ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The prevalence of spinal disorders and their cost to society is enormous. Spinal fusion is often recommended to alleviate disabling symptomatology and it is one of the most common operations performed today. Surgical nonunion occurs frequently, and often with less than ideal clinical results. Understanding the biology, biochemistry, and biomechanics of bone healing can increase the rate of successful fusion. In addition, the role of the graft recipient bed and the presence of underlying systemic diseases affect bone healing. Moreover, correct selection of the type of bone for the proposed graft, its site of origin, and its proper sizing to fit the planned bony defect are major factors that influence the final construct geometry and its chance of successful arthrodesis.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Reconstruction of the anterior thoracic and lumbar spine has recently become a standard procedure. One popular method of reconstruction is the titanium mesh cage. Titanium mesh cages offer structural support and allow bone to span across the adjacent vertebral endplates. The indications, technique, and potential complications of titanium mesh cages are discussed in detail with emphasis on proper placement of the device.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Posterior lumbar interbody fusion has been practiced for more than 50 years. There is little question that interbody techniques offer a significantly higher fusion rate than traditional posterolateral techniques, but the morbidity associated with autograft harvest, the risks of root injury or dural tear during graft placement, and the high pseudarthrosis rate noted when allograft is substituted for autograft have conspired to minimize the widespread use of the procedure.Recently, various types of interbody cages have been developed in an effort to minimize autograft harvest requirements, reestablish disc and foraminal height, and decrease the risks of graft extrusion or collapse. Instrumentation developed for the placement of such cages has improved the surgeon's ability to perform complete discectomy, to properly prepare endplates, to reestablish lordosis, and to minimize the risk to the exiting nerve roots and dural canal.An experienced surgeon may expect fusion rates of 80% to 90% in one or two level lumbar fusions performed for degenerative disease using current techniques. Future improvements using more biocompatible or bioresorbable devices and various bone morphogenetic proteins will extend the life of these techniques well into the next century.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In the last 10 years, there has been a tremendous increase in the number of patients being treated with interbody fusion for degenerative disease of the lumbar spine. Although traditionally the preferred approach has been from a posterior exposure, the advent of minimally invasive surgery has ushered in anterior techniques developed for placing lumbar interbody fusion devices that avoid posterior element disruption. The anterior technique has some advantages over posterior lumbar interbody fusion, but it is not without significant risk. This report reviews the technical aspects of the “mini” open anterior lumbar interbody fusion and the important lessons we have learned through our experience with this technique.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Laparoscopy has revolutionized the field of general surgery. Recently, laparoscopic methods have been applied to the field of spinal surgery. Orthopedic surgeons and neurologic surgeons are now performing anterior laparoscopic lumbar interbody fusions with the assistance of general surgeons.Patients must be carefully selected for this procedure. The history, examination, and imaging studies must be concordant prior to undertaking this challenging operation. Often, discography in its more modern rendition is useful in the decision-making process. Fusions may be performed with threaded titanium cages or threaded bone dowels. Preoperative assessment of the imaging studies allows for templating of the approximate size of the implant.Four laparoscopic portals are generally required to perform this operation. These portals are used for dissection, retraction, visualization, and implant placement. Specialized instruments are used to distract the disc space and ream holes for the implants. Fluoroscopy is used to confirm accuracy and precision throughout the procedure. Laparoscopic fusion methods provide a viable alternative for fixation and fusion of the lumbosacral spine.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The initial treatment of disc space and vertebral body infections consists of antibiotics and bedrest. The indications for surgery are the failure of medical management that may include neurologic deficit, epidural abscess, progressive deformity, spinal instability, or intractable pain. The surgical approach must be tailored to directly address the anatomic focus of an infectious process. The general principles of aggressive debridement, drainage of an epidural abscess, correction of spinal deformity, and spinal reconstruction must be followed. This chapter reviews the pathophysiology of spinal infections and the principles of conservative and operative management, particularly involving spinal reconstruction of disc and vertebral defects utilizing implants.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Anterior approaches and instrumentation systems offer selected patients significant advantages over posterior surgery. Anterior surgery allows shorter segment fixation, superior torsional and axial stability, and better overall outcome in terms of improvement in neurologic function. Technical considerations can make surgery more difficult and can be associated with unique risks. However, with specialized training, anterior surgery can be performed safely with excellent results and minimal complications.

ISSN:1077-2855    

出版商:OVID    

年代:2001

数据来源: OVID