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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Endoscopic surgery of the thoracic spine has up to now been considered as an experimental procedure. Reports published in recent years have shown that the results achieved with this technique are as good as, or for some indications superior to, those reported for classic open approaches. A review of the indications, limitations, advantages and disadvantages is presented. Although there is still resistance to acknowledging the effectiveness of this procedure, experience has shown that the results are as good, complications are fewer and postoperative recovery is improved, thus shortening the total hospitalization time.
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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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Computer assistance has been shown to improve significantly the accuracy and safety of pedicle screw insertion under clinical conditions. The technique of image-guided navigation is described in this article, based on the authors' clinical experience of over 4 years. ⋯ Pros and cons of computer guidance are discussed. The authors predict computer navigation will be used in percutaneous and minimally invasive procedures in the near future.
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Indications and timing of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the conditions, were reviewed. Advances in spinal imaging and accumulation of clinical experience have provided some clues as to indications and timing of surgery for cervical myelopathy. Duration of myelopathy prior to surgery and the transverse area of the spinal cord at the maximum compression level were the most significant prognostic parameters for surgical outcome. ⋯ When surgery is properly carried out, long-term surgical results are expected to be good and stable, and the natural course of myelopathy secondary to cervical spondylosis may be modified. However, little attention has been paid to the questions "When and what can surgery contribute to treatment of cervical radiculopathy?". A well-controlled clinical study including natural history should be done to provide some answers.
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Interbody cages in the lumbar spine have met with mixed success in clinical studies. This has led many investigators to supplement cages with posterior instrumentation. The objective of this literature review is to address the mechanics of interbody cage fixation in the lumbar spine with respect to three-dimensional stabilization and the strength of the cage-vertebra interface. ⋯ The axial compressive strength of this interface is highly dependent upon vertebral body bone density. Other factors such as preservation of the subchondral bony end-plate and cage design are clearly less important in the compressive strength. Supplementary posterior instrumentation does not enhance substantially the interface strength in axial compression.