The American journal of orthopedics
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Multicenter Study Clinical Trial
Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up.
The clinical benefits and complications of posterior lumbar interbody fusion (PLIF) have been studied over the past 60 years. In recent years, spine surgeons have had the option of treating low back pain caused by degenerative disc disease using PLIF with machined allograft spacers and posterior pedicle fixation. The purpose of this clinical series was to assess the clinical benefits of using a machined PLIF allograft spacer and posterior pedicle fixation to treat degenerative disc disease, both in terms of fusion rates and patient outcomes, and to compare these results with those in previous studies using autograft and metal interbody fusion devices. ⋯ The graft-related complication rate among all patients who underwent PLIF was 1.61%. When performed with machined allograft spacers and posterior pedicle fixation, PLIF is a safe and effective surgical treatment for low back pain caused by degenerative disc disease. The patients in this clinical series had outcomes equal or superior to the outcomes in previous series.
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Randomized Controlled Trial
Acute operative stabilization versus nonoperative management of clavicle fractures.
We conducted a prospective, randomized study to determine if patients with midshaft clavicle fractures would benefit from immediate operative stabilization with a modified Hagie pin in comparison with a matched group treated with nonoperative therapy. At a level II trauma center, patients with closed midshaft clavicle fractures were prospectively randomized to receive either operative or nonoperative treatment. Fifty-seven (29 operative, 28 nonoperative) patients were enrolled in the study. ⋯ Complications were higher in the operative group, and most were related to pin prominence at the posterior shoulder. Results of this study suggest that, though patients with midshaft clavicle fractures had higher functional scores at short-term follow-up after internal fixation, functional scores were similar at 6 months and 1 year. In addition, internal fixation with a modified Hagie pin was associated with a higher complication rate.
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Kyphoplasty is an effective surgical treatment for the pain and deformity that can accompany vertebral compression fractures. In certain cases, however, defects or clefts in the vertebral body result either from the original fracture or from expansion of inflatable bone tamps (IBTs). Through such a defect, cement may extrude into the epidural space, paraspinal soft tissues, or disc space. ⋯ Then, another batch of cement is mixed and is used to fill the cavities, as in the standard technique. Results for our first 21 patients show a mean correction of more than 6 degrees of kyphosis and no cement leaks into the spinal canal. We believe that this modification of the kyphoplasty technique is effective and safe for certain fractures.