The American journal of orthopedics
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This comprehensive review article encompasses a broad variety of topics within the spinal literature and includes an update on the latest technology and techniques for the spine.
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The Food and Drug Administration (FDA) does more than regulate food and drug products. Through its medical device evaluation process, FDA affects every orthopedic surgeon's practice and every orthopedic patient every day. FDA regulations affect the development of each orthopedic device in some way, from the product's inception to its senescence, but the regulatory process and what the FDA's stamp of approval means are not part of the curriculum in medical school or residency. ⋯ How different types of devices get to the patient are reviewed, and the basics of the regulatory process are explained in this paper. Common myths are set straight, and FDA's concerns with "off-label" use are discussed. The role of the orthopedic surgeon in the regulatory process is also introduced.
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Lumbar discography, a useful modality for evaluating patients with lower back pain, is performed under fluoroscopy with posteroanterior and lateral fluoroscopic imaging. Despite use of fluoroscopy, needle placement into the L5-S1 disc may be difficult, especially in the presence of degenerative changes. We describe use of angled posteroanterior fluoroscopy with the fluoroscopy beam directed 30 degrees to 40 degrees caudally in a prone patient for clear visualization of the L5-S1 disc space. Use of this radiographic view aids in accurate needle placement and might decrease both procedure duration and fluoroscopic exposition.