The spine journal : official journal of the North American Spine Society
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The current study was undertaken to determine if the presence of spinal instrumentation wear particulate debris deleteriously influences early osseointegration of posterolateral bone graft or disrupts an established posterolateral fusion mass. ⋯ Titanium particulate debris introduced at the level of a spinal arthrodesis elicits a cytokine-mediated particulate-induced response favoring proinflammatory infiltrates, increased expression of intracellular TNF-alpha, increased osteoclastic activity and cellular apoptosis. This is the first basic scientific study and the first clinical study demonstrating associations of spinal instrumentation particulates wear debris and increased cytokines and increased osteoclastic activity. Osteolysis is the number one cause of failure of orthopedic implants in the appendicular skeleton. Spinal surgeons need to increase their awareness of this destructive process.
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Editorial Historical Article
The future of spine care and the evolving role of physician as advocate.
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Intramedullary signal intensity changes on magnetic resonance imaging (MRI) in cervical spondylotic myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity changes remains controversial. ⋯ The presence of intramedullary signal changes on T1- as well as T2-weighted sequences on MRI in patients with cervical spondylotic myelopathy indicates a poor prognosis. However, the T2 signal intensity changes reflect a broad spectrum of spinal cord reparative potentials. Predictors of surgical outcomes are preoperative signal intensity change patterns of the spinal cord and their postoperative persistence/regression on radiological evaluations, age at the time of surgery, multiplicity of involvement and chronicity of the disease and surgical approach (anterior/posterior).
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Ketorolac Tromethamine (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID) with proven efficacy in decreasing postoperative pain in various surgical settings, including the treatment of spine deformities. However, some studies have raised questions regarding the potential side effects of this agent, such as increased bleeding and inhibition of bony fusion. ⋯ In this retrospective study of 208 children undergoing spine surgery, postoperative use of ketorolac did not significantly increase complications, including transfusion and reoperation.