Anterior Intervertebral Fusion Research Articles

Composite Enhancement Polyether-Ether-Ketone for Long Segmental Spinal Column Deformity Orthopedic Treatment

Polyether-ether-ketone (PEEK) anterior intervertebral fusion combined with posterior long segment orthopedic surgery is a common method for the therapy of orthopedic deformity of the spine. PEEK material plays an important role in the effect of surgery. Graphene on copper substrate was transferred to the surface of carbon-fiber reinforced polyether-ether-ketone (CFR-PEEK) material by ferric chloride (FeCl3) chemical erosion and physical adsorption, hence the compound enhancement polyether-ether-ketone (Ge-PEEK) was achieved. In terms of characterization, Raman spectrometer was used to analyze the characteristics of the product generation, the scanning electron microscope (SEM) was used to analyze the morphology of the product, and the hydrophilicity of the material was analyzed by the droplet contact Angle. From the perspective of intervertebral fusion, Ge-PEEK material was used in the intervertebral fusion device to analyze the effect of the fusion device in the correction of spinal deformity, such as displacement, convex Angle, and collapse. In the characterization test, Raman spectrum analysis showed that Ge-PEEK material had the characteristic peaks of graphene, and SEM analysis showed that CFR-PEEK material was covered on a large scale by graphene. In the droplet contact angle test, the contact angle of the graphene-modified CFR-PEEK material was significantly reduced (P < 0.05). The material had good hydrophilicity. In the analysis of lumbar interfusion, the anterior intervertebral fusion rate based on Ge-PEEK material was 95.8% (P < 0.05), and the vertebral deposition rate based on Ge-PEEK fusion device was 7.2% (P < 0.05). At the same time, the distance between the leading edge of the cone after operation and the last follow-up was compared, and it was found that the displacement distance of different segments was smaller (P < 0.05). This study proved that the proposed Ge-PEEK material was feasible for anterior intervertebral fusion in the correction of long-segment spinal deformity.

Clinical and radiological outcomes after stand-alone ALIF for single L5-S1 degenerative discopathy using a PEEK cage filled with hydroxyapatite nanoparticles without bone graft

ObjectiveRecent improvements in cage designs with integral fixation and screw attachments have made stand-alone ALIF a viable option with several possible advantages. The aim of this study was to confirm the efficacy and safety of a PEEK cage filled with hydroxyapatite nanoparticles without adding a bone graft for stand-alone ALIF in the treatment of L5-S1 isolated degenerative disc discopathy (DDD). Patients and methodsSixty-five patients who required surgery for DDD were evaluated. Clinical outcome evaluations included back and leg pain (VAS), disability (Oswestry Disability Index), and patient satisfaction (Macnab’s criteria). Radiological outcomes include the assessment of disc height, the L5-S1 intervertebral disc angle, and anterior intervertebral fusion through standard and functional sagittal X-rays of the lumbar spine. Clinical and radiological measurements were assessed 2, 6, 12, and 24 months after surgery. ResultsClinical outcomes improved progressively and stabilized from 12- to 24-month follow-up. Final postoperative ODI scores showed a notable improvement (95%CI = 36.1–48.9 points; p < .001). Similarly, 24-month postoperative VAS scores revealed a significant decrease in pain (95%CI = 5.4–6.2; p < .001). The fusion rate was 95.4%. Anterior disc height was restored from 4.1 ± 3.2 mm at baseline to 9.5 ± 1.6 mm in the immediate postoperative period (p < .001). A small collapse (17.9%) of the disc height was detected from the 2- and 24-month follow-ups. Cage subsidence (more than 3 mm collapse) was detected in 4 cases (6.2%) and was related to cage size (more than 11 mm height; P < .05). There were no serious bone substitute-related adverse events and no revision surgeries. ConclusionStand–alone anterior lumbar interbody fusion using hydroxyapatite nanoparticles without an autologous bone graft is an effective and safe treatment option for L5-S1 degenerative pathology. Clinical outcomes were very satisfactory with a high fusion rate.

MODIFIED FIXATOR FOR ANTERIOR SPINAL FUSION FOR COMMINUTED FRACTURES IN THE THORACIC AND LUMBAR SPINE

Objective. To investigate strength characteristics of the bone-implant system for anterior intervertebral fusion and of the implant-bone contact zones of standard and innovative vertebral body implants by analysis of stress testing data. Material and Methods. Standard and modified mesh implants for anterior fusion were prepared for the study. Samples were placed between polyurethane vertebra models and fixed in accordance with principles of anterolateral fixation. Compression tests were performed with universal dynamometer. The experience of surgical treatment of 12 patients with comminuted fractures of the thoracic and lumbar spine using modified mesh implants was analyzed. Results. Application of modified mesh interbody implant for anterior fusion statistically reliably increases the implantbone system stability. It provided good results after surgery in 100 % of patients. Conclusion. Design features and bioactive properties of the modified fixator optimize and accelerate formation of a solid bone-metal block of the operated segments. This improves surgical results of anterior fusion for comminuted fractures of the thoracic and lumbar spine. Hir. Pozvonoc. 2012;(2):16-23.

Application of anterior intervertebral fusion with SOLIS for the treatment of traumatic cervical disc protru-sion

Objective To evaluate the application of SOLIS in the surgery on anterior intervertebral fusion for the treatment of traumatic cervical disc protrnsion. Methods 53 traumatic single segment cervical disc protrusion were divided into three groups randomly. The A group (SOLIS) :n=18, SOLIS filled with autocancellous bone were implanted between the cervical vertebrae. The B group(Syncage) :n =16, as the first group Syncage filled with auto-cancellous bone were implanted. The C group:n=19,anterior cervical decompression and fusion with bone autograft and internal fixation with ACPS. The operations of the surgery on anterior cervical decompression in three groups were the same. Recovery of nerve function was observed by JOA score and the fusion state, stability and changes of interver-tebra height of fusion segment were evaluated by X ray. Results The average duration of the follow-up was 16.5 months in 53 cases. Bony fusion could be found 3～9months after operation in all cases. In all A (SOLIS) group cases,the movement of the implanted $OLIS Cage were not found. The heights of the cervical intervertebral spaces and the physiological curvature were restored without loss in the duration of follow-up. The average JOA was(10.4±2.4) be-fore operation and(14.9±2.0)after operation. There was highly significant variation between the former and the latter (P 0.05). Conclusion Treatment of single segment prolapse of the cervical intervertebral disc with SOLIS cage has some advantages such as higher fusion rate, higher recovery rate of nerve function and low rate of loss of intervertebra] height. Key words: Spinal fusion; Intervertebral disk displace ment

CORPORODESIS AS A VARIANT OF TREATMENT FOR UNSTABLE LUMBOSACRAL OSTEOCHONDROSIS

Objective. To study and compare variants of surgical treatment for unstable lumbosacral osteochondrosis. Material and Methods. The study group included 65 patients who had undergone surgery for unstable lumbar osteochondrosis associated with intervertebral disc herniation. There were 30 males and 35 females at the age of 19 to 64 years. Patients were operated on by anterior coupled wedging-and-stabilizing corporodesis. The study group was compared with sex- and agematched control group, which included 60 patients who had undergone discectomy and conventional wedging anterior intervertebral fusion with bone autograft according to Ya.L. Tsivian. Results. In the study group 38 (58.4 %) patients had excellent, 22 (33.8 %) – good, and 5 (7.6 %) – satisfactory results. Unsatisfactory result (ineffective surgery or patient’s condition deterioration) was not observed in any of 65 operated patients. Intervertebral corporodesis with coupled autografts (study group) provided reducing a duration of hospital stay and terms of bone block formation, and better treatment result as compared with control group. Conclusion. Anterior coupled intervertebral corporodesis is very effective and can serve as a method of choice for treatment of unstable lumbar osteochondrosis.

Reoperation after surgical treatment of lumbar spondylolisthesis

To study the causes of failure following surgical treatment of lumbar spondylolisthesis, procedures for redo surgery and the final result of reoperation. 20 patients who had a repeat operation for lumbar spondylolisthesis were studied retrospectively. On average 24.3 months following the previous surgery, all of these patients had recurrence or progression of back and leg pain. All of 20 patients were reoperated by means of three different procedures. The causes of failure were post-operative destabilization (6 cases); progressive spondylolithesis (3 cases) implants failure (10 cases) and mistake segment (one case). After reoperation, a mean 34.1 months' follow-up was made. The excellent or good rate was 90%. Incorporation of graft was found in 18 cases with fusion by inter-transverse process and 2 cases by intervertebral space. New bone formation was found in 6 out of 8 cases that had a simultaneous intervertebral cage implant. No implant failure was found in all patients. Simple laminectomy or discectomy was not indication for lumbar spondylolithesis. No bone graft or union was the main causes of implant failure. Posterior instrumented fusion with laminectomy decompression can be used in the patients who had a prior surgery of simple discectomy or anterior intervertebral bone graft. Except for posterior instrumented fusion with extensive laminectomy decompression, Intervertebral fusion should be considered in the patients who had a prior surgery of laminectomy decompression with instrument, anterior intervertebral fusion (ALIF) was recommended for these cases.

Predictive value of magnetic resonance imaging in lumbosacral fusion decision making. A case report

Study design: A case report of a L4-5 Modic I discopathy and its post operative clinical and MRI outcome emphazise importance of adjacent disc pre operative assessement.Objective: To assess the need of a correct strategy in lumbosacral fusion decision making.Summary and background data: Modic classification is well known but evolution and relations between the three different stages is not well documented.Methods: A L4-5 fusion performed with Titanium instrumentation enables to document a Modic I stage becoming Modic II after successfull fusion. In the mean time the upper adjacent disc L3-4 Modic III deteriorated in Modic I. A new fusion L3-Sacrum enabled to document the same outcome L3-4 Modic I becoming after successfull fusion Modic II.Result: this specific case demonstrates twice the efficiency of postero lateral fusion in the treatment of discopathy. Modic II stage assessing local stability correlated in our case to good clinical evolution. It also demonstrates the risk of adjacent disc failure in case of Modic I image.Conclusion: M.R.I. pre operative finding needs to be taken in account in fusion decision making. Discopathy can be cured by successful postero lateral fusion. Thus anterior intervertebral fusion or postero lumbar interbody fusion is not mandatory as demonstrated twice in this specific case. Levels of fusion needs correct assessement and can explain poor results.

Anterior lumbar interbody fusion with osteoinductive growth factors.

Anterior intervertebral fusion increasingly is used as a treatment for discogenic or intersegmental pathologic diseases of the lumbar spine. This is in part attributable to the evolution and refinement of laparoscopic and minimally invasive surgical techniques that now can be used to access the anterior spinal column. It also is attributable to the availability of newer generation intervertebral fixation devices such as the threaded titanium cages or threaded allograft bone dowels, both of which are technically simpler to implant. Recently, limited clinical studies of intervertebral lumbar fusion have examined the use of these devices combined with osteoinductive growth factors as substitutes for autogenous bone graft. Early clinical results of lumbar fusion using threaded intervertebral implants filled with recombinant human bone morphogenetic protein-2 have been favorable. Higher fusion rates, shorter operative times, and shorter hospital stays have been reported in the initial series. Clinical trials involving larger cohorts with various spinal applications for osteoinductive molecules currently are in progress.

結核との混合感染が疑われた非チフス型サルモネラ菌による化膿性脊椎炎の治療経験

Osteomyelitis of the spine caused by Salmonella is rare. The authors describe a case in which the patient had fusion of the L1 to L3 vertebrae, which wereaffected by spondylitis of the Salmonella group O9.A man, sixty-eight years old, had a two-month history of low back pain and gait disturbance without any injury. He was already observed with incomplete paraplegia and bladder disturbance on admission. Laboratory findings suggested mild inflammation. Radiographs of the lumbar spine showed the burst fracture of the L3 vertebra and instability between the L2 and L3 vertebrae. MRI showed the rim enhancment of the abscess in the psoas. We performed anterior intervertebral fusion with iliac bone graft and found Salmonella group O9 from the culture of thegranulation tissue. Six months after, he was able to walk with Lofstrand crutches.Salmonella spondylitis may mimic tuberculous spondylitis both clinically and radiologically. Therefore it is important to discriminate Salmonella spondylitis from other pyogenic or tuberculous spondylitis.

非定型抗酸菌による脊椎炎の１例

Atypical mycobacterium infection of spine is very rare. It is often misdiagnosal and treated unsatisfactory. We report a case of spondylitis due to atypical mycobacterium.A man, seventy years old, had a 1-month history of back pain and right buttock pain. He has abscess discharging pus on right buttock. Radiographs of the thoracic spine were suggestive of inflammatory disease such as pyogenic or tuberculous, with destrucion of the T10 and T11 vertebral bodies. Laboratory findings included a white blood cell count of 10, 600, erythrocyte sedimentation rate of 125mm per hour and C reactive protein of 13.7mg/dl. We found E. coil and Staphylococcus milleri from the culture of the buttock's abscess. We diagnosed the patient as pyogenic spondylitis, and we gave him antibiotic drugs. Spondylitis persisted and resulted in more destruction of vertebral body. After 2 months, we performed anterior intervertebral fusion with iliac bone graft. We found mycobacterium kansasii from the culture of granulation sent at operation. After the operation, we gave him antitubercular drugs, but he has had numbness of lower fegs and spasticity. Laboratory findings have suggested mild inflammation, indicating the weed for careful observation.It is important to discriminate spondylitis cannd by atypical mycobacterium from pyogenic or tuberculous spondylitis.

Posterior reduction and anterior intervertebral fusion in lumbar spondylolisthesis

Surgical Principles Complete reduction of the spondylolisthesis with a special reduction tool [5–7] through a posterior approach. Distraction of the affected intervertebral space, stabilization of the vertebral segment involved through internal fixation [2]. Anterior intervertebral fusion with autologous iliac crest bone.

Changes of Kyphotic Angle in Children and Adults after Anterior Intervertebral Fusion in Spinal Tuberculosis

Changes of Kyphotic Angle in Children and Adults after Anterior Intervertebral Fusion in Spinal Tuberculosis

SPONTANEOUS ANTERIOR FUSION OF VERTEBRAL BODIES

1. Five patients are reported in whom osteochondritis is shown to have given rise to anterior intervertebral fusion. 2. It is suggested that anterior intervertebral fusion discovered in radiographs of adult spines may arise from osteochondritis rather than from a congenital abnormality or infection.