Spine
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Review Comparative Study
Anterior cervical discectomy and fusion using a porous hydroxyapatite bone graft substitute.
This study analyzed the use of a coral hydroxyapatite bone substitute for use in ACDF both with and without an anterior cervical plate. ⋯ The use of a coral-based hydroxyapatite bone graft substitute for anterior cervical fusions led to significant rates of implant collapse at 12 weeks but showed excellent biologic compatibility with good early creeping substitution of the implant by host bone. The concomitant use of an anterior cervical plate with the implant prevents extrusion.
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The authors evaluated transverse atlantal ligament integrity in patients with fractures of the odontoid process of the axis. ⋯ Osteoperiosteal ligamentous avulsion injuries were identified on MR imaging in three patients and were associated with acute and delayed instability and nonunion. The combination of MR imaging, CT, and plain radiographs is useful in evaluating unstable odontoid fractures to facilitate rational treatment planning. Odontoid fractures with transverse ligament injuries should be considered for early surgical stabilization because this combination of injuries is unlikely to heal nonoperatively. Anterior odontoid screw fixation should be avoided when the ligament is injured.
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Transverse areas of the spinal canal, the dural tube and the spinal cord of the cervical spine of normal adults and patients with cervical spondylotic myelopathy (CSM) were analyzed by magnetic resonance imaging (MRI). ⋯ These results suggest that the narrow area and high ratio of the spinal canal to the spinal cord are responsible for a static factor in CSM.
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This study retrospectively reviewed consecutive spinal cord injured patients older than 50 years of age. ⋯ Incomplete cervical cord lesions have the best prognosis for return to home and a functional lifestyle. Complete cervical cord injuries in patients older than 50 years of age have a 60% mortality rate. Complete cervical cord injuries in patients over 65 years have a poor prognosis for survival.
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A retrospective study of all patients who underwent spinal fusion between 1986 to 1989 with inexpensive, locally made unconventional pedicle spinal instrumentation systems was undertaken. Implants were made with passivated 316L stainless steel, and a single level of instrumentation cost +f430. ⋯ Anterior column reconstruction in anterior column deficient spines will re-create the normal biomechanics and significantly reduce the incidence of implant failures and loss of sagittal alignment with these systems. Pedicle screw failure in itself is not necessarily associated with a bad result. These inexpensive, locally made unconventional systems, with the proper understanding of biomechanics and creation of appropriate load-sharing constructs, are as good as the conventional systems available today.