The spine journal : official journal of the North American Spine Society
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Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates. ⋯ Even after adjusting for patient demographics and comorbidity, we observed a large variation in reoperation rates across hospitals and surgeons after lumbar discectomy, a relatively simple spinal procedure. These findings suggest uncertainty about indications for repeat surgery, variations in perioperative care, or variations in quality of care.
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Anterior cervical plating increases stability and hence improves fusion rates to treat cervical spine pathologies, which are often symptomatic at multiple levels. However, plating is not without complications, such as dysphagia, injury to neural elements, and plate breakage. The biomechanics of a spacer with integrated plate system combined with posterior instrumentation (PI), in two-level and three-level surgical models, has not yet been investigated. ⋯ The anatomically profiled spacer with integrated plate allows treatment of cervical disorders with fewer steps and less impact to cervical structures. In this biomechanical study, spacer with integrated plate construct showed comparable stability to traditional spacer and plate for two-level and three-level fusion. Posterior instrumentation showed significant effect only in three-level fusion. Clinical data are required for further validation of using spacer with integrated plate at multiple levels.
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The intervertebral disc plays a major functional role in the spinal column, providing jointed flexibility and force transmission. The end plate acts as an important structural transition between the hard vertebral tissues and the compliant disc tissues and is therefore a region of potentially high stress concentration. The effectiveness of anchorage of the tough annulus fibers in the end plate will have a major influence on the overall strength of the motion segment. Failure of the end plate region is known to be associated with disc herniation. ⋯ Given both the limited thickness of the end plate and the intrinsic strength of the interface bond between bundle and end plate matrix, the branched morphology is consistent with a mechanism of optimal shear stress transfer wherein a greater strength of annular fiber anchorage can be achieved over a relatively short insertion distance.