Spine
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Comparative Study
Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion.
Retrospective radiographic evaluation of the sagittal alignment of the lumbar spine in patients undergoing short-segment instrumented posterior lumbar interbody fusion with cage systems of different shape. ⋯ The cage geometry has a significant impact on the alignment of the lumbar spine after instrumented posterior lumbar interbody fusion. With rectangular cages, lumbar lordosis and segmental lordosis of the segments fused decrease; sagittal balance is maintained by compensatory changes of the sacral tilt. Wedge-shaped cages significantly increase segmental lordosis, enhance lumbar lordosis, and therefore should be preferred for restoring sagittal alignment in instrumented posterior lumbar interbody fusion procedures.
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A literature review of experiences with vertebroplasty and kyphoplasty for treating symptomatic, osteoporotic vertebral compression fractures (VCFs). ⋯ Vertebroplasty and kyphoplasty are currently used to treat osteoporotic VCFs with successful short-term results. Prospective, randomized studies comparing these procedures to one another and comparing their long-term outcomes to conventional medical management are required to define precise roles of these exciting treatments in the spine physician's armamentarium.
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This article reviews the potential utilization of various growth factors to enhance spinal fusion and outlines the principles of gene therapy and its application to spinal fusion surgery. ⋯ Gene therapy strategies for spine fusion are appealing because the setting is uniquely suited for genetic manipulation. The intervention is locally applied. Only a short duration of transgene response by the cells is necessary to establish a spine fusion, and a variety of osteoinductive growth factors have been identified and are available for use. Attempts at spine fusion using gene therapy in the lower animals have been successful using both in vivo and ex vivo approaches. Before human clinical trials can be established, further testing is required in more challenging animal models of bone induction such as nonhuman primates. Should a successful clinical program of gene therapy for spine fusion be established, the use of autograft and its associated morbidities could be eliminated. In fact, gene therapy offers the potential for minimally invasive applications that could bypass the need for an open procedure altogether. It is likely that gene therapy will be a powerful therapeutic tool for the spine surgeon in the new millennium.
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Secondary analysis of data collected from spine patients' normal clinic visits from 1998 to 2001. ⋯ The short form 12-item survey demonstrated good internal consistency reliability, construct validity, and responsiveness in patients with back pain.
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Retrospective study of consecutive patient series. ⋯ Patients with global sagittal imbalance of the spine were effectively treated with a combined anterior and posterior arthrodesis as measured by radiographic parameters. Patient satisfaction with surgery, and overall clinical outcomes were best in cases that resulted in an increase in lumbar lordosis. The subset of patients with preoperative regional hypolordosis of the lumbar spine has better outcomes than those with preoperative lumbar lordosis in the physiologic range.