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 cortical bone trajectory (CBT) is an alternative to the traditional pedicle screw trajectory (TT) in posterior spinal instrumentation, enhancing screw contact with cortical bone and therefore increasing fixation strength. Additional to the trajectory, insertion depth (pericortical vs. bicortical placement) could be a relevant factor affecting the fixation strength. However, the potential biomechanical benefit of a bicortical placement of CBT screws is unknown. Therefore, the aim of this study was to quantify the fixation strength of pericortical- versus bicortical-CBT (pCBT versus bCBT) screws in a randomized cadaveric study. ⋯ The authors do not recommend placing CBT screws bicortically, as no relevant biomechanical advantage is gained while the potential risk for iatrogenic injury to structures anterior to the spine is increased.
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Biomechanical comparison between rigid and non-rigid posterior stabilization systems following lumbar interbody fusion has been conducted in several studies. However, most of these previous studies mainly focused on investigating biomechanics of adjacent spinal segments or spine stability. The objective of the present study was to compare biomechanical responses of the fusion devices when using different posterior instrumentations. ⋯ Compared with conventional rigid posterior stabilization system, the use of non-rigid stabilization system (i.e., the PEEK rod system and DIAM system) following lumbar interbody fusion might increase the risks of cage subsidence and cage damage, but promote bony fusion due to higher stress in the bone graft. For the pedicle screw-based rod stabilization system, using PEEK rod might reduce the risk of screw breakage but increased breakage risk of the rod itself.
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Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool. ⋯ Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low-high risk patients for re-HNP. Additional validation is needed for potential global implementation.
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The authors describe a percutaneous technique to treat advanced degenerative disk disease in elderly patients. ⋯ Percutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.
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Observational Study
Classification of endplate lesions in the lumbar spine and association with risk factors, biochemistry, and genetics.
To detect the associations between the degree of the endplate (EP) lesions with the presence of risk factors, biochemical and genetic markers previously observed in low back pain (LBP) patients with EP defects in comparison with hernia/discopathy patients and healthy controls. ⋯ The markers previously identified as associated with the presence of EP lesions have been confirmed as related to their severity and could be used to follow the pathology progression.