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ObjectivesThis study presents the successful posterior surgical reduction and fusion on a 26-month-old child with chronic unilateral locked facet joint and spinal cord injury (SCI).MethodsA 26-month-old child with chronic unilateral locked facet joint and SCI treated by posterior surgical reduction and fusion. Plaster external fixation was applied and rehabilitation exercise was trained post-operatively.ResultsChronic unilateral locked facet joint was reduced successfully and bone fusion of C4/5 was achieved 3 months after surgery. The function of both lower limbs was improved 1 year after surgery, aided with physical rehabilitation.ConclusionUnilateral locked facet joint in pediatric population is rare. Few clinical experiences were found in the literature. Non-surgical treatment has advantages of not being invasive and is preferred for acute patients; however, it may not be suitable for chronic unilateral locked facet joint with SCI, in which surgical intervention is needed.

Objective The timing of cranioplasty and method of bone flap storage are known risk factors of non-union and resorption of bone flaps. In this animal experimental study, we evaluated the efficacy of cranioplasty using frozen autologous bone flap, and examined whether the timing of cranioplasty after craniectomy affects bone fusion and new bone formation. Methods Total 8 rabbits (male, older than 16 weeks) were divided into two groups of early cranioplasty group (EG, 4 rabbits) and delayed cranioplasty group (DG, 4 rabbits). The rabbits of each group were performed cranioplasty via frozen autologous bone flaps 4 weeks (EG) and 8 weeks (DG) after craniectomy. In order to obtain control data, the cranioplasty immediate after craniectomy were made on the contralateral cranial bone of the rabbits (control group, CG).The bone fusion and new bone formation were evaluated by micro-CT scan and histological examination 8 weeks after cranioplasty on both groups. Results In the micro-CT scans, the mean values of the volume and the surface of new bone were 50.13±7.18 mm3 and 706.23±77.26 mm2 in EG, 53.78±10.86 mm3 and 726.60±170.99 mm2 in DG, and 31.51±12.84 mm3 and 436.65±132.24 mm2 in CG. In the statistical results, significant differences were shown between EG and CG and between DG and CG (volume : p=0.028 and surface : p=0.008). The histological results confirmed new bone formation in all rabbits. Conclusion We observed new bone formation on all the frozen autologous bone flaps that was stored within 8 weeks. The timing of cranioplasty may showed no difference of degree of new bone formation. Not only the healing period after cranioplasty but the time interval from craniectomy to cranioplasty could affect the new bone formation.

Bone fusion can be achieved by one or more of three methods: in situ, onlay, and interbody fusion. Interbody implants provide the spine with the ability to bear an axial load. They function optimally when placed along the neutral axis and produce little, if any, significant bending moment. Interbody implants may be comprised of bone, non-bone materials such as acrylic, or a combination of both such as in interbody cages. In this report the authors' goal is to provide some insight into the theoretical, as well as practical, biomechanical factors that influence bone fusion, focusing on interbody implants. They review the concept of stress shielding and its impact on fusion. With the attendant biomechanical nuances of the different regions of the spine, they discuss region-specific strategies involved in successful fusion. Finally, they review intraoperative techniques that will improve the chance of achieving a successful arthrodesis.

The purpose of this study is to compare intervertebral bone fusion and clinical outcomes in L4-5 posterior lumbar interbody fusion (PLIF) using the same posterior instrumentation with four combinations of one of three types of interbody cage with one of two bone grafts, iliac and local or only local. In 67 patients who underwent L4-5 PLIF, 19 patients had the Brantigan cage and iliac and local bone graft, 18 with the TELAMON C cage and iliac and local bone graft, 16 with the TELAMON C cage and local bone graft (TL), and 14 with the OIC PEEK cage and local bone graft. Clinical assessments were based on Japanese Orthopaedic Association (JOA) scores and on the visual analogue scale (VAS). The bone fusion assessments were based on radiography and CT scans according to the Brantigan, Steffee, and Fraser criteria. More than 2 years after surgery, these assessments were made. In the results, the fusion outcome for the group receiving TL was significantly less than those for the other three groups. In TL, multivariate logistic regression analysis showed that the inside volume of the cage of ≥2.0 mL was the only significant factor for incomplete fusion. Moreover, the VAS (low back pain) score was significantly higher for TL than for the other three groups. In conclusions, we believe that the large volume inside the cage (≥2.0 mL) with local bone graft may lead incomplete interbody bone fusion and residual postsurgical low back pain after PLIF.

ALTHOUGH ELECTRICAL STIMULATION to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.

Object. The management of odontoid fractures remains controversial. Only direct anterior screw fixation provides immediate stabilization of the spine and may preserve normal C1–2 motion. To determine the indications, optimum timing, and results for direct anterior screw fixation of odontoid fractures, the authors reviewed the surgery-related outcome of patients who underwent this procedure at two institutions. Methods. One hundred forty-seven consecutive patients (98 males and 49 females) who underwent direct anterior screw fixation for recent (≤ 6 months postinjury [129 patients]) or remote (≥ 18 months postinjury [18 patients]) Type II (138 cases) or III (nine cases) odontoid fractures at the University of Utah (94 patients) and National Institute of Traumatology in Budapest, Hungary (53 patients) between 1986 and 1998 are included in this study (mean follow up 18.2 months). Data obtained from clinical examination, review of hospital charts, operative findings, and imaging studies were used to analyze the surgery-related results in these patients. In patients with recent fractures there was an overall bone fusion rate of 88%. The rate of anatomical bone fusion of recent fractures was significantly (p ≤ 0.05) higher in fractures oriented in the horizontal and posterior oblique direction (compared with anterior oblique), but this finding was independent (p ≥ 0.05) of age, sex, number of screws placed (one or two), and the degree or the direction of odontoid displacement. In patients with remote fractures there was a significantly lower rate of bone fusion (25%). Overall, complications related to hardware failure occurred in 14 patients (10%) and those unrelated to hardware in three patients (2%). There was one death (1%) related to surgery. Conclusions. Direct anterior screw fixation is an effective and safe method for treating recent odontoid fractures (< 6 months postinjury). It confers immediate stability, preserves C1–2 rotatory motion, and achieves a fusion rate that compares favorably with alternative treatment methods. In contradistinction, in patients with remote fractures (≥ 18 months postinjury) a significantly lower rate of fusion is found when using this technique, and these patients are believed to be poor candidates for this procedure.

Objective To evaluate the successful fusion rate in postmenopausal women with single-level anterior cervical discectomy and successful fusion (ACDF) and identify the significant factors related to bone successful fusion in pre- and postmenopausal women. Methods From July 2004 to December 2010, 108 consecutive patients who underwent single-level ACDF were prospectively selected as candidates. Among these, the charts and radiological data of 39 women were reviewed retrospectively. These 39 women were divided into two groups : a premenopausal group (n=11) and a postmenopausal group (n=28). To evaluate the significant factors affecting the successful fusion rate, the following were analyzed : the presence of successful fusion, successful fusion type, age, operated level, bone mineral density, graft materials, stand-alone cage or plating with autologous iliac bone, subsidence, adjacent segment degeneration, smoking, diabetes mellitus, and renal disease. Results The successful fusion rates of the pre- and postmenopausal groups were 90.9% and 89.2%, respectively. There was no significant difference in the successful fusion rate or successful fusion type between the two groups. In the postmenopausal group, three patients (10.8%) had successful fusion failure. In the postmenopausal group, age and subsidence significantly affected the successful fusion rate (p=0.016 and 0.011, respectively), and the incidence of subsidence in patients with a cage was higher than that in patients with a plate (p=0.030). Conclusion Menopausal status did not significantly affect bone successful fusion in patients with single-level ACDF. However, in older women with single-level ACDF, the combination of use of a cage and subsidence may unfavorably affect successful fusion.

Objective : It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcor tical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evalu ate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Methods : Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ≥2 mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Results : Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). Conclusion : With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

he aim of any instrumented fixation procedure is to provide an environment for bone fusion. Successful bone T fusion certifies the quality of the fixation. For several years, iliac crest bone autograft has formed an ideal material for bone fusion. Immunocompetence, ease of harvesting the graft, quality and quantity of corticocancellous bone material that is available, and the nil or low rate of postoperative symptoms related to harvesting make it an ideal choice. Personally, I am entirely satisfied with the fusion outcome achieved by use of iliac crest bone as a graft material. Iliac crest graft forms the gold standard, and any material that is used as an alternative should compete with it (1-7). Moreover, it seems that the ultimate bone fusion heavily depends on the nature of immobilization provided by the fixation. In this respect, transarticular fixation as described by Magerl and lateral mass fixation procedure as described by Goel and Laheri (1) have a unique opportunity to provide a zeromovement situation ideally suited for bone fusion. It must be understood that no matter how firm the instrumented fixation, it is ultimately the bone fusion that determines the outcome. Although instrumentation will stabilize the region for few weeks, bone fusion will ultimately be responsible for holding the instruments and stabilizing the region.

Introduction C1-C2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures (vertebral arteries and spinal cord) and the wide range of motion of the joint, hampering bone fusion. A variety of techniques have been successively recommended to reduce anatomic risk and improve results in terms of biomechanical stability and fusion rates. Recently, Harms described a new technique using polyaxial screws in the C1 lateral masses and C2 pedicles. Material and method The present study reports our experience in a consecutive series of 26 patients operated on by C1-C2 arthrodesis using the Goel and Harms technique, and details technical aspects step by step. Routine systematic immediate postoperative CT and 6-month CT controlled screw positioning and assessed fusion. Follow-up was at least 1 year, except in 2 cases (10 months). Results Twenty-six patients with a mean age of 57 years were included. Indications comprised: C2 non-union ( n = 11), C1-C2 fracture and/or dislocation ( n = 11), inflammatory pathology ( n = 2) and tumoral pathology ( n = 2). The results showed the technique to be reliable (no neurovascular complications and 85% of screws with perfect positioning) and an excellent rate of fusion (100% at 6 months). Conclusion Anatomic and biomechanical considerations, combined with the present clinical and radiological outcomes, indicate that Goel and Harms fusion is to be considered the first-line attitude of choice for posterior C1-C2 arthrodesis. Level of Evidence Level IV prospective study.

Structural violations in paravertebral muscles — spinal units stabilizators, are related to the risk factors for degenerative lumbar spane diseases. Experts pay attention to their condition after the surgical treatment — spinal fusion. However effect of muscle activity on the result of surgical treatment is not studied well. Subject: to evaluate results of posterior spinal fusion and lumbar transpedicular spinal fusion in rats depending on animals muscle activity. Methods: experiment is carried out in 20 laboratory rats (age 5 month, weight from 430 to 500 gr.) with were divided in to four groups, 5 animals in each, depending on the physical activity level. Animals swam before and after (I), before (II), after (III) the surgery and didn't swim (IV). Vertebral bodies of adjacent L ІV , L V bodies fixed using author’s method with transpedicular instrumentation and bone autoplasty. After 3 month postoperatively bone fusion formation analyzed using clinical, radiographic and histological data. Significance of interrelations between quality signs (physical activity pattern and surgical results) evaluated on the basis of contingency tables. Results: bone fusion formation confirmed clinicaly and radiographically after 3 month postoperatively found in 60 % (II group), 40 % (III), 20 % (IV) and 80 % (I). It is observed histological signs of significant bone formation in spinous process, spreading into inter laminar spaces that joins vertebras between. Conclusion: it is found positive effect of physical stresses (swimming) on bone fusion formation (G = 0.671642, р = 0.013097). The best results achieved in the animals group who swim with high level of physical activity (swam before and after the surgery).

Introduction/ObjectivesClinical applications of Mesenchymal Stem Cells (MSCs) harvested from bone marrow (BM) are well established. Iliac crest (IC) is considered to be the gold standard. Vertebral body (VB) BM represents an alternative source, promoting bone fusion in spinal operations. Existing literature, comparing ICBM and VBBM MSCs, presents limitations. Density gradient centrifugation (lymphoprep, Lmp) for BM processing is used, despite the known effectiveness on ICBM, of the red cell lysis technique (ammonium chloride, AC). This study compared the yield and differentiation capacities of MSCs in VBBM and ICBM, and evaluated the effectiveness of two harvesting procedures on both BM sources.Patient/MethodsEighteen patients undergoing idiopathic scoliosis surgery were recruited (median age 15.4 years, range 13–17). BM was aspirated intraoperatively from IC (10ml) and 12th thoracic vertebra (10ml). Aspirates were processed using AC and Lmp. MSCs were enumerated using standard CFU-F assay. Colony areas, ...

IntroductionThe goal of arthrodesis is bone fusion, effected at the craniovertebral junction through onlay of either morselized iliac crest autograft (ICAG), or posterior structural unicortical ICA...

Introduction: Ventral cervical spinal epidural abscess is a very rare clinical condition with a relatively high morbidity and mortality. Due to the paucity of reported cases there is heterogeneity and no clear “gold standard” in the treatment of these patients. Objective: The authors report four consecutive patients with ventral cervical spinal epidural abscess treated with anterior cervical discectomy, abscess drainage and original non-instrumented cortico-cancellous allograft spinal fusion. Methods: The authors retrospectively reviewed a series of four patients treated for ventral cervical epidural spinal abscess. All patients were treated with an urgent operation. Anterior cervical discectomy, abscess drainage, and non-instrumented cortico-cancellous allograft spinal fusion followed by cervical immobilization and systemic antibiotic treatment were utilized. Results: The bone fusion occurred within a mean of 3.5 months of follow-up. No significant radiologic or clinical evidence of graft subsidence was noted after a minimum of 2.5 years follow-up. All patients resolved infection and were neurologically intact. No complications of treatment were noted. Conclusion: Urgent operative treatment with anterior cervical discectomy, abscess drainage and non-instrumented cortico-cancellous allograft spinal fusion, followed by immobilization and the appropriate systemic antibiotic treatment is an effective original modification for the treatment and resolution of ventral cervical epidural spinal abscess.

The internal fixing materials made from shape-memory alloys (SMAs) have recently been reported for long bone fracture. We present a new internal fixation technique using a cylindrical SMAs implant in a rat femoral fracture healing. The implant was designed in a shape to circumferentially fix the fractured bone using resilient SMA claws. To evaluate the fixing ability of the implant, three-point bending and rotation tests were performed. Fifteen female Wister rats were treated surgically as an experimental model. All rats were killed at 16 weeks postoperatively, and the radiological and histological evaluations were performed. In biomechanical test, the good fixation ability of the implant was demonstrated. In animal model, no cases of postoperative infection or death were encountered and postoperative gait was stable in all cases. Radiological examination at 16 weeks postoperatively demonstrated the implant firmly fixed to the fractured part, endosteal healing, and no callus formation in all cases. In Histological evaluation, bone union in all cases was characterized by endochondral ossification from within the medullary cavity. In conclusion, our cylindrical SMA implant provided good fixation in biomechanical tests, and achieved bone union in all 15 rats. If a larger size is designed in the future, our implant will be a clinically applicable, useful fixing material for fracture of the human long bones.

Silicon nitride (Si(3)N(4)) is a ceramic material developed for industrial applications that demand high strength and fracture resistance under extreme operating conditions. Recently, Si(3)N(4) has been used as an orthopedic biomaterial, to promote bone fusion in spinal surgery and to develop bearings that can improve the wear and longevity of prosthetic hip and knee joints. Si(3)N(4) has been implanted in human patients for over 3 years now, and clinical trials with Si(3)N(4) femoral heads in prosthetic hip replacement are contemplated. This review will provide background information and data relating to Si(3)N(4) ceramics that will be of interest to engineering and medical professionals.

El proceso de fusión intervertebral depende de factores relacionados con la edad, enfermedades y calidad del hueso receptor, también se ve afectado por algunos parámetros del implante tales como tamaño de la jaula, diámetro externo e interno, grado de porosidad, tamaño del poro e interconectividad de los poros. La mayor parte de los estudios que se han documentado del crecimiento del hueso trabecular en vertebras con implante, son estudios experimentales en los cuales no se pueden controlar todas las variables que tienen efecto sobre el proceso de fusión y para obtener los resultados se necesita más tiempo que incrementa los costos. El objetivo de esta investigación es determinar el efecto de las variables de diseño (porosidad y tamaño del poro) de una jaula de fusión intersomática, en el proceso de fusión ósea implementando un modelo de optimización. Los resultados obtenidos presentan una distribución de densidad ósea y un incremento en la rigidez del nuevo tejido dependiendo de los parámetros del implante y las cargas impuestas, confirmando que el hueso se considera como un material de auto-optimización. Abstract. The process of intervertebral fusion depends on factors related to age, diseases and the quality of the bone receptor, as well as it is affected by various implant parameters such as the size of the cage, internal and external diameter, grade of porosity, pore size and the interconnectivity of the pores. The major part of documented studies regarding trabecular bone growth in vertebrae with an implant are experimental studies in which all of the variables that effect bone growth cannot be controlled and in order to obtain the results they need more time is required which raises the cost of studies. The objective of this investigation is to determine the effect of the design variables (porosity and pore size) of an interbody fusion cage in the bone fusion process implementing an optimization model. The results obtained present a distribution of bone density and an increase in rigidity of the new tissue depending of the parameters of the implant and the loads imposed, confirming that the bone is considered a self-optimizing material. Maestría

The purpose of this study was to assess the fusion rate on CT examinations and to correlate clinically the functional result with the degree of bone fusion in the subtalar joint after posterior arthroscopic subtalar arthrodesis (PASTA).Fourteen cases, from 36 to 84 years old, were retrospectively followed-up for a minimum of one year (range 12-92 months). A CT scan had been systematically performed at the six-month follow-up visit. The CT scans were examined in sagittal 2-mm-thick reformatted slices, measuring the length of the joint surface and the length of the fused portion of the joint space on each image.At six months, the average fusion ratio was 39±19% (range 0-69%). Fusion defined by a fusion ratio superior or equal to 33% on the CT scan was observed in 11 cases. One patient had a delayed union and required a revision of fixation. One patient had a bilateral nonunion. Mean average AOFAS score improved from 51±10 to 77±9 at last follow-up.Compared to open procedures, the posterior arthroscopic fusion seems to offer a promising alternative. However, our results suggest that the fusion rate following PASTA is not as favourable as reported in previous studies. Factors such as adequate compression and stable fixation provided by the screws together with the surgeons' experience with this demanding technique are of the utmost importance. A 33% CT fusion ratio threshold could accurately discriminate between clinical stability and instability.

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

Spinal fixation devices can be used to form a rigid construct with the spine to replace bone, restore alignment, maintain position, and prevent motion in the treatment of fractures, degenerative disease, neoplasm, and congenital deformities. Because most spinal constructs will eventually fail if bone fusion does not occur, bone graft material is often used along with the implant to promote fusion. Conventional radiographs, obtained in two projections, remain the mainstay of implant evaluation, demonstrating the position of the spinal elements, hardware, graft material, and evidence of complication. Possible complications connected with use of fixation devices include intraoperative soft-tissue injuries, postoperative hematomas, and infection. The components (through incorrect use, malpositioning at surgery, and later dislodgment or fracture) may also contribute to complications such as instability; failure of fusion; or pain, with possible resultant neurologic damage. Bone graft material can migrate or hypertrophy, resulting in impingement on the spinal canal or neural foramen. Radiologists should be familiar with the various spinal fixation devices and techniques to better identify evolving complications.

Spinal fixation devices provide stability and restore anatomic alignment in the treatment of fractures, degenerative disease, infection, and tumors and correct congenital deformities such as those seen in scoliosis. The devices provide immediate stability but are not strong enough to withstand prolonged stress and eventually fail, in most cases, if bone fusion does not occur. Bone graft material is often used to promote fusion and to replace bone after resection. Internal fixation is used to maintain position and alignment and to prevent motion as the spine fuses. Plates and rods are attached to the vertebral body or posterior elements with wire, screws, and hooks. Screws and wire can also be used alone as a means of fixation. Surgical techniques and instrumentation have advanced in recent years, and radiologists are exposed to a myriad of devices. They need to be able to identify the various plates, screws, wiring techniques, and grafts used most commonly and to understand their function in the cervical spine for fusions and treatment of fractures and degenerative disease.

This study reports the outcome of 16 patients treated with a modified four-bone fusion for symptomatic stage II and III advanced carpal collapse. The technique is based on fusion of the capitate, lunate, hamate and triquetrum using an autogenous corticocancellous bone-graft fixed with screws. The void left behind after scaphoid excision was filled with an extensor carpi radialis longus anchovy. After an average follow up of 3 years; there were 13 excellent and three good outcomes. In every patient pain relief was achieved with preservation of joint motion and grip strength. All the patients were able to return to their previous activities and jobs. Radiographic evaluation showed bone fusion in all 16 patients with a slight decrease in carpal height but a well preserved radiolunate joint space. In conclusion, this technique provides immediate stable fixation and early mobilization and assures bone fusion.

The occipitocervical junction with its complex anatomy and biomechanics represents unique anatomical structure difficult for operative treatment. Biomechanics forces in this region need to be resisted with rigid metallic construction to facilitate bone fusion. Surgeon must be careful about close relations of the bone, vascular and neurologic structures and must have good skills and knowledge to avoid serious complications during operations. Before 2004 for instability treatment in this region of spine wires and pin construction for fixation of bone grafts were used. In our Institute rod constructions with screws have been used to get more rigid construction since 2004. In this paper we will present our early results in occipitocervical instability treatment by SUMMIT instrumentation.

We report an 11-year-old girl who had previously undergone an operation for basilar invagination involving a foramen magnum decompression and midline wire fixation. After improving initially, her neurological condition worsened again. Repeated investigations showed a firm midline craniovertebral fixation and bone fusion. However, she was found to have a vertical mobile and reducible atlantoaxial dislocation. Treatment of the vertical dislocation by lateral mass fixation resulted in lasting relief from her symptoms. Vertical instability at the atlantoaxial joints needs to be identified and appropriately treated as it may be a cause of failure of midline fixation.

Fourteen cases with a fracture of the middle third of the clavicle were treated by percutaneous pin fixation. In all cases, satisfactory results were obtained with bone fusion and normal function of the shoulder joint.We concluded that percutaneous pin fixation was more promising than operative or conservative therapy as it prouided good cosmetic result and allawed preservation of the potential for bone fusion.

The authors after a review of certain elements of the physiology and pathophysiology of the scapho-lunate couple, report a series of 10 patients presenting a post-traumatic scapho-lunate instability stabilized by scapho-lunate bone graft in order to obtain scapho-lunate arthrodesis. The bone fusion was obtained 5 times out of 10, 3 times complete and 2 times by an incomplete bony bridge. In 5 cases, bone fusion was not evident, a fibrous non-union probably occurred which maintained the correction. Nevertheless, the overall results were considered good in 9 out of 10 cases with only one poor result. The outcome with a mean follow-up of 4 years did not show any arthritic changes. The authors consider that scapho-lunate stabilization with an interposed bone graft is a good method which can ensure good stabilization and good clinical results.

Ten cases of thoracolumbar lesions (eight burst fractures, one disc hernia and one discitis) were treated using Kaneda device.When the lesion exists in the anterior column of the spine, one-stage anterior decompression and bone fusion stabilized with Kaneda device seems the best method for early ambulation and for good bony fusion. The application of this method is discussed.

The mechanical and biologic factors that drive bone fusion can be better understood. This is evident in the fact that of the approximately 200,000 spine fusion procedures performed each year failure to achieve a bony union can occur in as many as 40% of the cases (Boden 2002). Advances in computational methods and mathematical modeling of bone fusion make it advantageous to use numerical methods such as the finite element method, to better understand bone remodeling mechanics.Copyright © 2008 by ASME

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:55:57Z No. of bitstreams: 1 S0102-09352007000400018.pdf: 314242 bytes, checksum: 5e2ea15f60555e862f8d0bf039081766 (MD5) Made available in DSpace on 2013-08-22T18:55:57Z (GMT). No. of bitstreams: 1 S0102-09352007000400018.pdf: 314242 bytes, checksum: 5e2ea15f60555e862f8d0bf039081766 (MD5) Previous issue date: 2007-08-01 Made available in DSpace on 2013-09-30T19:49:21Z (GMT). No. of bitstreams: 2 S0102-09352007000400018.pdf: 314242 bytes, checksum: 5e2ea15f60555e862f8d0bf039081766 (MD5) S0102-09352007000400018.pdf.txt: 28545 bytes, checksum: 0e56ff5f480eb053e66df3d74d4e85a3 (MD5) Previous issue date: 2007-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:13:04Z No. of bitstreams: 2 S0102-09352007000400018.pdf: 314242 bytes, checksum: 5e2ea15f60555e862f8d0bf039081766 (MD5) S0102-09352007000400018.pdf.txt: 28545 bytes, checksum: 0e56ff5f480eb053e66df3d74d4e85a3 (MD5) Made available in DSpace on 2014-05-20T15:13:04Z (GMT). No. of bitstreams: 2 S0102-09352007000400018.pdf: 314242 bytes, checksum: 5e2ea15f60555e862f8d0bf039081766 (MD5) S0102-09352007000400018.pdf.txt: 28545 bytes, checksum: 0e56ff5f480eb053e66df3d74d4e85a3 (MD5) Previous issue date: 2007-08-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Realizaram-se 25 artrodeses em 21 casos, quatro em gatos e 17 em cães, utilizando hidroxiapatita sintética como substituto ao enxerto ósseo autógeno esponjoso fresco, sendo oito na articulação do carpo, 10 na articulação do tarso, seis na do cotovelo e uma na do joelho. As avaliações radiográficas foram realizadas aos 30 dias em um animal, aos 45 dias em outro e aos 60 dias nos 19 casos restantes. Visibilizou-se união óssea em 24 artrodeses e a não-união em um cotovelo foi atribuída a falha na estabilização. O retorno à função do membro foi classificado de bom a excelente em 22 casos. A hidroxiapatita foi capaz de viabilizar o crescimento ósseo e mostrou-se factível para utilização na prática cirúrgica rotineira em pequenos animais. Twenty-five arthrodeses were performed in four cats and 17 dogs using synthetic hydroxyapatite as fresh autogenous graft cancellous bone substitute. Arthrodesis was performed in the carpal joint in eight cases, in the tarsal joint in 10, in the elbow joint in six, and in the knee joint in one case. The mean radiographic follow-up time was 30 days in one animal, 45 days in another animal and 60 days in the 19 remaining cases. Bone union was observed in 24 arthrodeses. Non-union of one elbow arthrodesis was due to failure of stabilization. Restoration of limb functionality was classified as good to excellent in 22 cases. Hydroxyapatite was able to promote bone growth and is suitable for using in routine surgical procedures for small animals. União Metropolitana de Educação e Cultura UNESP Faculdade de Ciências Agrárias e Veterinária Universidade Federal do Rio Grande do Sul (UFRGS) UNESP Faculdade de Ciências Agrárias e Veterinária

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-28Bitstream added on 2014-06-13T20:21:57Z : No. of bitstreams: 1 doreaneto_fa_dr_jabo.pdf: 1608125 bytes, checksum: 3f4786116d52404397afbb4ba51cd232 (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Objetivou-se nesta pesquisa estudar o comportamento e a bioatividade do cimento de alfa-fosfato tricalcico de dupla pega em artrodeses tarsocrurais. Utilizaram-se seis caes, adultos, macho ou femeas, sem raca definida, com idades entre dois e cinco anos e pesando entre 18 e 30 kg. Foram constituidos dois grupos com 3 animais cada: um grupo onde empregou-se o cimento de ¿-fosfato tricalcico de dupla pega (Grupo I) e outro utilizando osso esponjoso autogeno (Grupo II). A avaliacao radiografica ocorreu aos 30, 45, 60, 90 e 120 dias apos o procedimento cirurgico. Radiograficamente, a fusao dos ossos das articulacoes ocorreu em ambos os grupos apos o 30o dia, sem qualquer reacao adversa ou do tipo corpo estranho. A estabilidade das articulacoes foi satisfatoria com a utilizacao de fixadores esqueleticos externos. Histologicamente, aos 120 dias, observaram-se diferencas na maturidade das celulas osseas entre os dois grupos ocorrendo absorcao lenta e remodelacao da bioceramica (Grupo I). Relativamente a microscopia eletronica de varredura, foi observada formacao de osso novo diretamente na superficie da bioceramica, sem causar formacao de lacuna entre a interface osso-ceramica. O cimento de alfa-fosfato tricalcico de dupla pega demonstrou ter uma boa resistencia mecanica, propriedades de biocompatibilidade, crescimento osseo direto sobre a ceramica, osteoconducao e, ainda, ocorrencia de lenta absorcao quando comparado ao enxerto ósseo. The purpose of this research was to estuding the behaviour and bioactivity of the á-tricalcium phosphate cement double setting in tarsocrural arthrodesis. Therefore, six canines, both male and female adults mongrel dogs, aged between two and five years old and weighing between 12 and 18kg, were the objects of this study. They were vi divided into two groups with three animals each. On Group I á-tricalcium phosphate cement double setting was used. The Group II, also considered the control group, autogenous cancellous bone graft was used. The periods chosen for the radiographic analysis were 30, 45, 60, 90 and 120 days after surgery. Radiographyc bone fusions on the joints were observed on both groups after 30 days. The stabilization of the joints with external fixators proved to be very satisfactory. No reaction of foreigh body or infection process due to the material used was observed. The histological analysis performed after 120 days after surgery revealed differences in terms of the maturity of the bone cells between the two groups, showing slow absorption and remodelling of the bioceramic (Group I). In terms of the scanning electronic microscopy, bone growth was detected, right on the surface of the bioceramic, without causing gap formation on the bone-ceramic joint. The á-tricalcium phosphate cement double setting demonstrated to have a good mechanical resistance, bioacompatibility properties, direct bone growth on the ceramic and osteocondution and, still, the occurrence of slow absorption when compared to the bone graft.

Realizaram-se 25 artrodeses em 21 casos, quatro em gatos e 17 em cães, utilizando hidroxiapatita sintética como substituto ao enxerto ósseo autógeno esponjoso fresco, sendo oito na articulação do carpo, 10 na articulação do tarso, seis na do cotovelo e uma na do joelho. As avaliações radiográficas foram realizadas aos 30 dias em um animal, aos 45 dias em outro e aos 60 dias nos 19 casos restantes. Visibilizou-se união óssea em 24 artrodeses e a não-união em um cotovelo foi atribuída a falha na estabilização. O retorno à função do membro foi classificado de bom a excelente em 22 casos. A hidroxiapatita foi capaz de viabilizar o crescimento ósseo e mostrou-se factível para utilização na prática cirúrgica rotineira em pequenos animais. Twenty-five arthrodeses were performed in four cats and 17 dogs using synthetic hydroxyapatite as fresh autogenous graft cancellous bone substitute. Arthrodesis was performed in the carpal joint in eight cases, in the tarsal joint in 10, in the elbow joint in six, and in the knee joint in one case. The mean radiographic follow-up time was 30 days in one animal, 45 days in another animal and 60 days in the 19 remaining cases. Bone union was observed in 24 arthrodeses. Non-union of one elbow arthrodesis was due to failure of stabilization. Restoration of limb functionality was classified as good to excellent in 22 cases. Hydroxyapatite was able to promote bone growth and is suitable for using in routine surgical procedures for small animals.

Previous bone fusion surgery by surgeon has three major difficulties: lack of operation accuracy, surgeon’s overexposure to radioactive contamination, and need of surgeon’s intensive labor during operation. This paper proposes a bilateral teleoperation system for spine bone fusion surgery, BiTESS-II, to overcome those problems. In order to determine design specification of the system, we estimated human bone properties during gimleting and screwing process using the developed data acquisition systems. Based on the spine bone properties, we designed an end effecter, a slave robot and 2 master devices. The slave robot can perform surgical operation to gimlet cortical bone and to insert screws into human spine. Master devices are used to control the pose of the slave robot and to generate haptic information identical to the slave side. We also developed novel force reflection methods without force sensor so that the end effecter can be designed simple and light. The performance of the developed system was verified by experiments.

Dear Editor, Traumatic Injuries is a serious threat to global health as more than five million people in the world are losing their lives annually making it 9% of global mortality and millions are having temporary or permanent disabilities (http://www.who.int). The biggest cause of traumatic injuries is road traffic injuries which is currently 9 largest cause of deaths globally and has been predicted to be the top fifth cause in coming decades (http://www.who.int). Low and middleincome countries (LMICs) are facing serious disabilities because of in adequate care system given in emergency departments. Recently a detailed statistical analysis and possible improvement strategies has been given regarding the care systems provided in emergency departments in LMICs which is the main reason of permanent disabilities [1, 2]. Stem cell therapy has attracted a huge attention in last few years as a promising agent in the treatment of neural damage, muscle trauma, disk degeneration, bone fusion, regeneration of craniofacial bone, spinal trauma etc [3-5]. Mesenchymal stem cells have the potential to serve as an efficient antiviral and anti-inflammatory agents against several kind of infections happened in traumatic injuries leading to disability or deaths[6]. Stem cells have also attracted attention of clinical practitioners for damaged cartilage and tendon regeneration [7, 8]. Traumatic injuries are a serious concern for health policy makers and medical practitioners on every continent regardless of LETTER

Se consideran variantes esqueléticas menores (VEM) a las pseudoepífisis (PE), braquimesofalanges (BMP), epífisis en cono (EC), epífisis supernumerarias (ES) y la fusión ósea (FO). El objetivo de esta investigación fue evaluar en 3.596 radiografías de la mano y muñeca izquierda de un grupo de niños y adolescentes entre 2 a 15 años, la presencia de VEM analizando la frecuencia de éstas y su asociación (chi-cuadrado) con el sexo, edad cronológica, edad gestacional, estado nutricional al nacer, la presencia de déficit primarios del crecimiento y con maduración ósea. Se encontró que la prevalencia general de VEM fue de 27,7%; PE: 23,9% más frecuentes en varones; EC: 3,3% más frecuentes en niñas; BMF: 3,1%; ES: 0,08% y FO: 0,2%. Sólo 2,5% de los sujetos con VEM presentaron algún déficit primario de crecimiento. No se encontró asociación entre VEM y prematuridad, talla baja al nacer, estadio de maduración ósea, aunque si entre pequeño simétrico para la edad gestacional con PE, BMF y EC, y retardo del crecimiento intrauterino con PE, BMF. La prevalencia de las VEM encontradas corresponde fundamentalmente a población sin déficit primario de crecimiento de comienzo prenatal y se encuentra dentro de los rangos que reporta la literatura internacional, así como también, la frecuencia de las localizaciones y las tendencias en uno u otro sexo. En aquellos niños con retardo del de crecimiento al nacer, se encontró asociación con PE, BMF y EC. Abstract The frequency of Minor Skeletal Variants (MSV): pseudo-epiphysis (PSE), cone-shaped epiphysis (CSE), brachymesophalangy (BMP), supernumerary epiphysis (SE), and bone fusion (BF) was analyzed in 3,596 subjects between 2-15 years of age by means of a radiological study of left hands and wrists according to sex, age, and the location and presence of growth primary deficit. Chi-square relation was established between the MSV at gestational age, nutritional status at birth and skeletal maturation status. The MSV prevalence found was 27.6%; PSE: 23.9% more frequent in boys; CSE: 3.3% more frequent in girls; BMP: 3.1%; SE: 0.08% and BF: 0.2%. Only 2.5% showed some growth primary deficit. No relation was found between prematurity with MSV, low stature at birth, epiphysis maturation status; however, some relation was found between small symmetric for gestational age with PSE, BMP, and CSE and intrauterine retarded growth with PSE and BMP. The prevalence of the different MSV found in this study corresponds to children and adolescents without primary growth failure of prenatal onset and are within the ranges reported in international literature, as well as the location and trend frequencies for either one or the other sex. In the children with intrauterine retarded growth an association was found with PSE, BMP and CSE.

Full coalescence after the anterior interbody fusion using bone cortical-cancellous iliac crest autografts and rigid plates in the surgical treatment of fresh injuries of the cervical spine may be reached in 95–100 % of cases. Despite on this the number of unsatisfactory results of operations related to bone graft amounts 50.7 %, and complications due to the use of hardware can range from 5 % to 35 %. Objective: To analyze the complications and mistakes after the anterior interbody bone fusion using cortical-cancellous iliac crest autografts and rigid plates in cases of surgical treatment of the subaxialcervical functional spinal units’ injuries. Material and Methods: There were analyzed outcomes in 123 patients with fresh cervical spine injuries, 91 (73.9 %) men and 32 (26.08 %) of women aged from 16 to 67 years among them. For all patients we performed decompressive and stabilizing surgeries by means of bone cortical-cancellous autografts from the ipsilateral iliac crest and rigid plates developed at the Institute according to known and designed at the Institute techniques. Time from injury to surgery ranged from 3 to 42 hours (mean, 9.54 hours), and duration of surgery ranged from 90 to 210 minutes (average, 1 hour 50 minutes). All patients were examined clinically and radiologically by known methods. Results: An interbody fusion was achieved in 95.8 % of cases, and the overall complication rate was 30.9 %. All complications and mistakes were systematized and analyzed. The greatest number of complications was associated with metal constructs (11.38 %), with bone graft implemented in interbody space (4.87 %) and occurred on the site of the donor wound (5.69 %). The least amount of complications was observed at the postoperative cervical wound region (3.24 %). Conclusions: Enhancement of a technique for the anterior interbody fusion by means of bone autografts and cervical rigid plates and careful compliance with the principles of stabilization of the cervical functional spinal units as well as rules for such surgeries will prevent technical mistakes, reduce the number of complications and improve outcome.

The cellular and molecular events governing bone formation in the embryo, healing of a fractured bone, and induced bone fusion follow a similar pattern. Discovery, purification, and recombinant synthesis of bone morphogenetic proteins (BMPs) constiute a major milestone in the understanding of bone physiology. In this review the author discusses the mechanism of action, clinical applications, dosage, and optimum carriers for BMPs. The roles played by other growth factors are also discussed.

This editorial refers to ‘ In vivo heating of pacemaker leads during magnetic resonance imaging’† by R. Luechinger et al ., on page 376 One of the earliest lessons learned by physicians and technologists working in the field of magnetic resonance imaging (MRI) is that cardiac pacemakers represent a strict contraindication to performing an examination. However, there are multiple examples of implants and devices that previously were contraindicated for MRI and are now allowed within specific guidelines. These include neurostimulation systems, cochlear implants, a drug infusion pump, and a bone fusion stimulator. Because of expanding clinical indications, both MR and pacemaker technology has steadily advanced. It is no surprise then that these two powerful technologies might clash. There has been a steady increase in the number of pacemakers implanted in the United States and worldwide. More than 900 000 pacemakers were implanted worldwide in 2003, and since 1999 implantation rates have increased 5–6% per year. MR systems have been increasing in number as well. There are now ∼15 000 MR systems worldwide, and 35 million MR studies performed yearly. MR is an important diagnostic tool in musculoskeletal, central nervous system, and oncological disorders. It is also rapidly expanding into the cardiovascular arena. Because of its varied clinical applications there are times when denying MR examinations to patients with a pacemaker may have a significant impact on public health. The patients may be subjected to a more invasive or less accurate test which may influence the quality of healthcare. A 1999 Japanese study found that 17% of patients with pacemakers were denied MRI in the previous year.1 Applying those numbers worldwide, the effect could influence the healthcare of over 1 million people. Notably, harmful effects to patients have been documented. To date there have been 10 deaths attributed to … *Corresponding author. Tel: +1 918 592 0999; fax: +1 918 878 2436. E-mail address : martin{at}oklahomaheart.com

The use of bioabsorbable implants in spine surgery is expanding at a rapid pace. These implants are mimicking the roles of traditional metallic devices and are demonstrating similar efficacy in terms of maintaining stability and acting as carriers for grafting substances. Biomechanical studies have demonstrated their ability to stabilize effectively a degenerative cervical and lumbar motion segment. In numerous animal models, researchers have illustrated the ability of bioabsorbable implants to function satisfactorily as an interbody spacer and to achieve satisfactory bone fusion. Investigators have explored various opportunities for these implants to replace their metallic counterparts in clinical studies conducted in humans. The gradual resorption of these implants appears effectively to transfer gradual loads to the grafting substances promoting the biological mechanisms of fusion.Novel uses of bioabsorbable technology are constantly evolving. Their future as a carrier of biological agents such as bone morphogenetic proteins and bone graft extenders, their radiolucency, and their eventual resorption make them an ideal implant for use in spinal degenerative disease.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:59:27Z No. of bitstreams: 1 S0103-84782004000300043.pdf: 138335 bytes, checksum: a24ec6dafe45b597d04b176a2f288450 (MD5) Made available in DSpace on 2013-08-22T18:59:27Z (GMT). No. of bitstreams: 1 S0103-84782004000300043.pdf: 138335 bytes, checksum: a24ec6dafe45b597d04b176a2f288450 (MD5) Previous issue date: 2004-06-01 Made available in DSpace on 2013-09-30T19:56:24Z (GMT). No. of bitstreams: 2 S0103-84782004000300043.pdf: 138335 bytes, checksum: a24ec6dafe45b597d04b176a2f288450 (MD5) S0103-84782004000300043.pdf.txt: 16171 bytes, checksum: eb149cb5e31d36f799f8355ea27643a8 (MD5) Previous issue date: 2004-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:14:40Z No. of bitstreams: 2 S0103-84782004000300043.pdf: 138335 bytes, checksum: a24ec6dafe45b597d04b176a2f288450 (MD5) S0103-84782004000300043.pdf.txt: 16171 bytes, checksum: eb149cb5e31d36f799f8355ea27643a8 (MD5) Made available in DSpace on 2014-05-20T15:14:40Z (GMT). No. of bitstreams: 2 S0103-84782004000300043.pdf: 138335 bytes, checksum: a24ec6dafe45b597d04b176a2f288450 (MD5) S0103-84782004000300043.pdf.txt: 16171 bytes, checksum: eb149cb5e31d36f799f8355ea27643a8 (MD5) Previous issue date: 2004-06-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Realizaram-se artrodeses carpais em dois gatos como forma de tratamento para alterações severas na articulação carpiana. A hidroxiapatita foi empregada para preenchimento do espaço articular do carpo. Os animais foram encaminhados ao Serviço de Ortopedia do Hospital Veterinário, UNESP, Campus de Jaboticabal, São Paulo - Brasil. O animal 1, Siamês, 10 anos de idade, apresentava apoio inadequado do membro torácico esquerdo, dor, hiperextensão, instabilidade, luxação, degeneração articular e osteartrite da articulação radiocárpica. O animal 2, sem raça definida, 8 meses de idade, apresentava apoio inadequado do membro torácico direito, hiperflexão da articulação cárpica, contração dos tendões da região carpiana, rotação externa do olécrano e o membro voltado para dentro. Foram aplicados fixadores esqueléticos externos (tipo IIb) com barras de polimetilmetacrilato, em ambos os casos. As avaliações clínicas e radiográficas após os procedimentos, demonstraram que a hidroxiapatita é uma alternativa promissora como substituto para os enxertos ósseos. Severe disorders of the carpus in two cats were treated with arthrodesis. Hydroxyapatite was usage in filling up of the joint space in the carpus. Both cats were sent to the Orthopedic Service of the Veterinary Hospital, UNESP, Jaboticabal, São Paulo - Brazil. The first cat, a Siamese, 10 years old, showed hyperextension movements and luxation of the carpus joint and pain with inadequate support of the left thoracic limb. It was also observed joint degeneration and osteoarthritis. The second animal, a domestic shorthair, 8 months of age, showed inadequate support of the right thoracic limb with hyperflexion of the carpus joint and contractures of the carpus flexor tendons. A modified trans-articular external skeletal fixator (tipe IIb) with methylmethacrylate bars was utilized in these cases. The clinical and radiographic evaluations of the joints after the surgical procedure proved that the hydroxyapatite can be used as an promising alternative to cancellous bone grafts. Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Universidade Federal do Rio Grande do Sul (UFRGS) Professor Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias

The special focus section covers a number of different methods of managing patients with SNAC- and SLAC-wrist. The various authors have recommended changes from the original 4 bone fusion technique. These include the 3 bone (triquetral excision), 4 1/2 bone fusion (proximal scaphoid included in the fusion mass), 5 bone (entire scaphoid included in the fusion mass). There is one paper on an isolated scaphoidectomy, with a capsulodesis, as the only form of stabilization of the midcarpal joint (i.e., 0 bone fusion). The surgical technique and rehabilitation is simpler with the scaphoidectomy than the other procedures. The concern is instability of the carpus with the scaphoid excised; however, if this is identified at the time of surgery, the surgeon can perform a midcarpal fusion. With further research over the next 5 years, we will obtain a better understanding of the place of scaphoidectomy and capsulodesis. There has been extensive research comparing the 4 bone fusion and the proximal row carpectomy. However, further comparative research is required to identify the place of each of the different procedures and the optimal method of fixation of the fusion mass. Although some may see the motion preserving procedures of the wrist as a staged full wrist fusion, if the indications are accurately respected and the technique is well performed to prevent complications, then good long-term results can be obtained.