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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Randomized Controlled Trial Comparative Study
A prospective randomized study comparing a cervical carbon fiber cage to the Smith-Robinson technique with allograft and plating: up to 24 months follow-up.
Intervertebral carbon fiber cages may reduce graft collapse and promote bony fusion. Their safety and efficacy in the cervical spine have been investigated; however, no study has compared the outcomes of anterior cervical decompression and placement of a carbon fiber cage with placement of allograft and plate. ⋯ The outcomes after cervical decompression and placement of a carbon fiber cage appear to be similar to cervical decompression with allograft and plating by the Smith-Robinson technique.
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Polyetheretherketone (PEEK) is a novel polymer with potential advantages for its use in demanding orthopaedic applications (e.g. intervertebral cages). However, the influence of a physiological environment on the mechanical stability of PEEK has not been reported. Furthermore, the suitability of the polymer for use in highly stressed spinal implants such as intervertebral cages has not been investigated. ⋯ The stress and strain maxima in the implants were well below the material strength limits of PEEK. In summary, the experimental results verified the mechanical stability of the PEEK-OPTIMA polymer in a simulated physiological environment, and over extended loading periods. Finite element analysis supported the use of PEEK-OPTIMA for load-bearing intervertebral implants.
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A retrospective clinical-radiological study to evaluate the long-term outcome after artificial disc replacement was performed. The objective is to investigate long-term results after implantation of a modular type artificial disc prosthesis in patients with degenerative disc disease (DDD). Total disc replacement (TDR) is a surgical procedure intended to save segmental spinal function, and thus replace spondylodesis. ⋯ Although no adjacent segment degeneration was observed in the functional implants (17%), these patients were significantly less satisfied than those with spontaneous ankylosis. TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing.
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In degenerative disc disease (DDD), increased loading in the posterior column increases facet joint subchondral bone density and may lead to facet joint degeneration. While spinal fusion is commonly used to treat patients with symptomatic DDD, increased stress at the levels adjacent to fusion may accelerate facet joint and adjacent segment degeneration. Artificial disc replacements have been developed as an alternative to fusion. ⋯ In this study, replacement of degenerated intervertebral discs with the CHARITE Artificial Disc was not associated with increased loading of the facet joints at the operated or adjacent levels. Decreases in subchondral bone density may indicate reduced loading in the posterior column following disc replacement compared with loading in the pre-operative degenerated spine. Further study is required to establish the baseline for healthy subchondral bone density and to compare this baseline with long-term measurements in patients undergoing disc replacement.
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Two cases with a long-standing thoracolumbar kyphosis due to ankylosing spondylitis are presented with a symptomatic localized destructive kyphotic lesion of the spine. Clinical and radiographic findings demonstrated a progressive vertebral and discovertebral kyphotic pseudarthrosis, known as an Andersson lesion, at the L1 and L1-2 level, respectively. ⋯ The indication for surgery, the surgical technique and the 2 years' clinical results are described. In addition, the difficulties experienced with preoperative deformity planning are evaluated.