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JournalISSN: 1536-0652

Journal of Spinal Disorders & Techniques 

Lippincott Williams & Wilkins
About: Journal of Spinal Disorders & Techniques is an academic journal. The journal publishes majorly in the area(s): Lumbar & Spinal fusion. It has an ISSN identifier of 1536-0652. Over the lifetime, 1727 publications have been published receiving 54709 citations.


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Journal ArticleDOI
TL;DR: Lumbar fusion using rhBMP-2 and a tapered titanium fusion cage can yield a solid union and eliminate the need for harvesting iliac crest bone graft in patients with degenerative lumbar disc disease.
Abstract: In a multicenter, prospective, randomized, nonblinded, 2-year study, 279 patients with degenerative lumbar disc disease were randomly divided into two groups that underwent interbody fusion using two tapered threaded fusion cages. The investigational group (143 patients) received rhBMP-2 on an absorbable collagen sponge, and a control group (136 patients) received autogenous iliac crest bone graft. Plain radiographs and computed tomographic scans were used to evaluate fusion at 6, 12, and 24 months after surgery. Mean operative time (1.6 hours) and blood loss (109.8 mL) were less in the investigational rhBMP-2 group than in the autograft control group (2.0 hours and 153.1 mL). At 24 months the investigational group's fusion rate (94.5%) remained higher than that of the control group (88.7%). New bone formation occurred in all investigational patients. At all intervals, mean postoperative Oswestry, back pain, and leg pain scores and neurologic status improved in both treatment groups with similar outcomes. In the control group, eight adverse events related to the iliac crest graft harvest occurred (5.9%), and at 24 months 32% of patients reported graft site discomfort and 16% were bothered by its appearance. Lumbar fusion using rhBMP-2 and a tapered titanium fusion cage can yield a solid union and eliminate the need for harvesting iliac crest bone graft.

652 citations

Journal ArticleDOI
TL;DR: Results of this study indicate that minimally invasive transforaminal lumbar interbody fusion is feasible and offers several potential advantages over traditional open techniques.
Abstract: Forty-nine patients underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) from October 2001 to August 2002 (minimum 18-month follow-up). The diagnosis was degenerative disc disease with herniated nucleus pulposus (HNP) in 26, spondylolisthesis in 22, and a Chance-type seatbelt fracture in 1. The majority of cases (n = 45) were at L4-L5 or L5-S1. A paramedian, muscle-sparing approach was performed through a tubular retractor docked unilaterally on the facet joint. A total facetectomy was then conducted, exposing the disc space. Discectomy and endplate preparation were completed through the tube using customized surgical instruments. Structural support was achieved with allograft bone or interbody cages. Bone grafting was done with local autologous or allograft bone, augmented with recombinant human bone morphogenetic protein-2 in some cases. Bilateral percutaneous pedicle screw-rod placement was accomplished with the Sextant system. There were no conversions to open surgery. Operative time averaged 240 minutes. Estimated blood loss averaged 140 mL. Mean length of hospital stay was 1.9 days. All patients presenting with preoperative radiculopathy (n = 45) had resolution of symptoms postoperatively. Complications included two instances of screw malposition requiring screw repositioning and two cases of new radiculopathy postoperatively (one from graft dislodgement, the other from contralateral neuroforaminal stenosis). Narcotic use was discontinued 2-4 weeks postoperatively. Improvements in average Visual Analogue Pain Scale and Oswestry Disability Index (preoperative to last follow-up) scores were 7.2-2.1 and 46-14, respectively. At last follow-up, all patients had solid fusions by radiographic criteria. Results of this study indicate that minimally invasive TLIF is feasible and offers several potential advantages over traditional open techniques.

527 citations

Journal ArticleDOI
TL;DR: The results confirm that the pelvis and spine in the sagittal plane can be considered as a linear chain linking the head to the Pelvis where the shape and orientation of each anatomic segment are closely related and influence the adjacent segment to maintain a stable posture with a minimum of energy expenditure.
Abstract: Objective:The purpose of this study is to introduce a method to analyze and characterize the global sagittal balance of the human trunk using indexes derived from the shape and orientation of the pelvis and cervical, thoracic, and lumbar spine.Methods:Standing lateral x-rays of a cohort of 160 asymp

524 citations

Journal ArticleDOI
TL;DR: The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration.
Abstract: The aim of this work was to add to the body of data on the frequency and severity of degenerative radiographic findings at adjacent levels after anterior cervical interbody fusion and on their clinical impact and to contribute to the insights about their pathogenesis. One hundred eighty patients who were treated by anterior cervical interbody fusion and who had a follow-up of >60 months were clinically and radiologically examined by independent investigators. For all patients, the long-term Odom score was compared with the score as obtained 6 weeks after surgery. For myelopathic cases, both the late Nurick and the Odom score were compared with the initial postoperative situation. For the adjacent disc levels, a radiologic "degeneration score" was defined and assessed both initially and at long-term follow-up. At late follow-up after anterior cervical interbody fusion, additional radiologic degeneration at the adjacent disc levels was found in 92% of the cases, often reflecting a clinical deterioration. The severity of this additional degeneration correlated with the time interval since surgery. The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration.

443 citations

Journal ArticleDOI
TL;DR: In this paper, a technique of C2 rigid screw fixation using bilateral, crossing C2 laminar screws, not previously reported in the literature, which does not place the vertebral artery at risk during C2 fixation was described.
Abstract: Rigid screw fixation of the axis, for either atlantoaxial fixation or for incorporation of C2 into subaxial cervical constructs, provides significant stability and excellent long-term fusion results but remains technically demanding due to the danger of injury to the vertebral artery. Anatomic variability of the foramen transversarium in the body of the axis can preclude safe transarticular C1-C2 screw placement in up to 20% of patients. Although more recent methods of C2 screw fixation with pedicle screws allow safer fixation in a higher number of patients, there remains a significant risk to the vertebral artery with C2 pedicle screw placement. The author describes a novel technique of C2 rigid screw fixation using bilateral, crossing C2 laminar screws, not previously reported in the literature, which does not place the vertebral artery at risk during C2 fixation. This technique has been successfully used by the author in cases of craniocervical and atlantoaxial fixation as well as for incorporation of C2 into subaxial fixations. The technique is illustrated, and the author's initial experience in treating 10 patients with crossing, bilateral C2 aminar screws for indications of trauma, neoplasm, pseudarthrosis, and degenerative disease is reviewed. The possible advantages of C2 fixation with C2 laminar screws are discussed.

416 citations

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Performance
Metrics
No. of papers from the Journal in previous years
YearPapers
202152
202056
201930
201829
2015164
2014118