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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Accelerated degenerative changes at intervertebral levels adjacent to a spinal fusion, the so-called adjacent segment degeneration (ASD), have been reported in many clinical studies. Even though the pathogenesis of ASD is still widely unknown, biomechanical in vitro approaches have often been used to investigate the impact of spinal instrumentation on the adjacent segments. The goal of this review is (1) to summarize the results of these studies with respect to the applied protocol and loads and (2) to discuss if the assumptions made for the different protocols match the patients' postoperative situation. ⋯ The three test protocols mainly differ in the assumption on the postoperative motion behavior of the patients, which is the main reason for the conflicting findings. However, the protocols have never been validated using in vivo kinematic data. In a parallel review on in vivo kinematics by Malakoutian et al., it was found that the assumption that the patients move exactly the same after fusion implemented with the stiffness- and hybrid protocol does not match the patients' behavior. They showed that the motion of the whole lumbar spine rather tends to decrease in most studies, which could be predicted by the flexibility protocol. However, when the flexibility protocol is used with the "gold standard" pure moment, the difference in the kinematic changes between the cranial and caudal adjacent segment cannot be reproduced, putting the validity of current in vitro protocols into question.
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Multicenter Study Observational Study
Maverick total disc replacement in a real-world patient population: a prospective, multicentre, observational study.
Controlled trials have shown that total disc replacement (TDR) can provide pain and disability relief to patients with degenerative disc disease; however, whether these outcomes can also be achieved for patients treated in normal surgical practice has not been well documented. ⋯ This is the first international observational study to report outcomes of TDR in real-world clinical settings. We showed statistically significant improvements in disability and pain scores at 6 months following Maverick TDR, which were maintained for 2 years alongside an acceptable rate of perioperative complications. The safety and tolerability shown in this observational study were comparable to those from controlled trials.
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Review
Factors that may affect outcome in cervical artificial disc replacement: a systematic review.
To identify the factors that may affect outcome in C-ADR and provide the pooled results of postoperative success rate of implanted segment range of motion (ROM), incidence of heterotopic ossification (HO), incidence of radiographic adjacent segment degeneration (r-ASD)/adjacent segment disease (ASD), and surgery rate for ASD. ⋯ The available evidence showed that most of the pre-selected factors had no effect on outcome after C-ADR, and the ROM success rate, incidence of HO and r-ASD/ASD, and surgery rate for ASD are acceptable. There is a lack of evidence from RCTs for some factors.
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To assess the efficacy of a novel preemptive multimodal analgesic regimen for reducing postoperative pain and complications after primary lumbar fusion surgery. Preemptive multimodal analgesia is revealed to be an effective alternative to conventional morphine administration providing improved postoperative pain control with diminished side effects. However, an optimal regimen for spinal fusion surgery remains unknown. ⋯ The preemptive multimodal analgesic combination in this study appears to be safe and effective after lumbar fusion surgery.