The spine journal : official journal of the North American Spine Society
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Recently the financial relationships between industry and professional medical associations have come under increased scrutiny because of the concern that industry ties may create real or perceived conflicts of interest. Professional medical associations pursue public advocacy as well as promote medical education, develop clinical practice guidelines, fund research, and regulate professional conduct. Therefore, the conflicts of interest of a professional medical association and its leadership can have more far-reaching effects on patient care than those of an individual physician. ⋯ The NASS experience can provide a template for other professional medical associations to help manage their own possible conflicts of interest issues.
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Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS). The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter. ⋯ The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis. The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery.
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Posterior spine fusion is associated with significant intra- and postoperative blood losses. When referring to the total blood loss during spine surgery, the standard is to measure the intraoperative bleeding plus the postoperative drainage. This ignores the "hidden" blood loss that was found to be significant in other fields of surgery. ⋯ After posterior spinal fusion, there may be a large amount of the hidden blood loss.
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Human recombinant bone morphogenetic protein-2 (BMP-2) is commonly used in spinal surgery to augment arthrodesis, and a number of potential complications have been documented. ⋯ This is the first reported case of a symptomatic calcified perineural cyst developing after a fusion procedure in which BMP-2 was used. The presence of connective tissue with metaplastic bone formation and maturation within the lesion suggests that formation of the cyst was secondary to application of BMP-2, as it possesses both osteogenic and chondrogenic capabilities.
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Novel dual-threaded screws are configured with overlapping (doubled) threads only in the proximal shaft to improve proximal cortical fixation. ⋯ Although dual-threaded screws required higher insertion torque than standard screws in bone and low density foam, dual-threaded and standard pedicle screws exhibited equivalent axial pullout and cyclic fatigue endurance. Unlike single-threaded screws, the mechanical performance of dual-threaded screws in bone was relatively independent of BMD. In foam, the mechanical performance of both types of screws was highly dependent on porosity.