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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We have previously shown that the lumbar spine has an intrinsic shape specific to the individual and characteristic of sitting, standing and supine postures. The purpose of this study was to test the hypothesis that this intrinsic shape is detectable throughout a range of postures from extension to full flexion in healthy adults. ⋯ This study shows that an individual's intrinsic lumbar spine shape is quantifiable and detectable throughout lumbar flexion and extension. These findings will enable the role of lumbar curvature in injury and low back pain to be assessed in the clinic and in the working and recreational environments.
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Healthy subjects performed lumbar flexion and were assessed by video fluoroscopy to measure the in vivo kinematics of the lower lumbar motion segments. ⋯ L4-L5 exhibited the largest anterior and posterior margin strains (29 and 65%, respectively). Strains in the disc during in vivo lumbar flexion are due to both angular rotation and linear translation.
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The anterior approach is widely used for access to the lumbar spine in the setting of adult deformity either as a stand-alone procedure or in combined anterior-posterior procedures. Access-related complication rates have so far not been reported in an elderly patient population, in which it has been suggested that anterior lumbar surgery is indicated with caution. Here, the complication rates in patients over 60 years of age are reported. ⋯ Anterior lumbar surgery in an elderly population does not necessarily have higher overall complication rates than in a younger population. The risk of vascular injury requiring repair was higher, but has not resulted in major blood loss and the procedure therefore can be carried out safely. The overall complication rate and blood loss compare favourably to complication rates in posterior adult deformity procedures.
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The objective of our paper was to ascertain the self-reported competency level of surgeons who had completed a 1-year spine fellowship versus those who had not. Our secondary objective was to determine whether there was any difference between orthopaedic and neurosurgeons. ⋯ In order to provide an efficient and safe service covering the broad spectrum of spinal pathology, a formal spine fellowship, ideally with a formal curriculum, should be considered.
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Recent investigations using an ovine spine model have established that the disc nucleus contains a highly convoluted fibre network with endplate-to-endplate connectivity, this connectivity being achieved via distinctive nodal attachment points. The purpose of this study was to investigate how this nodal anchoring system might be influenced by maturation. ⋯ The nodal attachment points identified previously in mature ovine discs are also present in newborn, and 3- and 12-month-old animals with an initial rapid increase in their linear density between birth and 3 months, after which it remained constant. The size and morphology of the attachment points were similar for all ages. Our study suggests that the increase in nodal density in the ovine disc endplate is part of an adaptive response to the loading environment that the disc is exposed to from birth to maturity.