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 145 records · Page 8Linked to original sources
PubMed1997

The role of preoperative pulmonary function tests in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

STUDY DESIGN: A retrospective review of the case records and radiographs of 133 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation between 1986 and 1992. OBJECTIVES: To evaluate the incidence of abnormal results on preoperative pulmonary function tests and their correlation to immediate postoperative pulmonary impairment in patients with adolescent idiopathic scoliosis who had posterior spinal fusion. SUMMARY OF BACKGROUND DATA: It has been stated that preoperative pulmonary function tests are essential to assess surgical risk in a patient with scoliosis because of the possibility of further compromising the pulmonary function. Authors of previous studies have reported on the increased incidence of postoperative pulmonary complications in patients undergoing anterior spinal surgery. METHODS: The case records and radiographs of 133 patients with either a thoracic or a double-major curve, who underwent posterior spinal fusion, were reviewed. The presence of any preoperative or postoperative cardiopulmonary symptoms and increased requirement of postoperative ventilatory support were noted. Results of preoperative pulmonary function tests were classified as normal, restrictive, or obstructive disease. Postoperative chest radiographs were examined to note the presence of atelectasis, infiltrates, pneumothorax, hemothorax, or pneumonia. RESULTS: The majority of patients (72.9%) had normal results on pulmonary function tests. The mean coronal Cobb angle of the thoracic curve was 48 degrees, and the mean angle of kyphosis was 26 degrees. None of the patients had any increased requirement of postoperative ventilatory support. The overall incidence of postoperative pulmonary complications was 2.3%. CONCLUSIONS: Performance of a thoracoplasty was the only risk factor for postoperative pulmonary complications in patients undergoing posterior spinal fusion. There was no correlation between deterioration of preoperative pulmonary function and the risk of postoperative pulmonary complications. It appears that performance of preoperative pulmonary function tests in patients with moderate adolescent idiopathic scoliosis-scheduled for posterior spinal fusion is not necessary.

Adolescent↗
PubMed2002

Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial.

STUDY DESIGN: To evaluate the clinical outcome respective of the type of bone graft used, 69 patients undergoing instrumented lumbar spinal fusion were randomized to receive either their own bone (harvested from the iliac crest) or allograft bone (fresh-frozen femoral head from donors undergoing total hip joint arthroplasty). Self-completed questionnaires were administered before surgery and at intervals thereafter. OBJECTIVES: To compare the clinical outcome of lumbar spinal fusion carried out using either allograft or autograft bone. SUMMARY OF BACKGROUND DATA: Previous studies have suggested that allograft bone is effective in cervical and thoracic fusion operations but that it is less effective in lumbar spinal fusions. Most of these studies used a radiographic means of determining fusion. However, no reliable radiologic assessment method has yet been agreed upon. It has also been shown that radiographic appearance does not correlate with clinical outcome. METHODS: A total of 69 patients undergoing instrumented posterolateral lumbar spinal fusion surgery were randomized to receive either allograft bone from the North East of Scotland Blood Transfusion Service or autologous bone from the iliac crest. The patients were then followed up at 1-year intervals over 6 years regarding clinical outcome. RESULTS: Patients receiving allograft bone had outcome scores similar to those who had received their own bone, except that in the autograft group there was a significant incidence of donor site pain that was persistent in about one sixth of patients. CONCLUSIONS: Allograft bone, in the form of fresh-frozen human femoral head, gives clinical results at least as good as autograft bone in instrumented posterolateral lumbar spinal fusion and completely avoids any donor site complications.

Adult↗
PubMed2006

Electrical stimulation therapies for spinal fusions: current concepts.

Electrical stimulation therapies have been used for more than 30 years to enhance spinal fusions. Although their positive effects on spinal fusions have been widely reported, the mechanisms of action of the technologies were only recently identified. Three types of technologies are available clinically: direct current, capacitive coupling, and inductive coupling. The latter is the basis of pulsed electromagnetic fields and combined magnetic fields. This review summarizes the current concepts on the mechanisms of action, animal and clinical studies, and cost justification for the use of electrical stimulation for spinal fusions. Scientific studies support the validity of electrical stimulation treatments. The mechanisms of action of each of the three electrical stimulation therapies are different. New data demonstrates that the upregulation of several growth factors may be responsible for the clinical success seen with the use of such technologies.

Animals↗
PubMed1995

An experimental lumbar intertransverse process spinal fusion model. Radiographic, histologic, and biomechanical healing characteristics.

OBJECTIVE: The purpose of this investigation was to develop, characterize, and validate an animal model for lumbar intertransverse process fusion. STUDY DESIGN: This study used a rabbit model to characterize the radiographic, histologic, and biomechanical properties of the intertransverse process spinal fusion healing process. METHODS: Sixty adult New Zealand white rabbits underwent bilateral posterolateral spinal fusion at L5-L6 using autogenous iliac bone graft. Four of the rabbits were used as negative controls: two received bone graft without decortication of the transverse process, and two underwent decortication without bone grafting. Rabbits were killed at 2, 3, 4, 5, 6, or 10 weeks and the spinal fusions were analyzed by radiography, manual palpation, and uniaxial tensile mechanical testing or light microscopy. RESULTS: Overall the nonunion rate was 33% in animals 4 or more weeks from surgery. Biomechanical strength and stiffness of the fusions became statistically different from the adjacent unfused control levels after the third week (P < 0.05). Tensile strength of the nonunions (1.4 times unfused control levels) was statistically less (P < 0.05) than that of the solidly fused levels (1.8 times unfused controls) in weeks 4, 5, 6, and 10. Fusion was not achieved in any of the control animals with omission of decortication or bone grafting. Light microscopic analysis showed three distinct and reproducible phases of spinal fusion healing. CONCLUSIONS: This animal model overcomes the limitations of previous models by more closely replicating the human procedure in surgical technique, graft healing environment, and outcome (i.e., a nonunion rate similar to that seen in humans). This model provides an opportunity to explore questions relevant to the biology of intertransverse process fusion and to investigate the coupling of the membranous and endochondral mechanisms of bone formation during spinal fusion.

Animals↗
PubMed2003

The use of Irradiated Allografts in Posterior Spinal Fusion for Healed Tubercular Kyphosis in Children.

Post-tubercular spinal kyphosis in children is not only cosmetically unacceptable but functionally disabling as well, as with the progression of the deformity there is a very significant risk of late onset paraplegia. We present our preliminary results in a prospective study of 12 cases of healed post-tubercular kyphosis in children treated with isolated posterior spinal fusion using irradiated allografts and autogenous cancellous grafts.The study included 12 patients of healed post-tubercular kyphosis documented by clinical, radiological and haematological criteria, with >2 spine at risk signs radiologically. The mean age was 7 years. In situ posterior spinal fusion with irradiated allografts and autogenous cancellous bone graft without any instrumentation was done for all the patients. The total follow-up is 5 years (mean 2.8 years).Eight patients (66%) showed a correction of the kyphosis, 3 patients (25%) were static and only 1 patient showed worsening of the deformity. Eleven patients had sound fusion and 1 patient had good fusion but a pseudoarthrosis at the lower vertebral level.Good posterior fusion was achieved because of the judicious use of morcellised, irradiated cancellous allografts with autogenous cancellous grafts. The proposed mechanism of correction is selective anterior column growth vis-à-vis posterior fused mass leading to gradual self-correction and remodelling.Conclusion. In situ posterior spinal fusion with irradiated allografts is a simple, safe, easily reproducible, less morbid surgical procedure with good results which may alter the long term disability of the patients.

Journal Article↗
PubMed1994

Posterior spinal fusion in neuromuscular scoliosis using a tibial strut graft. Results of a long-term follow-up.

STUDY DESIGN: Risks and benefits of using a tibial graft for posterior spinal fusion in neuromuscular scoliosis were evaluated in a long-term follow-up study. A consecutive series of 72 patients underwent posterior spinal fusion for neuromuscular scoliosis. OBJECTIVES: Radiologic outcome was assessed to evaluate the quality of the spinal fusion. Patients were followed serially to detect donor site complications. Mean follow-up was 17 years and 8 months (minimum: 6 years, 6 months). SUMMARY OF BACKGROUND DATA: Mean age of the patients at the time of surgery was 15 years. Progression of the curvature was minimal at last follow-up (mean progression at last follow-up: lumbar curve, 4.5 degrees; thoracic curve, 5.3 degrees). Concerning donor site complications, four patients had a leg length discrepancy of less than 2 cm at last follow-up. This complication was related to tibial overgrowth at the donor site. METHODS: Solid fusion was defined in this long-term study as the absence of modification of the radiologic aspect at last follow-up in addition to the presence of a massive contagious trabecular fusion mass. RESULTS: The fusion appeared to be solid in all patients. No obvious pseudarthrosis could be documented. The constant successful outcome differs significantly from spinal fusion that uses bank bone. The absence of stress fracture was correlated to the low level of constraint in this essentially nonambulatory population. CONCLUSION: This experience indicates that the tibial graft deserves consideration in posterior spinal fusion for neuromuscular scoliosis.

Adolescent↗
PubMed2005

Advances in spinal fusion.

Since its initial description about a century ago, spinal fusion has become a common surgical intervention in the treatment of various debilitating spinal disorders. However, given the complexities and demands of the procedure, patient selection remains a key component in the success of the operation. In this article, we will review the various indications for spinal fusion, the current advances in fusion techniques, as well as the potential complications associated with the procedure.

Adult↗
PubMed1995

The indications for lumbar spinal fusion with and without instrumentation.

STUDY DESIGN: Literature review. OBJECTIVES: A review, analysis, and discussion of the extensive literature on lumbar spinal fusion were done to attempt to place in perspective the indications and success rate for lumbar spinal fusion with and without instrumentation. SUMMARY OF BACKGROUND DATA: A wide variety of lumbar spinal conditions have been managed by spinal fusion. Results appear better when the diagnosis is very specific and related to definable instability or deformity in patients with a stable psychologic state. METHODS: Search of literature. RESULTS: Success rates are higher in isthmic spondylolisthesis, unstable spinal stenosis syndromes (degenerative spondylolisthesis, degenerative scoliosis), and in patients with objective segmental instability. Variable success rates are reported for disc-related low back pain conditions and in patients with failed previous surgery. Instrumentation appears to be beneficial in situations where complex deformities or obvious instability is present. When applied for other diagnoses (e.g., internal disc disruption), results appear no better than with traditional surgical techniques. CONCLUSIONS: The outcome of lumbar spinal fusion depends on careful assessment of the anatomic cause of pain and of the patient's functional state and expectations.

Humans↗
PubMed2004

Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities.

The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at operation was 9.3 years (standard deviation (SD): 2.4). Spinal curvature was measured according to Cobb. Pelvic obliquity and trunk decompensation were measured as well. The ambulation level was scored according to Hoffer, and functional abilities, as well as the amount of caregiver assistance, were documented using the Pediatric Evaluation of Disability Inventory. All patients were assessed before surgery and three times after surgery, with a total follow-up duration of 18 months after surgery. After spinal fusion, magnitude of primary curvature decreased significantly (p=0.002). Pelvic obliquity and trunk decompensation did not change. In spite of less immobilization as compared with other reported experiences, ambulation became difficult in three out of four patients who had been able to ambulate prior to surgery. Functional abilities and amount of caregiver assistance concerning self-care (especially regarding dressing upper and lower body, and self-catheterization) and mobility (especially regarding transfers) showed a nonsignificant trend to deterioration within the first 6 months after surgery, but recovered afterwards. From pre-surgery to 18 months after surgery, functional skills on self-care showed borderline improvement (p=0.07), whereas mobility did not (p=0.2). Mean scores on caregiver assistance improved significantly on self-care (p=0.03), and borderline on mobility (p=0.06), meaning that less caregiver assistance was needed compared with pre-surgery. The complication rate was high (80%). In conclusion, within the first 6 months after spinal fusion, more caregiver assistance is needed in self-care and mobility. It takes about 12 months to recover to pre-surgery level, while small improvement is seen afterwards. After spinal fusion, ambulation often becomes difficult, especially in exercise walkers. These findings are important for health-care professionals, in order to inform and prepare the patients and their parents properly for a planned spinal fusion.

Activities of Daily Living↗
PubMed2003

Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective comparison of three different types of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. OBJECTIVE: To determine the efficacy of bone marrow and demineralized bone matrix as a bone graft substitute for spinal fusion. SUMMARY OF BACKGROUND DATA: Several reports have documented a high morbidity associated with harvesting autologous iliac crest bone graft (ICBG) for spinal fusion. Composite bone graft consisting of demineralized bone matrix and aspirated bone marrow may reduce the morbidity and still retain the osteoinductive properties of iliac crest autograft. METHODS: Three different bone grafting techniques were used by a single surgeon in 88 consecutive patients who had posterior spinal fusion for adolescent idiopathic scoliosis. Segmental instrumentation with dual-rod fixation was used in all cases. Selection of type of graft was determined historically by the time when the operations were performed. Autologous ICBG was used in Group A, freeze-dried corticocancellous allograft in Group B, and composite graft of autologous bone marrow and demineralized bone matrix in Group C. Seventy-seven patients were reviewed, with a minimum of 2 years' follow-up (mean, 3 years 7 months; range, 2 years-9 years 5 months). Radiographs were assessed for pseudarthrosis and loss of correction of 10 degrees or more. Loss of 10 degrees of correction has been previously identified as an indicator of potential pseudarthrosis or fusion instability. Both of these criteria were used to compare success of fusion. RESULTS: Failure caused by pseudarthroses was seen in two patients (2.6%), one in Group A and one in Group B. Eleven patients lost greater than 10 degrees of correction, but only one demonstrated pseudarthroses. The 13 patients with pseudarthroses or loss of correction constitute the failure group for purposes of graft assessment. The failure rate was 12.5% in Group A (ICBG), 28% in Group B (freeze-dried corticocancellous allograft), and 11.1% in Group C (composite graft of autologous bone marrow and demineralized bone matrix). Eliminating patients with crankshaft phenomenon did not substantially change the results. There was no morbidity associated with bone marrow aspiration. CONCLUSIONS: Fusion rates were comparable for GroupA (ICBG) and Group C (composite graft of autologous bone marrow and demineralized bone matrix). The composite graft is our preferred graft for fusions in adolescent idiopathic scoliosis.

Adolescent↗
PubMed1998

Biomechanical testing sequelae relevant to spinal fusion and instrumentation.

The increasing prevalence of spinal disorders and associated treatments has produced a dramatic increase in the number of available devices. The biomechanical evaluation leading to the design, development, and implementation of spinal instrumentation has resulted in a number of in vitro and in vivo testing methods. This article reviews some of the methods and associated results obtained by various evaluation techniques of spinal fusion hardware. Current work and future considerations also are presented.

Animals↗
PubMed2003

BMPs and gene therapy for spinal fusion: summary statement.

The use of biologic technologies to engender spinal fusion is at various stages of scientific and clinical development. Recombinant human bone morphogenetic protein 2 is now available for clinical use in anterior lumbar intervertebral fusion and has been extensively studied in other spinal fusion applications. Recombinant bone morphogenetic protein 7 is under examination in regulated clinical trials. Gene therapy technologies are in the preclinical stage of development. In time, biologic interventions will continue to capture greater roles in the treatment of spinal disease.

Animals↗
PubMed1992

Spinal fusion in Duchenne muscular dystrophy.

Sixty-eight patients from a clinical population of 183 patients with Duchenne muscular dystrophy underwent posterior spinal fusion with instrumentation for progressive spinal deformity. Pulmonary complications were the most common postoperative problem, occurring in 17 per cent of the patients. A 35 per cent normal forced vital capacity was a reliable indicator of pulmonary complication risk. The patients with surgically stabilized spines were more comfortable in the later years of life and easier to care for, but deteriorating pulmonary function was not affected by the spinal fusion. The average age at death for the 29 boys who underwent spinal fusion was 18.3 years, which was similar to that of the 58 boys with scoliosis. Factors that improved the patients' quality of life included segmental instrumentation, fusion from T2 to the pelvis, correcting or balancing scoliosis, creating normal sagittal plane alignment and correcting pelvic obliquity.

Adolescent↗
PubMed2005

A poly(propylene glycol-co-fumaric acid) based bone graft extender for lumbar spinal fusion: in vivo assessment in a rabbit model.

STUDY DESIGN: An animal model of posterolateral intertransverse process lumbar spinal fusion compared fusion rates amongst autologous bone (group 1), a porous, bioabsorbable, scaffold based on the biopolymer, poly(propylene glycol-co-fumaric acid) (PPF) (group 2), and a combination of autograft and the bioabsorbable scaffold (group 3). OBJECTIVES: To evaluate the feasibility of augmenting spinal fusion with an osteoconductive and bioabsorbable scaffold as an alternative or as an adjunct, i.e., an extender, to autograft. SUMMARY OF BACKGROUND DATA: There is little preclinical data on applications of bioabsorable bone graft extenders in spinal fusion. METHODS: New Zealand White rabbits underwent single-level lumbar posterolateral intertransverse process fusion. Animals were treated with one of three materials: autologous bone (group 1), a bioabsorable material based on PPF (group 2), and the PPF biopolymer scaffold with autologous bone graft (group 3). Animals were evaluated at 6 weeks, and fusion was evaluated by manual palpation, and radiographic, histologic, and histomorphometric analyses. RESULTS: Radiographic and manual palpation showed evidence of fusion in all three groups. Histomorphometric measurement of bone ingrowth showed the highest quantity of new bone in group 3 (91%), followed by group 1 (72%) and group 2 (53%). CONCLUSIONS: Results of this study suggested that osteoconductive bioabsorbable scaffolds prepared from PPF might be used as an autograft extender when applied as an adjunct to spinal fusion.

Animals↗
PubMed2003

Importance of the back-café concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up.

STUDY DESIGN: A prospective, randomized, clinical study with a 2-year follow-up. OBJECTIVES: To analyze the effect of three different rehabilitation strategies for lumbar spinal fusion patients. SUMMARY OF BACKGROUND DATA: Fifteen percent to 40% of lumbar spinal fusion patients are not expected to improve significantly over a 2-year period. Optimization of present forms of rehabilitation could possibly further improve the outcome. MATERIALS AND METHODS: Between 1996 and 1999, 90 patients who had undergone lumbar spinal fusion were 3 months after surgery randomized to one of three different rehabilitation groups. Video group participants watched a video of exercises for training and were subsequently and only once provided instruction regarding their use. The back-café group was provided the same program as the video group, but as a supplement met with a back-café with other fusion-operated patients three times over an 8-week period. The training group was provided physical therapy training twice weekly for 8 weeks. Functional outcome was evaluated at 6, 12, and 24 months after surgery by use of the low back pain rating scale and a questionnaire covering daily functions, work status, and a patient's contact with the primary sector. RESULTS: By 2-year follow-up, the back-café and video groups had less pain compared with the training group (P < 0.03). The back-café group was better at performing daily functions such as carrying bags of market items (P < 0.01), getting up from a chair (P < 0.01), and ascending staircases (P < 0.01) compared with the video and training groups. More in the back-café group resumed working after surgery compared with the two other groups (P < 0.04). The video group had significantly more contacts with general practitioners, physical therapists, and so on compared with the back-café and training groups (P < 0.001). CONCLUSION: The patients in the back-café group were significantly better at accomplishing a succession of daily tasks compared with the video and training groups 2 years after lumbar spinal fusion. At the 2-year follow-up the training group had a significant pain problem compared with the video and back-café groups. The video group had significantly more treatment demands outside the hospital system. This study demonstrates the relevance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.

Absenteeism↗
PubMed2005

Murine spinal fusion induced by engineered mesenchymal stem cells that conditionally express bone morphogenetic protein-2.

OBJECT: The authors hypothesized that spinal fusion can be achieved and monitored by using cell-mediated gene therapy. Mesenchymal stem cells (MSCs) genetically engineered to express recombinant human bone morphogenetic protein-2 (rhBMP-2) conditionally, were implanted into the paraspinal muscles of mice to establish spinal fusion. The goal was to demonstrate an MSC-based gene therapy platform in which controlled gene expression is used to obtain spinal fusion in a murine model. METHODS: Mesenchymal stem cells expressing the rhBMP-2 gene were injected into the paravertebral muscle in mice. Bone formation in the paraspinal region was longitudinally followed by performing micro-computerized tomography scanning, histological studies, and an analysis of osteocalcin expression to demonstrate the presence of engrafted engineered MSCs. The minimal period of rhBMP-2 expression by the engineered MSCs required to induce fusion was determined. The results of this study demonstrate that genetically engineered MSCs induce bone formation in areas adjacent to and touching the posterior elements of the spine. This newly formed bone fuses the spine, as demonstrated by radiological and histological studies. The authors demonstrate that injected cells induce active osteogenesis at the site of implantation for up to 4 weeks postinjection. They found that a 7-day induction of rhBMP-2 expression in genetically engineered MSCs was sufficient to form new bone tissue, although the quantity of this bone increased as longer expression periods were implemented. CONCLUSIONS: After their injection genetically engineered MSCs can efficiently form new bone in the paraspinal muscle of the mouse to obtain spinal fusion. The extent and quantity of this newly formed bone can be monitored by controlling the duration of rhBMP-2 gene expression.

Animals↗
PubMedDate not supplied

Effect of spinal fusion on growth of the spine and lower limbs in girls with adolescent idiopathic scoliosis: a longitudinal study.

Two-hundred thirty-eight Southern Chinese girls, aged 10 to 14 years, treated previously for adolescent idiopathic scoliosis were studied longitudinally from the commencement of their treatment until maturity. Their standing, sitting, and suprasternal heights were measured at each follow-up visit, and their lower limb, head-neck, and spinal lengths were calculated. The results in 113 girls treated by posterior spinal fusion and Harrington instrumentation were compared with those of 125 girls who were treated with a brace. At maturity, the mean standing height of girls who underwent spinal fusion was not significantly different from that of patients treated with a brace. The fusion group had significantly shorter spinal lengths (p = 0.001), but significantly greater leg lengths (p = 0.001) compared to those of the brace group. Their arm lengths were similar, however. The girls who underwent spinal fusion had progressively increasing leg/arm ratios postoperatively from bone age 14-15 years onward compared to those treated with a brace, which indicated disproportionately longer legs in the girls who had spinal fusion. These findings suggest that spinal fusion performed on the girls with adolescent idiopathic scoliosis did retard the longitudinal growth of the spine. The standing height was unaffected, however, as the loss in spinal length was compensated by an increase in leg length.

Adolescent↗
PubMed1985

Posterior spinal fusion without blood replacement in Jehovah's Witnesses.

Posterior spinal fusion without blood replacement is a formidable procedure that most orthopedic surgeons are reluctant to attempt. This procedure has been performed without transfusions on 19 patients, all of whom were Jehovah's Witnesses. The operations were performed over four spinal segments at a time and were planned so that the procedure could be terminated when 10% of the patient's estimated total blood volume had been lost. Allogeneic donor bone was used to minimize blood loss whenever this was acceptable to the patient. The procedure was associated with a high incidence of pseudarthrosis, all cases of which occurred when allogeneic bone was used. No deaths or life-threatening complications were encountered. Thus, posterior spinal fusion can be performed in Jehovah's Witnesses without transfusion, but the procedure should be conducted only by the experienced spinal surgeon.

Adolescent↗