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Revision of failed posterior cervical fusions
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Trevor Mordhorst, Vadim Goz, William Ryan Spiker
Fusion failure after revision surgery has a higher risk than the failure after the index procedure, and additional measures are sometimes taken to prevent fusion failure a second time. One such option is an external bone growth stimulator. These devices are worn on the skin for several hours a day and produce an electric field that some studies say stimulates bone growth and improves fusion rates. Patients are instructed to use the external stimulator for 3–9 months after their surgery.
Treatment of L5-S1 spondyloptosis with stand-alone anterior lumbar interbody fusion in a patient with neurofibromatosis
Published in British Journal of Neurosurgery, 2023
Barry Cheaney, Katie L. Krause, Enjae Jung, Khoi D. Than
Postoperatively, the patient reported new left leg radicular pain in the L5 distribution, although her post-operative lumbar computed tomography (CT) scan (Figure 5) and x-rays demonstrated appropriately placed hardware. The remainder of her hospital stay was unremarkable and she was discharge to home on post-operative day 4. Given the lack of true segmental fixation (only one screw and no plate), she was instructed to wear a lumbosacral orthosis for 6 weeks and was also prescribed a combined magnetic field bone growth stimulator (DJO Global, Vista, CA). At 2-week follow-up she continued to have left lower extremity pain running posteriorly from the buttock to her heel, but the preoperative low back pain had improved and the numbness had resolved. At 6 weeks, her left lower extremity pain had resolved and x-ray displayed an appropriately placed L5-S1 interbody spacer. By 3 months, she had complete resolution of her preoperative symptoms. At 1-year follow-up, she remained asymptomatic and had well positioned instrumentation with solid body fusion on CT across the interbody and across the facets (Figure 6). At 2-year follow-up, the patient continued to do well and x-rays re-demonstrated stable hardware with solid bony fusion (Figure 7).
Evaluation of femoral perfusion using dynamic contrast-enhanced MRI after simultaneous initiation of electrical stimulation and steroid treatment in an osteonecrosis model
Published in Electromagnetic Biology and Medicine, 2018
Hiroki Yamamoto, Keiichiro Ueshima, Masazumi Saito, Kazuya Ikoma, Masashi Ishida, Tsuyoshi Goto, Shigeki Hayashi, Akira Ikegami, Mikihiro Fujioka, Osam Mazda, Toshikazu Kubo
Steroid-induced ON was generated via intramuscular injection (the right gluteus maximus muscle) of methylprednisolone (MPSL) (20 mg/kg body mass) in 14 rabbits. This technique induces ON in the femoral bones of approximately 70% of treated rabbits within 4 weeks after steroid injection (Miyanishi et al., 2001, 2005; Motomura et al., 2004). Seven rabbits (ES group) were subjected to ES (10 h/day) over the gluteofemoral area for 2 weeks after steroid administration. Seven rabbits without ES were included in the control group. ES was generated by an OrthoPak Noninvasive Bone Growth Stimulator System (Biomet Osteobiologics, Parsippany, NJ), which delivered direct current stimulation (output waveform, sinusoidal waveform; output frequency, 60 kHz; output voltage, 6.8 V; output current, 10 mA). ES was generated percutaneously by a pair of electrode pads (diameter, 30 mm) on the gluteofemoral area of the rabbits (Figure 1), and the electrical current flows between this pair of electrode pads. The seven rabbits in the control group were kept in the same cages and a pair of electrode pads (diameter, 30 mm) was placed on the gluteofemoral area as in the ES group (Figure 1), though the ES device was nonfunctional in the control group. ES treatment was initiated simultaneously with steroid treatment and continued for 10 h per day for 2 weeks. The pads were detached from the rabbits during any time other than the 10-h ES period. The effectiveness of this device is time dependent and increases with longer exposure times (Brighton et al., 2001). The ES protocol used in this study was selected based on a reasonable amount of time that a human can wear the device in everyday life during clinical application. All rabbits were housed in separate cages and had free access to water and food during ES treatment. All experiments in this study were conducted in parallel and in a randomized fashion.