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Foreman M, Patel A, Nguyen A, Foster D, Orriols A, Lucke-Wold B. Management Considerations for Total Intervertebral Disc Replacement. World Neurosurg 2024; 181:125-136. [PMID: 37777178 DOI: 10.1016/j.wneu.2023.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
The burden of disease regarding lumbar and cervical spine pain is a long-standing, pervasive problem within medicine that has yet to be resolved. Specifically, neck and back pain are associated with chronic pain, disability, and exorbitant health care use worldwide, which have only been exacerbated by the increase in overall life years and chronic disease. Traditionally, patients with significant pain and disability secondary to disease of either the cervical or lumbar spine are treated via fusion or discectomy. Although these interventions have proved curative in the short-term, numerous longitudinal studies evaluating the efficacy of traditional management have reported severe impairment of normal spinal range of motion, as well as postoperative complications, including neurologic injury, radiculopathy, osteolysis, subsidence, and infection, paired with less than desirable reoperation rates. Consequently, there is a call for innovation and improvement in the treatment of lumbar and cervical spine pain, which may be answered by a modern technique known as intervertebral disc arthroplasty, or total disc replacement (TDR). Thus, this review aims to describe the management strategy of TDR and to explore updated considerations for its use in practice, both to help guide clinical decision making.
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Affiliation(s)
- Marco Foreman
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
| | - Aashay Patel
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Andrew Nguyen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Devon Foster
- Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Adrienne Orriols
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Hunt JP, Begley MR, Block JE. Truss implant technology™ for interbody fusion in spinal degenerative disorders: profile of advanced structural design, mechanobiologic and performance characteristics. Expert Rev Med Devices 2021; 18:707-715. [PMID: 34160337 DOI: 10.1080/17434440.2021.1947244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Interbody fusion devices are customarily used in fusion of the anterior spinal column for treatment of degenerative disc disease. Their traditional role is to reestablish and maintain intervertebral disc height, contain bone graft and provide mechanical support for the spine while osseointegration takes place. Utilizing the principles of mechanobiology, a unique biokinetic interbody fusion device has been developed that employs an advanced structural design to facilitate and actively participate in the fusion consolidation process.Areas covered: This article profiles and characterizes 4WEB Medical's Truss Implant Technology™ which includes a range of 3D-printed titanium spinal interbody implants and non-spinal implants whose design is based on truss structures enabled by advances in additive manufacturing. Four main areas of the implant design and functionality are detailed: bio-architecture, mechanobiologic underpinnings, bioactive surface features, and subsidence resistance. Pre-clinical and clinical examples are provided to describe and specify the bioactive roles and contributions of each design feature.Expert opinion: The distinct and unique combination of features incorporated within the truss cage design results in a biokinetic implant that actively participates in the bone healing cascade and fusion process.
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Affiliation(s)
| | - Matthew R Begley
- Department of Engineering, University of California, Santa Barbara, Santa Barbara, USA
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Qiu X, Tan Z, Tang W, Ye H, Lu X. Effects of controlled hypotension with restrictive transfusion on intraoperative blood loss and systemic oxygen metabolism in elderly patients who underwent lumbar fusion. Trials 2021; 22:99. [PMID: 33509270 PMCID: PMC7841987 DOI: 10.1186/s13063-020-05015-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns. The aim of this study was to evaluate blood loss, oxygen metabolism, and renal function in different levels of controlled hypotension induced by intravenous nitroglycerin, in combination with limited infusion, in elderly patients undergoing posterior lumbar fusion. METHODS A total of 40 patients, aged 60-75 with ASA grade II or III, who were planned for posterior lumbar fusion were randomly allocated into two groups: experimental group [target mean arterial pressure 65 mmHg (MAP 65) or control group (MAP 75)]. Indicators for blood loss, hemodynamic, systemic oxygen metabolism, and renal function evaluation index were recorded before operation (T0), 1 h after induced hypotension (T1), 2 h after hypotension (T2), and in recovery (T3). We compared changes in these parameters between groups to evaluate the combined effects of controlled hypotension with restrictive infusion. RESULTS CI, DO2I, and VO2I were lower in both groups at T1-T3 compared with T0 (p < 0.05). DO2I and VO2I in the MAP 65 group were lower than the MAP 75 group after operation. In both groups, SCysC increased at T1, T2, and T3 (p < 0.05) compared with T0. CONCLUSIONS Restrictive transfusion and control MAP at 65 mmHg can slightly change in renal function and reduce the risk of insufficient oxygen supply and importantly have no significant effect on blood loss and postoperative complications. TRIAL REGISTRATION ChiCTR-INR-16008153 . Registered on 25 March 2016.
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Affiliation(s)
- Xiaodong Qiu
- Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
| | - Zhiying Tan
- Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Wenhao Tang
- Department of General Surgery, Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, China
| | - Hui Ye
- Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xinjian Lu
- Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Coric D, Roybal RR, Grubb M, Rossi V, Yu AK, Swink IR, Long J, Cheng BC, Inzana JA. Bidirectional Expandable Technology for Transforaminal or Posterior Lumbar Interbody Fusion: A Retrospective Analysis of Safety and Performance. Int J Spine Surg 2020; 14:S22-S30. [PMID: 33122186 DOI: 10.14444/7123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Expandable devices for transforaminal or posterior lumbar interbody fusion (TLIF and PLIF, respectively) may enable greater restoration of disc height, foraminal height, and stability within the interbody space than static spacers. Medial-lateral expansion may also increase stability and resistance to subsidence. This study evaluates the clinical and radiographic outcomes from early experience with a bidirectional expandable device. METHODS This was a retrospective analysis of a continuous series of patients across 3 sites who had previously undergone TLIF or PLIF surgery with a bidirectional expandable interbody fusion device (FlareHawk, Integrity Implants, Inc) at 1 or 2 contiguous levels between L2 and S1. Outcomes included the Oswestry Disability Index (ODI), a visual analog scale (VAS) for back pain or leg pain, radiographic fusion by 1 year of follow-up, subsidence, device migration, and adverse events (AE). RESULTS There were 58 eligible patients with radiographs for 1-year fusion assessments and 45 patients with ODI, VAS back pain, or VAS leg pain data at baseline and a mean follow-up of 4.5 months. The ODI, VAS back pain, and VAS leg pain scores improved significantly from baseline to final follow-up, with mean improvements of 14.6 ± 19.1, 3.4 ± 2.6, and 3.9 ± 3.4 points (P < .001 for each), respectively. In addition, 58% of patients achieved clinically significant improvements in ODI, 76% in VAS back pain, and 71% in VAS leg pain. By 1 year, 96.6% of patients and 97.4% of levels were considered fused. There were zero cases of device subsidence and 1 case of device migration (1.7%). There were zero device-related AEs, 1 intraoperative dural tear, and 3 subsequent surgical interventions. CONCLUSIONS The fusion rate, improvements in patient-reported outcomes, and the AEs observed are consistent with those of other devices. The bidirectional expansion mechanism may provide other important clinical value, but further studies will be required to elucidate the unique advantages. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Mark Grubb
- Northeast Ohio Spine Center, Akron, Ohio
| | - Vincent Rossi
- Carolina Neurosurgery & Spine Associates, Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | - Alex K Yu
- Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Isaac R Swink
- Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Jason Long
- Department of Radiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Boyle C Cheng
- Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
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Augusto A, Dias RG, Wajchenberg M, Martins D. EXTREME LATERAL INTERBODY FUSION IN PACIENTS WITH CHRONIC LOW BACK PAIN. ACTA ORTOPEDICA BRASILEIRA 2020; 28:256-260. [PMID: 33144843 PMCID: PMC7580297 DOI: 10.1590/1413-785220202805233621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of lateral lumbar interbody fusion (LLIF) or oblique interbody fusion (OLIF) on low back pain due to degenerative intervertebral disc disease. METHODS We systematically reviewed articles on surgical treatment of low back pain by LLIF and OLIF, according to the Cochrane Handbook for Systematic Reviews of Interventions. We searched through electronic databases, including Medline via PubMed, Lilacs through the Virtual Health Library (VHL), Cochrane Collaboration/Central and Cohrane/Dare Cochrane Controlled Trials Register, without language or publication date restrictions and with design for prospective cohorts and randomized clinical trials. RESULTS We have selected and presented three studies. CONCLUSION The literature review showed great relevance in the improvement of the new surgical approach (LLIF) in relation to TLIF, but greater content availability in the databases is necessary to reach a satisfactory conclusion regarding the efficiency of the lateral approach and its advantages over other traditional procedures. Level of Evidence II, Systematic review of Level II studies.
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Affiliation(s)
| | | | - Marcelo Wajchenberg
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - Delio Martins
- Universidade Anhembi Morumbi, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. Int J Mol Sci 2020; 21:ijms21062135. [PMID: 32244936 PMCID: PMC7139690 DOI: 10.3390/ijms21062135] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022] Open
Abstract
With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.
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Volpe RH, Mistry D, Patel VV, Patel RR, Yakacki CM. Dynamically Crystalizing Liquid-Crystal Elastomers for an Expandable Endplate-Conforming Interbody Fusion Cage. Adv Healthc Mater 2020; 9:e1901136. [PMID: 31805223 DOI: 10.1002/adhm.201901136] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/13/2019] [Indexed: 12/31/2022]
Abstract
Degenerative disc disease (DDD) is the leading cause of low back pain and radiating leg pain. DDD is commonly treated surgically using spinal fusion techniques, but in many cases failure occurs due to insufficient immobilization of the vertebrae during fusion. The fabrication and demonstration of a 3D-printed semi-crystalline liquid crystal elastomer (LCE) spinal fusion cage that addresses these challenges in particular subsidence are described. During implantation of the fusion cage, the LCE is rubbery and capable of deforming around and conforming to delicate anatomy. In the hours following implantation, the device crystallizes into a rigid, structural material with the modulus increasing tenfold from 8 to 80 MPa. In the crystalline regime, a 3D-printed prototype device is capable of enduring 1 million cycles of physiologic compressive loading with minimal creep-induced ratcheting. Effects of LCE molecular architecture on the rate and magnitude of modulus increase, material processability, and mechanical properties are explored. This fundamental characterization informs a proof-of-concept device-the first bulk 3D printed LCE demonstrated to date. Moreover, the novel deployment strategy represents an exciting new paradigm of spinal fusion cages, which addresses real clinical challenges in expandable interbody fusion cages.
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Affiliation(s)
- Ross H. Volpe
- Department of Mechanical Engineering University of Colorado Denver CO 80204 USA
| | - Devesh Mistry
- Department of Mechanical Engineering University of Colorado Denver CO 80204 USA
| | - Vikas V. Patel
- Department of Orthopedics University of Colorado Anschutz Medical Campus Aurora CO 80045 USA
| | - Ravi R. Patel
- Department of Mechanical Engineering University of Colorado Denver CO 80204 USA
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Sandhu FA, Dowlati E, Garica R. Lumbar Arthroplasty: Past, Present, and Future. Neurosurgery 2019; 86:155-169. [DOI: 10.1093/neuros/nyz439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/17/2019] [Indexed: 01/27/2023] Open
Abstract
Abstract
Lumbar degenerative disc disease is a pathologic process that affects a large portion of our aging population. In the recent past, surgical treatment has involved fusion procedures. However, lumbar disc arthroplasty and replacement provides an alternative for carefully selected patients. It provides the major advantage of motion preservation and thus keeps adjacent segments from significantly progressive degeneration. The history of lumbar disc replacement has roots that start in the 1960s with the implantation of stainless-steel balls. Decades later, multiple implants with different material design and biomechanical properties were introduced to the market. New third-generation implants have made great strides in improved biomechanics and clinical outcomes. Although there is room for further advancement and studies are warranted to assess the long-term durability and sustainability of lumbar disc arthroplasty, it has certainly proven to be a very acceptable alternative within the surgical armamentarium that should be offered to patients who meet indications. In this review we present an overview of lumbar disc arthroplasty including its history, indications, biomechanics, challenges, and future directions.
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Affiliation(s)
- Faheem A Sandhu
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Ehsan Dowlati
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia
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Patel RR, Noshchenko A, Dana Carpenter R, Baldini T, Frick CP, Patel VV, Yakacki CM. Evaluation and Prediction of Human Lumbar Vertebrae Endplate Mechanical Properties Using Indentation and Computed Tomography. J Biomech Eng 2019; 140:2681673. [PMID: 30029240 DOI: 10.1115/1.4040252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Current implant materials and designs used in spinal fusion show high rates of subsidence. There is currently a need for a method to predict the mechanical properties of the endplate using clinically available tools. The purpose of this study was to develop a predictive model of the mechanical properties of the vertebral endplate at a scale relevant to the evaluation of current medical implant designs and materials. Twenty vertebrae (10 L1 and 10 L2) from 10 cadavers were studied using dual-energy X-ray absorptiometry to define bone status (normal, osteopenic, or osteoporotic) and computed tomography (CT) to study endplate thickness (μm), density (mg/mm3), and mineral density of underlying trabecular bone (mg/mm3) at discrete sites. Apparent Oliver-Pharr modulus, stiffness, maximum tolerable pressure (MTP), and Brinell hardness were measured at each site using a 3 mm spherical indenter. Predictive models were built for each measured property using various measures obtained from CT and demographic data. Stiffness showed a strong correlation between the predictive model and experimental values (r = 0.85), a polynomial model for Brinell hardness had a stronger predictive ability compared to the linear model (r = 0.82), and the modulus model showed weak predictive ability (r = 0.44), likely due the low indentation depth and the inability to image the endplate at that depth (≈0.15 mm). Osteoporosis and osteopenia were found to be the largest confounders of the measured properties, decreasing them by approximately 50%. It was confirmed that vertebral endplate mechanical properties could be predicted using CT and demographic indices.
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Affiliation(s)
- Ravi R Patel
- Department of Mechanical Engineering, University of Colorado Denver, Campus Box 112, P.O. Box 173364, Denver, CO 80217 e-mail:
| | - Andriy Noshchenko
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 13001 E 17th Avenue, Building 500, Mail Stop 432, Aurora, CO 80045 e-mail:
| | - R Dana Carpenter
- Department of Mechanical Engineering, University of Colorado Denver, Campus Box 112, P.O. Box 173364, Denver, CO 80217 e-mail:
| | - Todd Baldini
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 13001 E 17th Avenue, Building 500, Mail Stop 432, Aurora, CO 80045 e-mail:
| | - Carl P Frick
- Department of Mechanical Engineering, College of Engineering and Applied Science, University of Wyoming, , Laramie, WY 82071 e-mail:
| | - Vikas V Patel
- Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 12631 E. 17th Avenue, Academic Office 1, Room 4602, Denver, CO 80045 e-mail:
| | - Christopher M Yakacki
- Department of Mechanical Engineering, University of Colorado Denver, Campus Box 112, P.O. Box 173364, Denver, CO 80217 e-mail:
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Zigler J, Gornet MF, Ferko N, Cameron C, Schranck FW, Patel L. Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials. Global Spine J 2018; 8:413-423. [PMID: 29977727 PMCID: PMC6022955 DOI: 10.1177/2192568217737317] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES To evaluate the long-term efficacy and safety of total disc replacement (TDR) compared with fusion in patients with functionally disabling chronic low back pain due to single-level lumbar degenerative disc disease (DDD) at 5 years. METHODS PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials reporting outcomes at 5 years for TDR compared with fusion in patients with single-level lumbar DDD. Outcomes included Oswestry Disability Index (ODI) success, back pain scores, reoperations, and patient satisfaction. All analyses were conducted using a random-effects model; analyses were reported as relative risk (RR) ratios and mean differences (MDs). Sensitivity analyses were conducted for different outcome definitions, high loss to follow-up, and high heterogeneity. RESULTS The meta-analysis included 4 studies. TDR patients had a significantly greater likelihood of ODI success (RR 1.0912; 95% CI 1.0004, 1.1903) and patient satisfaction (RR 1.13; 95% CI 1.03, 1.24) and a significantly lower risk of reoperation (RR 0.52; 95% CI 0.35, 0.77) than fusion patients. There was no association with improvement in back pain scores whether patients received TDR or fusion (MD -2.79; 95% CI -8.09, 2.51). Most results were robust to sensitivity analyses. Results for ODI success and patient satisfaction were sensitive to different outcome definitions but remained in favor of TDR. CONCLUSIONS TDR is an effective alternative to fusion for lumbar DDD. It offers several clinical advantages over the longer term that can benefit the patient and reduce health care burden, without additional safety consequences.
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Affiliation(s)
| | | | - Nicole Ferko
- Cornerstone Research Group Inc, Burlington, Ontario, Canada
| | - Chris Cameron
- Cornerstone Research Group Inc, Burlington, Ontario, Canada
| | | | - Leena Patel
- Cornerstone Research Group Inc, Burlington, Ontario, Canada
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Zigler J, Ferko N, Cameron C, Patel L. Comparison of therapies in lumbar degenerative disc disease: a network meta-analysis of randomized controlled trials. J Comp Eff Res 2018. [DOI: 10.2217/cer-2017-0047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the efficacy and safety of total disc replacement, lumbar fusion, and conservative care in the treatment of single-level lumbar degenerative disc disease (DDD). Materials & methods: A network meta-analysis was conducted to determine the relative impact of lumbar DDD therapies on Oswestry Disability Index (ODI) success, back pain score, patient satisfaction, employment status, and reoperation. Odds ratios or mean differences and 95% credible intervals were reported. Results: Six studies were included (1417 participants). Overall, the activL total disc replacement device had the most favorable results for ODI success, back pain, and patient satisfaction. Results for employment status and reoperation were similar across therapies. Conclusion: activL substantially improves ODI success, back pain, and patient satisfaction compared with other therapies for single-level lumbar DDD.
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Affiliation(s)
- Jack Zigler
- Texas Back Institute, 6020 West Parker Road #200, Plano, TX 75093, USA
| | - Nicole Ferko
- Cornerstone Research Group, 204–3228 South Service Rd., Burlington ON, Canada
| | - Chris Cameron
- Cornerstone Research Group, 204–3228 South Service Rd., Burlington ON, Canada
| | - Leena Patel
- Cornerstone Research Group, 204–3228 South Service Rd., Burlington ON, Canada
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Scott RT, McAlister JE, Rigby RB. Allograft Bone: What Is the Role of Platelet-Derived Growth Factor in Hindfoot and Ankle Fusions. Clin Podiatr Med Surg 2018; 35:37-52. [PMID: 29156166 DOI: 10.1016/j.cpm.2017.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arthrodesis of the ankle or foot is a common procedure for chronic pain and disability. Nonunion remains a prevalent complication among arthrodesis procedures. Some patients present with an inherent risk of developing a nonunion. Allograft biologics have gained popularity in an effort to reduce complications such as nonunion. Various biologics bring unique properties while maintaining a singular purpose. Platelet-derived growth factor (PDGF) may be introduced into a fusion site to facilitate healthy bony consolidation. The purpose of this article is to review the benefits and modalities of PDGF and how it can improve patient outcomes in ankle and hindfoot fusions.
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Affiliation(s)
- Ryan T Scott
- The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023, USA.
| | - Jeffrey E McAlister
- The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023, USA
| | - Ryan B Rigby
- Logan Regional Orthopedics, 1350 North 500 East, Logan, UT 84341, USA
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Abstract
: Lumbar total disc replacement, now in use since 2004, was determined by the panel to be a standard of care for the treatment of symptomatic single-level lumbar degenerative disc disease in the active patient subpopulation as outlined by the investigational device exemption study criteria. The large body of evidence supporting this statement, including surgeons' experiences, was presented and discussed. Consensus statements focusing on decision-making criteria reflected that efficacy, long-term safety, clinical outcomes with validated measures, and cost-effectiveness should form the basis of decision-making by payers. Diagnostic challenges with lumbar degenerative disc disease patients were discussed among the panel, and it was concluded that although variably used among surgeons, reliable tools exist to appropriately diagnose discogenic back pain.
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Abstract
: Long-term data are now available to support the safety and efficacy of lumbar total disc replacement (TDR). Five-year randomized and controlled trials, meta-analyses, and observational studies support a similar or lower risk of complications with lumbar TDR compared with fusion. The panel concluded that published data on commercially available lumbar TDR devices demonstrate minimal concerns with late-onset complications, and that the risk of adjacent segment degeneration and reoperations can be reduced with lumbar TDR versus fusion. Survey results of surgeon practice experiences supported the evidence, revealing a low rate of complications with TDR. Panelists acknowledged the importance of adhering to selection criteria to help minimize patient complications.
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Barrett-Tuck R, Del Monaco D, Block JE. One and two level posterior lumbar interbody fusion (PLIF) using an expandable, stand-alone, interbody fusion device: a VariLift ® case series. JOURNAL OF SPINE SURGERY 2017; 3:9-15. [PMID: 28435912 DOI: 10.21037/jss.2017.02.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgical interventions such as posterior lumbar interbody fusion (PLIF) with and without posterior instrumentation are often employed in patients with degenerative spinal conditions that fail to respond to conservative medical management. The VariLift® Interbody Fusion System was developed as a stand-alone solution to provide the benefits of an intervertebral fusion device without the requirement of supplemental pedicle screw fixation. METHODS In this retrospective case series, 25 patients underwent PLIF with a stand-alone VariLift® expandable interbody fusion device without adjunctive pedicle screw fixation. There were 12 men and 13 women, with a mean age of 57.2 years (range, 33-83 years); single level in 18 patients, 2 levels in 7 patients. Back pain severity was reported as none, mild, moderate, severe and worst imaginable at baseline, 6 and 12 months. Preoperatively, 88% (22 of 25) of patients reported severe back pain. RESULTS All patients experienced symptomatic improvement and, by 12 months postoperatively, 71% (15 of 21) of patients reported only mild residual pain. Overall, pain scores improved significantly from baseline to 12 months (P=0.0002). There were no revision surgeries and fusion was achieved 12 of 13 patients (92%) who returned for a 12-month radiographic follow-up. There were three cases of intractable postsurgical pain which required extended hospitalization or pain management, one wound infection and one case of surgical site dehiscence, both treated and resolved during inpatient hospitalization. CONCLUSIONS In this single-physician case series, the VariLift® device used in single or two-level PLIF provided effective symptom relief and produced a high fusion rate without the need for supplemental fixation.
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Affiliation(s)
| | - Diana Del Monaco
- Wenzel Spine, Inc., 1130 Rutherford Lane, Ste. 200, Austin, TX 78753, USA
| | - Jon E Block
- 2210 Jackson Street, Ste. 401, San Francisco, CA 94115, USA
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Ding F, Jia Z, Zhao Z, Xie L, Gao X, Ma D, Liu M. Total disc replacement versus fusion for lumbar degenerative disc disease: a systematic review of overlapping meta-analyses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:806-815. [DOI: 10.1007/s00586-016-4714-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 07/05/2016] [Accepted: 07/17/2016] [Indexed: 02/08/2023]
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Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:23-31. [PMID: 26855595 PMCID: PMC4725636 DOI: 10.2147/ceor.s97345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Increasing evidence supports minimally invasive sacroiliac joint (SIJ) fusion as a safe and effective treatment for SIJ dysfunction. Failure to include the SIJ in the diagnostic evaluation of low back pain could result in unnecessary health care expenses. DESIGN Decision analytic cost model. METHODS A decision analytic model calculating 2-year direct health care costs in patients with chronic low back pain considering lumbar fusion surgery was used. RESULTS The strategy of including the SIJ in the preoperative diagnostic workup of chronic low back pain saves an expected US$3,100 per patient over 2 years. Cost savings were robust to reasonable ranges for costs and probabilities, such as the probability of diagnosis and the probability of successful surgical treatment. CONCLUSION Including the SIJ as part of the diagnostic strategy in preoperative patients with chronic low back pain is likely to be cost saving in the short term.
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Affiliation(s)
- David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
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Deukmedjian AJ, Cianciabella AJ, Cutright J, Deukmedjian A. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:183-9. [PMID: 26692696 PMCID: PMC4660495 DOI: 10.4103/0974-8237.167869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. MATERIALS AND METHODS Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS). RESULTS The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge. CONCLUSION Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.
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Affiliation(s)
- Ara J Deukmedjian
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
| | | | - Jason Cutright
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
| | - Arias Deukmedjian
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
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