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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There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a Goel-Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005-2007). ⋯ All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.
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Single level axial lumbar interbody fusion (AxiaLIF) using a transsacral rod through a paracoccygeal approach has been developed with promising early clinical results and biomechanical stability. Recently, the transsacral rod has been extended to perform a two-level fusion at both L4-L5 and L5-S1 levels (AxiaLIF II). No biomechanical studies have been conducted on multilevel fusion using the AxiaLIF technique. ⋯ In conclusion, the standalone rod reduced intact ROM significantly. Supplementary fixations including facet screws and pedicle screws are required to achieve higher construct stability for successful fusion. Further clinical studies are essential to evaluate the practical success of this technique.
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Multicenter Study Clinical Trial
Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up.
The interest in cervical total disc replacement (TDR) as an alternative to the so-far gold standard in the surgical treatment of degenerative disc disease (DDD), e.g anterior cervical discectomy and fusion (ACDF), is growing very rapidly. Many authors have established the fact that ACDF may result in progressive degeneration in adjacent segments. On the contrary, but still theoretically, preservation of motion with TDR at the surgically treated level may potentially reduce the occurrence of adjacent-level degeneration (ALD). ⋯ Finally, after 2 years, 91% of the patients assume that they would undergo the procedure again. These intermediate results of TDR with Mobi-C are very encouraging and seem to confirm the efficacy and the safety of the device. Regarding the preservation of the status of the adjacent levels, the results of this unconstrained device are encouraging, but longer FU studies are needed to prove it.
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Randomized Controlled Trial Comparative Study
Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?
Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related re-operation rate. ⋯ In this series, the Wallis interspinous implant changed the natural history of ASD and saved the two cephalad adjacent unfused vertebra from fusion, while it lowered the radiographic ASD incidence until to 5 years postoperatively. Longer prospective randomized studies are necessary to prove the beneficial effect of the interspinous implant cephalad and caudal to instrumented fusion. We recommend Wallis device for UCLA degeneration I and II.
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Multiple myeloma (MM) is a B cell malignancy characterized by important alterations of physiologic bone turnover, wherein increased osteoclastic bone resorption is not accompanied by a comparable increase in bone formation, resulting in diffuse osteopenia, focal lytic lesions, pathologic fractures, hypercalcemia, and bony pain. Consequently, patients with MM frequently require for quality of life's improvement and pain's treatment radiation therapy, surgery, and analgesic medication. Minimally invasive surgical procedures such as the kyphoplasty allows patients with pathological osteolytic vertebral lesions to have immediate improvement in their quality of life. ⋯ Segmental kyphosis angle correction showed a mean decrease of 1.7 degrees (range 0 degrees -2.5 degrees ) at radiographic control at 5-year follow-up, with respect to the immediate postoperative X-ray, although lower than preoperative. The data obtained demonstrated the effectiveness of kyphoplasty in the treatment of vertebral collapse in MM. The results achieved with this minimally invasive technique were clinically and biomechanically satisfactory.