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Papers by ira fedder
日本整形外科學會雜誌 the Journal of the Japanese Orthopaedic Association, Apr 25, 1997
Wolters Kluwer Health Adis (ESP), Sep 30, 2014
The Artificial Disc, 2003
A study was performed in our laboratory to investigate the SB Charite ™ Artificial Disc’s bioacti... more A study was performed in our laboratory to investigate the SB Charite ™ Artificial Disc’s bioactive double coating of pure titanium and an overcoat of calcium phosphate (Fig. 6.1). To date we have experience with inserting several different types of artificial disc prostheses (SB Charite, Takiron, and AcroFlex) in over 60 baboons, non-human primates.
SPINE, 2018
issue healing, repair, and reconstruction require the T coordinated activation of molecular and c... more issue healing, repair, and reconstruction require the T coordinated activation of molecular and cellular processes. Bioactive implants, defined as implants which influence the surrounding cell-recruitment and osseointegration, are replacing the passive mechanical devices that have been implanted in the past. This evolution will, undoubtedly, reframe biomechanics away from the macroscopic framework of bone structural properties toward that of interactions of cells on the surrounding matrix through integrins and other cytoskeletal components. This emphasis may incorporate micro, and especially, nanotopographical features, with a greater emphasis on the biology of the implants, and the specific surface features that provide systemic or local influences. As we move from macro to micro to nano environments, we will be able to design to promote attributes on a specific length scale, down from the cellular to the molecular level. This type of stimulation would work through some nonmechanical avenues, stimulating healing by manipulating surface energy and surface properties. The development of customized nanotextured surfaces, either by chance or design, could allow for the optimization of cellular adhesion and growth on the surfaces of implants.
日本整形外科學會雜誌 the Journal of the Japanese Orthopaedic Association, Apr 25, 1997
The Orthopedic clinics of North America, 1996
Minimally invasive techniques including closed laparoscopy and thoracoscopy as well as video-assi... more Minimally invasive techniques including closed laparoscopy and thoracoscopy as well as video-assisted procedures using limited open incisions provide an excellent alternative for treating vertebral osteomyelitis and tuberculous infections in the thoracic and lumbar spine. The traditional principles of surgical debridement and a stable interbody fusion are unchanged when applying endoscopic techniques. In the future, the spinal endoscopist will have available a larger selection of endoscopic instruments, more sophisticated video technology, and the development of anterior instrumentation systems to allow for rigid internal fixation. These advances, along with the surgeon's endoscopic experience and refined techniques, will further establish minimally invasive surgical techniques in the field of spinal surgery.
Colloids and Surfaces B: Biointerfaces
The Spine Journal
HYPOTHESIS: Motor vehicle collision (MVC) related cervical spine injury is a severe and often per... more HYPOTHESIS: Motor vehicle collision (MVC) related cervical spine injury is a severe and often permanently disabling injury. Although advances in automobile crashworthiness have reduced both fatalities and some severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on cervical spine injury is unknown. The purpose of this study is to investigate the relationship between the occurrence of cervical spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A case-control study among subjects obtained from the 1995 to 2001 National Automobile Sampling System (NASS). Cases were identified based on having sustained a cervical spine injury of equal to or greater than 2 on the Abbreviated Injury Scale, 1990 Revision. RESULTS: Approximately half (44.7%) of 8,412 cases of cervical spine injury were unrestrained occupants while belted only, airbag only and both restraint systems represented 38.2%, 8.8% and 8.4% of cases respectively. Overall, the combined use of airbag and seatbelt had the greatest protective effect, relative to unrestrained occupants, with an odds ratio (OR) of 0.19 and a 95% confidence interval (CI) of 0.12 and 0.30. Use of a seatbelt only also had a protective effect (OR=0.40, 95% CI=0.23 to 0.70). Occupant use of an airbag only neither increased nor decreased the risk of cervical spine injuries relative to unrestrained occupants (OR=1.02, 95% CI=0.57 to 2.13). DISCUSSION: Seatbelts have been clearly shown to reduce overall mortality and morbidity in automobile accidents. Airbags may provide an element of protection against cervical spine injury. The results of this study reveal that airbag use alone led to no significant increase or decrease in the risk of cervical spine fracture. However, when combined with seatbelts, airbags provided significant protection against cervical fracture and neurologic injury when compared to unrestrained occupants. This risk reduction is significantly more than that seen for seatbelt use alone. CONCLUSIONS: The results of this study suggest that there is an increase in overall protection against cervical spine injury by combining airbag and seatbelt restraint systems relative to seatbelt alone. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts.
Journal of spinal disorders & techniques, 2003
Sixty patients with one-level discogenic pain confirmed by plain radiography, magnetic resonance ... more Sixty patients with one-level discogenic pain confirmed by plain radiography, magnetic resonance imaging, and provocative discography for degenerative disc disease were randomized: one-third BAK anterior interbody fusion and two-thirds anterior SB Charité artificial disc replacement. The mean age was 40.3 years (range 21-56 years). Nineteen cases were at L4-L5 and 41 cases were at L5-S1. Nineteen cases had BAK anterior interbody fusion and 41 cases were randomized as SB Charité disc replacement. The length of surgery was mean 88.4 minutes (range 54-137 minutes) for both groups. The estimated blood loss was mean 289.5 mL (range 50-1800 mL). The length of hospital stay was a mean of 3.03 days (range 2-6 days). Oswestry Disability Index scores for the SB Charité disc (aggregate study group) were 50.0 +/- 14.3 preoperatively and 25.0 +/- 20.1 at 1-3 years' follow-up (P < 0.001). This is the first study that shows improvement of functional outcome measures in a prospective randomi...
Spine, 2003
A study was conducted to investigate the biomechanical, histochemical, and biologic ingrowth char... more A study was conducted to investigate the biomechanical, histochemical, and biologic ingrowth characteristics of the most widely used total disc prosthesis, the hydroxyapatite-coated SB Charité prosthesis. To compare the porous ingrowth, linear apposition, or bony ingrowth in total disc replacement with published reports of porous ingrowth prostheses in the appendicular skeleton. Seven mature baboons (Papio cynocephalus) underwent L5-L6 total disc replacement through an anterior transperitoneal approach. The SB Charité prosthetic vertebral endplates (n = 14) were cobalt-chrome covered by two layers of thin titanium with a hydroxyapatite coating, which was electrochemically bonded to the implant surface. At 6 months after surgery, the range of motion exhibited by the SB Charité and the nonoperative control subjects under axial compression, flexion-extension, and lateral bending showed no statistical difference (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Plain film radiographic analysis showed no lucencies or loosening of any prosthetic vertebral endplate. Gross histopathologic analysis of the hydroxyapatite-coated SB Charité prosthesis demonstrated excellent ingrowth at the level of the implant-bone interface, without evidence of fibrous tissue or synovium. Histochemical assays showed no accumulation of particulate wear debris (no titanium, ultrahigh molecular weight polyethylene, or cobalt-chrome) nor cytokines (tumor necrosis factor-alpha, prostaglandin E2, interleukin-1, -2, or -6). Total endplate area showed a mean ingrowth (volume fraction) of 47.9% +/- 9.12% and a total ingrowth range of 35.5% to 58.8%. The porous ingrowth (percentage of pore ingrowth coverage at the bone-metal interface) was more favorable for total disc replacement than for cementless total joint components in the appendicular skeleton (range, 10-30%). The reason for the improved degree of porous ingrowth in total disc replacement prostheses probably is that ligamentotaxis causes sustained compression across the metal-bone interface.
Spine, 1998
Eighteen patients with lumbar instability from fractures, postlaminectomy syndrome, or infection ... more Eighteen patients with lumbar instability from fractures, postlaminectomy syndrome, or infection were treated prospectively with minimally invasive retroperitoneal lumbar fusions. To determine if interbody Bagby and Kuslich fusion cages and femoral allograft bone dowels can be inserted in a transverse direction via a lateral endoscopic retroperitoneal approach to achieve spinal stability. Endoscopic spinal approaches have been used to achieve lower lumbar fusion when instrumentation is placed through a laparoscopic, transperitoneal route. However, complications of using this approach include postoperative intra-abdominal adhesions, retrograde ejaculation, great vessel injury, and implant migration. This study is the first clinical series investigating the use of the lateral retroperitoneal minimally invasive approach for lumbar fusions from L1 to L5. Eighteen patients underwent anterior interbody decompression and/or stabilization via endoscopic retroperitoneal approaches. In most cases, three 12-mm portals were used. Two parallel transverse interbody cages restored the neuroforaminal height and the desired amount of lumbar lordosis was achieved by inserting a larger anterior cage, distraction plug, or bone dowel. The overall morbidity of the procedure was lower than that associated with traditional "open" retroperitoneal or laparotomy techniques, with a mean length of hospital stay of 2.9 days (range, outpatient procedure to 5 days). The mean estimated intraoperative blood loss was 205 cc (range, 25-1000 cc). There were no cases of implant migration, significant subsidence, or pseudoarthrosis at mean follow-up examination of 24.3 months (range, 12-40 months) after surgery. This preliminary study of 18 patients illustrates that endoscopic techniques can be applied effectively through a retroperitoneal approach with the patient in the lateral position. Unlike the patients who had undergone transperitoneal procedures described in previous reports, in these preliminary 18 patients, there were no cases of retrograde ejaculation, injury to the great vessels, or implant migration.
Spine, 1999
Using an in vivo interbody arthrodesis model, the efficacy of the Bagby and Kuslich (BAK) device ... more Using an in vivo interbody arthrodesis model, the efficacy of the Bagby and Kuslich (BAK) device packed with recombinant human osteogenic protein-1 (rhOP-1) was evaluated. To compare the efficacy of osteogenic protein with that of autograft for interbody arthrodesis, with fusion success based on biomechanical, histologic, and radiographic analyses. The use of recombinant human bone morphogenetic proteins (rhBMPs) as osteoinductive bone graft substitutes or expanders has recently gained considerable research interest, particularly when applied in posterolateral arthrodesis. However, whether these results can be extrapolated to a successful interbody spinal arthrodesis remains uncertain. Twelve sheep underwent a multilevel thoracic spinal decompression by thoracoscopic approach. Three noncontiguous destabilization sites (T5-T6, T7-T8, T9-T10) were prepared and randomly treated as follows. Control group treatments were nonsurgical, destabilization alone, and empty BAK. Experimental groups were treated with autograft alone, BAK device packed with autograft, or BAK device packed with rhOP-1. Four months after surgery, interbody fusion status was quantified by biomechanical testing, computed tomography, microradiography, and histomorphometry. Results of biomechanical analysis showed statistically higher segmental stiffness levels when comparing the control and experimental groups with four of the five testing methods (P &amp;amp;amp;lt; 0.05). Computed tomography and microradiography characterized destabilization alone as producing one fusion in six preparations; the empty BAK, two in six;, autograft alone, four in eight; BAK with autograft, five in eight; and BAK with rhOP-1 group, six in eight-all evidenced by woven trabecular bone spanning the fusion sites. Histomorphometry yielded significantly more trabecular bone formation at the fusion sites in the three experimental groups than in the two control groups (P &amp;amp;amp;lt; 0.05). Interbody spinal fusions showing biomechanical and histomorphometric equivalency to autologous fusions have been achieved with rhOP-1. The functional unit stability and histologic osteointegration evidenced by the BAK/rhOP-1 complex shows this interbody arthrodesis technique to be a viable alternative toconventional autologous iliac crest, thereby obviating the need for an iliac crest donor site and associated patient morbidity.
Experimental and therapeutic medicine, 2012
The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (... more The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (VATS) and open lobectomy for the treatment of stage I lung cancer using meta-analytical techniques. A literature search was undertaken until July 2011 to identify comparative studies evaluating survival rates, recurrence rates and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed- or random-effects model. These studies included a total of 1,362 patients: 668 treated with VATS and 694 treated with open lobectomy. The overall survival was significantly higher in patients treated with VATS than with open thoracotomy (OR=2.01, 95% CI 1.44-2.78) at 5 years. However, there was no statistically significant difference in 1.3-year overall survival between the VATS and open lobectomy groups (OR=3.21, 95% CI 0.77-13.40; OR=0.91, 95% CI 0.49-1.70). The data did not demonstrate a significant difference in locoregional recurrence (OR=0.5...
Thrombosis Research, 1983
The effect of a large daily dose of i.v. carbenicillin, cefoxitin and cefamandole on platelet agg... more The effect of a large daily dose of i.v. carbenicillin, cefoxitin and cefamandole on platelet aggregation with adenosine diphosphate (ADP) and the effect of carbenicillin on ADP induced shape change were evaluated. Six volunteers received carbenicillin 100 mg/kg every 4 hours. Three of them also received cefoxitin 3 gm every 6 hours and cefamandole 2 gm every 4 hours. All treatments were separated by 14 days. Prior to treatment, as well as 1 and 24 hours after the last dose of antibiotic, citrated platelet-rich plasma was tested for the extent of aggregation at a series of ADP concentrations. As previously reported by several groups, carbenicillin decreased the sensitivity of platelets in their aggregation response to ADP. Thus, the concentration of ADP needed to obtain 50% of maximal aggregation response was increased 3.5 +/- 1.7 (S.D.) fold. In addition, when measured separately, the sensitivity of platelets in their shape change response to ADP was decreased to a similar degree. The concentration of ADP needed to produce 50% of maximal shape change response was 2.8 +/- 1.6 (S.D.) fold higher after carbenicillin treatment. The results are in accordance with previous in vitro studies suggesting that carbenicillin interferes with the initial phase of platelet activation. Cefoxitin and cefamandole had no apparent effect on platelet aggregation.
The Spine Journal, 2004
BACKGROUND CONTEXT: For decades there has been a desire to restore motion of a painful degenerate... more BACKGROUND CONTEXT: For decades there has been a desire to restore motion of a painful degenerated spinal segment. Artificial discs have been used in Europe for almost 20 years. In the few reports available in the literature, the results have been promising. However, there have been no prospective randomized studies comparing artificial discs with spinal fusion. PURPOSE: The purpose of this study was to determine if patients with symptomatic degenerative disc disease treated with Charité artificial disc (DePuy Spine, Raynham, MA) arthroplasty would show significant improvement in functional outcome measures and to compare these results to fusion. STUDY DESIGN/SETTING: This was a prospective randomized clinical trial comparing total disc replacement with anterior lumbar interbody fusion using cages. The data reported were collected from two spine specialty centers participating in a Food and Drug Administration regulated trial. METHODS: A consecutive series of 144 patients were randomized using a 2:1 ratio of Charité versus BAK (Zimmer Spine, Minneapolis, MN). All patients were being treated for single-level discogenic pain confirmed by plain radiography, magnetic resonance imaging and provocative discography. Data were collected at designated follow-up periods for up to 24 months. RESULTS: The mean age was 40.1 years (range, 21 to 56 years). Forty-four cases had BAK anterior interbody fusion, and 100 cases were randomized to Charité disc replacement. The mean operating time was 76.2 minutes (range, 54 to 137 minutes) for the Charité cases. The mean estimated blood loss was 196.2 cc (range, 50 to 1,800 cc). Most patients were discharged in 1 to 2 days with a soft corset and returned to normal activities within 3 weeks if they underwent the disc replacement. The mean Oswestry Disability Index score for the BAK group was 69.6Ϯ12.8 preoperatively and 27.5Ϯ26.4 at 24-month follow-up (pϽ.001) The corresponding mean Oswestry score for the Charité disc patients was 70.9 preoperatively and 30.0 at 24-month follow-up (pϽ.001). CONCLUSIONS: In this prospective randomized study, both surgical groups improved significantly. Complications of total disc replacement were similar to those encountered with anterior lumbar interbody fusion. Total disc replacement appears to be a viable alternative to fusion for the treatment of single-level symptomatic disc degeneration unresponsive to nonoperative management.
日本整形外科學會雜誌 the Journal of the Japanese Orthopaedic Association, Apr 25, 1997
Wolters Kluwer Health Adis (ESP), Sep 30, 2014
The Artificial Disc, 2003
A study was performed in our laboratory to investigate the SB Charite ™ Artificial Disc’s bioacti... more A study was performed in our laboratory to investigate the SB Charite ™ Artificial Disc’s bioactive double coating of pure titanium and an overcoat of calcium phosphate (Fig. 6.1). To date we have experience with inserting several different types of artificial disc prostheses (SB Charite, Takiron, and AcroFlex) in over 60 baboons, non-human primates.
SPINE, 2018
issue healing, repair, and reconstruction require the T coordinated activation of molecular and c... more issue healing, repair, and reconstruction require the T coordinated activation of molecular and cellular processes. Bioactive implants, defined as implants which influence the surrounding cell-recruitment and osseointegration, are replacing the passive mechanical devices that have been implanted in the past. This evolution will, undoubtedly, reframe biomechanics away from the macroscopic framework of bone structural properties toward that of interactions of cells on the surrounding matrix through integrins and other cytoskeletal components. This emphasis may incorporate micro, and especially, nanotopographical features, with a greater emphasis on the biology of the implants, and the specific surface features that provide systemic or local influences. As we move from macro to micro to nano environments, we will be able to design to promote attributes on a specific length scale, down from the cellular to the molecular level. This type of stimulation would work through some nonmechanical avenues, stimulating healing by manipulating surface energy and surface properties. The development of customized nanotextured surfaces, either by chance or design, could allow for the optimization of cellular adhesion and growth on the surfaces of implants.
日本整形外科學會雜誌 the Journal of the Japanese Orthopaedic Association, Apr 25, 1997
The Orthopedic clinics of North America, 1996
Minimally invasive techniques including closed laparoscopy and thoracoscopy as well as video-assi... more Minimally invasive techniques including closed laparoscopy and thoracoscopy as well as video-assisted procedures using limited open incisions provide an excellent alternative for treating vertebral osteomyelitis and tuberculous infections in the thoracic and lumbar spine. The traditional principles of surgical debridement and a stable interbody fusion are unchanged when applying endoscopic techniques. In the future, the spinal endoscopist will have available a larger selection of endoscopic instruments, more sophisticated video technology, and the development of anterior instrumentation systems to allow for rigid internal fixation. These advances, along with the surgeon's endoscopic experience and refined techniques, will further establish minimally invasive surgical techniques in the field of spinal surgery.
Colloids and Surfaces B: Biointerfaces
The Spine Journal
HYPOTHESIS: Motor vehicle collision (MVC) related cervical spine injury is a severe and often per... more HYPOTHESIS: Motor vehicle collision (MVC) related cervical spine injury is a severe and often permanently disabling injury. Although advances in automobile crashworthiness have reduced both fatalities and some severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on cervical spine injury is unknown. The purpose of this study is to investigate the relationship between the occurrence of cervical spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A case-control study among subjects obtained from the 1995 to 2001 National Automobile Sampling System (NASS). Cases were identified based on having sustained a cervical spine injury of equal to or greater than 2 on the Abbreviated Injury Scale, 1990 Revision. RESULTS: Approximately half (44.7%) of 8,412 cases of cervical spine injury were unrestrained occupants while belted only, airbag only and both restraint systems represented 38.2%, 8.8% and 8.4% of cases respectively. Overall, the combined use of airbag and seatbelt had the greatest protective effect, relative to unrestrained occupants, with an odds ratio (OR) of 0.19 and a 95% confidence interval (CI) of 0.12 and 0.30. Use of a seatbelt only also had a protective effect (OR=0.40, 95% CI=0.23 to 0.70). Occupant use of an airbag only neither increased nor decreased the risk of cervical spine injuries relative to unrestrained occupants (OR=1.02, 95% CI=0.57 to 2.13). DISCUSSION: Seatbelts have been clearly shown to reduce overall mortality and morbidity in automobile accidents. Airbags may provide an element of protection against cervical spine injury. The results of this study reveal that airbag use alone led to no significant increase or decrease in the risk of cervical spine fracture. However, when combined with seatbelts, airbags provided significant protection against cervical fracture and neurologic injury when compared to unrestrained occupants. This risk reduction is significantly more than that seen for seatbelt use alone. CONCLUSIONS: The results of this study suggest that there is an increase in overall protection against cervical spine injury by combining airbag and seatbelt restraint systems relative to seatbelt alone. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts.
Journal of spinal disorders & techniques, 2003
Sixty patients with one-level discogenic pain confirmed by plain radiography, magnetic resonance ... more Sixty patients with one-level discogenic pain confirmed by plain radiography, magnetic resonance imaging, and provocative discography for degenerative disc disease were randomized: one-third BAK anterior interbody fusion and two-thirds anterior SB Charité artificial disc replacement. The mean age was 40.3 years (range 21-56 years). Nineteen cases were at L4-L5 and 41 cases were at L5-S1. Nineteen cases had BAK anterior interbody fusion and 41 cases were randomized as SB Charité disc replacement. The length of surgery was mean 88.4 minutes (range 54-137 minutes) for both groups. The estimated blood loss was mean 289.5 mL (range 50-1800 mL). The length of hospital stay was a mean of 3.03 days (range 2-6 days). Oswestry Disability Index scores for the SB Charité disc (aggregate study group) were 50.0 +/- 14.3 preoperatively and 25.0 +/- 20.1 at 1-3 years' follow-up (P < 0.001). This is the first study that shows improvement of functional outcome measures in a prospective randomi...
Spine, 2003
A study was conducted to investigate the biomechanical, histochemical, and biologic ingrowth char... more A study was conducted to investigate the biomechanical, histochemical, and biologic ingrowth characteristics of the most widely used total disc prosthesis, the hydroxyapatite-coated SB Charité prosthesis. To compare the porous ingrowth, linear apposition, or bony ingrowth in total disc replacement with published reports of porous ingrowth prostheses in the appendicular skeleton. Seven mature baboons (Papio cynocephalus) underwent L5-L6 total disc replacement through an anterior transperitoneal approach. The SB Charité prosthetic vertebral endplates (n = 14) were cobalt-chrome covered by two layers of thin titanium with a hydroxyapatite coating, which was electrochemically bonded to the implant surface. At 6 months after surgery, the range of motion exhibited by the SB Charité and the nonoperative control subjects under axial compression, flexion-extension, and lateral bending showed no statistical difference (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Plain film radiographic analysis showed no lucencies or loosening of any prosthetic vertebral endplate. Gross histopathologic analysis of the hydroxyapatite-coated SB Charité prosthesis demonstrated excellent ingrowth at the level of the implant-bone interface, without evidence of fibrous tissue or synovium. Histochemical assays showed no accumulation of particulate wear debris (no titanium, ultrahigh molecular weight polyethylene, or cobalt-chrome) nor cytokines (tumor necrosis factor-alpha, prostaglandin E2, interleukin-1, -2, or -6). Total endplate area showed a mean ingrowth (volume fraction) of 47.9% +/- 9.12% and a total ingrowth range of 35.5% to 58.8%. The porous ingrowth (percentage of pore ingrowth coverage at the bone-metal interface) was more favorable for total disc replacement than for cementless total joint components in the appendicular skeleton (range, 10-30%). The reason for the improved degree of porous ingrowth in total disc replacement prostheses probably is that ligamentotaxis causes sustained compression across the metal-bone interface.
Spine, 1998
Eighteen patients with lumbar instability from fractures, postlaminectomy syndrome, or infection ... more Eighteen patients with lumbar instability from fractures, postlaminectomy syndrome, or infection were treated prospectively with minimally invasive retroperitoneal lumbar fusions. To determine if interbody Bagby and Kuslich fusion cages and femoral allograft bone dowels can be inserted in a transverse direction via a lateral endoscopic retroperitoneal approach to achieve spinal stability. Endoscopic spinal approaches have been used to achieve lower lumbar fusion when instrumentation is placed through a laparoscopic, transperitoneal route. However, complications of using this approach include postoperative intra-abdominal adhesions, retrograde ejaculation, great vessel injury, and implant migration. This study is the first clinical series investigating the use of the lateral retroperitoneal minimally invasive approach for lumbar fusions from L1 to L5. Eighteen patients underwent anterior interbody decompression and/or stabilization via endoscopic retroperitoneal approaches. In most cases, three 12-mm portals were used. Two parallel transverse interbody cages restored the neuroforaminal height and the desired amount of lumbar lordosis was achieved by inserting a larger anterior cage, distraction plug, or bone dowel. The overall morbidity of the procedure was lower than that associated with traditional "open" retroperitoneal or laparotomy techniques, with a mean length of hospital stay of 2.9 days (range, outpatient procedure to 5 days). The mean estimated intraoperative blood loss was 205 cc (range, 25-1000 cc). There were no cases of implant migration, significant subsidence, or pseudoarthrosis at mean follow-up examination of 24.3 months (range, 12-40 months) after surgery. This preliminary study of 18 patients illustrates that endoscopic techniques can be applied effectively through a retroperitoneal approach with the patient in the lateral position. Unlike the patients who had undergone transperitoneal procedures described in previous reports, in these preliminary 18 patients, there were no cases of retrograde ejaculation, injury to the great vessels, or implant migration.
Spine, 1999
Using an in vivo interbody arthrodesis model, the efficacy of the Bagby and Kuslich (BAK) device ... more Using an in vivo interbody arthrodesis model, the efficacy of the Bagby and Kuslich (BAK) device packed with recombinant human osteogenic protein-1 (rhOP-1) was evaluated. To compare the efficacy of osteogenic protein with that of autograft for interbody arthrodesis, with fusion success based on biomechanical, histologic, and radiographic analyses. The use of recombinant human bone morphogenetic proteins (rhBMPs) as osteoinductive bone graft substitutes or expanders has recently gained considerable research interest, particularly when applied in posterolateral arthrodesis. However, whether these results can be extrapolated to a successful interbody spinal arthrodesis remains uncertain. Twelve sheep underwent a multilevel thoracic spinal decompression by thoracoscopic approach. Three noncontiguous destabilization sites (T5-T6, T7-T8, T9-T10) were prepared and randomly treated as follows. Control group treatments were nonsurgical, destabilization alone, and empty BAK. Experimental groups were treated with autograft alone, BAK device packed with autograft, or BAK device packed with rhOP-1. Four months after surgery, interbody fusion status was quantified by biomechanical testing, computed tomography, microradiography, and histomorphometry. Results of biomechanical analysis showed statistically higher segmental stiffness levels when comparing the control and experimental groups with four of the five testing methods (P &amp;amp;amp;lt; 0.05). Computed tomography and microradiography characterized destabilization alone as producing one fusion in six preparations; the empty BAK, two in six;, autograft alone, four in eight; BAK with autograft, five in eight; and BAK with rhOP-1 group, six in eight-all evidenced by woven trabecular bone spanning the fusion sites. Histomorphometry yielded significantly more trabecular bone formation at the fusion sites in the three experimental groups than in the two control groups (P &amp;amp;amp;lt; 0.05). Interbody spinal fusions showing biomechanical and histomorphometric equivalency to autologous fusions have been achieved with rhOP-1. The functional unit stability and histologic osteointegration evidenced by the BAK/rhOP-1 complex shows this interbody arthrodesis technique to be a viable alternative toconventional autologous iliac crest, thereby obviating the need for an iliac crest donor site and associated patient morbidity.
Experimental and therapeutic medicine, 2012
The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (... more The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (VATS) and open lobectomy for the treatment of stage I lung cancer using meta-analytical techniques. A literature search was undertaken until July 2011 to identify comparative studies evaluating survival rates, recurrence rates and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed- or random-effects model. These studies included a total of 1,362 patients: 668 treated with VATS and 694 treated with open lobectomy. The overall survival was significantly higher in patients treated with VATS than with open thoracotomy (OR=2.01, 95% CI 1.44-2.78) at 5 years. However, there was no statistically significant difference in 1.3-year overall survival between the VATS and open lobectomy groups (OR=3.21, 95% CI 0.77-13.40; OR=0.91, 95% CI 0.49-1.70). The data did not demonstrate a significant difference in locoregional recurrence (OR=0.5...
Thrombosis Research, 1983
The effect of a large daily dose of i.v. carbenicillin, cefoxitin and cefamandole on platelet agg... more The effect of a large daily dose of i.v. carbenicillin, cefoxitin and cefamandole on platelet aggregation with adenosine diphosphate (ADP) and the effect of carbenicillin on ADP induced shape change were evaluated. Six volunteers received carbenicillin 100 mg/kg every 4 hours. Three of them also received cefoxitin 3 gm every 6 hours and cefamandole 2 gm every 4 hours. All treatments were separated by 14 days. Prior to treatment, as well as 1 and 24 hours after the last dose of antibiotic, citrated platelet-rich plasma was tested for the extent of aggregation at a series of ADP concentrations. As previously reported by several groups, carbenicillin decreased the sensitivity of platelets in their aggregation response to ADP. Thus, the concentration of ADP needed to obtain 50% of maximal aggregation response was increased 3.5 +/- 1.7 (S.D.) fold. In addition, when measured separately, the sensitivity of platelets in their shape change response to ADP was decreased to a similar degree. The concentration of ADP needed to produce 50% of maximal shape change response was 2.8 +/- 1.6 (S.D.) fold higher after carbenicillin treatment. The results are in accordance with previous in vitro studies suggesting that carbenicillin interferes with the initial phase of platelet activation. Cefoxitin and cefamandole had no apparent effect on platelet aggregation.
The Spine Journal, 2004
BACKGROUND CONTEXT: For decades there has been a desire to restore motion of a painful degenerate... more BACKGROUND CONTEXT: For decades there has been a desire to restore motion of a painful degenerated spinal segment. Artificial discs have been used in Europe for almost 20 years. In the few reports available in the literature, the results have been promising. However, there have been no prospective randomized studies comparing artificial discs with spinal fusion. PURPOSE: The purpose of this study was to determine if patients with symptomatic degenerative disc disease treated with Charité artificial disc (DePuy Spine, Raynham, MA) arthroplasty would show significant improvement in functional outcome measures and to compare these results to fusion. STUDY DESIGN/SETTING: This was a prospective randomized clinical trial comparing total disc replacement with anterior lumbar interbody fusion using cages. The data reported were collected from two spine specialty centers participating in a Food and Drug Administration regulated trial. METHODS: A consecutive series of 144 patients were randomized using a 2:1 ratio of Charité versus BAK (Zimmer Spine, Minneapolis, MN). All patients were being treated for single-level discogenic pain confirmed by plain radiography, magnetic resonance imaging and provocative discography. Data were collected at designated follow-up periods for up to 24 months. RESULTS: The mean age was 40.1 years (range, 21 to 56 years). Forty-four cases had BAK anterior interbody fusion, and 100 cases were randomized to Charité disc replacement. The mean operating time was 76.2 minutes (range, 54 to 137 minutes) for the Charité cases. The mean estimated blood loss was 196.2 cc (range, 50 to 1,800 cc). Most patients were discharged in 1 to 2 days with a soft corset and returned to normal activities within 3 weeks if they underwent the disc replacement. The mean Oswestry Disability Index score for the BAK group was 69.6Ϯ12.8 preoperatively and 27.5Ϯ26.4 at 24-month follow-up (pϽ.001) The corresponding mean Oswestry score for the Charité disc patients was 70.9 preoperatively and 30.0 at 24-month follow-up (pϽ.001). CONCLUSIONS: In this prospective randomized study, both surgical groups improved significantly. Complications of total disc replacement were similar to those encountered with anterior lumbar interbody fusion. Total disc replacement appears to be a viable alternative to fusion for the treatment of single-level symptomatic disc degeneration unresponsive to nonoperative management.