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PubMed1994

Odontoid fractures. Review of 150 cases and practical application for treatment.

A total of 150 odontoid fractures was treated over a 12-year period, 43 by anterior screw fixation. The rate of pseudarthrosis dropped from 20% to 5% in type II unstable fractures. Thus, anterior screw fixation seems to be safe and efficient, and may be more widely used to treat all type II and some type III fractures. Odontoid pseudarthrosis is usually tolerated quite well and therefore requires no correction. If necessary, anterior grafting with fixation can be proposed as an alternative for posterior fusion.

Bone Screws↗

PubMed1998

[Clinical results of primary intramedullary osteosynthesis with the unreamed AO/ASIF tibial intramedullary nail of open tibial shaft fractures].

From 04/91 to 06/96 sixty-nine open fractures of the tibia were primarily treated on the day of the accident with unreamed nailing (UTN, Synthese). The distributions of fracture type according to the AO classification and of soft tissue injury according to Gustilo were as follows: fracture type: A: 28%, B: 52%, C: 20%; soft tissue injury: I: 30%, II: 28%, IIIA: 12%, IIIB: 12%, IIIC: 6%. Of the 65 fractures assessed 46 (71%) healed within 18 weeks without secondary intervention. There was delayed healing in three fractures requiring secondary conversion to reamed nailing. Eight fractures (12%) developed pseudarthrosis of which five (8%) healed uneventfully. Deep infections was manifest in four fractures (6%). Three of these infections developed after secondary intervention to treat pseudarthrosis. Seven of the eight pseudarthroses and three of the four infections healed eventually. Revision procedures were necessary in 11 patients (17%) to deal with disturbed fracture healing or infection (10 reamed nailing procedures, three cancellous bone grafts, and one of each of the following: sequestrectomy, fibular osteotomy, plate fixation, external fixator, monorail procedure). The results show that the same good infection rates were achieved for the UTN as for the external fixator. The advantages of the UTN are, however, a lesser need for secondary intervention and greater patient comfort. Therefore, we find the UTN to be a good alternative to the external fixator in the treatment of open fractures with severe soft tissue damage.

Adolescent↗

PubMed2004

[The Sauvé-Kapandji operation. Indications and results].

The Sauvé-Kapandji procedure consists of an arthrodesis of the distal radioulnar joint (DRUJ) in combination with an intentional pseudarthrosis of the distal ulna. In addition to other methods, the Sauvé-Kapandji operation is a salvage procedure of for chronic disorders of DRUJ. Different studies have confirmed that this procedure results in a pain reduction of between 73 and 100% and that patient' satisfaction lies between 68 and 100%. A reliable improvement of rotation of the forearm of between 134 and 171 degrees can be expected. On the other hand, a decrease in grip strength on the affected side is usual. The potential problem of instability of the proximal ulna stump can be avoided by performing a short distal segment and a narrow pseudarthrosis gap. The Sauvé-Kapandji procedure is a reliable salvage procedure resulting in high patient satisfaction and a reliable improvement in range of motion.

Arthralgia↗

PubMed2001

[Vascularized fibula transplantation in orthopedic oncology. Personal experience and review of the literature].

Primary malignant bone tumors can be treated predominantly with limb salvage. After resection of large articular segments adjacent to the dia- or metaphysis of long bones modular endoprosthetic devices are most commonly used for reconstruction. In case non-vascularized corticocancellous bone is transplanted in order to bridge extensive bone defects, the risk of pseudarthrosis and fracture of the donor bone is significantly higher in comparison to a free vascularized transplant. From 1988 until 1999 we treated 20 patients with extensive bone defects after resection of tumors affecting the upper and lower extremity using a vascularized fibular graft. In this retrospective analysis we collected the data focusing on bone integration and functional outcome. The graft union was classified according to the standards of the "International Symposium of Limb Salvage". Evaluation of the functional outcome was quantified using the Enneking-score. The stabilisation of the transplant was obtained exclusively by plate fixation in the upper extremity. In 10 in a total of 12 patients the reconstruction using a vascularized fibula transfer was reinforced with an allograft in the lower extremity. The functional evaluation score reached 73% of normal function at the last follow-up. After 18 months the radiographic evaluation of graft union was "excellent" in 75%, "good" in 11%, "fair" in 6% and "poor" in 9% according to the criteria of the ISOLS. Main complications were graft fracture in of 15% and pseudarthrosis in 14.3%. Reconstruction of extensive bone defects using free vascularized fibula grafts are a demanding operative procedure. The procedure combines a biologic form of reconstruction with a legitimate expectation of good long term outcome and a relatively low rate of complications.

Adolescent↗

PubMed2000

Motion of threaded cages in posterior lumbar interbody fusion.

A high rate of pseudarthrosis and a high overall rate of implant migration requiring surgical revision has been reported following posterior lumbar interbody fusion using BAK threaded cages. The high rate of both pseudarthrosis and implant migration may be due to poor fixation of the implant. The purpose of this study was to analyse the motion of threaded cages in posterior lumbar interbody fusion. Six cadaveric human lumbar spine segments (three L2/3 and three L4/5 segments) were prepared for biomechanical testing. The segments were tested, without preload, under forces of axial compression (600 N), torsion (25 Nm) and shearing force (250 N). The tests were performed first with the segments in an intact state, and subsequently following instrumented stabilisation with two BAK cages via a posterior approach. These results were compared with those of a finite element model simulating the effects of identical forces on the segments with constructs. As the results were comparable, the finite element model was used for analysing the motion of BAK cages within the disc space. Motion of the implants was not seen in compression. In torsion, a rolling motion was noted, with a range of motion of 10.6 degrees around the central axis of the implant when left/right torsion (25 Nm) was applied. The way the implants move within the segment may be due to their special shape: the thread of the implants can not prevent the BAK cages rolling within the disc space.

Adult↗

PubMed1998

Comparison of three techniques of anterior fusion in single-level cervical disc herniation.

This study compared the clinical and radiographic outcome of three techniques of anterior fusion for cervical disc herniation: Cloward fusion with autograft, Cloward fusion with freeze-dried bone, and BAK-C device fusion. In a cohort of 84 consecutive patients, 34 were treated by classic autograft Cloward's technique, in 26 patients freeze-dried xenograft Surgibone was used and in the last 24 patients a BAK-C titanium device was implanted. The mean follow-up period of this last group was 14.6 months. All patients were operated by the same surgeon at the same hospital and all underwent single-level surgery. Results were evaluated on the basis of patient satisfaction and postoperative capacity to work. There was no significant difference between the three groups related to the preoperative assessment. The analysis revealed that BAK-C patients had significantly shorter hospital stays. No postoperative cervical collar was worn by BAK-C patients and they had the highest percentage of excellent clinical results. Concerning radiographic evaluation, BAK-C achieved a more stable fixation of the involved segment without complications in contrast with the two others, which presented a significant incidence of extrusion, collapse, kyphosis and pseudarthrosis. Measurement of the progressive kyphosis grade shows statistically significant differences between the three groups. BAK-C patients had the lowest kyphosis grade at the end of the follow-up. There is an important correlation between collapse, collapse with kyphosis and pseudarthrosis with bad clinical results. In conclusion, the BAK-C device showed significant advantages, including higher patient satisfaction, unnecessary postoperative collar, early rehabilitation and a lower rate of complications. Furthermore, BAK-C is cost effective because of it shortens postoperative hospital stay and allows an earlier return to work.

Bone Transplantation↗

PubMed2026

Efficacy and safety of Vertebral Body Sliding Osteotomy (VBSO) versus Anterior Cervical Corpectomy and Fusion (ACCF): A systematic review and meta-analysis.

Anterior cervical corpectomy and fusion (ACCF) is an established treatment for complex cervical myelopathy and ossification of the posterior longitudinal ligament (OPLL), yet it carries risks of dural injury and graft-related failure. Vertebral body sliding osteotomy (VBSO) is a novel technique that avoids direct OPLL manipulation by translating the vertebral body anteriorly to enlarge the spinal canal. Although early studies suggest VBSO may reduce complications, evidence remains limited to retrospective cohorts from the technique's developers, with no high-level synthesis directly comparing it to ACCF. We therefore conducted this meta-analysis to compare clinical outcomes, complications, and radiographic parameters between VBSO and ACCF, while critically evaluating the certainty of the evidence and its generalizability. A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and Web of Science (through June 2025) identified four retrospective cohort studies (449 patients; VBSO n = 209, ACCF n = 240). A critical limitation of the included evidence is that all studies originated from a single institution (Asan Medical Center, Seoul, Korea) with overlapping enrollment periods (2006-2020), increasing the risk of duplicate patient cohorts. Furthermore, the first author (D.-H. Lee) is the same across all included studies, introducing substantial surgeon-expertise bias. Outcomes included neurological recovery, functional outcomes, complications, and radiographic parameters. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Neurological recovery and functional outcomes were comparable between groups. ACCF showed slightly higher postoperative JOA scores (MD -0.59, 95% CI -0.96 to -0.22; p < 0.01), though the clinical relevance is uncertain. VBSO was associated with reduced risks of graft subsidence (RR 0.23; p < 0.01), pseudarthrosis (RR 0.25; p < 0.01), revision surgery (RR 0.17; p < 0.01), and neurological deterioration (RR 0.17; p = 0.02). CSF leakage appeared to be less frequent with VBSO, but the difference was not statistically significant. VBSO was also associated with greater postoperative cervical lordosis and shorter hospital stays. However, these findings must be interpreted with extreme caution: leave-one-out sensitivity analyses revealed that the results for postoperative JOA score, neurological deterioration, and pseudarthrosis were fragile and driven by a single large study, meaning these apparent advantages may not be robust. In addition, GRADE assessment revealed very low certainty across all assessed outcomes. Given the very low certainty of evidence, the preliminary nature of the available data, the fragility of several key findings, and the critical limitations of the underlying studies (single institution, overlapping patient cohorts, developer bias, and systematic imbalance in follow-up duration), the observed differences should be considered hypothesis-generating rather than definitive. VBSO should not be considered a proven superior alternative to ACCF based on the current evidence. Prospective, multicenter, international studies with balanced follow-up durations conducted by independent surgical teams are required before broader adoption can be recommended.

Humans↗

PubMed1975

A series of tibial fractures treated conservatively.

Two hundred and two fractures of the tibia have been reviewed. They were treated by a standard, conservative method; with a Phemister graft when union was delayed and a pseudarthrosis threatened. The classifications of Charnley (1968) and Nicoll (1964) have proved to be useful in assessing results and these complement each other. The factors that influence bony union include damage to the interosseous membrane, the degree of the displacement and comminution of the fracture, and injury to soft tissues. Infection has a very unfavourable influence on bone union and leads to the majority of bad sequelae. The fundamental object in reduction is to obtain as perfect apposition and alignment of the fragments as possible. Imperfect apposition, however, with normal alignment does not affect bone union severely. The problem arising from the use of an above-knee walking plaster that affects the patient physically, psychologically and socially, may be solved by the early use of a below-knee plaster. The functional sequelae are the result of soft-tissue damage rather than of immobilization. The Chutro-Phemister type of graft has proved to be a safe method in preventing pseudarthrosis. The analysis of the results obtained with this conservative method is sufficient reason against choosing surgical treatment for these fractures.

Accidents, Traffic↗

PubMed1993

Chronic lunotriquetral instability: diagnosis and treatment.

Fourteen patients with chronic lunotriquetral instability were evaluated. Forced wrist extension was the most common mechanism of injury. Fourteen patients underwent lunotriquetral arthrodesis. Arthrograms were positive in 9 of the 12 performed. In three cases abnormalities not identified by arthrography were demonstrated by arthroscopy. The follow-up period averaged 27 months. X-ray films showed fusion in 12 cases. One pseudarthrosis was asymptomatic. A second pseudarthrosis required a rearthrodesis that became solid 8 weeks after surgery. One patient had persistent wrist pain. Wrist motion compared to the contralateral side averaged 85%, 88%, 83% and 80%, respectively, for flexion, extension, ulnar deviation, and radial deviation. Grip strength compared to the contralateral side averaged 93%. Lunotriquetral instability is a clinical diagnosis confirmed by arthrography or arthroscopy. Lunotriquetral fusion reliably relieves pain while maintaining functional wrist motion and grip strength. The long-term effects of lunotriquetral fusion on carpal kinematics and wrist function are unknown.

Adult↗

PubMed1996

Changes of bone mineral mass and soft tissue composition after hip fracture.

The aim of this prospective longitudinal study was to measure prospectively the bone mineral density (BMD) and anthropometric variables after a hip fracture. In particular, we studied changes in the BMD in both the injured and uninjured hips, and examined if the postoperative mortality rate and complications, including pseudarthrosis of the fracture and late segmental collapse of the head of the femur, could be predicted by early bone mass measurements. The bone mineral density and the body composition were measured with dual energy X-ray absorptiometry in 102 consecutive hip fracture patients, 31 men and 71 women, with a mean age of 74 and 79 years, respectively. All cases were operated on within 3 days. The measurements were undertaken within 10 days after the fracture, after 4 and after 12 months. The BMD of the hip fracture cases decreased, especially in the lower extremities where the patients lost 7%, during the first year after the fracture. The patients also lost lean body mass (5%) but gained fat (11%) during the same period. They lost significantly more bone mass in the fractured hip than in the uninjured hip (p < 0.05). No difference was found between those patients who survived and those who died within 2 years after their hip fracture in neither the initial measurement nor in the follow-up measurements. Also, we found no difference between those patients whose hip fracture healed and those who developed late segmental collapse or pseudarthrosis. In conclusion, osteoporotic hip fracture cases lose bone mass at an increased rate, especially in the fractured hip. Also, their soft tissue composition changes, gaining fat while losing muscle mass. Furthermore, it seems that early bone mineral measurements cannot predict postoperative failures or postoperative mortality.

Aged↗

PubMed2007

Collapsed scaphoid non-union with dorsal intercalated segment instability and avascular necrosis treated by vascularised wedge-shaped bone graft and fixation.

Patients with the specific problem of a collapsed Nakamura volar type, scaphoid synovial pseudarthrosis with avascular necrosis on both magnetic resonance imaging and intraoperative inspection were studied to determine the ability of a trapezoidal wedge-shaped structural bone graft vascularised by the 1,2 intercompartmental supraretinacular artery to simultaneously achieve correction of the scaphoid dimension and a high union rate. Fifteen patients with this specific problem were followed for a mean of 32.1 months and achieved union in all cases at a mean of 11.5 weeks. Improvements were seen postoperatively in wrist flexion and extension, grip strength, degree of dorsal intercalated segment instability and degree of scaphoid collapse. Two complications relating to the fixation technique occurred. Although technically difficult, it is possible to achieve a high rate of union for scaphoid pseudarthrosis while correcting substantial collapse deformity by the use of a structural, wedge-shaped, vascularised bone graft.

Adolescent↗

PubMedDate not supplied

Shoulder arthrodesis: indications, technique, results, and complications.

Complications after shoulder arthrodesis are frequent. Through results and comparisons with the literature, the presented article analyzes the correlation of complications with the specific operative techniques, indications, and postoperative treatment. Between 1964 and 2001, a total of 43 cases of shoulder arthrodesis (13 screw and 30 plate arthrodeses) were performed and then analyzed after a mean of 6.7 years (range, 0.5-36 years). Surgery was carried out on 10 female patients (23%) and 33 male patients (77%) with a mean age of 35 years (range, 11-82 years). These patients had the following indications: paralysis (32 [74%]), osteoarthritis or humeral head necrosis (15 [35%]), infection (7 [16%]), and persistent shoulder instability (6 [14%]). The extent of active movement after arthrodesis was 56 degrees abduction (range, 20 degrees - 90 degrees) and 60 degrees forward flexion (range, 20 degrees - 105 degrees), with an increase in the Constant score in all cases, from a mean of 27 points preoperatively to 57 points postoperatively (difference, 30 points). The patients rated the outcome of surgery as excellent, good, or satisfactory in 91% of cases. Complications after shoulder arthrodesis were noted in 12 of 43 patients (28%). The most frequent complications after screw/plate arthrodesis included pseudarthrosis, 2 (15%)/3 (10%); infection, 1 (8%)/4 (13%); and fracture of the humerus, 0/4 (13%). No specific judgment can be attributed to the different osteosynthesis techniques used in shoulder arthrodesis, either in the cases presented at our clinic or in the literature. Pseudarthrosis appeared to be less frequent in cases of plate arthrodesis compared with screw arthrodesis. However, the application of plates resulted more often in infection, postoperative fractures of the humerus, and the necessity for removal of material. Particularly in patients with paralysis, a shoulder arthrodesis resulted in an improvement in postoperative active function and presented a suitable operative option.

Adolescent↗

PubMedDate not supplied

Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures.

BACKGROUND CONTEXT: Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. PURPOSE: The purpose of this study is to demonstrate both the possibility of neural canal decompression through a transpedicular approach without removing the posterior vertebral elements, which contribute to spinal stabilization, and the adequacy of posterior stabilization of severe vertebral deformities after burst fractures. STUDY DESIGN: Twenty-eight consecutive patients with complete or incomplete neurological deficits as a result of the thoracolumbar burst fractures were included in this study. All patients had severe spinal canal compromise (mean, 59.53%+/-14.92) and loss of vertebral body height (mean, 45.14%+/-7.19). Each patient was investigated for neural canal compromise, degree of kyphosis at fracture level and fusion after operation by computed tomography and direct roentgenograms taken preoperatively, early postoperatively and late postoperatively. The neurological condition of the patients was recorded in the early and late postoperative period according to Benzel-Larson grading systems. The outcome of the study was evaluated with regard to the adequate neural canal decompression, fusion and reoperation percents and neurological improvement. METHODS: Modified transpedicular approach includes drilling the pedicle for removal of retropulsed bone fragment under surgical microscope without damaging the anatomic continuity of posterior column. Stabilization with pedicle screw fixation and posterior fusion with otogenous bone chips were done after this decompression procedure at all 28 patients included in this study. RESULTS: Twenty-three of 28 patients showed neurological improvement. The percent of ambulatory patients was 71.4% 6 months after the operation. The major complications included pseudarthrosis in five patients (17.8%), epidural hematoma in one (3.5%) and inadequate decompression in one (3.5%). These patients were reoperated on by means of an anterior approach. Of the five pseudarthrosis cases, two were the result of infection. CONCLUSION: Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively.

Adolescent↗

PubMed2000

Behaviour of an artery enclosed within a normal or hypertrophic callus of a long-bone fracture.

The behaviour of the brachial artery enclosed in a hypertrophic or a normal callus was investigated in experimentally produced fractures of the humerus in 22 dogs. The brachial artery was displaced in a bony groove created at the fractured ends of the bone. The fracture was immobilized with a metal plate and four screws. The progress of the callus formation was studied and the patency of the artery was evaluated. In 15 out of the 22 animals a medium-sized or hypertrophic callus had developed that engulfed the brachial artery without obstructing its lumen and blood flow. In five dogs the fracture site was infected and the resultant osteomyelitis obstructed the artery. In the remaining two dogs the arterial lumen was extremely narrowed, due to breaking of the plate and formation of pseudarthrosis in one and injury of the artery in the other. Unless complicated by infection resulting in vascular occlusion, callus at the fracture site may engulf an artery without interference in its patency and blood flow. The possible involvement of a functioning artery within a callus or a mass of heterotopic ossification (myositis ossificans) should be kept in mind during surgical treatment of old fractures, hypertrophic callus with pseudarthrosis or extensive heterotopic ossification.

Animals↗

PubMed1981

Arthrodesis of the wrist-complications and their management.

This report confirms the concept previously established in the literature tha arthrodesis of the wrist is a technically demanding procedure witha significant incidence of postoperative complications. A series of 31 patients is presented in whom wrist arthrodesis was performed using three separate types of operative techniques, with emphasis on postoperative morbidity and complications. Major complications included: pseudarthrosis (six patients), deep wound infection (one patient), neuroma (one patient), fracture of healed fusion (two patients), and impingement of Steinmann pin on metacarpophalangeal joint (one patient). Minor complications occurred in 13 patients, with transient nerve palsy (four patients) and superficial skin necrosis (five patients) accounting for the majority. A technique is described for treating pseudarthrosis following fusion, which has been used successfully in four patients. In each case, an autogenous bone graft was taken from the ipsilateral proximal ulna, thus obviating the need for a second iliac bone graft.

Arthrodesis↗

PubMed1996

Sauvé-Kapandji procedure for disorders of the distal radioulnar joint: a simplified technique.

A simplified technique of the Sauvé-Kapandji (SK) procedure for disorders of the distal radioulnar joint (DRUJ) is described. The DRUJ is transfixed by a screw but is not formally exposed and fused, the periosteum of the distal ulna is not excised, and the pronator quadratus is not advanced into the pseudarthrosis. Stability of the ulna shaft is obtained by suturing the sheath of the extensor carpi ulnaris (ECU) and periosteum as a single layer firmly over the ulnar stump and pseudarthrosis. The operating time averages 20 minutes. Review of 28 wrists demonstrated relief of pain in 27; 80 degrees or greater of pronation and supination in 19 and 20, respectively; fusion of the DRUJ in 18; and ulnar carpal shift in 3. The main complications were related to screw placement and length and prominence of the ECU tendon. The simplified SK procedure reliably relieves pain and restores movement at the DRUJ.

Adult↗

PubMedDate not supplied

Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation.

BACKGROUND CONTEXT: A relatively high pseudarthrosis rate is associated with multilevel anterior cervical discectomy and fusion (ACDF). Anterior plate fixation increases fusion rate in multilevel ACDF. A debate still exists between the effectiveness of allograft versus autograft in plated multilevel ACDF. PURPOSE: To determine the efficacy of allograft versus autograft in fusion rate and clinical outcome in patients undergoing two- and three-level ACDFs with rigid anterior plate fixation. STUDY DESIGN: A retrospective radiographic and clinical review to assess fusion, risk factors and clinical outcome of 80 consecutive patients who underwent ACDF with rigid anterior plate fixation involving two and three levels with either allograft or autograft. PATIENT SAMPLE: There were 45 patients (56%) who had autogenous iliac crest tricortical grafts and 35 patients (44%) who received tricortical allograft with an average age of 49 years who were treated by multilevel ACDF with rigid anterior plate fixation at a single institution. Thirty-three Peak polyaxial (Depuy-Acromed, Rayham, MA), 26 Orion (Sofamor-Danek, Memphis, TN), 16 Atlantis (Sofamor-Danek, Memphis, TN) and 5 Synthes (Paoli, PA) anterior cervical plating systems were used. All patients underwent ACDF (61 two-level, 19 three-level) by a Smith Robinson technique. All patients had burring of the end plates, 2-mm distraction of the motion segment and graft countersunk 2 mm from the anterior vertebral border. Anterior cervical plate with unicortical screw purchase was used in all cases. Segmental screw fixation was performed in 46 patients. Soft collars were worn postoperatively for 3 to 4 weeks. OUTCOME MEASURES: Follow-up lateral neutral, flexion and extension radiographs were used to assess fusion. The radiographs were reviewed by an independent blinded observer in assessing fusion grades between autograft versus allograft. Clinical outcomes were rated excellent, good, fair and poor based on Odom's criteria. METHODS: Fusion rate and postoperative clinical outcome were assessed in 80 patients who underwent two- or three-level ACDF with rigid anterior plate fixation. Additional risk factors were also analyzed. RESULTS: Radiographic fusion was assessed in all patients (mean, 16 months). Seventy-eight patients (97.5%) achieved solid arthrodesis. Pseudarthrosis occurred in two patients who had allograft for two-level and three-level fusions. Nonsegmental screws were used in the two-level nonunion case. Postoperative dysphagia developed in one two-level nonunion patient, and revision surgery was performed in the other nonunion three-level patient. Twenty-three patients were smokers, and 26 patients had work-related injuries. Clinical outcome (mean, 20 months) was excellent in 23, good in 48 and fair in 9 patients. No statistical significance was noted between demographics, history of tobacco use, graft-type, end plate preparation technique, intermediate segmental screws, plate-type, clinical outcome of fused and nonfused patients and presence of work-related injuries (p>.05). CONCLUSIONS: A high fusion rate of 97.5% was obtained for multilevel ACDF with rigid plating with either autograft or allograft. In this study, nonunion occurred in patients with allograft but this difference was not statistically significant. Fusion was obtained in 97.8% of patients with segmental screw fixation and 97.1% with nonsegmental screw fixation. Nonsegmental screw fixation may contribute to less than adequate stability and contribute to a higher rate of nonunion, but such effects could not be discerned from this study. Excellent and good clinical outcome was noted in 88.8% of the patients. Proper patient selection and meticulous operative technique is essential to obtain high fusion rates and optimal clinical outcome, which is more important than graft type.

Adult↗

PubMed2002

Update on use of instrumentation in lumbar spine disorders.

The past 20 years have witnessed significant changes in the indications for and use of instrumentation in lumbar spine surgery. Absolute indications for surgical instrumentation include cases of clearly defined instability that commonly occur in the setting of trauma, tumour and infection. Relative indications for instrumentation must consider the clinical context and individual patient characteristics but may include cases of spondylolisthesis, junctional stenosis and pseudarthrosis. The use of instrumentation in the surgical treatment of degenerative disc disease is prevalent but remains highly controversial. Pedicle screws and interbody cages represent alternative forms of instrumentation with substantial clinical evidence supporting their safety and efficacy when applied in the correct clinical settings. Minimally invasive and computer-assisted surgical techniques have shown promising early results but must be subject to longer-term scrutiny. The development of prosthetic disc replacements is an exciting area of research, but clinical results have not approached the success currently enjoyed by hip and knee prostheses, and these devices should be considered experimental. One of the goals of instrumentation is to enhance the rate of spinal fusion. However, achievement of solid radiographic fusion does not guarantee a clinically successful outcome and, conversely, excellent results can be obtained in the setting of radiographic pseudarthrosis. The most important determinant of favourable surgical outcome is appropriate patient selection through a sound understanding of surgical indications.

Humans↗