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RISS 인기검색어
- 검색키워드
- 저자 : Kurpad Shekar (검색결과 2 건)
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A Comparison Study of Four Cervical Disk Arthroplasty Devices Using Finite Element Models
Purushothaman Yuvaraj,Choi Hoon,Yoganandan Narayan,Jebaseelan Davidson,Baisden Jamie,Kurpad Shekar 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.3
Study Design: The study examined and compared four artificial cervical disks using validated finite element models. Purpose: To compare and contrast the biomechanical behavior of four artificial cervical disks by determining the external (range of motion) and internal (facet force and intradiscal pressure) responses following cervical disc arthroplasty (CDA) and to elucidate any device design effects on cervical biomechanics. Overview of Literature: Despite CDA’s increasing popularity most studies compare the CDA procedure with anterior cervical discectomy and fusion. There is little comparative evaluation of different artificial disks and, therefore, little understanding of how varying disk designs may influence spinal biomechanics. Methods: A validated C2–T1 finite element model was subjected to flexion-extension. CDAs were simulated at the C5–C6 level with the Secure-C, Mobi-C, Prestige LP, and Prodisc C prosthetic disks. We used a hybrid loading protocol to apply sagittal moments. Normalized motions at the index and adjacent levels, and intradiscal pressures and facet column loads were also obtained. Results: The ranges of motion at the index level increased after CDA. The Mobi-C prosthesis demonstrated the highest amount of flexion, followed by the Secure-C, Prestige LP, and Prodisc C. The Secure-C demonstrated the highest amount of extension, followed by the Mobi-C, Prodisc C, and Prestige LP. The motion decreased at the rostral and caudal adjacent levels. Facet forces increased at the index level and decreased at the rostral and caudal adjacent levels following CDA. Intradiscal pressures decreased at the adjacent levels for the Mobi-C, Secure-C, and Prodisc C. Conversely, the use of the Prestige LP increased intradiscal pressure at both adjacent levels. Conclusions: While all artificial disks were useful in restoring the index level motion, the Secure-C and Mobi-C translating abilities allowed for lower intradiscal pressures at the adjacent segments and may be the driving mechanism for minimizing adjacent segment degenerative arthritic changes. The facet joint integrity should also be considered in the clinical decision-making process for CDA selection.
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Are Lumbar Fusion Guidelines Followed? A Survey of North American Spine Surgeons
Thiago S. Montenegro,Christopher Elia,Kevin Hines,Zorica Buser,Jefferson Wilson,Zoher Ghogawala,Shekar N. Kurpad,Daniel M. Sciubba,James S. Harrop 대한척추신경외과학회 2021 Neurospine Vol.18 No.2
Objective: To evaluate the use of guidelines for lumbar spine fusions among spine surgeons in North America. Methods: An anonymous survey was electronically sent to all AO Spine North America members. Survey respondents were asked to indicate their opinion surrounding the suitability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accordance with North America Spine Society (NASS) guidelines for lumbar fusion were considered NASS-concordant answers. Respondents were considered to have a NASS-concordant approach if ≥70% (13 of 18) of their answers were NASS-concordant answers. Comparisons were performed using bivariable statistics. Results: A total of 105 responses were entered with complete data available on 70. Sixty percent of the respondents (n=42) were considered compliant with NASS guidelines. NASS-discordant responses did not differ between surgeons who stated that they include the NASS guidelines in their decision-making algorithm (5.10±1.96) and those that did not (4.68± 2.09) (p=0.395). The greatest number of NASS-discordant answers in the United States. was in the South (5.75±2.09), with the lowest number in the Northeast (3.84±1.70) (p< 0.01). For 5 survey items, rates of NASS-discordant answers were ≥40%, with the greatest number of NASS-discordant responses observed in relation to indications for fusion in spinal deformity (80%). Spine surgeons utilizing a NASS-concordant approach had a significant lower number of NASS-discordant answers for synovial cysts (p=0.03), axial low back pain (p<0.01), adjacent level disease (p<0.01), recurrent stenosis (p<0.01), recurrent disc herniation (p=0.01), and foraminal stenosis (p<0.01). Conclusion: This study serves an important role in clarifying the rates of uptake of clinical practice guidelines in spine surgery as well as to identify barriers to their implementation.
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