Spine
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Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography. ⋯ Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.
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Lumbar spinal instability was evaluated using radiographic parameters and intraoperative biomechanical measurement. ⋯ Disc angle in flexion and ROM were the most prognostic parameters of lumbar distraction instability. Although the option of spinal arthrodesis method should be determined based on both clinical manifestation and imaging studies, the current study demonstrated that providing of anterior column support is biomechanically reasonable for degenerative spondylolisthesis with segmental kyphosis in flexion.
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Radiographic evaluation of bony union and clinical outcome were investigated after posterior lumbar interbody fusion (PLIF) performed with only local bone. ⋯ A 100% bony union rate was obtained 12 months after PLIF with only local bone. The results showed that clinical viability of local bone as a source of bone graft in PLIF.
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Comparative Study
Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament.
Benchtop cadaveric biomechanical comparative testing and caprine animal model in vivo implantation. ⋯ There are two basic types of total knee replacements, posterior cruciate ligament-preserving and posterior cruciate ligament-sacrificing designs. In the cervical spine, an analogous situation exists biomechanically depending on whether the posterior longitudinal ligament needs to be removed in its entirety as part of the spinal cord decompression part of the procedure--it may be helpful to conceptually differentiate between posterior longitudinal ligament-preserving and posterior longitudinal ligament-sacrificing total cervical disc replacements.
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Generally, implant-induced osteolysis is a manifestation of an adverse cellular response to phagocytosable particulate wear and corrosion debris. Initially termed "cement disease," particle-induced loosening was recognized by Charnley in the early 1960s. Despite the plethora of information gained over the last 40 years on the basic science of periprosthetic bone loss, much remains unanswered. The effect of unintended debris resulting from wear and corrosion (e.g., micromotion between the interconnection mechanisms in spinal implants) remains a clinical concern. The current study highlights what is known of particle-induced osteolysis and how the presence of spinal implant particulate debris deleteriously influences osseointegration of posterolateral bone graft or disrupts an established posterolateral fusion mass. Tissue explant, animal, and cell culture studies have revealed the complexity of cellular reactivity involved in aseptic particle-induced osteolysis. ⋯ More basic science and clinical research is needed to develop novel strategies for gaining knowledge, and developing effective evaluation and treatment of patients with implant debris related osteolysis. Titanium debris simulating that produced by spinal implants introduced at the level of a spinal arthrodesis elicits an inflammatory cytokine mediated particulate-induced response through increased expression of intracellular TNF-alpha, increased osteoclastic activity and cellular apoptosis. This study highlighted the association between spinal implants particulate wear debris and increased potential for osteolysis. Aseptic osteolysis is among the primary reasons for failure of orthopedic implants. Increased awareness of this destructive process is becoming more important with the growing popularity of total disc arthroplasty and highly modular spinal implants.