Journal of spinal disorders & techniques
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J Spinal Disord Tech · Feb 2005
Clinical TrialComputer-guided percutaneous interbody fixation and fusion of the L5-S1 disc: a 2-year prospective study.
The clinical outcomes of lumbar fusion are diminished by the complications associated with the surgical approach. Posterior approaches cause segmental muscular necrosis and anterior approaches risk visceral and vascular injury. This report details a two-year prospective study of a percutaneous method which avoids the major problems associated with existing approaches. ⋯ Percutaneous fusion of the lumbosacral spine appears safe and provides excellent clinical results with a minimal amount of associated tissue trauma.
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J Spinal Disord Tech · Feb 2005
Case Reports Clinical TrialPosterior lumbar interbody fusion using dense hydroxyapatite blocks and autogenous iliac bone: clinical and radiographic examinations.
Posterior lumbar interbody fusion (PLIF) is a standard surgical technique for the lumbar degenerative diseases. However, some problems such as collapse or retropulsion of the grafted bone and pseudoarthrosis have been reported when autogenous or cadaveric bone is used. Two iliac bone blocks with one-side cortex and one dense hydroxyapatite (HA) block were grafted together into the interbody space as in a sandwich. ⋯ Sinking was observed in 8 of 34 segments (23.5%), and cracking of HA block was observed in 6 segments (17.6%). A mean loss of lordosis was found to be 2.4 degrees. The dense HA block is a useful substitute for autogenous bone graft for PLIF.
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J Spinal Disord Tech · Feb 2005
Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure.
Vacuum-assisted wound closure (VAC) exposes the wound bed to negative pressure, resulting in removal of edema fluid, improvement of blood supply, and stimulation of cellular proliferation of reparative granulation tissue. It has been used to treat open wounds in the extremities, open sternal wounds, pressure ulcers, and abdominal wall wounds. This study retrospectively reviewed instrumented spine fusions complicated by surgical wound infection and managed by a protocol including the use of VAC in order to evaluate the efficacy of applying vacuum therapy on patients with deep spine infections and exposed instrumentation. ⋯ VAC therapy is an effective adjunct in closing complex deep spinal wounds with exposed instrumentation.
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J Spinal Disord Tech · Feb 2005
Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters.
The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and orientation of the pelvis and cervical, thoracic, and lumbar spine. ⋯ These results confirm that the pelvis and spine in the sagittal plane can be considered as a linear chain linking the head to the pelvis where the shape and orientation of each anatomic segment are closely related and influence the adjacent segment to maintain a stable posture with a minimum of energy expenditure. Changes in shape or orientation at one level will have a direct influence on the adjacent segment. Knowledge of these normal relationships is of prime importance for the comprehension of sagittal balance in normal and pathologic conditions of the spine and pelvis.
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J Spinal Disord Tech · Feb 2005
Structures at risk following anterior instrumented spinal fusion for thoracic adolescent idiopathic scoliosis.
With the increasing popularity of anterior instrumented spinal fusion for adolescent idiopathic scoliosis, there has also been a rising concern over the proximity of the descending aorta to the screw tips and the possibility of vessel wall erosion over time. This computed tomography (CT) study attempts to define the relative position of the thoracic aorta and other vital structures to the spine (preoperatively) and to the projected instrumentation (postoperatively) by level and curve magnitude in deformity patients. ⋯ The course of the thoracic aorta may vary in individuals; however, in deformity patients, it generally moves from a relatively anterolateral position proximally to a posteromedial position at the apex. Distally, it moves more anteriorly. Consequently, the aorta moves closer to the screw tips both at the apex and distally, whereas the distal screws are more frequently juxtaposed to the descending aorta (P < 0.05).