The spine journal : official journal of the North American Spine Society
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Comparative Study
Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation.
Polyetheretherketone (PEEK) has been increasingly used as a biomaterial for spinal implants. PEEK lumbar fusion rods have recently become available for use in posterior lumbar fusion procedures. ⋯ PEEK rods provide comparable stability to titanium rods of equivalent diameter in cadaveric testing. Mechanical testing suggests PEEK rods can withstand far beyond the angular displacements suggested by cadaveric testing and that of normal physiologic range of motion. Potential advantages to PEEK rods include better anterior column load sharing, reduced stress at bone-to-screw interface, and reduced computed tomography and magnetic resonance imaging scatter and artifact.
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Lumbar discectomy is the most common type of back surgery performed in the United States. Outcomes after this procedure can be variable and it appears that Workers' Compensation patients might be at increased risk for poor outcomes. ⋯ Results of this study suggest that compensated back surgery patients are at greater risk for poor lumbar discectomy outcomes than noncompensation patients. Presurgery correlates of poor outcomes may be useful in identifying high-risk compensation patients.
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It remains unknown whether aggressive disc removal with curettage versus conservative removal of a disc fragment with little disc invasion provides a better outcome for the treatment of lumbar disc herniation with radiculopathy. ⋯ There are no Level I studies to support conservative versus aggressive discectomy for the treatment of primary disc herniation. However, systematic review of the literature suggests that conservative discectomy may result in shorter operative time, quicker return to work, and a decreased incidence of long-term recurrent low back pain but with an increased incidence of recurrent disc herniation. Prospective randomized trails are needed to firmly assess this possible benefit.
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Although previous studies have primarily focused on testing the effectiveness of cervical orthoses under properly fit conditions, this study focuses on analyzing the effects of an ill-fitted cervical orthosis (Miami J). This may have significance to health-care providers in understanding the effects of an improperly fitted neck brace. ⋯ To our knowledge, the effects of improperly fitted cervical orthoses on CRoM are still unknown. Using the NOB electromagnetic tracking system combined with VR feedback, we were able to consider the motion restriction of ill-fitting Miami J orthoses for both primary and combined motions. For both motion types, increased motion was possible when the subject was improperly fitted with the Miami J. If not considered, these excessive motions could potentially have detrimental effects on patient satisfaction, clinical outcomes, or even lead to increased secondary injury.
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C2 laminar screws are becoming an increasingly used method of fixation. They allow for avoidance of fixation through the C2 pedicle, eliminating the risk of vertebral artery injury. Recent studies have described the anatomic considerations of this technique in a large cadaveric population. In clinical practice, however, direct measurement is impractical and preoperative imaging must be relied upon to determine whether or not this technique can be safely used. ⋯ Given the high degree of correlation between CT measurements and direct anatomic measurements, we conclude that CT scan can accurately determine laminar thickness, a measurement critical to safe placement of intralaminar screws. It appears that longer screw lengths that were previously reported may be safely used while remaining intra-osseous. We continue to advocate preoperative planning using CT to identify patients whose lamina may be unable to accommodate safe screw placement using this technique.