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Alexander R. Vaccaro - One of the best experts on this subject based on the ideXlab platform.
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does smoking have an impact on fusion rate in single level Anterior Cervical discectomy and fusion with allograft and rigid Plate fixation clinical article
Journal of Neurosurgery, 2013Co-Authors: Myles Luszczyk, Justin S Smith, Jeffrey S Fischgrund, Steven C Ludwig, Rick C Sasso, Christopher I Shaffrey, Alexander R. VaccaroAbstract:Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the Cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level Anterior Cervical discectomy and fusion (ACDF) with allograft and Plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked Anterior Cervical Plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an Anterior Cervical disc replacement to treat Cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked Cervical Plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months wa...
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Long-term magnetic resonance imaging evaluation of bioresorbable Anterior Cervical Plate resorption following fusion for degenerative and traumatic disk disruption.
Spine, 2006Co-Authors: Alexander R. Vaccaro, Regis W Haid, Benjamin H. Venger, John A. Carrino, Deshdeepak Sahni, Michael A. Pahl, James S. Harrop, Ashwini Sharan, Sumeet Vadera, Alan S. HilibrandAbstract:STUDY DESIGN: A retrospective magnetic resonance imaging (MRI) review of a series of patients who underwent a single-level Anterior Cervical discectomy and fusion followed by Anterior Plate stabilization using an Anterior Cervical resorbable mesh Plate and screw system. OBJECTIVE: MRI evaluation of the long-term implant resorption properties of a bioresorbable Anterior Cervical Plate and the adjacent peri-implant soft tissue environment. SUMMARY OF BACKGROUND DATA: The use of bioresorbable Anterior Cervical Plates for immediate Cervical stabilization following an Anterior Cervical discectomy and fusion presents several distinct advantages over metallic instrumentation. Bioresorbable polymers may diminish, by their resorbability, implant-related complications such as loosening, migration, and failure of instrumentation, as well as stress shielding of the underlying fusion. Information on the intermediate and long-term bony and soft tissue reaction to the resorption byproducts of these biomaterials is limited. METHODS: There were 9 consecutive patients who underwent single-level Anterior Cervical decompression and fusion using allograft cortical bone, followed by bioresorbable polylactide Anterior mesh Plate and screw fixation. Following institutional review board approval, 5 of the 9 patients agreed to postoperative MRI assessment of the peri-implant area. An independent radiologist then characterized implant degradation, and the presence of soft tissue inflammation and swelling during the resorption phase of the bioresorbable Plate. RESULTS: At an average follow-up of 32 months, MRI assessment showed no evidence of soft tissue swelling or inflammation related to the resorption of a bioresorbable Anterior Plate in any of the 5 patients. In addition, none of the patients complained of any dysphagia or phonation difficulties. CONCLUSIONS: Based on MRI assessment, these devices, at more than 2-year follow-up, did not indicate any local chronic inflammation or swelling resulting from their degradation. Clinical symptoms of dysphagia or dysarthria, a common reported problem following Anterior Cervical spine procedures, were not observed in any patient.
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use of a bioabsorbable Anterior Cervical Plate in the treatment of Cervical degenerative and traumatic disc disruption
Journal of Neurosurgery, 2002Co-Authors: Alexander R. Vaccaro, Benjamin H. Venger, Peter M. Kelleher, John A. Carrino, Todd J. Albert, Alan S. Hilibrand, Kush SinghAbstract:OBJECT: Anterior Cervical discectomy and fusion (ACDF) is a widely accepted treatment for Anterior degenerative or traumatic instability of the Cervical spine. To reduce or eliminate complications such as implant migration and failure, imaging degradation, and fusion stress shielding that are occasionally associated with spinal instrumentation, attention has been given to the use of bioresorbable Anterior Cervical Plate (ACP) devices. This paper is a preliminary report of a retrospective series in which a resorbable mesh and screw system was used for graft containment in single-level ACDF. METHODS: A review of patient charts and imaging studies was conducted to determine functional outcome, fusion success, and potential soft-tissue reaction to implant resorption. Nine patients with a Cervical degenerative disc disease or traumatic disc disruption were treated between October 2001 and March 2002. Follow up averaged 206 days. Eight patients were found to have an excellent result, one patient had a good result, and no patients had a satisfactory or poor result. At the time of follow-up examination, 77% of patients were found to have a radiographically solid fusion. The two patients without a solid fusion were examined only an average 8 months postoperatively and manifested no symptoms related to fusion nonhealing. No significant soft-tissue reaction was noted clinically or radiographically in any of the patients. CONCLUSIONS: The results of this preliminary study indicate that bioresorbable ACP systems for single-level ACDF are both safe and effective.
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Use of a bioabsorbable Anterior Cervical Plate in the treatment of Cervical degenerative and traumatic disk disruption.
Orthopedics, 2002Co-Authors: Alexander R. Vaccaro, Benjamin H. Venger, Peter M. Kelleher, Kush Singh, John A. Carrino, Todd J. Albert, Alan S. HilibrandAbstract:Object. Anterior Cervical discectomy and fusion (ACDF) is a widely accepted treatment for Anterior degenerative or traumatic instability of the Cervical supne. To reduce or eliminate complications such as implant migration and failure, imaging degradation, and fusion stress shielding that are occasionally associated with supnal instrumentation, attention has been given to the use of bioresorbable Anterior Cervical Plate (ACP) devices. This paper is a preliminary report of a retrospective series in which a resorbable mesh and screw system was used for graft containment in single-level ACDF. Methods. A review of patient charts and imaging studies was conducted to determine functional outcome, fusion success, and potential soft-tissue reaction to implant resorption. Nine patients with a Cervical degenerative disc disease or traumatic disc disruption were treated between October 2001 and March 2002. Follow up averaged 206 days. Eight patients were found to have an excellent result, one patient had a good resu...
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Stabilizing potential of Anterior Cervical Plates in multilevel corpectomies.
Spine, 1999Co-Authors: Taku Isomi, Manohar M Panjabi, Jawlin Wang, Steven R Garfin, Alexander R. Vaccaro, Tushar PatelAbstract:Study Design. An in vitro investigation of three-dimensional kinematics of Cervical spine models of one- and three-level corpectomy with Anterior Plate fixation. Objectives. To evaluate the capability of an Anterior Plate to stabilize the reconstructed Cervical spine under simulated physiologic motions, and to study the effects of fatigue loading. of Background Data. Clinical studies have found high failure rates of multilevel Anterior Cervical Plate fusions, indicating suboptimal stabilization. However, no biomechanical studies have been done to investigate the stabilizing capabilities of long-Plate instrumentations in corpectomy models. Methods. Seven fresh human cadaveric Cervical spine specimens (C2-T1) were used. Flexibility tests consisted of flexion, extension, and bilateral torsion, and lateral bending, each with a pure moment of 0.25, 0.5, 0.75, and 1.0 Nm. Stabilizing potential indices [(Motion Intact - Motion instrumented )/Motion Intact ] for ranges of motion and neutral zones obtained from the flexibility tests, were measured when the specimen was intact and after one-level (C5) and three-level (C4, C5, and C6) corpectomies and Anterior Plate stabilizations). The stabilizing potential indices were re-measured after a 1000-cycle fatigue loading (1 Nm flexion and extension moments at C5 vertebra at 0.14 Hz). Results. The differences in stabilizing potential indices of range of motion and neutral zone between one-level and three-level Plates were not significant before fatigue. However, after fatigue, the stabilizing potential indices significantly decreased (P < 0.05) for the three-level model, but not for the one-level Plate model. Conclusions. The capability of an Anterior Cervical Plate to stabilize the spine after three-level corpectomy was significantly reduced with fatigue loading.
Stephen I. Esses - One of the best experts on this subject based on the ideXlab platform.
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Anterior Cervical fusion: outcome analysis of patients fused with and without Anterior Cervical Plates.
Journal of Spinal Disorders, 1996Co-Authors: Patrick J. Connolly, Stephen I. Esses, John P. KostuikAbstract:The purpose of this study was to assess the role of the Anterior Cervical Plate in the treatment of Cervical spondylosis. Forty-three patients surgically treated for Cervical spondylosis were reviewed. The technique for discectomy and fusion was the same for both groups (Smith-Robinson with autologous iliac crest bone graft). Group I consisted of 25 consecutive patients treated with Anterior Cervical discectomy, autograft fusion, and Anterior Cervical Plate fixation (Morscher titanium hollow screw Plate system). Group II consisted of 18 consecutive patients treated without Plate fixation. The overall clinical results in this study were not improved with the use of Anterior Cervical Plate fixation (Fisher's exact test, p > 0.05). The fusion rate of one-level Cervical fusions was not improved with Anterior Cervical Plate fixation (Fisher's exact test, p > 0.05). The overall graft complication rate (pseudoarthrosis plus delayed union plus graft collapse) in multilevel fusions was decreased with Anterior Cervical Plate fixation (Fisher's exact test, p < 0.01). The cost effectiveness and risk versus benefit of Anterior Cervical Plate fixation in the surgical treatment of Cervical spondylosis require further investigation.
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Anterior Cervical Plate fixation with the titanium hollow screw Plate system
Spine, 1993Co-Authors: John P. Kostuik, Patrick J. Connolly, Stephen I. EssesAbstract:: Although Anterior Cervical Plates provide excellent fixation for the Anterior column, the potential risk for injury to the spinal cord or soft tissues involved with their use has been the reason they have not gained universal acceptance. Morscher introduced a system that attempts to prevent the migration and loosening of screws by using a cross-split screw head that can be locked into the Plate. The secondary advantage of this system is that it eliminates the requirement for posterior cortex purchase and thereby decreases the risk for spinal cord injury. This article reports the authors' experience using the Morscher titanium hollow screw Cervical Plate system. Forty-two patients in the series underwent Anterior Cervical arthrodesis for degenerative disease or trauma. The average number of levels fused were two. The fusion rate was 100%. Significant hardware loosening occurred in two patients. There was no iatrogenic injury to the spinal cord or esophagus. In conclusion, the titanium hollow screw Cervical Plate provides immediate stable fixation with minimal complications. Its use should be considered in the surgical treatment of patients requiring multilevel Anterior Cervical arthrodesis.
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Anterior Cervical Plate fixation with the titanium hollow screw Plate system a preliminary report
Spine, 1990Co-Authors: John P. Kostuik, Stephen I. EssesAbstract:: Morscher, of Switzerland, has developed an Anterior Cervical spine Plate system (THSP) that does not require screw purchase of the posterior cortex. This design eliminates potential neurologic complications usually associated with the Anterior Plate system, but maintains the mechanical advantages of internal fixation. The authors reviewed 13 consecutive patients in whom the THSP system was applied. Indications for the use of this device included acute trauma in three patients, trauma of more than 6 weeks' duration in five patients, and spondylosis in five patients. Fifteen Plates and 58 screws were placed, with no screws purchasing the posterior cortex. Postoperative immobilization varied from no immobilization to four-poster brace. With a mean follow-up of 13 months, all 13 patients went on to fusion. One patient had screws placed in the disc rather than in bone and went on to malunion. In all other patients, radiographs did not demonstrate screw migration, screw-bone lucency, graft dislodgement, or malunion. No patient suffered neurologic injury as a result of this device. The THSP system facilitates reliable fusion with minimal complications. Its use should be considered in multilevel Anterior spine defects, posttraumatic Cervical kyphosis, and Cervical fractures with posterior disruption requiring Anterior fusion.
John P. Kostuik - One of the best experts on this subject based on the ideXlab platform.
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Anterior Cervical fusion: outcome analysis of patients fused with and without Anterior Cervical Plates.
Journal of Spinal Disorders, 1996Co-Authors: Patrick J. Connolly, Stephen I. Esses, John P. KostuikAbstract:The purpose of this study was to assess the role of the Anterior Cervical Plate in the treatment of Cervical spondylosis. Forty-three patients surgically treated for Cervical spondylosis were reviewed. The technique for discectomy and fusion was the same for both groups (Smith-Robinson with autologous iliac crest bone graft). Group I consisted of 25 consecutive patients treated with Anterior Cervical discectomy, autograft fusion, and Anterior Cervical Plate fixation (Morscher titanium hollow screw Plate system). Group II consisted of 18 consecutive patients treated without Plate fixation. The overall clinical results in this study were not improved with the use of Anterior Cervical Plate fixation (Fisher's exact test, p > 0.05). The fusion rate of one-level Cervical fusions was not improved with Anterior Cervical Plate fixation (Fisher's exact test, p > 0.05). The overall graft complication rate (pseudoarthrosis plus delayed union plus graft collapse) in multilevel fusions was decreased with Anterior Cervical Plate fixation (Fisher's exact test, p < 0.01). The cost effectiveness and risk versus benefit of Anterior Cervical Plate fixation in the surgical treatment of Cervical spondylosis require further investigation.
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Anterior Cervical Plate fixation with the titanium hollow screw Plate system
Spine, 1993Co-Authors: John P. Kostuik, Patrick J. Connolly, Stephen I. EssesAbstract:: Although Anterior Cervical Plates provide excellent fixation for the Anterior column, the potential risk for injury to the spinal cord or soft tissues involved with their use has been the reason they have not gained universal acceptance. Morscher introduced a system that attempts to prevent the migration and loosening of screws by using a cross-split screw head that can be locked into the Plate. The secondary advantage of this system is that it eliminates the requirement for posterior cortex purchase and thereby decreases the risk for spinal cord injury. This article reports the authors' experience using the Morscher titanium hollow screw Cervical Plate system. Forty-two patients in the series underwent Anterior Cervical arthrodesis for degenerative disease or trauma. The average number of levels fused were two. The fusion rate was 100%. Significant hardware loosening occurred in two patients. There was no iatrogenic injury to the spinal cord or esophagus. In conclusion, the titanium hollow screw Cervical Plate provides immediate stable fixation with minimal complications. Its use should be considered in the surgical treatment of patients requiring multilevel Anterior Cervical arthrodesis.
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Anterior Cervical Plate fixation with the titanium hollow screw Plate system a preliminary report
Spine, 1990Co-Authors: John P. Kostuik, Stephen I. EssesAbstract:: Morscher, of Switzerland, has developed an Anterior Cervical spine Plate system (THSP) that does not require screw purchase of the posterior cortex. This design eliminates potential neurologic complications usually associated with the Anterior Plate system, but maintains the mechanical advantages of internal fixation. The authors reviewed 13 consecutive patients in whom the THSP system was applied. Indications for the use of this device included acute trauma in three patients, trauma of more than 6 weeks' duration in five patients, and spondylosis in five patients. Fifteen Plates and 58 screws were placed, with no screws purchasing the posterior cortex. Postoperative immobilization varied from no immobilization to four-poster brace. With a mean follow-up of 13 months, all 13 patients went on to fusion. One patient had screws placed in the disc rather than in bone and went on to malunion. In all other patients, radiographs did not demonstrate screw migration, screw-bone lucency, graft dislodgement, or malunion. No patient suffered neurologic injury as a result of this device. The THSP system facilitates reliable fusion with minimal complications. Its use should be considered in multilevel Anterior spine defects, posttraumatic Cervical kyphosis, and Cervical fractures with posterior disruption requiring Anterior fusion.
Caetano Coimbra - One of the best experts on this subject based on the ideXlab platform.
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Titanium cage reconstruction after Cervical corpectomy.
Journal of neurosurgery, 2020Co-Authors: Zeena Dorai, Howard Morgan, Caetano CoimbraAbstract:The authors evaluated the efficacy of titanium cage- and Anterior Cervical Plate (ACP)-augmented fusion for reconstruction following decompressive Cervical corpectomy in nontraumatic disease. Forty-five patients ranging from 37 to 77 years of age underwent Anterior Cervical corpectomy followed by titanium cage-assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion-extension radiography. Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endPlate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months. Autologous corpectomy bone-filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive Cervical corpectomy. This technique provides a reasonable alternative to procedures involving long solid strut grafts obtained from the bone bank or from the patient.
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titanium cage reconstruction after Cervical corpectomy
Journal of Neurosurgery, 2003Co-Authors: Zeena Dorai, Howard Morgan, Caetano CoimbraAbstract:Object The authors evaluated the efficacy of titanium cage— and Anterior Cervical Plate (ACP)—augmented fusion for reconstruction following decompressive Cervical corpectomy in nontraumatic disease. Methods Forty-five patients ranging from 37 to 77 years of age underwent Anterior Cervical corpectomy followed by titanium cage—assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion—extension radiography. Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endPlate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months. Conclusions Autologous corpectomy bone—filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive Cervical corpectomy. This technique p...
Zeena Dorai - One of the best experts on this subject based on the ideXlab platform.
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Titanium cage reconstruction after Cervical corpectomy.
Journal of neurosurgery, 2020Co-Authors: Zeena Dorai, Howard Morgan, Caetano CoimbraAbstract:The authors evaluated the efficacy of titanium cage- and Anterior Cervical Plate (ACP)-augmented fusion for reconstruction following decompressive Cervical corpectomy in nontraumatic disease. Forty-five patients ranging from 37 to 77 years of age underwent Anterior Cervical corpectomy followed by titanium cage-assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion-extension radiography. Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endPlate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months. Autologous corpectomy bone-filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive Cervical corpectomy. This technique provides a reasonable alternative to procedures involving long solid strut grafts obtained from the bone bank or from the patient.
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titanium cage reconstruction after Cervical corpectomy
Journal of Neurosurgery, 2003Co-Authors: Zeena Dorai, Howard Morgan, Caetano CoimbraAbstract:Object The authors evaluated the efficacy of titanium cage— and Anterior Cervical Plate (ACP)—augmented fusion for reconstruction following decompressive Cervical corpectomy in nontraumatic disease. Methods Forty-five patients ranging from 37 to 77 years of age underwent Anterior Cervical corpectomy followed by titanium cage—assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion—extension radiography. Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endPlate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months. Conclusions Autologous corpectomy bone—filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive Cervical corpectomy. This technique p...
