Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Spine 112 articles


Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study

Peter T. McCunniff MD, HoJun Yoo BS, Anthony Dugarte CSCS, Navkirat S. Bajwa MD, Jason O. Toy MD, Uri M. Ahn MD, Nicholas U. Ahn MD

Cadaveric studies have examined disc degeneration at the L4-L5 and L5-S1 motion segments; however, we are not aware of another study that has examined the relationship between bilateral spondylolysis and its effect on degenerative disc disease at those levels. This may have been overlooked by researchers owing to the majority of spondylolysis occurring at the L5 vertebra.

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Blazej Pruszczynski MD, William G Mackenzie MD, FRCS, Kenneth Rogers PhD, ATC, Klane K. White MD, MSc

Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children’s Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication.

Does Coordinated, Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

Gregg Ziemke PT, MS, MHA, OCS, CAPT, MSC, USN, Marco Campello PT, PhD, Rudi Hiebert ScM, Shira Schecter Weiner PT, PhD, Chris Rennix ScD, Margareta Nordin DrMedSci

Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team.

Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes

Scott L. Parker MD, Stephen K. Mendenhall BS, Saniya S. Godil MD, Priya Sivasubramanian BS, Kevin Cahill MD, MPH, John Ziewacz MD, MPH, Matthew J. McGirt MD

Long-term postdiscectomy degenerative disc disease and low back pain is a well-recognized disorder; however, its patient-centered characterization and quantification are lacking.

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Andrew J. Schoenfeld MD, MSc, Elyse N. Reamer BS, Emily I. Wynkoop BS, Hwajung Choi PhD, Christopher M. Bono MD

Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue.

UHMWPE Wear Debris and Tissue Reactions Are Reduced for Contemporary Designs of Lumbar Total Disc Replacements

Sai Y. Veruva BS, Todd H. Lanman MD, Jorge E. Isaza MD, Daniel W. MacDonald MS, Steven M. Kurtz PhD, Marla J. Steinbeck MT(ASCP), PhD

Lumbar total disc replacement (L-TDR) is a procedure used to relieve back pain and maintain mobility. Contemporary metal-on-polyethylene (MoP) L-TDRs were developed to address wear performance concerns about historical designs, but wear debris generation and periprosthetic tissue reactions for these newer implants have not been determined.

Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

Sjoerd P. F. T. Nota MD, Yvonne Braun MD, David Ring MD, PhD, Joseph H. Schwab MD, MS

Orthopaedic surgical site infections (SSIs) can delay recovery, add impairments, and decrease quality of life, particularly in patients undergoing spine surgery, in whom SSIs may also be more common. Efforts to prevent and treat SSIs of the spine rely on the identification and registration of these adverse events in large databases. The effective use of these databases to answer clinical questions depends on how the conditions in question, such as infection, are defined in the databases queried, but the degree to which different definitions of infection might cause different risk factors to be identified by those databases has not been evaluated.

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

Bryce A. Basques BS, Daniel D. Bohl MPH, Nicholas S. Golinvaux BA, Brian G. Smith MD, Jonathan N. Grauer MD

Posterior spinal fusion (PSF) is commonly performed for patients with adolescent idiopathic scoliosis (AIS). Identifying factors associated with perioperative morbidity and PSF may lead to strategies for reducing the frequency of adverse events (AEs) in patients and total hospital costs.

Is Sequestrectomy a Viable Alternative to Microdiscectomy? A Systematic Review of the Literature

Bahram Fakouri MD, Nitin R. Shetty MPhil, FRCS(Orth), Thomas C. H. White MRCS

Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected patients, however, it is possible to remove only the free fragment or sequester without clearing the intervertebral disc space. However, there is some controversy about whether that approach is sufficient to prevent recurrent symptoms and to provide adequate pain relief.

Experimental Disc Herniation in the Rat Causes Downregulation of Serotonin Receptor 2c in a TNF-dependent Manner

Daniel Jonsson MS, Oscar Finskas MS, Yuki Fujioka MD, Anders Ståhlberg PhD, Kjell Olmarker MD, PhD

During recent decades, the knowledge of the pathophysiology of disc herniation and sciatica has drastically improved. What previously was considered a strict biomechanical process is now considered a more complex interaction between leaked nucleus pulposus and the tissue in the spinal canal. An inflammatory reaction, with tumor necrosis factor (TNF) playing an essential role, has been demonstrated. However, the exact mechanisms of the pathophysiology of disc herniation remain unknown.