Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

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Articles

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.

Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011?

Andrea N. Doud MD, Ashley A. Weaver PhD, Jennifer W. Talton MS, Ryan T. Barnard MS, J. Wayne Meredith MD, Joel D. Stitzel PhD, Preston Miller MD, Anna N. Miller MD

While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design.

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Meric Enercan MD, Sinan Kahraman MD, Erden Erturer MD, Cagatay Ozturk MD, Azmi Hamzaoglu MD

The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach.

What Are Long-term Predictors of Outcomes for Lumbar Disc Herniation? A Randomized and Observational Study

Dana Kerr MD, Wenyan Zhao PhD, Jon D. Lurie MD, MS

Although previous studies have illustrated improvements in surgical cohorts for patients with intervertebral disc herniation, there are limited data on predictors of long-term outcomes comparing surgical and nonsurgical outcomes.

Molecular Basis of Intervertebral Disc Degeneration and Herniations: What Are the Important Translational Questions?

Tiffany Kadow MD, Gwendolyn Sowa MD, PhD, Nam Vo PhD, James D. Kang MD

Intervertebral disc degeneration is a common condition with few inexpensive and effective modes of treatment, but current investigations seek to clarify the underlying process and offer new treatment options. It will be important for physicians to understand the molecular basis for the pathology and how it translates to developing clinical treatments for disc degeneration. In this review, we sought to summarize for clinicians what is known about the molecular processes that causes disc degeneration.

Outcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence

Rueben Nair MD, Cynthia A. Kahlenberg BA, Wellington K. Hsu MD

Although lumbar discectomy for treatment of lumbar disc herniation in the general population generally improves patients’ pain, function, and validated outcomes scores, results of treatment in elite athletes may differ because of the unique performance demands required of competitive athletes.

Which Design and Biomaterial Factors Affect Clinical Wear Performance of Total Disc Replacements? A Systematic Review

Sai Y. Veruva BS, Marla J. Steinbeck MT(ASCP), PhD, Jeffrey Toth PhD, Dominik D. Alexander PhD, MSPH, Steven M. Kurtz PhD

Total disc replacement was clinically introduced to reduce pain and preserve segmental motion of the lumbar and cervical spine. Previous case studies have reported on the wear and adverse local tissue reactions around artificial prostheses, but it is unclear how design and biomaterials affect clinical outcomes.

Is Unilateral Kyphoplasty as Effective and Safe as Bilateral Kyphoplasties for Osteoporotic Vertebral Compression Fractures? A Meta-analysis

Zhaobo Huang MD, Shuanglin Wan MD, Lei Ning MD, Shiliang Han MD

An osteoporotic vertebral compression fracture is a common condition in elderly people, especially women. The percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Controversy remains regarding whether a unilateral or a bilateral approach is superior, and to our knowledge, there have been no large studies comparing these two approaches, therefore a meta-analysis synthesizing the data on this question is warranted.

How Does a Novel Monoplanar Pedicle Screw Perform Biomechanically Relative to Monoaxial and Polyaxial Designs?

Samuel R. Schroerlucke MD, Nikolai Steklov BS, Gregory M. Mundis MD, James F. Marino MD, Behrooz A. Akbarnia MD, Robert K. Eastlack MD

Minimally invasive spinal fusions frequently require placement of pedicle screws through small incisions with limited visualization. Polyaxial pedicle screws are favored due to the difficulty of rod insertion with fixed monoaxial screws. Recently, a novel monoplanar screw became available that is mobile in the coronal plane to ease rod insertion but fixed in the sagittal plane to eliminate head slippage during flexion loads; however, the strength of this screw has not been established relative to other available screw designs.