The spine journal : official journal of the North American Spine Society
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Epidemiology of indications and contraindications to total disc replacement in an academic practice.
Given the experience with anterior lumbar cages, the similar enthusiasm for total disc replacement (TDR) and the economic incentives driving use of this new technology, it is important to document reasonable expectations as to the incidence of patients with appropriate indications for this new technology. ⋯ Despite early enthusiasm for TDR replacing fusion, there was only a 0.5% incidence of indications for TDR in the overall population and a 5% prevalence in the fusion patients, but the majority were in young patients who averaged about 38 years old. The absence of contraindications for TDR did not equate to indications for TDR because other nonfusion techniques exist. Based on the history of the introduction of other new spinal technologies and the fact that the current criteria for TDR seems to result in a relatively small number of eligible patients, there is risk of overuse of this new technology.
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Comparative Study
Attenuation of postlaminectomy epidural fibrosis with monoclonal antibodies against intercellular adhesion molecule-1 and CD-18.
Data from studies in other diseases state implicate cellular adhesion molecules as mediators of fibrosis and scarring. We sought to explore and assess the effect of using monoclonal antibodies against intercellular adhesion molecule-1 (ICAM-1) and its ligand CD-18 to decrease epidural fibrosis in an animal spinal surgery model. ⋯ Therapy that targets ICAM-1 could be valuable in the management of epidural fibrosis. Blocking the function of ICAM-1 may provide cellular protection against epidural fibrosis and also it may serve as an important component in this period, acting to promote leukocyte migration across epidural area after laminectomy.
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As the aging population increases, the rising prevalence of osteoporosis-related spine fractures will have a dramatic impact on health care. At present, mainstay treatment relies on systemic medications intended to prevent diminishing bone mineral density (BMD) and bone mass. However, an adjunctive treatment strategy is to target specific areas of the skeletal system that are prone to clinically significant osteoporotic fractures. We term this strategy the "local treatment of osteoporosis" or osteoplasty. Potential use of osteoplasty involves the percutaneous injection of bioresorbable and bioactive bone cements into bones at risk of sustaining osteoporotic fractures. Calcium sulfate (CaSO(4)) is among the candidate bioresorbable bone cements with the material attributes desirable for potential application with osteoplasty, yet previous studies on the osteoconductive properties of CaSO(4) have been limited to animal models exhibiting normal bone biology and architecture. However, osteoporotic bone physiology may potentially interfere with the material properties of common osteoconductive biomaterials, such as that of CaSO(4). To further test this hypothesis, a suitable animal model is needed to evaluate the in vivo behavior of potential biomaterials in osteoporotic bone. ⋯ Future investigation of potential biomaterials intended for the local treatment of osteoporosis will require their study within an appropriate osteoporosis animal model. The OVX rat caudal spine exhibits pathologic bone changes consistent with the osteoporosis phenotype, including decreased BMD, diminished trabecular network density, cortical thinning, and decreased mechanical strength. These derangements in bone microarchitecture and physiology may contribute toward the accelerated cement resorption and altered bone response to CaSO4 observed in this study. Important advantages of the OVX rat caudal spine are the rapid and minimally invasive surgical exposure of the vertebral body and the ease of cement injection. We propose that the OVX rat caudal spine represents a valuable and cost-effective tool in the armamentarium of investigators evaluating biomaterials designed for implantation into the osteoporotic spine.