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 127 records · Page 7Linked to original sources
PubMedDate not supplied

Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion.

BACKGROUND CONTEXT: A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates. PURPOSE: Evaluation of this new type of spine system was done through biomechanical studies, analysis of lumbar lordosis preservation postoperatively, and multicenter review of patient outcomes with a minimum of 1 year follow-up. STUDY DESIGN/SETTING: Biomechanical studies of the spine system were performed according to American Society for Testing and Materials (ASTM) standards. To evaluate the maintenance of lordosis, radiographs from the first 119 patients were reviewed by the authors. Analysis of patient outcomes consisted of a review of the first 259 patients who underwent spinal fusion surgery with the new spine system. PATIENT SAMPLE: Evaluation of patient outcomes consisted of 122 men and 137 women with an average age of 50+/-13 years (range, 22-96 years) and a mean follow-up of 20+/-6 months (range, 12-54 months). The patient population was at high risk for fusion failure, with 127 smokers (49%), 141 who had previous spine surgery (54%), 22 with osteoporosis (8%), 63 were obese (24%), and 32 with diabetes (12%). One hundred two patients (39%) had a one-level fusion, 105 patients (41%) had two levels fused, and 52 patients (20%) had three or more levels fused. The majority of patients (66%) were covered under workers' compensation. OUTCOME MEASURES/METHODS: Radiographic fusion was deemed successful when the presence of trabecular bridging bone from transverse process to transverse process was observed, as well as no fixation failure nor radiographic evidence of screw loosening. Clinical success was rated excellent, good, fair, or poor depending on the patients pain level, function, and pain medication intake. RESULTS: Biomechanical studies of this intrasegmental fixation system have shown it to be strong under both static and fatigue testing, with exceptional strength in compression bending. In evaluating preservation of lumbar lordosis, no statistically significant loss of lordosis was observed. Overall, radiographic fusion was noted in 229 of 259 patients (88%) and did not differ significantly (p>.10) by the number of levels fused. Clinically, 69 patients (27%) had an excellent result, 111 patients (43%) had a good result, 50 patients (19%) had a fair result, and 29 patients (11%) had a poor result. The high rate of successful patient outcomes did not differ significantly (p>.10) by the number of levels fused, or other patient or surgical variables, except for the satisfaction level of workers' compensation versus nonworkers' compensation. One hundred of 118 patients (85%) who were working before surgery returned to work at an average 9+/-4 months postoperatively (range, 2-20 months). The use of direct current (DC) stimulation in this population was reserved for patients with one or more risk factors for fusion failure and was noted to be of benefit. There were no recorded intraoperative complications, but postoperatively 5 device and 19 non-device-related complications (9%) were noted, which is comparable to other lumbar fusion series. CONCLUSIONS: The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.

Adult↗
PubMed2001

Smoking as a predictor of negative outcome in lumbar spinal fusion.

STUDY DESIGN: A review of the smoking habits in 426 patients who had been followed prospectively for 2 years after a lumbar spinal fusion procedure was conducted. OBJECTIVE: To analyze the effect of pre- and postoperative smoking on clinical and functional outcome after lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: Several animal models have shown a negative effect of nicotine on spinal fusion. At this writing, the clinical effect of nicotine on spinal fusion has not been fully clarified. METHODS: The study comprised 426 patients who underwent lumbar spinal fusion between 1993 and 1997. These patients received a mailed questionnaire regarding their tobacco consumption before and after their surgery. All other data, including preoperative clinical and functional status, were collected prospectively during a 2-year follow-up period. To assess functional outcome, the Dallas Pain Questionnaire was used. RESULTS: The questionnaire was answered by 396 patients (93%). Of these patients, 54.5% (20% more than the background population) were smokers before the operation. Smoking of more than 10 cigarettes daily before the operation and attempted fusion at two or more levels increased the risk of nonunion: odds ratio, 2.01 (P < 0.016) and odds ratio, 3.03 (P < 0.001), respectively. Smoking cessation increased fusion rates to near those of nonsmokers. Smoking had no influence on functional outcome, as assessed by the Dallas Pain Questionnaire, but preoperative smoking predicted a negative answer to the question "Would you undergo the same treatment again, now that you know the result?" (odds ratio, 1.65; P < 0.054). CONCLUSIONS: Smoking was shown to have a negative effect on fusion and overall patient satisfaction, but no measurable influence on the functional outcome as assessed by the Dallas Pain Questionnaire.

Adult↗
PubMed2006

Spinal fusion after revision surgery for pseudarthrosis in adult scoliosis.

STUDY DESIGN: A retrospective study. OBJECTIVE.: To decipher the incidence, characteristics, functional outcomes, and complications of spinal fusion after revision surgery for recurrent pseudarthrosis in adult patients with scoliosis. SUMMARY OF BACKGROUND DATA: While the rate of spinal fusion has been examined in the past, there have been no studies that have examined the incidence, characteristics, functional outcomes, and complications of spinal fusion after pseudarthrosis repair in adult patients with scoliosis. MATERIALS AND METHODS: A total of 132 patients with failed spinal fusion surgery for adult scoliosis and painful pseudarthroses were studied. Each patient had an average of 3.7 spinal surgeries before undergoing revision at our institution. In addition to clinical assessment and imaging studies, pseudarthrosis was confirmed intraoperatively in all patients. All patients underwent reinstrumentation and fusion along with adjunctive procedures as needed. Spinal fusion was assessed clinically and radiographically after surgery for a minimum of 40 months. Subjective functional outcomes and complications associated with the procedures were also studied. RESULTS: The overall incidence of spinal fusion after revision surgery for pseudarthrosis in adult scoliosis was 90%. There was a propensity for pseudarthrosis to recur at the thoracolumbar and lumbosacral junctions. Increasing thoracolumbar kyphosis and loss of sagittal balance were significant risk factors for recurrent pseudarthrosis after revision surgery (mean thoracolumbar kyphosis of 23 degrees and mean sagittal balance of 7.9 cm anteriorly associated with persistent pseudarthrosis). Additionally, patients with multiple preoperative sites of pseudarthroses were at a higher risk for continued pseudarthrosis after surgery. Cigarette smoking, age, and surgical approach did not have any significant correlation with pseudarthrosis. Seventy-two percent of patients were satisfied with the outcome and 80% would have chosen to undergo surgery again if necessary. Thirty-three percent of patients who underwent surgery had some complication related to the surgery. CONCLUSION: Revision surgery for pseudarthrosis repair in adult scoliosis is most successful at attaining fusion when thoracolumbar and overall sagittal alignment are restored as much as possible.

Adult↗
PubMed1999

Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion.

OBJECTIVES: a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP). SETTING: Tertiary care pediatric intensive care unit (ICU) in a university hospital. DESIGN: A prospective cross-sectional, observational study with factorial design. PATIENTS: Thirty patients > or = 10 yrs of age undergoing spinal fusion admitted to the ICU for postoperative care. INTERVENTIONS: Patients underwent anterior, posterior, or both anterior/posterior spinal fusion. Blood was collected for serial measurements of ADH, ANP and serum electrolyte levels. Heart rate, blood pressure and central venous pressure were measured. MEASUREMENTS AND MAIN RESULTS: Thirty children were studied. Nineteen had idiopathic scoliosis, nine had neuromuscular scoliosis, one had Marfan's disease, and one had congenital scoliosis. Ten (33%) children met clinical criteria of SIADH. There was no difference in duration of surgery, blood loss, volume of iv fluid administration pre- and intraoperatively, or type of scoliosis between those who developed SIADH and those who did not. Hemodynamic variables were similar in both groups. ADH levels increased in both groups immediately postoperatively and at 6 hrs after surgery, but were much more elevated in those patients with SIADH. Patients with SIADH also had significantly higher ADH levels preoperatively. In relation to serum osmolality, ADH was considerably higher in those with SIADH compared with those who did not. Although ANP values tended to be higher in the group with SIADH, this did not reach statistical significance. CONCLUSION: SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.

Adolescent↗
PubMed2000

Horner's syndrome after posterior spinal fusion in a child: a case report.

STUDY DESIGN: A case report of a complication after posterior spinal fusion. OBJECTIVES: To present the clinical findings of a Horner's syndrome after posterior spinal fusion. SUMMARY OF BACKGROUND DATA: A 14-year-old girl underwent posterior spinal fusion for idiopathic scoliosis. METHODS: Clinical examination and pharmacologic pupillary testing were used to diagnose Horner's syndrome. RESULTS: After surgery, the patient developed a left-sided Horner's syndrome. The Horner's syndrome had resolved 6 months after surgery except for slight ptosis. CONCLUSIONS: This is the first reported case of Horner's syndrome occurring after posterior spinal fusion without the use of epidural analgesia.

Adolescent↗
PubMed2003

In vivo evaluation of bone marrow stromal-derived osteoblasts-porous calcium phosphate ceramic composites as bone graft substitute for lumbar intervertebral spinal fusion.

STUDY DESIGN: Autogenous bone marrow stromal-derived osteoblasts-porous calcium phosphate ceramic composites were constructed in vitro under cell culture for 48 hours and implanted as a bone graft substitute for lumbar intervertebral spinal fusion in rabbits. OBJECTIVES: To evaluate the efficacy of autogenous bone marrow stromal-derived osteoblasts-porous calcium phosphate ceramic composites as an alternative to autogenous graft materials in a lumbar interbody spinal fusion model. SUMMARY OF BACKGROUND DATA: Bone marrow contains a population of rare progenitor cells capable of differentiating into bone, cartilage, muscle, tendon, and other connective tissues. These cells can be induced and differentiated into osteogenic osteoblasts with addition of osteogenic supplements. Combining bone marrow stromal-derived osteoblasts with porous ceramics gave rise to bone tissue in subcutaneous sites and repaired critical size segmental femoral defects. Little work has been done in the spine to assess fusion rates and associated biomechanical characteristics. METHODS: Five experimental groups were evaluated: sham operation (Group I); porous calcium phosphate ceramics alone (Group II); autogenous tricortical iliac crest (Group III); bone marrow stromal-derived osteoblasts-calcium phosphate ceramic composites (Group IV); bone marrow stromal-derived osteoblasts-calcium phosphate ceramic composites with rhBMP-2 (Group V). All rabbits were killed 12 weeks after surgery, and the spinal fusion segments underwent the evaluation of gross inspection, manual palpation, radiography, computed tomography, nondestructive biomechanical testing, and histologic analysis. RESULTS: Successful spinal fusion was achieved by manual palpation in 100% (6/6) of animals in Group IV and Group V, 66.7% (4/6) in Group III, 50% (3/6) in Group II, and 0% (0/6) in Group I. Radiographic studies showed that minimal disc height loss was observed with ceramic blocks than with autograft. Biomechanical testingconfirmed that spines from Group IV and Group V were statistically significantly stiffer in flexion, extension, left and right bending, and left and right torsion than Group III and Group II. Histologic analysis demonstrated a qualitative increase of bone formation in fusion mass in Group IV and Group V versus all other groups. The size of fusion mass and the stiffness of fusion segments were greatest in Group V. CONCLUSION: The results indicate that bone marrow stromal-derived osteoblasts-calcium phosphate ceramic composites may provide an alternative to autogenous graft materials for lumbar interbody spinal fusion. Adding recombinant human bone morphogenetic protein-2 into the composites may reinforce the biomechanical stiffness for spinal fusion segments. Porous calcium phosphate ceramics alone were not suitable as a bone graft substitute for lumbar interbody spinal fusion.

Animals↗
PubMed2002

Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery.

STUDY DESIGN: A retrospective review was performed. OBJECTIVE: To determine clinical predictors of allogeneic and autologous red cell transfusion in children and adolescents undergoing spinal fusion surgery. SUMMARY OF BACKGROUND DATA: Blood loss during spinal fusion surgery often results in the need for transfusion therapy. Preoperative identification of patients at increased risk for red cell transfusion would allow more specific use of interventions designed to control excessive bleeding. METHODS: The medical records of all patients undergoing posterior spinal fusion surgery at a single institution between July 1, 1999 and June 30, 2001 were reviewed. Logistic and stepwise multiple regression analyses were used to identify predictors of allogeneic and autologous red cell transfusion during the operative and postoperative periods. RESULTS: Posterior spinal fusion surgery was performed in 107 patients (males, 42%) with a median age of 13.7 years (range, 1-20 years). The median intraoperative blood loss was 22 mL/kg (range, 4.4-72 mL/kg). Blood transfusion involved 63 patients (59%) who received 17 mL/kg (range, 3-65 mL/kg) of allogeneic packed red blood cells and 14 patients (13%) who received 7 mL/kg (range, 4-19 mL/kg) of autologous red cells donated before surgery. Underlying neuromuscular disease, lower body weight, and a higher number of vertebrae fused independently predicted a greater number of allogeneic red cells transfused (R2 = 0.53). The amount of autologous blood donated before surgery predicted the number of autologous red cells transfused (R2 = 0.56). CONCLUSIONS: Allogeneic red cell transfusion often is required for small patients with underlying neuromuscular disease who undergo extensive spinal fusion surgery. These patients may be less able to donate autologous blood before surgery. Newer therapies to reduce blood loss and transfusion requirement are needed most for this population.

Adolescent↗
PubMed2006

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain.

Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator's perspective.

Activities of Daily Living↗
PubMed2005

Experience with combined video-assisted thoracoscopic surgery (VATS) anterior spinal release and posterior spinal fusion in Scheuermann's kyphosis.

STUDY DESIGN: Retrospective. OBJECTIVES: To determine whether anterior endoscopic release and posterior spinal fusion could achieve stable correction in Scheuermann's kyphosis. SUMMARY OF BACKGROUND DATA: The initial treatment of choice of Scheuermann's kyphosis is thoracic hyperextension and postural exercises and/or Milwaukee brace. Milwaukee bracing is most efficacious in the early stages when the curvature is flexible and in the skeletally immature. However, it is known that larger curves, vertebral wedging greater than 10 degrees, and skeletally mature patients will not usually respond to this treatment. Surgery is indicated in the skeletally immature with severe deformity where brace treatment has failed to prevent progression. Posterior spinal instrumentation can achieve adequate correction in the less rigid curves. However, the more rigid curves have been shown to be resistant to posterior spinal fusion alone, therefore needing anterior spinal release. METHODS: Between 1995 and 2001, 19 patients underwent video-assisted thoracoscopic surgery and posterior spinal fusion for the treatment of Scheuermann's kyphosis. The average age was 17.4 years with closed triradiate cartilage in all. Average follow-up was 2.7 years. An average of 8.3 discs were released anteriorly; an average of 13 levels were fused posteriorly. RESULTS: Average preoperative kyphosis was 84.8 degrees. Average postoperative kyphosis was 43.7 degrees. Average kyphosis at follow-up was 45.3 degrees. Only 1.6 degrees of correction loss was noted. No junctional kyphosis was present. Two patients developed pleural effusion; one required thoracocentesis. Two patients developed pneumothorax. One patient underwent revision surgery for inferior hook pullout. One required mechanical ventilation. CONCLUSIONS: Combined video-assisted thoracoscopic surgery release and posterior spinal fusion for the treatment of Scheuermann's kyphosis is a viable option for the treatment of the more severe and rigid curves.

Adolescent↗
PubMed1997

Free vascularised fibular strut graft for anterior spinal fusion.

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other. A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.

Adolescent↗
PubMedDate not supplied

Longitudinal parental perceptions of spinal fusion for neuromuscular spine deformity in patients with totally involved cerebral palsy.

Retrospective surveys of caregivers of patients with totally involved cerebral palsy who are undergoing arthrodesis for spine deformity have demonstrated satisfaction with results but are subject to retrospective bias. The Pediatric Orthopaedic Society of North America outcomes questionnaire was prospectively administered to parents of patients with consecutively presenting, totally involved cerebral palsy before spinal fusion, 6 months after spinal fusion, and 1 year after spinal fusion. Review of medical records determined complication rates. Parents of 20 consecutive patients completed preoperative questionnaires. Ten of these completed questionnaires 6 months and 1 year postoperatively, and seven more completed only 1-year postoperative questionnaires. There were no significant changes between preoperative and postoperative assessments of physical function, school absence, comorbidities, and parental health. Patient pain, happiness, frequency of feeling sick and tired, and parental satisfaction improved significantly by 1 year postoperatively. All but pain and happiness were significantly improved by 6 months postoperatively, also. The presence of complications did not significantly affect questionnaire results. This prospective study substantiates the subjective gains noted in previous retrospective studies of spinal fusion for neuromuscular spine deformity in cerebral palsy.

Adolescent↗
PubMed2001

Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. OBJECTIVE: To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. SUMMARY OF BACKGROUND DATA: Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. METHODS: Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. RESULTS: Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly, CVA-P correlated with CVA-G, and SVA-P correlated with SVA-G to the P < 0.05 level. CONCLUSIONS: Patients with adolescent idiopathic scoliosis undergoing spinal fusion show slightly decreased gait speed at 2 years postoperation without any change in lower extremity kinematics. Spinal-pelvic balance parameters are improved in the coronal plane and unchanged in the sagittal plane radiographically and during standing posture and gait. Transverse plane parameters also are improved at maximum shoulder rotation during gait.

Adolescent↗
PubMed2003

[Laparoscopic anterior lumbar interbody spinal fusion].

The technique of Laparoscopic Anterior Lumbar Interbody Spinal Fusion (ALIF) has been developed in recent years for treating patients with spondylolisthesis, symptomatic degenerative disc disease and as salvage for failed posterior spinal fusion. The authors have performed 23 laparoscopic ALIF procedures with the close cooperation of spine and laparoscopic surgeons. This collaboration resulted in the successful laparoscopic completion of 87% of our cases. Postoperative length of stay was 2 days and patients required only minimal amounts of oral pain medications. Fourteen patients (70%) achieved excellent long term pain relief while 3 patients subsequently required an additional posterior fusion. There was only one major complication of bleeding from an ileac vein. Our results, similar to the results published by others, demonstrate the feasibility and effectiveness of laparoscopic ALIF. Further proof is still necessary to determine whether this procedure carries significant advantages vis-a-vis the open anterior or retroperitoneal approach.

Adult↗
PubMed2006

The osteoinductive properties of Nell-1 in a rat spinal fusion model.

BACKGROUND CONTEXT: Recombinant growth factors bone morphogenetic protein-2 (BMP-2) and BMP-7 are currently approved for human use but are associated with various adverse effects including ectopic bone formation and local inflammatory reaction. The development of alternative growth factors may help minimize the adverse effects of current osteoinductive therapeutics. Nell-1 (Nel-like molecule-1; Nel [a protein strongly expressed in neural tissue encoding epidermal growth factor like domain]) is a novel secretory molecule that appears to act more specifically on osteoblasts than the BMPs, which can act on multiple cell types. From a molecular point of view, Nell-1 is directly regulated by runt-related transcription factor 2 (Runx2/Cbfa1), a master regulatory gene controlling bone formation. Previous studies showed that Nell-1 accelerates osteogenic differentiation in vitro and calvarial bone formation in vivo. We hypothesize that Nell-1 may also effectively form bone in spinal fusion. PURPOSE: Our primary aim was to assess if direct adenoviral gene delivery with Nell-1 in a demineralized bone matrix (DBM) carrier can improve spinal fusion in a rat model. Because adenoviral vectors allow for sustained growth factor delivery, they were used for initial feasibility testing before protein studies. STUDY DESIGN/SETTING: Two groups of 20 athymic rats underwent posterolateral intertransverse process spinal fusion at L4-L5 with implanted DBM carrier containing either adenovirus coding for Nell-1 (AdNell-1) or control, Lac Z (AdLacZ). No cells were implanted. The 20 rats were sacrificed at 6 weeks for evaluation of spinal fusion. METHODS: All animals underwent Faxitron radiographs at 2, 4, and 6 weeks, manual spine palpation at 6 weeks, and high-resolution micro computerized tomography (microCT) at 6 weeks. Spinal fusion rate was assessed by: 1) 6-week Faxitron images; 2) manual palpation by three independent observers; 3) microCT; and 4) histology. New bone formation was assessed by hematoxylin-eosin and Masson trichrome staining on decalcified, coronally sectioned spine segments. RESULTS: All differences achieved statistical significance. After 6 weeks, direct application of adenoviral Nell-1 in a DBM carrier achieved significantly higher rates of spinal fusion over Lac Z controls: 60% Nell-1 versus 20% Lac Z by manual palpation and 70% Nell-1 versus 20% Lac Z by microCT and histology. Histological assessment of bone quality and maturity revealed more mature, higher quality bone in all the Nell-1 treated specimens relative to Lac Z at 6 weeks. CONCLUSIONS: Spinal fusion is more accurately assessed by microCT and histology than manual palpation. Direct application of adenoviral Nell-1 in a DBM carrier achieved significantly higher rates of spinal fusion over Lac Z controls at 6 weeks. Direct application of adenoviral Nell-1 in a DBM carrier also achieved significantly higher rates of spinal fusion over other reports in the literature using direct adenoviral BMP application. Direct application of adenoviral BMP in an allograft carrier achieved 8% fusion for BMP-2 and 16% fusion for BMP-7 at 8 weeks. These results indicate that Nell-1 may be a potent osteoinductive molecule. In addition, the regulation of Nell-1 by the master bone regulatory gene, Runx2 suggests that Nell-1 may exert its effects more specifically in osteoblastic cells than BMPs which affect multiple cell types. Overall, Nell-1 may fulfil a current need for an osteoinductive factor.

Adenoviridae↗
PubMedDate not supplied

Caring for the adult patient undergoing anterior/posterior spinal fusion.

Adult patients with severe scoliosis are increasingly undergoing a combined anterior/posterior spinal fusion to correct the spinal deformity. If the scoliosis is thoracolumbar, a retroperitoneal approach and a thoracotomy are required. This combined surgical approach requires increased knowledge and assessment skills of the attending nurse. Included in this article is the preoperative, intraoperative, and postoperative management of the adult patient undergoing anterior/posterior spinal fusion.

Adult↗
PubMed2006

Changes in the utilization of spinal fusion in the United States.

OBJECTIVE: Several reports suggest that spine surgery has experienced rapid growth in the past decade. Limited data exist, however, documenting the increase in spinal fusion. The objective of this work was to quantify and characterize the contemporary practice of spinal fusion in the United States. METHODS: Clinical data were obtained from the Nationwide Inpatient Sample for the years from 1993 to 2003. All patients with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes indicating cervical fusion, thoracolumbar fusion, lumbar or unspecified fusion were identified (n = 471,990). Primary ICD-9-CM diagnosis codes were used to determine the rationale for surgical fusion. Population-based utilization rates overall and for each procedure were calculated from United States census data. Rank order of spinal fusion compared with other inpatient procedures from the Nationwide Inpatient Sample was reported for the years 1997 to 2003. RESULTS: Overall utilization increased during the time period for cervical, thoracolumbar, and lumbar fusions by 89, 31, and 134%, respectively. Patients aged 40 to 59 years experienced the rapid rise in utilization for cervical fusions (60-110 per 100,000) and lumbar fusions (35-84 per 100,000). For patients 60 years and older, utilization also increased for cervical (30-67 per 100,000), thoracolumbar (4-9 per 100,000), and lumbar (42-108 per 100,000). Spinal fusion rose from the 41st most common inpatient procedure in 1997 to the 19th in 2003. CONCLUSION: Cervical, thoracolumbar, and lumbar spinal fusion have experienced a rapid increase in utilization in isolation and compared with other surgical procedures in contemporary practice. These changes are most pronounced for patients over 40 years of age, and degenerative disc disease seems to account for much of this increase.

Adult↗
PubMed1977

Delayed paresis following spinal fusion with Harrington instrumentation.

Immediate postoperative paresis following spinal fusion for scoliosis is uncommon. This neurological disaster can occur either within hours or days after surgical correction of the curvature. Paresis of the right lower extremity occurred on the third postoperative day in a 15-year-old boy who underwent spinal fusion for a pseudarthrosis of a previous fusion and in whom a Harrington rod was inserted for stability but not correction. The rod was removed within four hours of recognition of the paresis; within 18 months the child made an almost complete recovery of all motor function; slight residual weakness of the anterior dorsiflexors of the foot still remain.

Adolescent↗
PubMed2006

Spinal fusion with Cotrel-Dubousset instrumentation for neuropathic scoliosis in patients with cerebral palsy.

STUDY DESIGN: Retrospective. OBJECTIVE: To report on the treatment of patients with cerebral palsy and neuropathic scoliosis with third-generation instrumented spinal fusion by Cotrel-Dubousset instrumentation. SUMMARY OF BACKGROUND DATA: Second-generation instrumented spinal fusion is considered the standard for progressive neuropathic scoliosis in cerebral palsy, despite high complication rates. Evidence is needed to evaluate the increasing use of third-generation instrumented spinal fusion in similar patients. METHODS: Patients with cerebral palsy and spinal deformity treated consecutively by 1 surgeon with Cotrel-Dubousset instrumentation and minimum 2-year follow-up were reviewed. An outcome questionnaire was administered at final follow-up. RESULTS: A total of 60 patients were included. Mean age was 15 years at surgery. Mean follow-up was 79 months. There were 26 anteroposterior and 34 posterior-only procedures. Correction of coronal deformity and pelvic obliquity averaged 60% and 40%, respectively. Major complications affected 13.5% of patients, and included implant loosening, deep infection, and pseudarthrosis. Minor complications affected 10% of patients. Outcome questionnaires showed marked improvements in the areas of satisfaction, function, and quality of life after surgery. CONCLUSIONS: Segmental, third-generation instrumented spinal fusion provides lasting correction of spinal deformity and improved quality of life in patients with cerebral palsy and neuropathic scoliosis, with a lower pseudarthrosis rate compared to reports on second-generation instrumented spinal fusion.

Adolescent↗