European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This review will summarize the major efforts currently underway to develop osteoinductive bone graft substitutes for minimally invasive spine fusions. The primary categories of substitute include purified bone growth factors, recombinant bone growth factors, and growth factors delivered by gene therapy approaches. Clinical trials are underway for the purified and recombinant bone growth factors and pre-clinical studies have yielded promising results for a variety of gene therapy techniques for generating bone.
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Comparative Study
Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain.
The objective of this study was to conduct a radiological analysis of posture before and after lumbosacral fusion to evaluate the influence of spinal alignment on the occurrence and pattern of post surgical pain. The study included 81 patients, of whom 51 had a history of previous low back surgery. We excluded patients with suspected or confirmed nonunion. ⋯ Appropriate position of the fused vertebrae is also of paramount importance to minimize muscle work during posture maintenance. The main risk is failing to correct or to causing excessive pelvic retroversion with a vertical sacrum leading to a sagittal alignment that replicates the sitting position. This situation is often accompanied by loss of lumbar lordosis and adversely affects stiff or degenerative hips.
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Comparative Study
Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients.
The technique of posterior lumbar interbody fusion allows decompression of the spinal canal and interbody fusion through one posterior incision. A number of techniques exist to achieve additional posterior stability. The literature reports wide variation in outcomes for these different techniques. ⋯ All patients showed radiographic evidence of stable fixation. Four patients sustained a neurological complication, three of which resolved completely. The combination of PLIF with IPLF demonstrates clinical success, a stable circumferential fixation and a low complication rate.
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Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. ⋯ In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.
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Bioactive glass S53P4 and autogenous bone were used as bone graft materials in an experimental rabbit model for spinal fusion. The study focused on differences in bone formation using bioactive glass and autogenous bone as bone graft materials. Bioactive glass, a mixture of bioactive glass and autogenous bone or autogenous bone was implanted for 4 and 12 weeks at the thoracolumbar level. ⋯ By 12 weeks, no significant difference in bone formation between the three groups was observable. The bone formation in two selected standardized areas at 12 weeks was 21 and 24% in the glass group, 23 and 28% in the glass/autograft bone group and 27 and 26% in the autograft bone group. We consider bioactive glass as a potential bone graft material in experimental spinal fusion.