Spine
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Comparative Study
Threaded fusion cages for lumbar interbody fusions. An economic comparison with 360 degrees fusions.
This study compared the surgical and hospitalization costs, operating times, and blood loss attributable to lumbar interbody fusions at one and two lumbar levels by the use of two device systems: 1) the Ray Threaded Fusion Cage, and 2) an anteroposterior interbody technique with pedicle screw and rod stabilization (360 degrees fusion). The clinical efficacy and complication rate of each method were similar. ⋯ Assuming that the fusion success, clinical outcome, and complication rates are sufficiently similar between these two techniques, the striking improvement in overall surgical and hospitalization costs, surgical time, and blood losses provided by the threaded fusion cage technique can be major decision points in method selection. Further, no threaded fusion cage case having a normal adjacent level preoperatively developed a fusion transition syndrome over a followup period from 3 to 29 months (averaging 24 months) that required a second fusion procedure, and no cage had to be removed because of instrumentation-associated pain, although each of these problems are known to occur in at lease 10% of pedicle screw implants. Ten of the 25 (40%) 360 degrees fusion cases in this study required subsequent instrumentation removal, although no case has required adjacent level surgery for transition syndrome.
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Comparative Study
Comparison of interbody fusion approaches for disabling low back pain.
This is a study comparing two groups of patients surgically treated for disabling low back pain. One group was treated with lumbar anteroposterior fusion (360 degrees fusion), the other with posterior lumbar interbody fusion and an interbody fixation device. ⋯ Posterior lumbar interbody fusion-BAK achieves equal patient satisfaction but fiscally surpasses the 360 degrees fusion approach. Today's environment of regulated medical practice requires the surgeon to consider cost effectiveness when performing fusion for low back pain.
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A series of patients were prospectively studied to determine the morbidity and possible complications of minimally invasive anterior lumbar interbody fusion by two new microsurgical approaches (retroperitoneal for segments L2-L3, L3-L4, and L4-L5, and transperitoneal for L5-S1). ⋯ The microsurgical approaches described in this article are atraumatic techniques to reach the lumbar spinal levels L2-L3, L3-L4, L4-L5, and L5-S1. They represent microsurgical modifications of the surgical approaches well known to the spine surgeon. They can be learned in a step-by-step fashion, starting with a conventional skin incision and, once the surgeon is familiar with the instruments, moving on to the microsurgical technique. The approaches are not restricted to the type of fusion (iliac crest autograft) presented in this series.
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Multicenter Study Clinical Trial
Threaded titanium cages for lumbar interbody fusions.
This study evaluated safety, fusion success rate, and clinical outcome of a new lumbar interbody hollow, threaded titanium fusion cage in a multicenter, prospective 236-case program adhering to a United States Food and Drug Administration Investigational Device Exemption controlled protocol. ⋯ The Ray titanium fusion cage (Surgical Dynamics, Norwalk, CT) implant method has been found to be an effective, rapid, safe procedure for lumbar spine fusions, demonstrating a high fusion rate and clinical success with rare, serious, or permanent complications.