Spine
-
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.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain.
A prospective randomized controlled trial. ⋯ The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone. The present study showed that short, specific treatment programs with proper patient information may alter the course of chronic low back pain.
-
Review Meta Analysis
Physical conditioning programs for workers with back and neck pain: a cochrane systematic review.
To determine the effect on time lost from work of physical conditioning programs for workers with back and neck pain. DATA SOURCES Randomized trials were located by searching MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Controlled Trial Register, and PEDro. ⋯ Physical conditioning programs that incorporate a cognitive-behavioral approach reduce the number of sick days for workers with chronic back pain when compared to usual care.
-
Experimental scoliosis was created in an immature goat model. ⋯ This study establishes an experimental model for scoliosis that creates progressive, structural, idiopathic-type, lordoscoliotic curves convex to the right in the thoracic spine of the immature goat with high statistical significance (P < 0.001). In addition, this method of experimental scoliosis creation avoids violation of the spinal elements throughout the maximal portion of the curve providing an ideal opportunity subsequent study of the deformity.
-
Comparative Study Clinical Trial
Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support.
A radiographic and clinical outcomes analysis of 41 patients treated for thoracolumbar adolescent idiopathic scoliosis utilizing a single anterior rigid rod construct. ⋯ The use of interbody structural support does not appear to be necessary to maintain an appropriate sagittal profile or to maximize coronal curve correction when a rigid rod construct with packed morselized bone is used for the treatment of thoracolumbar adolescent idiopathic scoliosis. Parameters predicting horizontalization of the lower instrumented vertebra and uninstrumented segments below the construct were identified, which, if achieved, should predict an optimal long-term outcome. Clinical outcomes were very good in both groups.