Ebook Dynamic reconstruction of the spine: Part 2
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Ebook Dynamic reconstruction of the spine: Part 2
Dynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2ul, £hn M. Shucoiky. and jordan McAfee29.1IntroductionWith the Agile and N-flancc spinal devices being withdrawn from (he market and not being available for sale in (he Uni(ed States, the practical application of dynamic stabilization is limited. Furthermore, the prospective randomized Food and Drug Ebook Dynamic reconstruction of the spine: Part 2 Administration (IDA) study of (he Dynesys Dynamic Stabilization System (Zimmer Spine. Minneapolis. MN) was not approved. This leaves the Transition sEbook Dynamic reconstruction of the spine: Part 2
tabilization System (Globus Medical. Inc., Audubon. RA) as the main remaining instrumentation system available for clinical use in the treatment of spDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2ce of correction transitioning from the rigid titanium rod portion of an instrumentation system to the uninstrumented mobile portion of the spine outside the vertebral levels of surgery.' There were three indications for using (he Transition: (I) topping off. (2) hybrid cases with one or two lewis o Ebook Dynamic reconstruction of the spine: Part 2f solid rod combined with one or more levels of KU. and (3) load sharing between the posterior dynamic rod and an anterior poly ether ketone (PEEK) spEbook Dynamic reconstruction of the spine: Part 2
acer at the same vertebral level. We reviewed a scries of 85 consecutive cases treated as one of these three indications in the setting of revision suDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2quentially borne by the spinal fusion. If 100% of the load is absorbed by the spinal instrumentation the pedicle screws bear higher cantilever bending stresses, there are higher strains on the solid metal rods, and a higher incidence of pedicle screw breakage can be expected. The focus of this study Ebook Dynamic reconstruction of the spine: Part 2 of 85 consecutive patients was to take a discrete unarguable definition of failurc-rcoperation-and apply dynamic, shock-absorbing instrumentation inEbook Dynamic reconstruction of the spine: Part 2
the setting of prior failure of lumbar fusion, thereby to determine whether the reoperation rate IS more favorable titan with conventional instrumentaDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2.29.2Definitions of Successful Clinical FusionAll cases in this series were Lenke grade D in appearance on radiographs. All patients had mechanical back pain, fulfilled the criterion of disability for a minimum of 6 months preoperatively. and had over 2 mm of angular motion of prcopcrativc flexionex Ebook Dynamic reconstruction of the spine: Part 2tension radiographs.In a review of 56 cases of isthmic spondylolisthesis, treated with uninstrumented posterolateral fusion using autogenous iliac creEbook Dynamic reconstruction of the spine: Part 2
st bone graft. Lenke et al classified the different grades of fusion from radiographs as follows:(a)Definitely solid (50%)-large. solid, trabeculated Dynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2in fusion masses bilaterally(d)Definitely not solid (21 %)-graft resorption bilaterally or fusion mass with obvious bilateral pseudarthrosis29.2.1Clinical ExperienceEighty-five patients were treated with Transition segmental spinal pedicle screw instrumentation for pseudarthrosis. Thirty-three of th Ebook Dynamic reconstruction of the spine: Part 2e prior surgical procedures had used spinal instrumentation. which had to be removed at the start of the revision procedure. The indications for the sEbook Dynamic reconstruction of the spine: Part 2
econdary procedure were pscudarthrosis (85 cases), recurrent herniated disc (14 cases), recurrent lumbar spinal stenosis (22 cases), adjacent segment Dynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2ion Surgical Technique and Design FeaturesTransition is a pedicle screw-based system consisting of a KU bumper and spacer to provide a soft stop at (he limits of spinal flexion and extension. The amount of flexibility is determined by the total amount of KU in (he bumper and the spacers, which can b Ebook Dynamic reconstruction of the spine: Part 2e of various lengths, from 20 to 42 mm. The Transition system uses a semirigid rod that provides translational stability to horizontal shear forces beEbook Dynamic reconstruction of the spine: Part 2
cause the spools overlap and encompass the sleeves. The unique feature of the system is that it provides for angulation of (he adjacent pedicle screwsDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2xiralordotic so (hat the overall construct lordosis can be varied from straight to 40 degrees of global lumbar lordosis from LI to 51. The polyethylene terephthalate (PET) cord has greater than 3.100 tensile strength and pullout strength of over 1,000 N where it attaches to the end of the titanium r Ebook Dynamic reconstruction of the spine: Part 2od. In fatigue testing to 5 million cycles the Transition rods did not fail with shear stresses, whereas two other competitive FDA-approved dynamic syEbook Dynamic reconstruction of the spine: Part 2
stems failed at a mean ofTable 29.1 Predominant indications (much overlap)indicationPseudarthrusn85Recurrent herniated nucleus pulpusus14Recurrent lumDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2Fig. 29.1 (a) Bench-top laboratory testing reproduced the mechanism of faAire for the AGILE system (Medtronic) using polycarbonate urethane (KU) and a cable to provide dynamic posterior stabilisation. I he laboratory failure Is shown on the left, demonstratng cable breakage with 3 mm of anterior-pos Ebook Dynamic reconstruction of the spine: Part 2terior shear during fatigue loading. Illis was predictive of dinõcal failure shown on the right, witli cable breakage and dry frictional wear particulEbook Dynamic reconstruction of the spine: Part 2
ate around the pseudarthross mass, (b) I his Is a fractured Agile rod-cable bilaterally In a 32-year-old man 12 months after the original surgery elseDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2ra is retrodlsplaced 5 mm posterior relative to the IS vertebra, mdlcatcg that the Agile device was not able to withstand posterior shear, (c) I his was successfully revised with repair of the pseudarthrosh with autologous bone graft and replacement with llse Transition system (Globus Medical) (rom Ebook Dynamic reconstruction of the spine: Part 2L4 to SI. Notice that the posterior shear fortes are stabilứed by the instrumentation by means ol titanium spools, which overlap and encompass the polEbook Dynamic reconstruction of the spine: Part 2
ycarbonate urethane (KU) spacers, (d) At 3-years post-revision surgery the fterion-extenslon radiographs document stability. I he Is 8 degrees of anguDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2s (Agile) (► Fig. 29.1) and 13.465 cycles (N-Hance) (► Fig. 29.2).The goals of a compressible semirigid fusion system an? threefold'1': (1) to optimize load sharing between the anterior and posterior spinal columns to re-create the natural 80:20 balance or load distribution. Static titanium and stai Ebook Dynamic reconstruction of the spine: Part 2nless steel pedicle screw systems increase the load on the posterior column well beyond 80%: (2) to promote more uniform loading of an interbody spaceEbook Dynamic reconstruction of the spine: Part 2
r (as does the Transition) by allowing the pedi-cle-to-pcdicic or interpedicular distance to compress as the spine is loaded in an axial direction. PEDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2ng of an interbody spacer. Only the anterior column can compress an interbody spacer with a static rod. Transition is designed to allow telescoping of the middle column to the same extent as the anterior column: therefore the inteibody spacer isloaded uniformly across the vertebral end plates: (3) t Ebook Dynamic reconstruction of the spine: Part 2o minimize stress at tlie bone-screw interface. Because the PCU rods absorb some of the loads, there is less stress at the bone-screw interface. The iEbook Dynamic reconstruction of the spine: Part 2
ncidence of screw loosening and breakage should be reduced, particularly in challenging revision procedures with documented pseudarthrosis and windshiDynamic Stabilization for Revision of29 Dynamic stabilization for Revision of Lumbar Spinal Pseudarthrosis with TransitionPaul c McAfee, liana Chotiku Ebook Dynamic reconstruction of the spine: Part 2s 54.5 years (range. 31-81 years). The mean estimated blood loss of the surgery was 806 ml (range. 200-2.900 mL). including the revision decompression, fusion, and Transition segmental instrumentation system The mean length of surgery was 147 minutes (range. 85-297 min). The mean length of hospital Ebook Dynamic reconstruction of the spine: Part 2stay was 3.54 days (range. 2-5 d).208Dynamic Stabilization for Revision ofHg. 29.2 (a) On the left 1$ the fatore of the N Spine (N Hance. Synthes. IncEbook Dynamic reconstruction of the spine: Part 2
,) instrumentation system in the laboratory, and on the nght Is shown a cHnkal failure. Notice that cyclical bench-top testing with 3 mm of slsear wasGọi ngay
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