Spine
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In treating patients with idiopathic scoliosis and Lenke 1C curves, surgeons must choose between selective fusion of the thoracic spine (STF) and nonselective fusion of the thoracic and lumbar spines. Research shows mixed results. Demura et al reported that 40% of patients who had undergone selective fusion of the thoracic curve were decompensated 2 cm after 2 years, and 89% of those treated with nonselective fusion were balanced in the thoracic and lumbar planes, regardless of preoperative balance.
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When spinal cord injury (SCI) occurs, injured cells must survive and regenerate to close gaps caused by the injury and to create functional motor units. After peripheral nerve injury, Wallerian degeneration in the distal nerve stump creates a neurotrophic and growth-supportive environment for injured neurons and axons via Schwann cells and secreted cytokines/neurotrophins. In both SCI and peripheral nerve injury, injured motor and sensory neurons must regenerate axons, eventually reaching and reinnervating target tissue (SDC Figure 1, http://links.lww.com/BRS/B116). This process is often unsuccessful after SCI, and the highly complex anatomy of branching axons and nerves in the peripheral nervous system leads to slow recovery of function, even with careful and appropriate techniques.
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Improving spinal fusion by optimizing scaffold and surface engineering is a topic of interest for both surgeons and researchers. Concerns regarding patient safety with off-label use of bone morphogenetic protein (BMP) have increased, and patients are choosing minimally invasive spine surgery to lessen morbidity by avoiding harvest of bone graft. These trends may be driving studies on how surgeons can avoid issues associated with biologics (e.g., cost, morbidity), while achieving efficacious and safe bone fusion.
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Preclinical animal study. ⋯ NA.