The spine journal : official journal of the North American Spine Society
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Use of bone morphogenetic protein (BMP) as an adjunct to spinal fusion surgery proliferated after Food and Drug Administration (FDA) approval in 2002. Major safety concerns emerged in 2008. ⋯ Use of BMP in spinal fusion surgery declined subsequent to published safety concerns and revelations of financial conflicts of interest for investigators involved in the pivotal clinical trials.
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Orthopedic residents seeking additional training in spine surgery commonly use the Internet to manage their fellowship applications. Although studies have assessed the accessibility and content of Web sites in other medical specialties, none have looked at orthopedic spine fellowship Web sites (SFWs). ⋯ Most orthopedic spine surgery programs underuse the Internet for fellow education and recruitment. The inaccessibility of information and paucity of content on SFWs allow for future opportunity to optimize these resources.
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Pedicle screw fixation is currently widely used in spine surgery for various pathologies. Increasing screw placement accuracy would improve the outcomes. ⋯ The results of our study show that conventional methods for pedicle screw placement remain safe and accurate, with best results obtained in the lumbosacral spine, followed by the thoracolumbar junction. Nonetheless, results are less accurate in the midthoracic spine.
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With an increasing prevalence of low back pain, physicians strive to optimize the treatment of patients with degenerated motion segments. There exists a consensus in literature that osteoporotic patients exhibit nonphysiologic loading patterns, while degenerated intervertebral discs (IVDs) are also believed to alter spine biomechanics. ⋯ The investigation presented refined insight into the dynamic biomechanical response of a degenerated spine segment. The increase in the calculated occurring stresses was considered as critical in the motion segment adjacent and superior to the degenerated one. This suggests that prevalent trauma in a motion segment may be a symptomatic condition of a poorly treated formal pathology in the inferior spine level.
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Prior studies have demonstrated the superiority of decompression and fusion over decompression alone for the treatment of lumbar degenerative spondylolisthesis with spinal stenosis. More recent studies have investigated whether nonfusion stabilization could provide durable clinical improvement after decompression and fusion. ⋯ Patients with degenerative spondylolisthesis and spinal stenosis treated with decompression and PTB demonstrated no progressive instability at 2 years follow-up. Excellent/good outcomes and significant improvements in patient-reported pain and disability scores were still observed at 2 years, with no evidence of implant failure or migration. Further study of this treatment method is warranted to validate these findings.