Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SPINAL FUSION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed2005

The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion.

STUDY DESIGN: A prospective study. OBJECTIVES: To compare the efficacy of calcium sulfate pellets plus laminectomy bone chips with a fresh autologous iliac bone graft for short-segment lumbar fusion. SUMMARY OF BACKGROUND DATA: Bone graft substitute material can be used to expand an existing quantity of available laminectomy bone chips. METHODS: Seventy-four patients underwent surgery for instrumented one- or two-segment fusion with decompression. Autologous iliac crest bone graft was placed in one posterolateral gutter, while on the other side, an equal quantity of autogenous laminectomy bone supplemented with calcium sulfate was placed. Radiographic assessment included radiographs alone; this was performed every 3 months (3 months to 12 months), then annually. The status of fusion and the relative size of the fusion bone mass on either side of the vertebra were compared. RESULTS: Using iliac crest bone graft (control side) versus autograft laminectomy bone with calcium sulfate (test side), there was no significant difference between the fusion rate and sizes of the fusion bone mass (P > 0.05). Follow-up periods ranged from 30 months to 34 months, averaging 32.5 months. For the 39 patients who received single-segment fusion, 34 patients (87.2%) exhibited bone fusion on the test side, and 35 patients (89.7%) had evidence of fusion on the control side. For the 35 patients who received two-segment fusion, 29 patients (82.9%) exhibited bone fusion on the test side and 30 patients (85.7%) demonstrated complete fusion on the control side. CONCLUSIONS: The fusion rate and fusion size between the two groups are similar. Calcium sulfate pellets may play a role as a bone graft extender in short-segment spinal fusion.

Adult↗
PubMedDate not supplied

The mechanical consequence of failure of ossified union in attempted posterior spinal fusion. A canine model.

The mechanical behavior of pseudarthrosis in posterior spinal fusion was investigated. A canine model was developed in which an incompletely ossified posterior fusion mass was consistently produced. The spines were excised, and the motion segments were mechanically tested using a specially developed loading apparatus. Tests were performed to evaluate stiffness of the segments to loading with compression, torsion, and anterioposterior and lateral bending shear stiffness. Changes in other modes of loading were less consistent. The motion characteristics of the pseudarthrosis could not be predicted from the extent of the osseous defect noted on roentgenograms. These findings correlate clinically with the progression of curvature seen with pseudarthrosis in scoliosis surgery and the unpredictable results of pseudarthrosis in posterior fusion performed in treatment of degenerative disc disease.

Animals↗
PubMed1994

Evaluation of human bone morphogenetic protein 2 in a canine spinal fusion model.

The efficacy of purified recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in a porous biodegradable copolymer, poly [D,L (lactide--coglycide)] (PLGA) was evaluated using a canine posterior segmental spinal fusion model. rhBMP-2/PLGA was compared to autogenous cancellous bone and to PLGA alone. Thirty three fusion sites in 11 beagle dogs were evaluated at 12 weeks for union and mechanical strength. Union score and mechanical testing showed no difference between autogenous cancellous bone and rhBMP-2/PLGA. Union scores for autogenous cancellous bone and rhBMP-2/PLGA sites were superior to those with PLGA alone (p = 0.001 and p = 0.0007, respectively). These findings suggest that synthetic bone graft substitute materials delivering purified rhBMP-2 may be suitable for posterior spinal fusions. The use of such materials may provide efficacy equivalent to autogenous cancellous bone and avoid the morbidity associated with the harvest of autogenous graft.

Animals↗
PubMed1997

Smoking and the human vertebral column: a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion.

Chronic cigarette consumption has significant adverse effects on the human spinal column. Multiple mechanisms induced by tobacco use lead to less strong, less healthy, mineral-deficient vertebrae with reduced bone blood supply and fewer and less functional bone-forming cells among chronic smokers. Compared to nonsmokers, chronic smokers develop advanced bony degradation, are more likely to suffer from spinal column degenerative disease, and seem more susceptible to traumatic vertebral injury. Spinal fusion procedures in chronic smokers are less often clinically and radiographically successful, compared to similar procedures performed among nonsmokers for definitive biological, physiological, and mechanical reasons.

Animals↗
PubMed2003

[Psoas abscess after anterior spinal fusion].

We present 3 cases of secondary psoas abscess after anterior spinal fusion. Psoas abscess is still a rare clinical entity. It is often associated with unspecific symptomatology and may present as late infection. A high index of suspicion is required for early diagnosis and treatment. Computed tomography is the imaging technology of choice. Treatment includes open abscess drainage and antibiotic therapy. In secondary psoas abscess causative treatment of the primary infection focus is essential. For psoas abscess after anterior spondylodesis this includes treatment of a deep wound infection. Predisposing factors for postoperative infection are large implants, bone grafting, long operating times, previous spinal surgery, immunodeficiency and metabolic disorders. Usually several operations are necessary to eradicate infection. As long as stability is guaranteed, implant materials should be removed. Continuing antibiotic therapy for 2-3 weeks after normalization of infectious parameters is suggested. Delayed therapy results in an increase of the morbidity and mortality of psoas abscess.

Adult↗
PubMedDate not supplied

Intraoperative awakening for early recognition of possible neurologic sequelae during Harrington-rod spinal fusion.

To permit early recognition of possible cord trauma due to spinal fusion with Harrington-rod instrumentation, 42 patients were awakened introperatively for testing voluntary motor function of the limbs. N2O-O2-curare and morphine were used for anesthesia in all patients. In 5 patients, who refused IV induction, halothane was given for induction only. Only 1 patient had any complaint referrable to being awakened intraoperatively. The awakening caused no displacement of Harrington rods in any patient. No neurologic sequelae were found.

Adolescent↗
PubMed1983

Fatal fat embolism after spinal fusion for scoliosis.

An adolescent girl who underwent Harrington instrumentation and spinal fusion for idiopathic scoliosis had the adult respiratory distress syndrome develop in the immediate postoperative period. Massive fat embolization to the lungs was present at postmortem examination, an apparently rare complication of this surgical procedure. This case emphasizes the necessity of maintaining a high index of suspicion. In any clinical setting that would place a patient at risk for fat emboli and illustrates the unreliability of many of the clinical and laboratory features frequently described as useful for establishing the diagnosis.

Adolescent↗
PubMed2003

Anterior spinal fusion with TSRH instrumentation for scoliosis.

OBJECTIVE: To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes. METHODS: The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis. RESULTS: Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up. CONCLUSION: If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.

Adolescent↗
PubMed1997

Multidirectional stabilizing potential of BAK interbody spinal fusion system for anterior surgery.

Improvement in laparoscopic surgery requires spinal-fusion devices appropriately designed for this technique. The BAK interbody fusion device (Spine Tech Inc., Minneapolis, MN, U.S.A.), which consists of two titanium screw cages, meets this requirement. Multidirectional stabilizing potential of this device was investigated by using an in vitro human cadaveric model. Four fresh-frozen human lumbosacral spine specimens (L5-S1) were used. The flexibility test consisted of applying six pure moments (flexion, extension, bilateral axial torques, and lateral bending moments) and measuring the ensuing three-dimensional motion. Moments were applied in four load steps: 0, 2.5, 5.0, 7.5, and 10.0 Nm, and for three load and unload cycles. Motion of the top vertebra was recorded during the third load cycle by using a three-dimensional optoelectronic motion-measurement system. The motion parameters studied were the ranges of motion (ROM) and the neutral zone (NZ). Comparing the ROM of the intact specimen and after the fixation, all motions except extension were reduced significantly (p < 0.005). Average percentage decrease in ROM were 45.8% in flexion, 40.4% in axial rotation, and 65.6% in lateral bending. The only significant changes in NZ were a 255.7% increase in extension, a 90.9% increase in axial rotation, and a 70.8% decrease in lateral bending. This biomechanical study revealed that the BAK system provided decreases in ROM in all directions except in extension. The increased NZ in extension and axial rotation is most likely related to the positioning of the implant. Because these implants were placed from the anterior, damage to anterior annulus and anterior longitudinal ligament is inevitable. For clinical relevance, the patients undergoing this surgical procedure should avoid extension motions.

Adult↗
PubMed2001

Analgesic effect of low-dose intrathecal morphine after spinal fusion in children.

BACKGROUND: This study was designed to assess the postoperative analgesic effect of low-dose intrathecal morphine after scoliosis surgery in children. METHODS: Thirty children, 9-19 yr of age, scheduled for spinal fusion, were randomly allocated into three groups to receive a single dose of 0 (saline injection), 2, or 5 microg/kg intrathecal morphine. After surgery, a patient-controlled analgesia device (PCA) provided free access to additional intravenous morphine. Children were monitored for 24 h in the postanesthesia care unit. RESULTS: The three groups were similar for age, weight, duration of surgery, and time to extubation. The time to first PCA demand was dose-dependently delayed by intrathecal morphine. The first 24 h of PCA morphine consumption was 49 +/- 17, 19 +/- 10, and 12 +/- 12 mg (mean +/- SD) in the saline, 2 microg/kg morphine, and 5 microg/kg morphine groups, respectively. Pain scores at rest were significantly lower over the whole study period after 2 and 5 microg/kg intrathecal morphine than after saline, but there was no difference between intrathecal doses. Pain scores while coughing and the incidence of side effects were similar in the three groups. CONCLUSIONS: These data demonstrate that low-dose intrathecal morphine supplemented by PCA morphine provides better analgesia than PCA morphine alone after spinal fusion in children. The doses of 2 and 5 microg/kg seem to have similar effectiveness and side-effect profiles, whereas a reduction of intraoperative bleeding was observed in patients who received 5 microg/kg but not 2 microg/kg intrathecal morphine.

Adolescent↗
PubMedDate not supplied

Results of spinal fusion for radiation scoliosis.

There were 150 children with neuroblastoma and 183 children with Wilms' tumor who received radiation therapy, orthovoltage up to 1967, and cobalt therapy thereafter. In all except two cases, radiation therapy crossed the midline. Of all of the children treated, 13 required spinal fusion. There were six with Wilms' tumor; three had kyphosis; and three had scoliosis. Nine fusions were done with three pseudoarthroses, one broken rod, and two hook pullouts. There were seven with neuroblastoma, of whom five had kyphosis and two had scoliosis. Nineteen spinal fusions were done on these seven patients for neuroblastoma; two developed paraplegia; seven had pseudoarthroses; two had broken rods; and one had infection. Complications were attributed to laminectomies (five of seven) and high orthovoltage dosage (3680 rad), causing bone death and destroyed bone growth, with resultant infantile-size spines. The authors continue to follow up postradiation patients and observe rapid deterioration of kyphosis and scoliosis during the adolescent growth spurt. The authors now recommend early and extensive combined two-stage, long anterior and posterior fusions for kyphosis of 35 degrees and over, and a posterior fusion with Harrington rod instrumentation with extensive bone grafting is done for early (35 degrees) pure scoliosis. Postoperative immobilization is much longer than for regular spine fusions--at least one year.

Child↗
PubMed1993

Critical analysis of strut grafts in anterior spinal fusions.

Fifty patients undergoing anterior spinal decompression with partial or complete corpectomy and fusion with strut grafting were reviewed. The etiology of the spinal lesions included pathologic fracture (9 patients), trauma (22 patients), congenital/developmental lesions (6 patients), failed fusion (6 patients), and degenerative lesions (7 patients). Vertebral body reconstruction of the cervical, thoracic, or lumbar spine used iliac crest (20 cases), rib (12 cases), and fibular autografts (9 cases). Additionally, in 10 cases fibular allografts were used. There were four deaths, all secondary to systemic disease. Of the remaining 46 patients, 2 required revisions and all subsequently progressed to a solid anterior arthrodesis with an average follow-up of 30.4 months (range 12-62 months). Posterior spinal fusion was staged in 38 patients. Twenty of 29 patients with neurologic lesions improved after corpectomy. Eleven cases treated for a progressive, painful kyphosis averaged correction of 11.4 degrees (26%), which was maintained on long-term follow-up. Complications were primarily pulmonary and/or genitourinary. Others included a pseudarthrosis, an early fractured strut, and a late allograft infection. On the basis of this review, it appears that spinal arthrodesis with anterior decompression and strut grafting is an effective method of treating anterior compressive syndromes of the spine and painful progressive kyphoses.

Adolescent↗
PubMed2005

Pain management after lumbar spinal fusion surgery using continuous subcutaneous infusion of buprenorphine.

PURPOSE: The continuous subcutaneous infusion (CSI) technique is a simple, inexpensive method for managing postoperative pain. We examined the analgesic effects of CSI of buprenorphine in patients undergoing lumbar spinal fusion surgery. METHODS: The patients were randomly assigned to one of three groups for postoperative pain management: control group (n = 17), high-dose buprenorphine group (BH group, n = 17), and low-dose buprenorphine group (BL group, n = 16). Infusion solutions containing buprenorphine at concentrations of 25.0 and 16.7 microg x ml(-1) combined with droperidol at a concentration of 52.0 microg x ml(-1) were used in the BH and BL groups, respectively; and an infusion solution containing droperidol at a concentration 52.0 microg x ml(-1) was used in the control group. CSI of each solution was started at a rate of 1 ml x h(-1) and was continued for 48 h. RESULTS: The BH and BL groups showed significantly lower scores than the control group on the Visual Analogue Scale. There were significantly fewer administrations of flurbiprofen as a supplemental analgesic in the BL and BH groups than in the control group. The incidences of sedation and nausea were comparable in the three groups. The median number of administrations of flurbiprofen was significantly less in the BH group than in the control group on the day of the operation and on the first postoperative day, whereas the number in the BL group was less than that in the C group only on the day of the operation. CONCLUSION: CSI of buprenorphine effectively reduces pain after lumbar spinal fusion surgery without apparent side effects. This technique is simple and useful for postoperative pain management.

Adult↗
PubMed2005

Initial fusion rates with recombinant human bone morphogenetic protein-2/compression resistant matrix and a hydroxyapatite and tricalcium phosphate/collagen carrier in posterolateral spinal fusion.

STUDY DESIGN: Prospective, randomized, unblinded study of iliac crest bone graft (ICBG) versus recombinant human bone morphogenetic protein-2/compression resistant matrix (rhBMP-2/CRM)in a posterolateral instrumented fusion procedure. OBJECTIVES: Document initial radiographic characteristics, based on computed tomography, with rhBMP-2/CRM for posterolateral fusion at 6 and 12-month intervals. SUMMARY OF BACKGROUND DATA: As the acceptance of INFUSE bone graft as an ICBG replacement becomes more widespread, surgeons have begun to study applications for rhBMP-2 in posterior spinal fusion. Preclinical studies have examined variables including carrier composition, rhBMP-2 concentration, and rhBMP-2 dose. Pilot studies have been performed with encouraging initial results. METHODS: Patients with single level lumbar degenerative disease were enrolled in a randomized study of ICBG versus rhBMP-2/CRM in a posterolateral instrumented fusion procedure. Computed tomography scans at 6 and 12 months were graded as demonstrating no fusion (grade 1), partial or limited unilateral fusion (grade 2), partial or limited bilateral fusion (grade 3), solid unilateral fusion (grade 4), or solid bilateral fusion (grade 5). RESULTS: At our institution, 74 patients (38 rhBMP-2/CRM, 36 ICBG) reached minimum 1-year follow-up and were included in this analysis. Mean fusion grade (scale1-5) at 6 months after surgery was 4.35 in the rhBMP-2/CRM group versus 3.09 in the ICBG group (P < 0.0001). At 1 year after surgery mean fusion grade was 4.62 in the rhBMP-2/CRM group versus 3.77 in the ICBG group (P < 0.0023). CONCLUSIONS: These early results are encouraging and suggest a more rapid incorporation and development of the fusion mass with rhBMP-2/CRM than iliac crest autograft in a single level posterior instrumented fusion.

Adult↗
PubMed1998

Laparoscopic spinal fusion.

This article details the development of the laparoscopic technique of interbody spinal fusion. The rationale for this procedure is discussed as are indications, contraindications, and operative technique. The results of over 100 laparoscopic lumbar fusions are presented along with their complications and surgical recommendations.

Cervical Vertebrae↗
PubMed2006

Bone morphogenetic protein gene therapy using a fibrin scaffold for a rabbit spinal-fusion experiment.

OBJECTIVE: To observe the feasibility of using fibrin gel as a scaffold during rabbit spinal fusion with rat kidney cells carrying bone morphogenetic protein-2 (BMP-2) expression vector. METHODS: Normal Rattusnorvegicus (rat) kidney (NRK) cells were transfected with pCMV-BMP2 vectors by using a nonviral reagent (FuGENE6), following which the transfected cells (1.5 x 10(7)) were encapsulated and evenly suspended in a fibrin scaffold, and implanted to either side of the L5-L6 intertransverse space for six test rabbits. For the control group (six rabbits), the transfected cells (1.5 x 10(7)) were added on and absorbed in a surgical gelatin sponge, and implanted in an analogous location. Radiographs of the spine of all animals were taken at six, ten, and 12 weeks subsequent to fusion surgery. Gross and histological examination of the fusion masses for all the animals were performed subsequent to animals having been sacrificed at 12 weeks. RESULTS: Expression of BMP-2 was verified in the pCMV-BMP2 transfected NRK cells which were used for the subsequent rabbit experiment. For all 12 rabbits, no evidence of implanted-tissue rejection was seen during the postoperative course. Neither residual scaffold nor inflammatory granulation tissue was seen in the harvested spinal segments. For the six study-group rabbits, radiographic examinations revealed that four individuals (67%) featured prominent new-bone formation (good fusion), and two (33%) revealed moderate new-bone formation (fair fusion) at the implanted sites, whereas all six control-group rabbits revealed no evidence of new-bone formation (nonfusion) at the implanted sites. For the histological examinations, all animals in the study group revealed the presence of osseous tissue at the sites corresponding to the sites of radiographically demonstrated new-bone formation, whereas for the control group, no osseous tissue was seen at the implanted sites for any animal CONCLUSION: Fibrin gel, being a biocompatible and biodegradable matrix, can encapsulate pCMV-BMP2 transfected NRK cells and adhere to the intertransverse lumbar-spine spaces of test rabbits. With the above characteristics, it plays an important role in the successful delivery of pCMV-BMP2-transfected cells for this rabbit spinal-fusion experiment. Being a natural matrix and able to be obtained readily from patients' own blood, fibrin gel seems to be a promising scaffold for future gene therapy in human trials.

Animals↗
PubMed1989

Pulmonary function test study and after spinal fusion in young idiopathic scoliosis.

A homogeneous population of 42 women with idiopathic scoliosis (mean age, 20.8 years and mean major thoracic curve of 58.2 degrees) had a complete pulmonary function test (PFT) at rest before, and a minimum of 3 years after, spinal fusion (mean, 7.7 years) to evaluate the effect of scoliosis and its surgical correction on PFT at rest. A multifactorial analysis showed that only the vital capacity (VC) was significantly lowered to 81% of predicted value (P less than 0.05). All of the other parameters of pulmonary volumes, flow, and gas exchanges, where corrected for the loss of lung volume, were within normal limits, showing pure restrictive changes in this population. Double-major curves were more severe, but no significant difference in PFTs were found with single thoracic curves. Curves over 50 degrees had significantly lower VC. The surgical correction of 40% is permanent and the functional improvement in postoperative vital capacity (VC) of 12% is significant (P less than 0.05). Other factors, such as the time between the two evaluations, the age of the patient, pelvic obliquity, trunk imbalance, and degree of kyphosis did not have any correlation with the observed changed on any of the PFT results. Therefore, early correction by spinal fusion in idiopathic scoliosis brings on some improvement of the vital capacity at rest and may prevent deterioration with progression of the curve.

Adolescent↗
PubMed1986

Allograft bone in spinal fusion for paralytic scoliosis.

To determine the efficacy of allograft bone in spinal surgery, a retrospective study was carried out on thirty-two patients who had had spinal fusion with banked bone from the femoral head between 1977 and 1983. The diagnoses were paralytic and neuromuscular scoliosis. At final follow-up (average, 3.7 years), the infection rate was 9.3 per cent. There were no pseudarthroses, and all patients had well marginated trabecular markings by eighteen months. The rates of complications and of fusion were comparable with or better than those obtained using autogenous bone graft.

Adolescent↗