PubMed Health⌕ Search

Biomedical subjects

D Greg Anderson

Publications and source records attributed to D Greg Anderson.

At least 37 records · Page 2Linked to original sources
PubMed2005

A fibronectin fragment alters the metabolism by rabbit intervertebral disc cells in vitro.

STUDY DESIGN: A biochemical and gene expression study was conducted to determine the effects of the 30-kDa N-terminal fibronectin fragment (Fn-f) on the glycosaminoglycan content of nucleus pulposus (NP) explant cultures, and on the gene expression profile of NP cells in alginate culture. OBJECTIVE: To determine the effects of Fn-f on NP cells in alginate culture and disc explant cultures. SUMMARY OF BACKGROUND DATA: The macroscopic and histologic features of disc degeneration have been well described, but the molecular biology of disc degeneration remains poorly understood. Although fibronectin and fibronectin fragments are known to accumulate in degenerative discs, the role of fibronectin fragments on the degenerative process has not been elucidated. This study sought to define the effects of Fn-f on the expression of key matrix and degradative genes and on disc matrix proteins. METHODS: New Zealand white rabbits discs were harvested. NP cells were either isolated and grown in alginate culture or cultured as explanted tissue. The cultured cells were exposed to 10 nmol/L, 100 nmol/L, and 1 micromol/L concentrations of 30-kDa N-terminal Fn-f or a control substance and then analyzed histologically, biochemically, and with gene expression studies. RESULTS: Alginate-cultured NP cells maintained a histologic appearance and phenotypic expression pattern similar to disc cells in vivo. Exposure of these cells to Fn-f led to the up-regulation of the MMP-9, MMP-13, and Fas genes and the down-regulation of the Type II collagen and aggrecan genes. In explant culture, Fn-f exposure led to a 60% reduction in glycosaminoglycan content compared with controls. CONCLUSION: Treatment of NP cells in vitro with Fn-f led to changes in matrix proteins and gene expression similar to those seen during disc degeneration in vivo. This supports a possible detrimental role of the N-terminal fibronectin fragment in degenerative disc disease.

Animals↗
PubMed2005

A 2-year follow-up pilot study evaluating the safety and efficacy of op-1 putty (rhbmp-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions.

The ability of bone morphogenetic proteins (BMPs) to induce bone formation has led to a multitude of investigations into their use as bone graft substitutes in spinal surgery. The purpose of this multi-center clinical pilot study was to evaluate the safety and efficacy of BMP-7 (osteogenic protein 1, OP-1), in the form of a putty, combined with autograft for intertransverse process fusion of the lumbar spine in patients with symptomatic spinal stenosis and degenerative spondylolisthesis following spinal decompression. Twelve patients with spinal stenosis and degenerative lumbar spondylolisthesis underwent a laminectomy and partial or complete medial facetectomy as required for decompression of the neural elements, followed by an intertransverse process fusion by placing iliac crest autograft and OP-1 putty between the decorticated transverse processes. No instrumentation was used. Patients were followed clinically using the Oswestry scale and SF-36 outcome forms, and radiographically using static and dynamic radiographs to assess their fusion status over a 2-year period. Independent and blinded radiologists assessed the films for the presence of bridging bone between the transverse processes and measured translation and angulation on dynamic films using digital calipers. Radiographic outcome was compared to a historical control (autograft alone fusion without instrumentation for the treatment of degenerative spondylolisthesis). All adverse events were recorded prospectively. The results showed eight of the nine evaluable patients (89%) obtained at least a 20% improvement in their preoperative Oswestry score, while five of ten patients (50%) with radiographic follow-up achieved a solid fusion by the criteria used in this study. Bridging bone on the anteroposterior film was observed in seven of the ten patients (70%). No systemic toxicity, ectopic bone formation, recurrent stenosis or other adverse events related to the OP-1 putty implant were observed. A successful fusion was observed in slightly over half the patients in this study, using stringent criteria without adjunctive spinal instrumentation. This study did not demonstrate the statistical superiority of OP-1 combined with autograft over an autograft alone historical control, in which the fusion rate was 45%. There were no adverse events related to the OP-1 putty implant in this study, which supports findings in other studies suggesting the safety of bone morphogenetic proteins in spinal surgery.

Aged↗
PubMed2005

Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma.

BACKGROUND: Contemporary understanding of the biomechanics, natural history, and methods of treating thoracolumbar spine injuries continues to evolve. Current classification schemes of these injuries, however, can be either too simplified or overly complex for clinical use. METHODS: The Spine Trauma Group was given a survey to identify similarities in treatment algorithms for common thoracolumbar injuries, as well as to identify characteristics of injury that played a key role in the decision-making process. RESULTS: Based on the survey, the Spine Trauma Group has developed a classification system and an injury severity score (thoracolumbar injury classification and severity score, or TLICS), which may facilitate communication between physicians and serve as a guideline for treating these injuries. The classification system is based on the morphology of the injury, integrity of the posterior ligamentous complex, and neurological status of the patient. Points are assigned for each category, and the final total points suggest a possible treatment option. CONCLUSIONS: The usefulness of this new system will have to be proven in future studies investigating inter- and intraobserver reliability, as well as long-term outcome studies for operative and nonoperative treatment methods.

Algorithms↗
PubMed2005

Modulation of chondrocytic properties of fat-derived mesenchymal cells in co-cultures with nucleus pulposus.

Human subcutaneous fat-derived mesenchymal cells recently have been shown to have the potential to differentiate in vitro into a variety of cell types, including adipocytes, osteoblasts, chondrocytes, and myoblasts. This effect suggests that fat tissue may serve as an abundant and easily acquired source of multipotent cells for tissue engineering. The multipotential characteristics of fat-derived mesenchymal cells from the inguinial fat pad of rabbit have not been clearly defined. In this study we have isolated a population of mesenchymal cells from inguinal fat from adult New Zealand white rabbits. The cells that were maintained under various differentiation conditions were shown to differentiate in vitro into adipocytes, osteoblasts, or chondrocytes; this differentiation was demonstrated using gene expression for tissue-specific proteins. We also co-cultured the cells with intervertebral disk tissue from the nucleus pulpous or from the annulus fibrosus. The fat-derived cells co-cultured with nucleus pulposus showed an increase in expression of type II collagen and aggrecan genes, compared with cells in alginate alone and cells co-cultured with annulus fibrosus. The data suggest that the fat-derived mesenchymal cells responded to soluble mediators from the disk. Future studies on intervertebral disk reconstruction could be based on our findings with fat-derived multipotential cells from the inguinal region of the rabbit that were co-cultured with disk tissue and may prove useful in tissue engineering strategies.

Adipose Tissue↗
PubMed2005

An anatomical study comparing standard fluoroscopy and virtual fluoroscopy for the placement of C1-2 transarticular screws.

OBJECT: The authors sought to compare radiation exposure, surgical time, and accuracy of screw placement when using either standard fluoroscopy or virtual fluoroscopy for the placement of C1-2 transarticular screws. METHODS: Twenty-two C1-2 transarticular screws were placed in 11 cadavers in a randomized and alternating order by using either standard fluoroscopy or virtual fluoroscopy (fluoronavigation). The radiation time, procedure time, and accuracy of screw placement were recorded and statistically compared. A small but statistically significant reduction in fluoroscopy time was noted with the virtual fluoroscopy technique but the surgical times were similar between the two techniques. The incidence of noncritical and critical breaches (those at risk of causing a neurovascular injury) was not significantly different between the two groups. Careful analysis of the C1-2 anatomy in these specimens underscored the importance of placing the screw path in a maximally dorsal and medial portion of the C-2 isthmus to avoid injury to the vertebral artery and to maximize the bone purchase of the C-1 lateral mass. CONCLUSIONS: Although virtual fluoroscopy may represent a useful tool for transarticular screw placement, it does not supplant traditional surgical techniques and does not appear to lower the incidence of bone breaches that can occur when performing this demanding procedure.

Bone Screws↗
PubMed2005

The effect of nonsteroidal anti-inflammatory agents on spinal fusion.

A large body of information suggests NSAIDS have a negative impact on the healing of bone. Although each clinical healing scenario presents a slightly different level of challenge, the healing of a posterolateral spinal fusion is one of the most difficult challenges in bony healing. Clinically, this results in a relatively high rate of nonunions using traditional fusion techniques. Spinal fusion models have confirmed NSAIDS have a definite inhibitory effect on healing of the fusion. Although data are limited, it appears this effect is most severe when NSAIDS are administered in the early postoperative period. Moreover, the effect may be worse with certain types initial inflammatory, subsequent reparative, and final remodeling phases. Because of the anti-inflammatory activity of NSAIDS, one might assume their effects would be worse when administered in the inflammatory phase. Indeed, the study by Riew et al suggests the inhibitory effects are more significant when NSAIDS are administered earlier following fusion. Other studies conducted with non-spinal models also suggest early administration of NSAIDS results in greater inhibition of bone formation (Goodman et al). Unfortunately, the length of the inflammatory phase in humans is not well known. This leaves the clinician unsure about the safe time to allow resumption of NSAID usage clinically. It appears likely NSAID use following a spinal fusion procedure will increase the rate of pseudarthrosis. The literature suggests that avoidance of NSAIDS in the postoperative period may avoid nonunion. Additionally, we propose that chronic NSAID usage should be addressed in a similar manner to cigarette smoking. While neither are absolute contraindications to elective spinal fusion, patients should be counseled to discontinue the use of NSAIDS in the peri- and postoperative period to maximize their chance for a successful fusion.

Animals↗
PubMed2005

The thoracolumbar injury severity score: a proposed treatment algorithm.

OBJECTIVE: Significant controversy exists regarding the optimal management of thoracolumbar injuries. This is in part due to the lack of understanding of the natural history of various injury subtypes and the absence of a universally accepted classification scheme that facilitates communication among care providers and assists in directing treatment. The Spine Trauma Study Group has developed an injury severity score based on three major variables: the mechanism of injury determined by radiographic appearance, the integrity of the posterior ligamentous complex, and the neurologic status of the patient. By systematically assigning specific point values within each category based on the severity of injury, a final severity score may be generated that can be used to help direct treatment. The goal of this work is to present a proposal of a detailed treatment algorithm to assist in the nonoperative or operative management of thoracolumbar injuries. METHODS: A detailed review of the world's spinal literature was performed to ascertain predictors of instability following thoracolumbar trauma. With use of known biomechanical and clinical outcome measures, an arbitrary assignment of point values to various injury descriptors was performed. The assessment of the validity of the severity score was compared retrospectively with a variety of selected cases representing the typical injury patterns under the three major injury groups: compression, translational/rotational, and distraction injuries. CONCLUSIONS: The proposed treatment algorithm is an attempt to assist physicians using best-evidence medicine in managing thoracolumbar spinal injuries. The final point flow chart with graduated treatment recommendations is only preliminary and needs to be validated through prospective cohort analysis. In addition, the importance of the chosen variables determining spinal stability must also be verified.

Algorithms↗
PubMed2005

A cadaveric study comparing standard fluoroscopy with fluoroscopy-based computer navigation for screw fixation of the odontoid.

Although direct osteosynthesis of certain types of odontoid fractures may increase union and decrease the need for prolonged immobilization, screw fixation remains a technically demanding procedure. This study compares radiation exposure, surgical time, and accuracy of hardware placement using standard fluoroscopy versus computer-assisted fluoroscopy-based navigation ("virtual fluoroscopy") to assist with the placement of odontoid screws. Twenty-two cadavers were divided into two groups and underwent placement of a single odontoid screw using either standard fluoroscopic or virtual fluoroscopic guidance. Following screw placement, dissection of the C1-C2 segments was performed to assess accuracy. A significant reduction in fluoroscopy time was noted with the computer-based fluoroscopy technique, whereas the surgical time was not found to differ significantly between the techniques. No critical breaches (those risking neurovascular injury) were noted in either group, and the rate of noncritical breaches did not differ. The authors conclude that fluoroscopy-based virtual navigation appears to have a safety profile similar to standard fluoroscopy while allowing a reduction in radiation exposure.

Bone Screws↗
PubMed2004

A pilot study evaluating the safety and efficacy of OP-1 Putty (rhBMP-7) as a replacement for iliac crest autograft in posterolateral lumbar arthrodesis for degenerative spondylolisthesis.

STUDY DESIGN: A prospective, randomized, controlled, multicenter clinical study was conducted. OBJECTIVE: To compare the clinical and radiographic outcomes of patients treated with OP-1 (BMP-7) Putty to autogenous iliac crest bone graft for one-level uninstrumented posterolateral fusion of the lumbar spine following decompressive laminectomy for the treatment of symptomatic degenerative spondylolisthesis with spinal stenosis. BACKGROUND: Preclinical studies have demonstrated that osteoinductive recombinant human osteogenic protein 1 in the form of OP-1 Putty is successful at achieving a posterolateral fusion in rabbits and dogs without any significant safety concerns. METHODS: Thirty-six patients with degenerative lumbar spondylolisthesis and symptoms of neurogenic claudication were randomized (2:1) to either OP-1 Putty (3.5 mg of OP-1 per side) or autogenous iliac crest bone graft for one-level uninstrumented posterolateral fusion following a decompressive laminectomy. Enrollment in the study was complete when 24 OP-1 Putty patients and 12 autograft patients had been randomized and treated. A patient administered Oswestry scale and SF-36 scale were used to determine clinical outcomes. Independent, blinded neuroradiologists reviewed both static and dynamic radiographs to determine fusion status. RESULTS: At the 1-year follow-up, 32 patients were available for clinical analysis and 29 patients were available for radiographic review. Clinical success as measured on the Oswestry scale was achieved by 18 of 21 (86%) OP-1 Putty patients and 8 of 11 (73%) autograft patients. SF-36 pain index scores showed similar results. Fourteen of 19 (74%) OP-1 Putty patients and 6 of 10 (60%) autograft patients achieved a successful posterolateral fusion fulfilling all fusion criteria. Of the 29 evaluable patients, 15 were both clinical and radiographic successes, 5 were radiographic successes but were clinical failures, 1 patient was both a radiographic and clinical failure, and 8 patients were radiographic failures but were clinical successes. No systemic toxicity, ectopic bone formation, recurrent stenosis, or other adverse events related to the OP-1 Putty implant were observed. CONCLUSION: Although the posterolateral spine is a challenging fusion environment in patients with degenerative spondylolisthesis, successful radiographic fusion was obtained using OP-1 Putty at a rate that was similar to autograft given the number of patients in this study. Importantly, there were no apparent adverse consequences related to the use of the OP-1 Putty implant in this patient population.

Adult↗
PubMed2004

Multiple unstable cervical fractures with cord compromise treated nonoperatively: a case report.

STUDY DESIGN: The case of a 17-year-old boy who sustained an unusual pattern of multiple unstable cervical spine fractures with a spinal cord injury is presented. OBJECTIVE: To review the management and treatment of multiple unstable cervical spine fractures. SUMMARY OF BACKGROUND DATA.: Combined unstable cervical spine injuries are uncommon. Treatment of multiple-level cervical spine fractures remains controversial. METHODS: The case of a 17-year-old boy who sustained a ring fracture of the atlas, an atypical traumatic spondylolisthesis of the axis, bilateral pedicle fractures of C3 with significant anterior subluxation of C3 on C4, a C6 burst fracture, compression fractures of C7 and T1, and significant cord compression as the result of a motor vehicle accident is presented. RESULTS: The patient was successfully treated with an initial closed reduction using cervical traction for 1 week followed by placement of a cervical halo vest. The fractures healed successfully, and the patient regained near-normal neurologic function. CONCLUSIONS: Despite advances in the surgical treatment of cervical fractures and dislocations, nonoperative treatment with halo immobilization remains a viable option for selected complex injury patterns.

Adolescent↗
PubMed2004

In vivo bioluminescent imaging of virus-mediated gene transfer and transduced cell transplantation in the intervertebral disc.

STUDY DESIGN: Work presented here used a small animal model to demonstrate the feasibility and usefulness of in vivo bioluminescent imaging to studying degenerative disc disease. OBJECTIVES: To determine the utility of in vivo bioluminescent imaging to monitor the temporal and spatial expression of genetically modified cells within the intervertebral disc of a rodent model. SUMMARY OF THE BACKGROUND DATA: Noninvasive imaging of genetically engineered cells in the spine has the advantage of allowing events to be tracked without killing the animal and can be used to follow the time course of a particular therapy. Results are presented on the use of Sprague-Dawley rats in experimental studies in which the luciferase reporter gene was delivered to the lumbar intervertebral disc through adenovirus-mediated or cell-based transfer techniques to demonstrate the feasibility to monitor gene expression noninvasively over time. METHODS: Tissue culture, disc surgery, and in vivo bioluminescent imaging were used. The intervertebral disc of the rat was either injected in situ with an adenovirus containing the luciferase reporter gene or implanted with fat, bone marrow or intervertebral disc cells transduced ex vivo and contained in a bioresorbable carrier. Results were assessed with in vivo bioluminescent imaging at several time points. CONCLUSION: Data from 11 animals were obtained with imaging up to 14 days. To our knowledge, this is the first description of in vivo bioluminescence imaging to study spinal conditions. We have characterized the relative expression of three cell types transduced with the Ad-luc virus by ex vivo transfection followed by cell implantation in the rat spine and compared them to one another and to direct infection of Ad-luc adenovirus in situ. Our results demonstrate the feasibility of tracing genetically altered cells in the spine. This technique has the potential to be used to noninvasively track the fate and expression of therapeutic genes within the spine of small animals used in disc research.

Adenoviridae↗
PubMed2003

Skeletal fracture demographics in spinal cord-injured patients.

INTRODUCTION: The demographics of skeletal fractures found in patients presenting with a spinal cord injury to a modern level-one trauma center have not been reported. MATERIALS AND METHODS: A retrospective review was performed of 1290 patients presenting between January 1997 and December 1999 with an acute vertebral fracture and spinal cord or cauda equina injury to determine the incidence, fracture type, and mechanism of all fractures of the extremities and pelvis. RESULTS: Overall, 128 (10% of 1290) of these patients sustained 203 associated skeletal fractures including 16 open fractures (8% of 203). The most common associated fractures involved the radius, tibia, femur, humerus, fibula, and ulna. Some 48% of the injuries was due to motor vehicle accidents, 41% to falls, 6% to recreational injuries or assaults, and 5% to gunshot wounds. Twenty-four patients (1.8% of 1290) were found to have more than one vertebral fracture and sustained a high rate of associated fractures (42 fractures), averaging 1.8 fractures per patient. CONCLUSION: This study underscores the frequent association between vertebral fractures and fractures of the appendicular skeleton and pelvis and reinforces the need to maintain a high index of suspicion when evaluating neurologically injured patients due to the potential for symptom masking of acute nonspinal fracture.

Adolescent↗
PubMed2003

A fibronectin fragment stimulates intervertebral disc degeneration in vivo.

STUDY DESIGN: A radiographic, histologic, biochemical, and gene expression study was conducted in vivo in a rabbit model to determine the effect of injection of the N-terminal 30 kDa fibronectin fragment (Fn-f) into the intervertebral disc along with various control substances. OBJECTIVE: To determine if the Fn-f is able to induce disc degeneration in vivo. SUMMARY OF BACKGROUND DATA: Animal models of disc degeneration are crucial to defining the molecular events involved in disc degeneration. Although spontaneous and induced models of disc degeneration have been described, none is ideal for molecular studies. A better understanding of disc degeneration at the molecular level is necessary to promote rational design of therapies for degenerative disc disease. MATERIALS AND METHODS: Thirty-one New Zealand white rabbits underwent injection of Fn-f and control substances into the central region of separate lumbar discs using a fine needle. Euthanasia was performed at the 2-, 4-, 8-, 12-, and 16-week time points and the discs were examined radiographically, histologically, biochemically, and with gene expression. RESULTS: Radiographs demonstrated anterior osteophyte formation at Fn-f-injected disc spaces by the 12-week time point. Histology demonstrated a progressive loss of the normal architecture of the nucleus pulposus and anulus fibrosus over the 16-week study period. A progressive loss of proteoglycans was documented using GAG assay but total collagen did not appear to change appreciably. Gene expression studies demonstrated a significant down-regulation of both aggrecan and type II collagen mRNA between the 8- and 16-week time points. CONCLUSION: Fn-f appears to induce a progressive degenerative process within the intervertebral disc after injection that resembles degenerative disc disease. This model has several significant advantages for the study of disc degeneration at the molecular level. Further studies are warranted to elucidate the mechanism and molecular events associated with Fn-f-mediated disc degeneration.

Aggrecans↗
PubMed2003

A pilot safety and efficacy study of OP-1 putty (rhBMP-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions.

The ability of bone morphogenetic proteins (BMPs) to induce bone formation has led to an increasing interest in the potential for their use in fusion surgery. The purpose of this multi-center clinical pilot study was to evaluate the safety of one such BMP-osteogenic protein 1, in the form of OP-1 putty-combined with autograft for intertransverse process fusion of the lumbar spine in patients with symptomatic spinal stenosis and degenerative spondylolisthesis following spinal decompression. Twelve patients with spinal stenosis and degenerative lumbar spondylolisthesis underwent laminectomy and partial or complete medial facetectomy as required for decompression of the neural elements followed by intertransverse process fusion by placing iliac crest autograft and OP-1 putty between the decorticated transverse processes. No instrumentation was used. Patients were followed clinically using the Oswestry scale and radiographically using static and dynamic radiographs to assess their fusion status. Independent and blinded radiologists assessed the films for the presence of bridging bone between the transverse processes and measured translation and angulation on dynamic films using digital calipers. In addition to bridging bone, less than or equal to 5 degrees of angular motion and less than or equal to 2 mm of translation were required to classify the patients as successfully fused, as per the definition of successful fusion provided by the FDA for use in clinical trials involving investigational devices to attain spinal fusion. Radiographic outcome was compared to a historical control (autograft alone fusion without instrumentation for the treatment of degenerative spondylolisthesis). All adverse events were recorded prospectively. The results showed 9 of the 12 patients (75%) obtained at least a 20% improvement in their preoperative Oswestry score, while 6 of 11 patients (55%) with radiographic follow-up achieved a solid fusion by the criteria used in this study. Bridging bone on the anteroposterior film was observed in 10 of the 11 patients (91%). No systemic toxicity, ectopic bone formation, recurrent stenosis or other adverse events related to the OP-1 putty implant were observed. A successful fusion was observed in slightly over half the patients in this study, using stringent criteria without adjunctive spinal instrumentation. This study did not demonstrate the superiority of OP-1 combined with autograft over an autograft alone historical control, in which the fusion rate was approximately 45%. The lack of adverse events related to the OP-1 putty implant in this study is in agreement with other studies supporting the safety of bone morphogenetic proteins in spinal surgery.

Aged↗
PubMed2003

Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion.

STUDY DESIGN: This retrospective, questionnaire-based investigation evaluated iliac crest bone graft (ICBG) site morbidity in patients having undergone a single-level anterior cervical discectomy and fusion (ACDF) procedure performed by a single surgeon (T.J.A.). OBJECTIVE: To evaluate acute and chronic problems associated with anterior ICBG donation, particularly long-term functional outcomes and impairments caused by graft donation. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion procedures frequently use autologous anterior ICBG to facilitate osseous union. Although autologous ICBG offers several advantages over alternative grafting materials, donor site morbidity can be significant. Acute and chronic complications of donor sites have been reported, yet there are currently no reports of long-term functional outcomes after autologous anterior ICBG donation after single-level ACDF. METHODS: A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior ICBG harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered yes, no, or not applicable; pain was assessed with a Visual Analogue Scale (VAS). RESULTS: Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24-72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2%; and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 in 10, and 11.2% chronically use pain medication. Twenty-one patients (15.7%) reported abnormal sensations at the donor site, but only 5.2% reported discomfort with clothing. A unique functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5%; and household chores, 6.7%. CONCLUSIONS: A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.

Activities of Daily Living↗
PubMed2003

Epidemiology of athletic head and neck injuries.

In this article, we review the available data on sporting injuries to the head and neck and discuss sport-specific injury risk and prevention strategies, as well as the costs of head and neck injuries.

Adolescent↗