TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 11

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 11. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Spinal Instrumentation Chapter 3 75 . Holdsworth the two-column concept 43 . The surgical approach is traditionally more or less from anterior depending on the body region and the neighboring cavity. However especially for the lumbar spine other routes are established such as posterior lumbar interbody fusion PLIF or transforaminal procedures transforaminal lumbar interbody fusion TLIF 60 . Even if in the past anterior lumbar instrumentation has been questionable for some indications in the presence of sound alternatives in the future and with the advance of disc arthroplasty anterior surgery will probably gain in popularity. Furthermore anterior fusion will most likely retain its position as a salvage procedure for failed disc arthroplasty. Interbody Fusion Technique The technique of interbody or intercorporal fusion was introduced by Smith and Robertson in 1955 for the neck 91 and much earlier for the lumbar spine for surgically treating spinal deformity and Pott s disease by Hibbs and Albee in 1911 5 41 and later by Burns in 1933 for stabilizing spondylolisthesis 15 . As a surgical measure interbody fusion includes an at least partial removal of the intervertebral disc and of the cartilaginous endplates and subsequent filling-up of the disc space with structured bone graft or nowadays increasingly with artificial spacers cages . Cages were designed and first used by G. Bagby and D. Kuslich BAK cage in the late 1980s they were initially threaded hollow cylinders filled with bone graft. Nowadays a variety of cage designs are available for implantation using anterior or posterior approaches 97 98 . Different designs Fig. 6 are available threaded cylindrical cages ring-shaped cages with and without mesh structure box-shaped cages Intervertebral cages were originally proposed as stand-alone devices for anterior lumbar interbody fusion ALIF or PLIF. While the cages retain height and provide support and stability bony fusion occurs within and or around the cage. .

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