1,720,976 research outputs found
Sostituzione protesica del disco cervicale
No full textLa discectomia ed artrodesi cervicale per via anteriore (anterior cervical discectomy and fusion,
ACDF) rappresenta la procedura di scelta per il trattamento delle radicolopatie e mielopatie da ernia
del disco cervicale. Sebbene si tratti di una procedura efficace e con tassi di complicanze modesti
(2-4%), studi clinici e biomeccanici recenti hanno evidenziato come la tecnica di artrodesi cervicale
anteriore alteri irrimediabilmente la biomeccanica del rachide cervicale. L’artrodesi del livello trattato
determina una redistribuzione dei carichi meccanici sui livelli adiacenti con accelerazione del pro-
cesso di degenerazione discale. Stime attuali suggeriscono che circa il 25% dei pazienti sottoposti
ad ACDF svilupperà una discopatia del livello adiacente a 10 anni (3% all’anno) e la metà di questi
richiederà un nuovo intervento chirurgico. La sostituzione protesica del disco cervicale si propone
come procedura alternativa all’artrodesi anteriore (ma non alla decompressione!) per la prevenzione
della degenerazione dei segmenti adiacenti. I primi trials prospettici e randomizzati su ACDF e pro-
tesi discale hanno avuto inizio negli anni 2000 ed hanno dimostrato percentuali di successo simili o
a volte superiori per le protesi discali rispetto all’ACDF ed una sostanziale sovrapposizione in termini
di sicurezza tra le due metodiche. L’esito di questi trials ha portato all’immissione in commercio di
numerosi dispositivi per la sostituzione protesica discale cervicale. Il candidato ideale resta tuttora
il giovane adulto con radicolopatia sintomatica e con articolazioni posteriori intatte. L’obiettivo di
questo articolo è di revisionare criticamente la Letteratura a supporto dell’utilizzo delle protesi discali
cervicali tracciandone brevemente le linee di sviluppo future. La sostituzione protesica discale cer-
vicale è oramai una tecnica matura e riconosciuta a livello internazionale; i dati di medio follow-up
ad oggi disponibli sono incoraggianti, ma soltanto dati a più lungo termine potranno confermare la
promessa di una riduzione della degenerazione dei segmenti adiacenti.Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for the treatment
of cervical radiculopathy and myelopathy due to cervical disc disease. Although it is a generally
successful and safe procedure (complication rate between 2 and 4%), more recent studies have
raised concerns regarding alterations of cervical spine biomechanics following a fusion. The fusion
of a cervical segment leads to increased stress and loading on the adjacent segments which in turn
can accelerate the degeneration process. Current estimates suggest that 25% of patients treated
with ACDF will develop adjacent segment degeneration at 10 years (3% per year) and half of these
patients will require new surgical intervention. Cervical disc arthroplasty (CDA) was developed as an
alternative procedure to preserve motion both at the affected and adjacent levels and theoretically
lower rates of adjacent segment degeneration. Prospective randomized trials comparing ACDF with
CDA were initiated in 2000 and have demonstrated significant differences in some clinical outcome
measures favouring CDA and comparable safety profiles between the two techniques. Following
these trials many different devices have been licensed and are currently available on the market. The
typical candidate patient for CDA is the young active adult patient with single level symptomatic disc
disease and with intact posterior facet joints. The aim of this article is to critically review available
literature supporting clinical use of CDA. Cervical disc replacement is nowadays an accepted
technique with established short and medium-term follow-up data, however only long-term data will be able to confirm the promise of decreased adjacent segment disease
and fewer reoperations
Hydatid cyst of the spine
No full textWe describe a case of 62-year-old woman whose major complaints were back pain radiating to the legs and progressive weakness
in the lower limbs. Computed tomography and magnetic resonance imaging showed spinal and paraspinal hydatid cysts causing
neural foraminal widening, dumbbell appearance and spinal cord compression. The cysts were removed surgically
Gene therapy for in vivo bone formation: recent advances
No full textGene therapy has developed during the last two decades as a promising strategy for orthopaedics applications, since several different gene transfer techniques proved to be effective, both in vitro and in vivo, for the induction of bone formation. Successful results have been achieved with gene-based bone healing strategies in several preclinical studies, using different animal models. New genes and new viral and non-viral vector constructs have been developed to reduce the risks and safety issues, widening the field of possible applications and improving the potential therapeutical effects. We review the latest gene transfer technologies employed for in vivo bone formation, focusing on the recently identified network of growth factors and genes involved in the modulation of the osteogenetic process and on the variety of vectors utilized for gene delivery
Onset of a Charcot spinal arthropathy at a level lacking surgical arthrodesis in a paraplegic patient with traumatic cord injury
No full textThe study design included a case report of Charcot spinal arthropathy treated with posterior and anterior spinal instrumentation. The objective of the study was to report an unusual case of Charcot spinal arthropathy as a late complication of traumatic spinal cord injury in a patient previously treated with a long posterior thoraco-lumbar instrumentation and postero-lateral fusion. A 33-year-old man with T10-T11 complete paraplegia presented with focal low back pain, kyphotic deformity of the lumbar region with L2-L3 fracture-dislocation and hardware failure. Our treatment consisted of a circumferential arthrodesis performed with a combined anterior and posterior approach. Spinal stabilization was achieved and the patient was pain free and able to resume a sitting posture. This report suggests that the development of a Charcot spine arthropathy must always be considered as a late complication of a spinal cord injury. Moreover, we would emphasize the fundamental role of a strict clinical and radiological follow-up in order to detect an early Charcot spine complication
A carbon fiber reinforced composite material as a scaffold in anterior cervical interbody fusion. Congresso congiunto IORS-SISC. Varese. 30 giugno-2 luglio 1996
No full textIn Vivo Results of a Clinically Relevant Gene Therapy Approach for Orthopaedic Applicaions
No full textSurgical treatment of tuberculous spondylodiscitis
No full textBACKGROUND: Most patients affected by spinal tuberculosis can be successfully treated conservatively with chemotherapy, external bracing and prolonged rest. Nevertheless, kyphotic deformity, spinal instability and neurological deficit remain a common complication associated with conservative approach.
AIM: To illustrate different indications and treatment modalities for tuberculous spondylodiscitis, focusing on the role of surgery as an adjuvant of effective chemotherapy in the management of selected patients.
MATERIALS AND METHODS: Various early and late surgical procedures are recommended to treat spinal tuberculosis. The Authors analyzed surgical indications, approaches, complications and outcomes comparing their experience with available Literature.
RESULTS: Conservative management is preferable in patients without vertebral instability and deformity; in presence of abscesses, invasive radiological techniques in combination with abscess drainage and chemotherapy are recommended. In patients with vertebral collapse, kyphotic deformity or abscess formation, vertebral instability or neurological deficits, anterior radical debridement, anterior strut grafting and anterior instrumentation is an optimal standardized procedure. In patients with involvement of more than two vertebral levels or lumbosacral junction and in those whose sagittal alignment is markedly deformed with segmental kyphosis, and in patients who have difficulty in undergoing anterior instrumentation, posterior instrumentation is recommended in combination with anterior radical debridement and anterior strut grafting in one or two staged procedures.
CONCLUSIONS: Since surgery for spinal tuberculosis is demanding, it should be performed only after taking into account the risks and benefits in operable patients. Various surgical procedures are recommended to treat spinal tuberculosis but the common goals are to eradicate the infection and to prevent or to treat neurologic deficits or spinal deformity
A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities
No full textPercutaneous techniques may be helpful to reduce approach-related morbidity of conventional open surgery. The aim of the study was to evaluate the feasibility and safety of mini-open posterior lumbar interbody fusion for instabilities and degenerative disc diseases. From May 2005 until October 2008, 20 patients affected by monosegmental instability and disc herniation underwent mini-open lumbar interbody fusion combined with percutaneous pedicle screw fixation of the lumbar spine. Clinical outcome was assessed using the Visual Analog Scale, Oswestry Disability Index, and Short Form Health Survey-36. The mean follow-up was 24 months. The mean estimated blood loss was 126 ml; the mean length of stay was 5.3 days; the mean operative time was 171 min. At 24-month follow-up, the mean VAS score was 2.1, mean ODI was 27.1%, and mean SF-36 was 85.2%. 80 screws were implanted in 20 patients. 74 screws showed very good position, 5 screws acceptable, and 1 screw unacceptable. A solid fusion was achieved in 17 patients (85%). In our opinion, mini-open TLIF is a valid and safe treatment of lumbar instability and degenerative disc diseases in order to obtain faster return to daily activities
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