By Robert Gunzburg, H. Michael Mayer, Marek Szpalski, Max Aebi
Joint substitute is a logical step within the therapy of serious joint pathologies with irreversible lesions resisting conservative treatment. on the spinal point, arthrodesis turned, very early, the most beneficial of therapy for critical intervertebral disc pathologies. the following logical step was once to ascertain practical substitute, and this step used to be taken as early as 1956, while the 1st intervertebral implant used to be defined. in spite of the fact that, it took many extra years and an outstanding number of proposed implant designs ahead of scientific functions might be attempted.
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Fractures of the tibial pilon (plafond) characterize the most invalidating articular lesions. This quantity describes the anatomic and radiological class of those fractures and discusses modern remedies. For tibial pilon fractures in adults, the authors illustrate the excellence among closed lesions and lesions related to tender tissue publicity and trauma, and describe the various concepts.
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Extra resources for Arthroplasty of the Spine
Rachis 9:145-152 17. Ito S, Yamada Y, Tsuboi S (1990) An observation of ruptured annulus fibrosis in lumbar discs. J Spinal Disord 4: 462--466 18. Korge A, Nydegger Th, Polard JL, Mayer HM, Husson JL (2002) A spiral implant as nucleus prosthesis in the lumbar spine. 1007/s00586-002-0444-4 19. Kozak JA, Heilman AE, O'Brien JP (1994) Anterior lumbar fusion options. Clin Orthop 300:45-51 29 20. Larsen JM, Rimoldi RL, Capen DA, et al (1996) Assessment of pseudoarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, CT scanning, and bone scintigraphy with operative findings.
However, spinal fusion in degenerative disc disease without signs of instability or disturbed curvature, though performed quite frequently, is not generally accepted [13, 14, 19, 24]. In most cases, the indication is based on unsuccessful conservative therapy, and the lack of reasonable therapeutic alternatives. This lack of alternatives often leads surgeons to accept potential risks, side-effects and complications to help patients get rid of their symp- 24 toms [10,20,36]. However, the results seem to not always justify these decisions.
The nucleus is located between, and articulates with, shaped titanium plates (shells) that include convex porous ingrowth surfaces, to allow bony fixation to the adjacent vertebral endplates. The design provides for a normal range of motion (ROM) in flexion/extension, lateral bending, rotation and translation, as well as coupled motions. While prosthesis motion is unconstrained through the normal ROM, special geometric features provide soft limits to this range. Additionally, a unique flexible membrane surrounds the interior articulating shell surfaces, to separate the internal structures of the device from the external in vivo environment, and to contain a lubricant.
Arthroplasty of the Spine by Robert Gunzburg, H. Michael Mayer, Marek Szpalski, Max Aebi