Principles of Bone Fusion

Siemionow, Krzysztof; Muschler, George F.

doi:10.1016/b978-1-4160-6726-9.00067-5

Cited by 8 publications

(16 citation statements)

References 337 publications

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“…Техника подготовки тел позвонков к спонди-лодезу предполагает полное удаление малокро-воснабжаемой фиброзной ткани в пределах зоны планируемой костной пластики; минимальную механическую и термическую травматизацию, предотвращение высыхания тканей в зоне вмеша-тельства; обнажение кровоснабжаемого спонгиоз-ного вещества тел позвонков, минимальное исполь-зование гемостатического воска. После окончания костно-пластического этапа рекомендуется тща-тельное ушивание мягких тканей над пластическим материалом [19].…”

Section: обс у ж дениеunclassified

“…В определенных ситуациях (отсутствие ригидной фиксации) значение также имеет опороспособность материала. Костный ауто-трансплантат из гребня подвздошной кости, обла-дающий выраженными остеогенными свойствами, считается «золотым стандартом» костно-пласти-ческого материала в хирургии позвоночника [19]. Принципиальные недостатки данного материала связаны с процедурой забора трансплантата и ее последствиями (болезни донорской зоны) [4].…”

Section: обс у ж дениеunclassified

“…Принципиальные недостатки данного материала связаны с процедурой забора трансплантата и ее последствиями (болезни донорской зоны) [4]. Ауто генный кортикальный трансплантат (ребро) обладает меньшей остеогенной емкостью [19], од-нако характеризуется высокой опороспособностью и оптимален, если доступ к зоне пластики пред-полагает резекцию ребра. Для увеличения объема пластического материала возможно применение разнообразных синтетических материалов, об-ладающих остеокондуктивными свойствами [19], в том числе сульфата кальция [13].…”

Section: обс у ж дениеunclassified

“…Наиболее широко применяемой остеоиндуктивной средой служит ал-логенный деминерализованный костный матрикс. Добавление к синтетическому или аллогенному пластическому материалу пунктата костного мозга реципиента обеспечивает насыщение его живыми аутогенными клетками и придает материалу остео-генные свойства [19]. Комбинация различных сред, обладающих остеокондуктивными, остеоиндуктив-ными и остеогенными свойствами, позволяет по-лучить композитный материал с оптимальными характеристиками.…”

Section: обс у ж дениеunclassified

“…К управляемым системным факторам, влияю-щим на вероятность несостоятельности костного блока, относятся состояние питания пациента, железодефицитная анемия, применение нестеро-идных противовоспалительных препаратов [19]. При наличии у больного гипотрофии и/или желе-зодефицитной анемии эти состояния должны быть скорректированы до оперативного вмешательства.…”

Section: обс у ж дениеunclassified

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Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

et al. 2018

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Clinical case of successful operative treatment of congenital kyphosis is reported. Deformation was caused by multiple lower thoracic and lumbar vertebral body abnormalities. Associated spinal abnormalities were outspread absence of laminae, hydromyelia, and diastematomyelia. Preoperative computed tomography analysis revealed absence of instrumentable bony structures within malformed lower thoracic and lumbar spine. As instrumented fusion procedure was technically impossible anterior fusion without internal fixation was performed. Autogenous rib was used as a bone graft. Bone graft was extended with calcium sulphas (osteoconductive media), demineralized allograft bone matrix (osteoinductive media), and patient’s bone marrow aspirate (osteogenic media). Resulting combined bone grafting material possessed osteoconductivity, osteoinductivity, ostegenicity, and mechanical strength. At 18 months post operation follow-up computed tomography revealed solid bony fusion formation. Some neurologic improvement also was noticed. Congenital kyphosis caused by multiple outspread vertebral malformations remains insufficiently studied clinical problem. Affected children need individual multidisciplinary surgical approach, meticulous surgical planning, and regular neurological, imaging, and orthopedic follow-up until the end of bone growth. Absence of instrumentable bony structures in desired spinal arthrodesis does not preclude successful fusion. Combination of several heterogenous bone grafting materials with different properties provides fusion in difficult clinical setting.

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Section: обс у ж дениеunclassified

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Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

et al. 2018

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Effects of pregabalin on spinal fusion

2019

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Purpose Gamma-aminobutyric acid analogues are commonly used to treat neuropathic and chronic pain before and after spinal surgery in recent years. Aim of this study is to investigate the influence of pregabalin on spinal fusion and to determine the proper pregabalin dose for postoperative utilization in a validated rat intertransverse spinal fusion. Methods Lumbar intertransverse fusion surgeries performed in four groups of rats according to a previously established rat model for posterolateral spinal fusion. All rats were followed up for 6 weeks at the postoperative period by administering oral pregabalin doses of 10 (D10), 30 (D30) and 100 mg/kg/day (D100) except the control group. All rats were killed after 6 weeks and evaluated in terms of manual palpation, radiographic investigation and histological analysis to investigate posterolateral fusion. Results Assessment of fusion with manual palpation revealed lower fusion rates in D100 group. In histological analysis, scores were significantly lower in D30 and D100 groups compared to the control group; this finding was interpreted as inhibition of spinal fusion. Radiographic evaluation did not reveal any significant statistical difference between groups. Conclusions Histological analysis and manual palpation results showed inhibition of spinal fusion formation with high doses of pregabalin. According to these results, administration of high-dose pregabalin should be avoided at the postoperative period until successful fusion is obtained in patients who undergo spinal fusion surgery.

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Perioperative adverse events after different fusion approaches for single-level lumbar spondylosis

Gala

Ottesen

Kahan

et al. 2020

North American Spine Society Journal (NASSJ)

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Background: Low back pain from lumbar spondylosis affects a large proportion of the population. In select cases, lumbar fusion may be considered. However, cohort studies have not shown clear differences in long-term outcomes between PSF, TLIF, ALIF, and AP fusion. Thus, differences in perioperative complications might affect choice between these procedures for the given diagnosis. The current study seeks to compare perioperative adverse events for patients with lumbar spondylosis treated with single-level: posterior spinal fusion (PSF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), or combined anterior and posterior lumbar fusion (AP fusion).Methods: Patients with a diagnosis of lumbar spondylosis who underwent single-level lumbar fusion without decompression were identified in the 2010-2016 National Quality Improvement Program (NSQIP) database. Patients were categorized based on their procedure (PSF, TLIF, ALIF, or AP fusion). Unadjusted Fisher's exact and Pearson's chi-squared tests were used to compare demographics and comorbid factors. Analysis was secondarily done with propensity score matching to address potential differences in patient selection between the study cohorts.Results: In total, 1816 patients were identified: PSF n = 322, TLIF n = 800, ALIF n = 460, AP fusion n = 234. The procedures did not have different thirty-day individual or aggregated (any, serious, minor, or infection) adverse events. Further, propensity score matched analysis also revealed no differences in individual or aggregated thirtyday perioperative events. Conclusion:The current study demonstrates a lack of difference in thirty-day perioperative adverse events for different fusion procedures performed for lumbar spondylosis, consistent with prior longer-term outcome studies. These findings suggest that patient/surgeon preference and other factors not captured here should be considered to determine the best surgical technique for the select patients with the given diagnosis who are considered for lumbar fusion.

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Principles of Bone Fusion

Cited by 8 publications

References 337 publications

Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

Effects of pregabalin on spinal fusion

Perioperative adverse events after different fusion approaches for single-level lumbar spondylosis

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