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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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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Clinical Trial
A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation.
A new computer-based navigation system for spinal surgery has been designed. This was achieved by combining intraoperative fluoroscopy-based imaging using conventional C-arm technology with free-hand surgical navigation principles. Modules were developed to automate digital X-ray image registration. ⋯ Stereotactic instruments and graphical user interfaces for image-interactive transpedicular screw insertion have been developed. A detailed validation of the system was performed in the laboratory setting and throughout an early clinical trial including eight patients in two spine centers. Based on the resulting data, the new technique promises improved accuracy and safety in open and percutaneous spinal surgery.
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A 32-year-old woman, addicted to heroin, presented with a dorsal spondylodiscitis due to Candida albicans associated with epidural abscess. Antimycotic treatment was successful, and no neurosurgical decompression was necessary. To our knowledge, this is the first case of documented epidural involvement in candidal spondylodiscitis. The diagnosis of candidal spondylodiscitis should be considered in cases of para- or tetraplegia occurring in intravenous drug abusers.
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The most readily available source for autologous bone graft used in spinal fusion (the gold standard) is the iliac crest. However, the open surgical approach for harvesting corticocancellous iliac bone is associated with a marked increase in morbidity. This study suggests two alternatives to the traditional open harvesting procedure. ⋯ Regional bone graft harvest in anterior spine surgery is suggested to be anatomically safe and biomechanically acceptable. Any of the three filler materials can restore the vertebral body's mechanical strength, but the filler's long-term resorption/remodeling or osteointegration behavior is unknown. The minimally invasive bone graft harvester is a novel tool, which performed satisfactorily under laboratory conditions, but clinical results are still missing.
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Comparative Study
Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs.
Anterior lumbar interbody fusion (ALIF) cages are expected to reduce segmental mobility. Current ALIF cages have different designs, suggesting differences in initial stability. The objective of this study was to compare the effect of different stand-alone ALIF cage constructs and cage-related features on initial segmental stability. ⋯ The performance of stand-alone ALIF cage constructs generally increased the NZ in any loading direction, suggesting potential directions of initial segmental instability that may lead to permanent deformity. Differences between cages in flexion/extension and lateral bending NZ are attributed to the severity of geometrical cage-endplate surface mismatch. Stand-alone cage constructs reduced ROM effectively, but the residual ROM present indicates the presence of micromotion at the cage-endplate interface.