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Hassan A. Serhan, Gus Varnavas, Andrew P. Dooris, Avinash Patwardhan and Michael Tzermiadianos

✓The clinical success of lumbar spinal fusion varies considerably, depending on techniques and indications. Although spinal fusion generally helps to eliminate certain types of pain, it may also decrease function by limiting patient mobility. Furthermore, spinal fusion may increase stresses on adjacent nonfused motion segments, accelerating the natural degeneration process at adjacent discs. Additionally, pseudarthrosis, that is, incomplete or ineffective fusion, may result in an absence of pain relief. Finally, the recuperation time after a fusion procedure can be lengthy.

The era of disc replacement is in its third decade, and this procedure has demonstrated promise in relieving back pain through preservation of motion. Total joint replacement with facet arthroplasty of the lumbar spine is a new concept in the field of spinal surgery. The devices used are intended to replace either the entire functional spinal unit (FSU) or just the facets. These devices provide dynamic stabilization for the functional spinal segment as an adjunct to disc replacement or laminectomy and facetectomy performed for neural decompression. The major role of facet replacement is to augment the instabilities created by the surgical decompression or to address chronic instability. Additionally, facet joint replacement devices can be used to replace the painful facet joints, restore stability, and/or to salvage a failed disc or nucleus prosthesis without losing motion.

In this paper the authors review and discuss the role of the lumbar facet joints as part of the three-joint complex and discuss their role in intersegmental motion load transfer and multidirectional flexibility in a lumbar FSU.

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Paul Khoueir, K. Anthony Kim and Michael Y. Wang

✓Numerous new posterior dynamic stabilization (PDS) devices have been developed for the treatment of disorders of the lumbar spine. In this report the authors provide a classification scheme for these devices and describe several clinical situations in which the instrumentation may be expected to play a role. By using this classification, the PDSs that are now available and those developed in the future can be uniformly categorized.

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Paul McAfee, Larry T. Khoo, Luiz Pimenta, Andy Capuccino, Domagoj Coric, Robert Hes, Bart Conix, Farbod Asgarzadie, Azmi Hamzaoglu, Yigal Mirofsky and Yoram Anekstein

Lehmann TR , Spratt KF , Tozzi JE , Weinstein JN , Reinarz SJ , el-Khoury GY , : Long-term follow-up of lower lumbar fusion patients . Spine 12 : 97 – 104 , 1987 17 McAfee P : Biomechanics and results of implant testing of the TOPS Facet Replacement Device . Presented at the 5th Annual Spine Arthroplasty Society Meeting New York, New York , May 9 2005 . (Unverified) 18 Niosi CA , Zhu QA , Wilson DC , Keynan O , Wilson DR , Oxland TR : Biomechanical characterization of the three-dimensional kinematic behavior of the

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Ali Kiapour, D. Greg Anderson, David B. Spenciner, Lisa Ferrara and Vijay K. Goel

, Kiapour A , Faizan A , Krishna M , Friesem T : Finite element study of matched paired posterior disc Implant and dynamic stabilizer (360° motion preservation system) . SAS Journal 1 : 55 – 62 , 2007 6 Goel VK , Mehta A , Jangra J , Faizan A , Kiapour A , Hoy RW , : Anatomic facet replacement system (AFRS) restoration of lumbar segment mechanics to intact: a finite element study and in vitro cadaver investigation . SAS Journal 1 : 46 – 54 , 2007 7 Goel VK , Winterbottom JM : Experimental investigation of three

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Ranjith Babu, Steven Thomas, Matthew A. Hazzard, Yuliya V. Lokhnygina, Allan H. Friedman, Oren N. Gottfried, Robert E. Isaacs, Maxwell Boakye, Chirag G. Patil, Carlos A. Bagley, Michael M. Haglund and Shivanand P. Lad

cord or meninges, repair of meningocele or myelomeningocele, repair of a vertebral fracture, insertion or removal/revision of a spinal shunt, implantation or replacement of spinal neurostimulator leads, spinal fusion or refusion, insertion/removal of artificial spinal disc prosthesis, and insertion/removal of interspinous, pedicle-based stabilization, or facet replacement devices. TABLE 1: The ICD-9-CM diagnosis and procedure codes used for this study * ICD-9-CM Code Description procedure  03.01 removal of foreign body from

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distribute any published materials without written permission from JNSPG. 2015 Introduction An Investigational Device Exemption (IDE) study is being conducted to evaluate safety and efficacy of the ACADIA® Facet Replacement System. Methods Candidates have lateral, lateral recess and/or central canal stenosis at one level from L3 to S1 requiring decompression and facetectomy. Patients are randomized 2:1 to investigational ACADIA® or control PLF. The first two patients enrolled per site may be non-randomized to ACADIA®. Outcome measures are collected

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Matthew L. Goodwin, William Ryan Spiker, Darrel S. Brodke and Brandon D. Lawrence

R ecently , interest has grown in facet replacement devices for conditions such as spinal stenosis with instability. 8 Our institution participated in a randomized controlled trial studying the ACADIA facet replacement system (AFRS; Globus Medical, http://www.globusmedical.com/acadia-ide-study/ ), a pedicle-based device with a metal-on-metal (MOM) gliding joint that mimics the native facet biomechanics (clinical trial registration no. NCT00401518, clinicaltrials.gov) ( Fig. 1 ). Five patients with spinal stenosis and low-grade spondylolisthesis were randomized

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Brandon A. McCutcheon, Brian R. Hirshman, Brandon C. Gabel, Michael W. Heffner, Logan P. Marcus, Tyler S. Cole, Clark C. Chen, David C. Chang and Bob S. Carter

disc prosthesis, lumbosacral  84.69 Revision or replacement of artificial spinal disc prosthesis, not otherwise specified  84.80 Insertion or replacement of interspinous process device(s)  84.81 Revision of interspinous process device(s)  84.82 Insertion or replacement of pedicle-based dynamic stabilization device(s)  84.83 Revision of pedicle-based dynamic stabilization device(s)  84.84 Insertion or replacement of facet replacement device(s)  84.85 Revision of facet replacement device(s) Code Description Cranial  01.01 Cisternal puncture  01.02 Ventriculopuncture

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.3171/2017.11.SPINE17228 2017.11.SPINE17228 Failure of facet replacement system with metal-on-metal bearing surface and subsequent discovery of cobalt allergy: report of 2 cases Matthew L. Goodwin MD, PhD William Ryan Spiker MD Darrel S. Brodke MD Brandon D. Lawrence MD 07 2018 13 04 2018 29 1 81 84 10.3171/2017.10.SPINE17862 2017.10.SPINE17862 Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas Michael M. Safaee 1 MD Aaron J. Clark 1 MD, PhD Jan-Karl Burkhardt 1 MD Ethan A. Winkler 1 MD, PhD Michael T. Lawton 2 MD 07 2018 20