Info

Marcel T, Grausz JD The TMC Worldwide Gene Therapy Enrollment Report, end 1996. Hum Gene Ther 1997 8 775-800. Anderson WF Gene therapy. Sci Am 1995 273 124-128. Seth P, Willingham MC, Pastan I Adenovirus-dependent release of 51Cr from KB cells at an acidic pH. J Biol Chem 1984 259 14350-14353. Kramm C, Sena-Esteves M, Barnett FH, et al Gene therapy for brain tumors. Brain Pathol 1995 5 345-381. Le Gal La Salle G, Robert JJ, Berrard S, Ridoux V Stratford-Perricaudet LD, Perricaudet M, Mallet J...

Cervical Techniques with Image Guided Spinal Navigation

Section of Spinal Surgery, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA Image-guided spinal navigation is a computer-based surgical technology that was developed to improve intraoperative orientation to the unexposed anatomy during complex spinal procedures 12, 17 . It evolved from the principles of stereotaxy which have been used by neurosurgeons for several decades to help localize intracranial lesions. Stereotaxy is defined as the localization of a specific...

Cellular and Genetic Approaches for Spinal Fusions

Spinal Stabilization

Greg Andersonc Departments of aNeurosurgery, bBiomedical Engineering and cOrthopedic Surgery, University of Virginia Health System, Charlottesville, Va., USA A variety of evolving technologies are currently being evaluated in preclinical studies to promote tissue repair and or regeneration in the spinal region. Cellular and genetic techniques to induce bone formation for interbody or posterolateral spinal arthrodesis are an attractive approach, since this technology could...

Overview of Spinal Navigation

McLaughlin, Juan Bartolomei Neuro-Group, PA, Lawrenceville, N.J., USA An important advance in spinal surgery has been the development and application of image-guided techniques for spinal navigation and fixation. Image-guided technology includes both spinal stereotaxis as well as fluoroscopy-based image guidance systems. Both of these techniques offer significant advantages over commonly used plain radiography and fluoroscopy for complex spine procedures. Image-guided spine surgery has...

Uti

Wound infection Worsened radiculopathy stay, and approach-associated complications (tables 1-4). Comparisons were made for the entire series as well as for patients undergoing an L5 S1 ALIF 21 . One of the more striking differences observed between the two approaches was the time required to organize the operating room. This interval was estimated from the time of anesthesia induction to the point of surgical incision. The operative preparation time was significantly shorter for the mini-open...

Interbody Carbon Fiber

Elisabeth, Spinal Department, Straubing, Germany The fusion of spinal segments is one of the major goals in surgical treatment of degenerative disc disease (DDD). To obtain the best biomechanical support and fusion rates, interbody fusion is the preferred method. The main advantages of implants made of carbon fiber reinforced plastic (CFRP) are the radiolucency and the fact that there is no distortion on CT and MRI. The surgeon can chronologically follow the biological reaction in...

Epidemiology and Variations in Care of Spine Disease

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA Spine disease, with associated neck, back, and radicular pain, is common and costly. In the current American health care environment, many types of practitioners (primary care physicians, spine surgeons, physical therapists, chiropractors, and others) are involved in managing patients with spine disease, often with very different approaches. The varied nature and economic costs of spine disease are...

Cervical Laminoplasty

Alan Crockarda a Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, and b Spinal Surgery Unit, The Royal National Orthopaedic Hospital, Stanmore, UK Cervical laminoplasty is very much a Japanese invention. Its popularity in Japan arises from the formidable challenges of anterior decompression for ossification of the posterior longitudinal ligament 1-5 . These anterior multilevel surgeries would be frequently complicated...

An Update on Endoscopic Thoracic Spinal Surgery Thoracic Microendoscopic Discectomy

Branch Point Helix

Perez-Crueta, Bong-Soo Kimh, Faheem Sandhu0, Richard G. Fessler0 a Directory of Minimally Invasive Spine Surgery, Department of Neurosurgery, Chicago Institute of Neurosurgery and Neuroresearch, Rush-Presbyterian St. Luke's Medical Center and 0 Division of Neurosurgery, University of Chicago, Chicago, Ill., USA Clinically significant thoracic disc herniation is a relatively rare condition with an estimated annual incidence of approximately one per million. Surgical management of...

Endoscopic Posterior Cervical Foraminotomy and Microdiscectomy

Metrx Medtronic

Fessler Institute for Spine Care, Chicago Institute of Neurosurgery and Neuroresearch, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill., USA Recently microendoscopic discectomy (MED) techniques have been applied to perform laminoforaminotomy and discectomy for unilateral cervical radiculopathy 1, 11 utilizing the MED technique and instrumentation (fig. 1) developed by Smith and Foley in 1997 for lumbar disc disease 4, 6 . The muscle-splitting approach...

Virtual Fluoroscopy Overview and Future Implications

Mri After Pedicle Screw Fixation

Foleyb c a Divisions of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Canada b Division of Neurosurgery, University of Tennessee and c Image-Guided Surgery Center, Memphis, Tenn., USA The utilization of neuronavigation in spinal surgery continues to grow. Numerous advances in this field have facilitated more practical clinical applications and have led to greater acceptance of this technology. The successful combination of neuronavigational...

C1 Lateral Mass Fixation

Laterol Mass Screws

Birchb, Regis W. Haid, Jr.a a Department of Neurosurgery, The Emory Clinic, Atlanta, Ga., and b Department of Neurosurgery, The Mayo Clinic, Scottsdale, Ariz., USA A variety of techniques exist for fixation of the upper cervical spine. Recently, several authors have published case series reporting the use of C1 lateral mass screws for posterior cervical fixation 1-3 . In this chapter we describe our surgical technique for placement of C1 lateral mass screws, including...

Bone Morphogenetic Protein rhBMP2 Experimental Review and Clinical Update

Bone Morphogenetic Protein

Haid, Jr., Gerald E. Rodts, Jr., Carmen A. Petraglia The NeuroSpine Institute, Department of Neurological Surgery, Emory University, Atlanta, Ga., USA Over 30 years ago, Urist et al. 67, 68 identified a group of protein extracts, derived from the ground substance of mature bovine bone, capable of inducing both cartilage and bone formation when implanted into the soft tissues of study animals. Aptly named, bone morphogenetic proteins (BMPs) by Urist, these glycoproteins...

Placement of Thoracic Pedicle Screws

Kuklo Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, Washington, D.C., USA Thoracic pedicle screws are experiencing a significant increase in utilization in North America, as well as in the rest of the developed world 2, 5, 20, 21, 30-34 . Consequently, there is a heightened interest in factors leading to successful use. When placing pedicle screws in the thoracic spine, the surgeon primarily uses his or her knowledge of...

Thoracolumbar Deformity Advances

Lenke Classification

Operative Treatment of Thoracolumbar Deformity Praveen V. MummanenP, Stephen L. Ondra0, Rick C. Sassoc a Department of Neurosurgery, Emory University, Atlanta, Ga., b Department of Neurosurgery, Northwestern University, Chicago, Ill., and c Department of Orthopaedic Surgery, Indiana University School of Medicine, Indiana Spine Group, Indianapolis, Ind., USA Surgical fusions to treat spinal deformity were first developed in the 1900s. In 1911, Hibbs 1 performed a noninstrumented, posterior...

Laparoscopic versus Mini Open Anterior Lumbar Interbody Fusion

Haid, Jr., Brian R. Subach, Gerald E. Rodts, Jr. Department of Neurosurgery, Emory Clinic, Atlanta, Ga., USA The anterior approach for a lumbar interbody fusion was originally designed to treat Pott's disease 1 . Since that time, the anterior lumbar interbody fusion (ALIF) has evolved into an effective and popular alternative in the treatment of a variety of lumbar degenerative disorders, including degenerative disc disease, low-grade spondylolisthesis, and posterior...

Cervical Lateral Mass Advances

Laterol Mass Screws

Traynelish, Rick C. Sassoc a Department of Neurosurgery, Emory University, Atlanta, Ga., b Division of Neurosurgery, University of Iowa, Iowa City, Iowa, and c Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis Neurosurgical Group, Indianapolis, Ind., USA Posterior cervical fixation utilizing lateral mass plates has been shown to be a safe and efficacious method to achieve cervical fusion 1-3 . Lateral mass plating is...

Percutaneous Lumbar Pedicle Screws Indications Technique Results

Percutaneous Pedicle Screws

Department of Neurosurgery, Emory University, Atlanta, Ga., USA Lumbar pedicle fixation has proven to be a safe, effective means of lumbar stabilization. Prospective, randomized trials and community clinical experience using lumbar instrumentation have demonstrated an increased fusion rate. Lumbar instrumentation has also improved the ability to mobilize patients after surgery and perhaps brace them for shorter periods of time or not at all. To date, techniques of lumbar pedicle screw placement...

Lumbar Interbody Fusion Using Bone Morphogenetic Protein Results and Fusion Assessment

Lumbar Pseudarthrosis Cage Device

Foley0, Regis W. Haid, Jr.c aThe Hughston Clinic, PC, Columbus, Ga., bSemmes-murphy Clinic, Memphis, Tenn., and cDepartment of Neurosurgery, Emory University, Atlanta, Ga., USA No uniform criteria for determining fusion have been used in the reports of radiographic outcomes of anterior lumbar interbody fusion ALIF surgery 1, 2 . The most commonly reported standard for establishing the presence of a successful lumbar interbody fusion is evidence of trabecular bone...

Resorbable Technology for Spinal Stabilization

Alexander, William C. Welchc a Department of Neurological Surgery, University of Wisconsin, K4 834 Clinical Science Center, Madison, Wisc., b Department of Neurological Surgery, Wake Forest University, Winston-Salem, N.C., and c Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pa., USA Incredible advances in the surgeon's ability to restore stability to the unstable spine have been made in the last decade. Using metal implants, surgeons can...