The spine journal : official journal of the North American Spine Society
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Dural ectasia in the lumbosacral spine is a common feature of Marfan syndrome and is associated with low back pain and surgical complications, but its natural history is unknown. ⋯ During this 10-year period, the natural history of dural ectasia in adults with Marfan syndrome was not associated with a significant increase in ODI scores, dural ectasia size, or with the development/progression of spondylolisthesis or spondylolysis.
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Although several publications in the last decade have proved equality in safety and efficacy of the total disc replacement (TDR) to the anterior fusion procedure in cervical spine, the claim that TDR may reduce the incidence of adjacent segment disease (ASD) has not been corroborated by clinical evidence. ⋯ The incidence of symptomatic ASD after cervical TDR is 3.1% annually regardless of the patient's age, sex, smoking habits, and design of the TDR device. The presence of osteopenia and lumbar degenerative disease significantly increase the risk of developing ASD after anterior cervical surgery.
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Review Case Reports
Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review.
In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. ⋯ We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.
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Comparative Study
Comparison of the biomechanical effect of pedicle-based dynamic stabilization: a study using finite element analysis.
Recently, nonfusion pedicle-based dynamic stabilization systems (PBDSs) have been developed and used in the management of degenerative lumbar spinal diseases. Still effects on spinal kinematics and clinical effects are controversial. Little biomechanical information exists for providing biomechanical characteristics of pedicle-based dynamic stabilization according to the PBDS design before clinical implementation. ⋯ Implanted segments with PBDSs have limited ROM when compared with the intact spine. Center of rotation and stress distribution differed according to the design and materials used. These biomechanical effects produced a nonphysiological stress on the functional spinal unit when they were implanted. The biomechanical effects of current PBDSs should be carefully considered before clinical implementation.
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The rates of pseudoarthrosis after a single-level spinal fusion have been reported up to 35%, and the agents that increase the rate of fusion have an important role in decreasing pseudoarthrosis after spinal fusion. Previous studies have analyzed the effects of local insulin application to an autograft in a rat segmental defect model. Defects treated with a time-released insulin implant had significantly more new bone formation and greater quality of bone compared with controls based on histology and histomorphometry. A time-released insulin implant may have similar effects when applied in a lumbar spinal fusion model. ⋯ This study demonstrates the potential role of a time-released insulin implant as a bone graft enhancer using a rat posterolateral intertransverse lumbar fusion model. The insulin-treatment group had significantly higher fusion rates based on the radiographs and manual palpation and had significantly higher levels of IGF-I and significantly more bone volume on micro-CT.