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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The violation of the cranial adjacent facet is a frequent complication in lumbar instrumentations and can induce local pain and adjacent segment disease. Minimally invasive screw implantation is often stated as risk factor in comparison with open approaches. Percutaneous pedicle screw placement (PPSP) can be performed using single X-ray images (fluoroscopy) or intraoperative 3D navigation. The study compares top-level screws in percutaneous lumbar instrumentations regarding facet violations and screw pedicle position using navigation or fluoroscopy. ⋯ Both intraoperative imaging techniques allow lumbar PPSP with low rates of cranial facet violations if the surgeon intends to preserve facet integrity. Navigation was superior concerning accurate pedicle screw position, but could not significantly prevent facet violations.
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Lumbar interbody fusion (LIF) is a treatment option for low back pain secondary to lumbar instability and/or deformity. This review highlights recent studies of surgical techniques and bone healing strategies for LIF. ⋯ There have been significant advances in surgical technologies for LIF over the past decades. Post-operative non-union remains a major challenge, which could be addressed by development of more effective surgical techniques, fusion cages, and bone healing products through joint efforts from spine surgeons, bone biologists, and material engineers.
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Many patients receive magnetic resonance (MR) and computed tomography (CT) scans post-operatively to review screw placement. Traditionally, CT is diagnostic but as metal artefact reduction sequences are advancing in MR, the necessity for both MR and CT scans is questionable. The objective is to establish the statistical agreeability of MR and CT for evaluation of adequate screw placement in posterior lumbar interbody fusion. ⋯ Level III retrospective cohort study.
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Percutaneous pedicle screw (PPS) fixation has been commonly used for various spine surgeries. Rigid PPS fixation is necessary to decrease the incidence of screw loosening in osteoporotic spine. Recently, we have reported biomechanical advantages of augmentation technique using hydroxyapatite (HA) granules for PPS fixation in synthetic bone. However, its biomechanical performance in augmenting PPS fixation for osteoporotic spine has not been fully elucidated. The aim of the present study is to perform a cadaveric biomechanical analysis of PPS fixation augmented with HA granules. ⋯ The PPS fixation was significantly enhanced by the augmentation with HA granules in the osteoporotic lumbar spine. The PPS fixation augmented with HA granules might decrease the incidence of screw loosening and implant failure in patients with osteoporotic spine.
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To present a radiographic analysis of the anatomy of the lumbar plexus and retroperitoneal blood vessels with respect to psoas morphology and safe working zones (SWZ) for LLIF. ⋯ A detailed study of preoperative MRI scans should be carried out in patients planned for LLIF-particularly, at L4-L5 level and in females. A left-sided trans-psoas approach is safer to perform compared to the right side-a right-sided approach should be avoided at L4-L5 considering the narrow SWZ at that level.