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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There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. ⋯ Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.
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Disadvantages of thoracic posterior implants and developments in rod contouring in situ led to the design of a new spinal implant: the bipedicular spinal fixation device (BSF). The BSF is composed of two bifid hooks linked by a compression transverse connector and inserted into the costo-vertebral and costo-transverse joints. The aim of this biomechanical study was to determine the loading tolerance of the BSF. ⋯ The mean BMD estimated by DEXA was 0.557 g/cm(2). The BSF loading tolerance was compatible with the in situ rod contouring technique requirements when we considered posterior and lateral pull-out tests. The transversal compression test determined the appropriate and efficient BSF tightening force.
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Comparative Study
Anterior lumbar interbody fusion: does stable anterior fixation matter?
The purpose of this study was to compare the outcome of anterior lumbar interbody fusion without instrumentation (uninstrumented ALIF) against that with stable anterior cage fixation using Hartshill horseshoe instrumentation (ALIF-HH) for similar severity of disc disease. Between April 1994 and June 1998 the senior author N. R. ⋯ On subjective score assessment, there was a satisfactory outcome (score0.05). On classification by the Oswestry Index into four categories, we found no difference in outcome between the two groups: 83.3% ( n=20) had a satisfactory outcome (defined as Excellent or Better) with ALIF and 77.8% ( n=21) had a satisfactory outcome with ALIF-HH using the Oswestry Disability Index for post-operative assessment ( P>0.05). The results of this study indicate that the Hartshill horseshoe cage does improve the fusion rate, but does not affect clinical outcome.
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Randomized Controlled Trial Clinical Trial
Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage.
The objective of our study was to assess the efficacy of Graf ligamentoplasty in comparison with rigid fixation and fusion with the Hartshill horseshoe cage for similar severity of disc degeneration. Although studies have been done on the Graf ligamentoplasty procedure and the Hartshill horseshoe cage, their efficacy has never been compared in any study. This study was done to decide whether retaining mobility and stabilizing the spine is best or stiffening the lumbar segment by fusion is preferable. ⋯ At a minimum follow-up of 2.1 years, we found that 93% of patients who had undergone Graf ligamentoplasty had a satisfactory outcome (rated "excellent" or "better") compared to 77.8% of patients who had been treated with ALIF with Hartshill horseshoe cage stabilization and fusion, when measured on the Oswestry Disability Index ( P<0.05). Retaining mobility in the lumbar segments gives better results after stabilisation with Graf ligaments than rigid fixation and fusion with the Hartshill horseshoe cage in the short term. We will be watching this cohort of patients over the next few years.