge, this is the first report describing the complications resulting from cobalt chrome sphere implantation and revision strategies for managing the recently resurrected cobalt chrome sphere.
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A finite element model of the L4-L5 human segment was employed to carry out a parametric biomechanical investigation of lumbar interbody fusion with a novel "sandwich" cage having an inner stiff core and two softer layers in the areas close to the endplates, with and without posterior fixation. ⋯ The soft layers of the "sandwich" cage had the potential to limit the risk of cage subsidence and to preserve a significant loading of the structure even in combination with flexible posterior instrumentation, which may have a beneficial effect in promoting bony fusion.
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Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry. ⋯ Our study found that age, ASA status and blood loss were significant co-varieties for the occurrence of general complications. The risk of general complications is increased in older versus younger patients. Fusion or rigid stabilization does not lead to more complications. Surgical complications as well as complication rates at follow-up showed no significant age-related variation. Physician-based outcome was good or excellent in over 80% of patients in all age groups.
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Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. ⋯ Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.
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Case Reports
Limited access surgery for 360 degrees in-situ fusion in a dysraphic patient with high-grade spondylolisthesis.
Progressive high-grade spondylolisthesis can lead to spinal imbalance. High-grade spondylolisthesis is often reduced and fused in unbalanced pelvises, whereas in-situ fusion is used more often in balanced patients. The surgical goal is to recreate or maintain sagittal balance but if anatomical reduction is necessary, the risk of nerval damage with nerve root disruption in worst cases is increased. ⋯ At the last follow-up, she worked full time, was completely pain free and not limited in her free-time activities. The simultaneous presence of high-grade spondylolisthesis and spinal dysraphism make it very difficult to find a decisive treatment plan because both posterior and anterior treatment strategies have advantages and disadvantages in these challenging cases. The described technique combines several surgical options to achieve 360° fusion with limited access, reducing the risk of neurological sequelae.