ABSTRACT
OBJECTIVES: The authors evaluated the reliability in obtaining a posterolateral spinal arthrodesis (PSA) with autologous bone graft. SUMMARY OF BACKGROUND DATA: Posterolateral spinal arthrodesis using autogenous cancellous bone graft is the most simple and efficient technique to get a spinal graft. No extensive biomechanical study of PSA is available. Thus, an experimental model of PSA is needed. METHODS: Eleven sheep underwent lumbar autologous bone grafts and Cotrel-Dubousset instrumentations, and four sheep were used as controls. Sacrifice and biomechanical evaluation of the lumbar spines were performed after 1 year. RESULTS: All grafts appeared continuous. A large decrease of flexibility (in rotation and in translation) was found in grafted spines in every direction. Failure in extension occurred at a mean value of 35.26 +/- 3.71 Nm. CONCLUSION: A constant and homogenous PSA appears to be obtained in sheep under conditions close to the human surgery.
Subject(s)
Bone Transplantation , Spinal Fusion/methods , Animals , Biomechanical Phenomena , Sheep , Spinal Fractures/surgery , Transplantation, AutologousABSTRACT
OBJECTIVES: The authors evaluated two bone substitutes in a posterolateral spinal arthrodesis (PSA) model in sheep: coral porites (99% calcium carbonate, Biocoral, Inoteb, France) and a biphasic ceramic (BCP) (65% hydroxyapatite and 35% B tricalcium phosphate, Triosite, Zimmer International). SUMMARY OF BACKGROUND DATA: Bone substitutes would be of great interest for PSA. Previous trials began with two kinds of biomaterials: natural coralline calcium carbonate, and phosphate calcium ceramic. METHODS: A lumbar PSA was performed in 11 sheep (coral group) and in 9 sheep (BCP group). Sacrifice and biomechanical tests were performed after 1 year. RESULTS: A large decrease of flexibility in all directions was obtained with both coral PSA and BCP PSA similarly to autologous graft. No nonfusion case was observed. CONCLUSION: In conditions close to the human surgery, a PSA can be obtained using either coral porites or BCP as bone substitutes.
Subject(s)
Arthrodesis/methods , Bone Substitutes , Calcium Carbonate , Ceramics , Spinal Fusion/methods , Animals , Biomechanical Phenomena , Materials Testing , Pliability , SheepABSTRACT
A small percentage of low back pain sufferers are resistant to the various types of treatment tried and the problem becomes chronic. It is for this severely incapacitated group, threatened by socio-occupational misfortune, that we created: the School for Chronic Low Back Pain Sufferers. One hundred and five patients in whom treatment had failed were included after insurance programmes had agreed to provide cover. The system is of a multidisciplinary nature with hospitalisation for 5 days. The fate of 93 of these patients is known with a mean follow-up of 1 year. Quantified initial evaluation on an obstacle course confirmed that even severe low back pain sufferers were unaware of the basic rules for protection of the spine (mean score of 14/50 on admission). Socio-occupational fate analysed on the basis of a questionnaire showed: a high satisfaction index (90%) regardless of the subsequent outcome, and a correlation between follow-up time after the programme and the decrease in painful attacks (p less than 0.03, r = 0.23) or consumption of medications (p less than 0.01, r = 0.29). The relative simplicity of the system proposed, the situation of therapeutic impasse in which the patients for whom it is intended find themselves, the short time required and the results obtained confirm the importance of this multidisciplinary management approach being able to best envisage the possibilities of rehabilitation of the chronic low back pain sufferer, in particular when there are repeated periods off work.