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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Dynamic stabilization of the spine has been performed since the 1990s with the double purpose of restoring spinal segmental stability and allowing residual movement at the operated level. When we take into account the different motion-preserving devices and the spinal areas where they are applied, we can identify three categories of spinal implants: anterior cervical, anterior lumbar, and posterior lumbar. However, as in all prosthetic procedures performed in orthopedic surgery, the life span of a joint replacement device is a central topic of discussion, and this is true also for spinal dynamic devices, being revision surgery a complex procedure in specific cases. ⋯ Surgical revision of spinal dynamic implants could be a demanding surgery especially in anterior approaches. Anterior cervical revision remains globally safe, but careful preoperative evaluation of vessels and ureter are suggested to avoid intraoperative complications in the lumbar spine. In posterior revision, a proper sagittal alignment of the spine should be restored. These slides can be retrieved under Electronic Supplementary Material.
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Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques.
Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for complex deformity correction and is commonly associated with pseudoarthrosis, implant failure and loosening. This study compared pedicle screw fixation (PED) with three different sacropelvic fixation techniques, namely iliac screws (IL), S2 alar-iliac screws (S2AI) and laterally placed triangular titanium implants (SI), all in combination with lumbosacral instrumentation, accounting for implant micromotion. ⋯ Fixation with triangular implants did not result in stress increase on the lumbosacral instrumentation, likely due to the lack of connection with the posterior rods. IL and S2AI had a mild protective effect on S1 pedicle screws in terms of stresses and bone-implant loads. IL resulted in an increase in the rod stresses. A comparison between this study and previous work incorporating full osteointegration demonstrates how these results may be applied clinically to better understand the effects of different treatments on patient outcomes. These slides can be retrieved under Electronic Supplementary Material.
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To compare the clinical and economic outcomes of facet versus pedicle screw instrumentation for single-level circumferential lumbar spinal fusion. ⋯ One-level circumferential spinal fusion using facet screws was clinically superior and provided cost savings compared with pedicle screw instrumentation in the USA.
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To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). ⋯ Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume. These slides can be retrieved under Electronic Supplementary Material.
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Gamma-aminobutyric acid analogues are commonly used to treat neuropathic and chronic pain before and after spinal surgery in recent years. Aim of this study is to investigate the influence of pregabalin on spinal fusion and to determine the proper pregabalin dose for postoperative utilization in a validated rat intertransverse spinal fusion. ⋯ Histological analysis and manual palpation results showed inhibition of spinal fusion formation with high doses of pregabalin. According to these results, administration of high-dose pregabalin should be avoided at the postoperative period until successful fusion is obtained in patients who undergo spinal fusion surgery. These slides can be retrieved under electronic supplementary material.