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Acrylic spinal fusion

A 20-year clinical series and technical note

Robert R. Hansebout and Gustav A. Blomquist Jr.

to discuss the technique of acrylic fusion as it has evolved at the Montreal Neurological Hospital since 1959, when Dr. Gilles Bertrand performed an acrylic fusion using ostamer and Meurig-Williams plates on a terminally ill patient with Hodgkin's disease. We present a clinical series covering two decades based on the patients' records and autopsy examinations, and outline the present techniques used in acrylic-wire fusion. We hope that the presentation of this series will be of value in weighing the efficacy of acrylic-wire fusion in terms of effective stability

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Sagun K. Tuli, Jayshree Tuli, Peng Chen, and Eric J. Woodard

F usion rate as described in the literature is typically reported as the percentage of patients in whom fusion is successful over a range of follow-up times or at a specific end point. 2–12, 14–18, 21–36 Because the values of the ranges of observations and study end points vary, comparison of studies and perforce the ability to perform metaanalysis become difficult. Because fusion is a time-dependent phenomenon, a more accurate method of representation would use the median time to fusion, which is calculated using the Kaplan—Meier method of estimation. 20

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Mark B. Frenkel, Kevin S. Cahill, Ramin J. Javahary, George Zacur, Barth A. Green, and Allan D. Levi

I t is well known that pseudarthrosis remains a major limitation of instrumented, multilevel anterior cervical fusions. In 2002, Barnes et al. 1 reported on a series of 77 patients who had undergone anterior cervical discectomy and fusion using the Atlantis cervical plating system (Medtronic Sofamor-Danek) with fibular allograft; the authors reported satisfactory outcomes in only 65% of patients who had undergone multilevel procedures, with an overall fusion rate of only 90%. Other recent studies have shown that while anterior cervical plating can improve

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H. Gordon Deen, Richard S. Zimmerman, and Louis A. Lanza

A major concern in spine stabilization procedures is failure of the transplanted bone graft to achieve a solid bony fusion due to resorption or fatigue fracture. This complication is more likely when allograft, xenograft, or bone substitutes are used, but it may also occur when fresh autograft, the “gold-standard” graft material, is utilized. The use of bone grafts with vascular supply has been proposed in an effort to create a more optimum fusion environment, which might enhance the speed of bone consolidation and the ultimate strength of the construct. 5

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Claudius Thomé, Olaf Leheta, Joachim K. Krauss, and Dimitris Zevgaridis

S ince its introduction by Cloward 17 and by Smith and Robinson, 44 anterior decompression of the spinal canal and foramina has been an accepted treatment of degenerative cervical disc disease. Several technical modifications have been developed, but no consensus regarding the optimal technique has been established. 50 Interbody fusion following ACD for treatment of cervical radiculopathy or cervical myelopathy is thought to have several advantages compared with discectomy alone. 48 Controversy exists, however, regarding the optimal substrate for

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Robert E. Isaacs, Vinod K. Podichetty, Paul Santiago, Faheem A. Sandhu, John Spears, Kevin Kelly, Laurie Rice, and Richard G. Fessler

I nterbody arthrodesis techniques have been developed to improve fusion results while restoring more normal disc space height and maintaining vertebral alignment. 30 The evolution of interbody fusion has provided the spine surgeon with various options related to the approach, graft material, and fixation. 2, 10, 12, 18, 21, 22, 25, 29 Since the initial description by Cloward in the 1950s, PLIF has gained significant popularity 4, 5, 20, 34 as a result of material innovations (instrumentation and bone morphogenetic protein) and improved surgeon comfort with

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Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick

Neurosurgeons and orthopedists commonly perform cervical fusions in an effort to treat degenerative spine disease. In addition to assessment of neurological outcome, surgeons often use the presence or absence of a solid arthrodesis as a measure of operative success. Although definitive data correlating clinical outcome to successful arthrodesis is lacking, there are reports indicating a possible relationship and that patients improve after revision surgery of a failed fusion. 10 , 14 , 21 , 23 Therefore, it is useful to be able to diagnose with accuracy the presence or

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P. I. J. M. Wuisman, M. van Dijk, and T. H. Smit

E x vivo and in vivo animal models are essential to study spinal fusion. The spines are easily available, have uniform and mechanical properties, and have anatomical and biomechanical similarities to human spines. 1, 2, 12, 17, 29, 31, 39, 40 An advantage of using a goat or sheep model is that the lamellar bone growth rate is nearly equivalent to that in humans. 31, 39 Methods and Materials Study Design We report preliminary data from a study exploring the potential benefits of a novel bioresorbable PLLA cage with less stiffness than most of the

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Jonathon F. Parkinson and Lali H. S. Sekhon

A nterior cervical decompression is a recognized treatment for myelopathy or radiculopathy due to cervical disc herniation. The procedure is usually followed by interbody fusion with or without placement of instrumentation. 2, 6, 10, 12, 14 Cervical anterior interbody fusion is widely accepted as a means of reducing normal cervical spine motion and increasing the stress at adjacent levels. 3, 11, 16 Hilibrand, et al., 9 confirmed a 2.9% annual rate of adjacent-segment disease in patients who have undergone anterior interbody fusion. As a result of this

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Tanvir F. Choudhri, Praveen V. Mummaneni, Sanjay S. Dhall, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Alok Sharan, Jeffrey C. Wang, and Michael G. Kaiser

Recommendations There is no evidence that conflicts with the previous recommendations in the original version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.” Grade A Following lumbar fusion surgery, static lumbar radiographs are not recommended as a stand-alone method to assess fusion status. Grade B Following instrumented posterolateral lumbar fusions (PLFs), CT imaging with fine-cut axial and multiplanar reconstruction views is recommended as a method to assess fusion status. When