Dr. Bahaa Ali Kornah is a professor of orthopedics at Al-Azhar University in Cairo, Egypt. The document discusses various surgical modalities for preserving spinal motion, including total disc replacement, nucleus replacement, interspinous spacer devices, pedicle screw stabilization devices, and facet replacement systems. It provides details on specific total disc replacement prosthesis designs, including requirements for an ideal design, patient selection criteria, and examples like the Charite and ProDisc implants. Maintaining or restoring spinal motion is the goal of these non-fusion, motion preservation surgeries.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
painful hip in adults active person either male or female. limitation in hip movement, In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Femoroacetabular impingement in young adults
Dr.sandeep agrawal agrasen hospital,gondia maharashtra
A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head
Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty
Pelvic osteotomy ,outerbridge classification
As an orthopedic surgeon at Aurora Advanced Healthcare Orthopaedics in Milwaukee, Wisconsin, Dr. Mark Wichman builds on his extensive experience in surgical reconstruction of the anterior cruciate ligament, or ACL. Dr. Mark Wichman contributed a section explaining the use of a particular soft tissue fastener in the ACL procedure to the surgical technique manual of Medshape Orthopaedics, a manufacturer of orthopedic devices in Atlanta, Georgia.
Update on ACL reconstruction, with information on current direction of demineralized bone matrix (DBM) use in bone tunnels and biocartilage on chondral lesions
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Femoroacetabular impingement in young adults
Dr.sandeep agrawal agrasen hospital,gondia maharashtra
A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head
Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty
Pelvic osteotomy ,outerbridge classification
As an orthopedic surgeon at Aurora Advanced Healthcare Orthopaedics in Milwaukee, Wisconsin, Dr. Mark Wichman builds on his extensive experience in surgical reconstruction of the anterior cruciate ligament, or ACL. Dr. Mark Wichman contributed a section explaining the use of a particular soft tissue fastener in the ACL procedure to the surgical technique manual of Medshape Orthopaedics, a manufacturer of orthopedic devices in Atlanta, Georgia.
Update on ACL reconstruction, with information on current direction of demineralized bone matrix (DBM) use in bone tunnels and biocartilage on chondral lesions
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Dynamic reconstruction of the degenerative functional spinal unit (FSU) is a rapidly growing field iη spinal surgery.
Procedures such as :
nucleus replacement,
posterior dynamic stabilization,
interspinal distraction
biological methods to regenerate the disk are being tested in experimental or clinical studies
This article of mine which came out in the Journal of Orthopaedic Case Reports has been converted into a small book entitled `Modified Posterior Approach to the Hip Joint' which should be available world wide and also listed on Flipart, Amazon,infibeam.
e-Book - Rockstand, Scribid, Kobo, Kindle, Google Play store.
Dr.K.Mohan Iyer,Bangalore,India
I delivered this talk to a group of hand and arm therapists. Find out more about hand and arm problems at http://www.noelhenley.com
Ozark Orthopaedic: Henley C Noel MD
3317 North Wimberly Drive, Fayetteville, AR 72703
(479) 521-2752
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΜΕ ΜΟΝΗ ΔΕΣΜΗ ΣΕ ΑΝΑΤΟΜΙΚΗ ΘΕΣΗ. ...STAVROS ALEVROGIANNIS
(Παρουσίαση σε Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, POZNAN 2011).
FREE HAND NOVEL ANATOMIC SINGLE BAND TECHNIQUE FOR ACLR
(X/O BUTTON,CONMED,LINVATEC,USA).PRELIMINARY RESULTS.
(POZNAN 2011)
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
clinical examination is an essential step in diagnosis and good management. every doctor knees to knee how to examine a patient. this including orthopedic doctor dermatologist physical medicine
a painful knee can be classified into arthritic and non-arthatic. Many doctor forget non-arthic knee pain. This non-arthritic pain affect many pat.. younger more affected than old pat.,
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
This session provides a comprehensive overview of the latest updates to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (commonly known as the Uniform Guidance) outlined in the 2 CFR 200.
With a focus on the 2024 revisions issued by the Office of Management and Budget (OMB), participants will gain insight into the key changes affecting federal grant recipients. The session will delve into critical regulatory updates, providing attendees with the knowledge and tools necessary to navigate and comply with the evolving landscape of federal grant management.
Learning Objectives:
- Understand the rationale behind the 2024 updates to the Uniform Guidance outlined in 2 CFR 200, and their implications for federal grant recipients.
- Identify the key changes and revisions introduced by the Office of Management and Budget (OMB) in the 2024 edition of 2 CFR 200.
- Gain proficiency in applying the updated regulations to ensure compliance with federal grant requirements and avoid potential audit findings.
- Develop strategies for effectively implementing the new guidelines within the grant management processes of their respective organizations, fostering efficiency and accountability in federal grant administration.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Presentation by Jared Jageler, David Adler, Noelia Duchovny, and Evan Herrnstadt, analysts in CBO’s Microeconomic Studies and Health Analysis Divisions, at the Association of Environmental and Resource Economists Summer Conference.
Donate to charity during this holiday seasonSERUDS INDIA
For people who have money and are philanthropic, there are infinite opportunities to gift a needy person or child a Merry Christmas. Even if you are living on a shoestring budget, you will be surprised at how much you can do.
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#charityforchildren, #donateforchildren, #donateclothesforchildren, #donatebooksforchildren, #donatetoysforchildren, #sponsorforchildren, #sponsorclothesforchildren, #sponsorbooksforchildren, #sponsortoysforchildren, #seruds, #kurnool
Understanding the Challenges of Street ChildrenSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
Transit-Oriented Development Study Working Group Meeting
Spine motion preservation
1. Dr. Bahaa Ali Kornah
Prof.. Of Orthopedic
Al-Azhar University
Cairo - Egypt
2. Dr. Bahaa Ali Kornah
Prof.. Of Orthopedic
Al-Azhar University
Cairo - Egypt
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
3. Introduction
Methods
Total disc replacement
Nucleus replacement
Interspinous spacer devices
Pedicle screw based stabilization devices
Total facet replacement system
Autologus disc chondrocyte transplantation
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
4. EACH VERTEBRA HAS THREE
FUNCTIONAL COMPONENTS:
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
5. The
verbral
body
• Weight bearing
• Compression side
The
neural
arch
• neural elements protection
• tension band side
Body
process
es
• Site of muscle and ligamentous attachment
• increase the efficiency of muscle action
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
6. functional spinal unit
A functional spinal
unit (FSU) (or motion
segment) is the smallest
physiological motion unit
of the spine to
exhibit biomechanical
characteristics similar to
those of the entire spine.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
7. functional spinal unit
-2 adjacent vertebrae.
-Intervertebral disc.
-The connecting ligaments.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
16. Treatment for Axial Backache Secondary to
Degenerative Disc Disease (DDD)
(Fritzell et al. 2002, 2001 Volvo Award)
FUSION
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
17. Spinal fusion is the gold
standard treatment of
patients with disabling
low back pain due to
degenerative disc disease
not responding to
conservative therapy.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
18. The Rational for Fusion in DDD
The relief of backache through acceleration of
the lumbar degenerative cascade to its end
stage
Ideally,
allowing adequate room for the neural
elements and
preserving the normal sagittal alignment
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
20. Problems regarding fusion surgery for axial
backache
Symptomatic accelerated degeneration of the
adjacent segments above or below the fused
levels for the young patient and even the
elder
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
21. Fusion procedures have -ve side effects
➢Abnormal segmental sagittal alignment+ Adjacent
segment degeneration
➢Increase intradiscal pressure
➢Hyper mobility above and below fused segment
➢ Superior segment facet joint violation,
➢Adjacent segment spondylarthrosis with consecutive
spinal canal stenosis
➢persisting pain from harvesting of the Autologus bone
graft
Causing
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
22. development of new clinical symptoms
that correspond to radiographic
changes adjacent to the level of a
previous spinal fusion.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
25. Problems regarding fusion surgery for axial
backache: The most critical one
The persistent dissociation between radiographic
success of fusion and clinical outcome (pain and
return):
95% radiographic fusion vs.
60 to 80% of clinical success
Prime motivator to look for alternative
means
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
26. FUSION IS GOOD,
BUT MOTION IS BETTER.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
28. This new category of Thoracolumbar spinal
surgery focuses on the concept of
Maintaining or
Restoring Intervertebral motion in a
controlled fashion, whether by restricting the
extremes of spinal movement or by
dampening the kinetic energy involved in
motion.
The goal of these surgeries is to mimic the
behavior of the healthy spinal column.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
29. 1. Total disc replacement (TDR)
2. Nucleus replacement
3. -Interspinous spacer devices
4. Pedicle screw based stabilization devices
5. Total facet replacement system
6. Autologus disc chondrocyte transplantation
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
30. Most of these Devices are under
trial and several controlled
prospective studies are ongoing
to assess the effectiveness of
these devices.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
31. Surgical modalities preserving spinal
motion include,
-
Total disc replacement
-Nucleus replacement
-Interspinous spacer devices
-Pedicle screw based stabilization devices
-Total facet replacement system
-Autologus disc chondrocyte
transplantation
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
33. Two of the most important fundamental
objectives of replacement arthroplasty
1. Pain relief
2. Restoration of
the joint function
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
34. Ideal Design for Total Disc Prosthesis
1) providing proper ROM (quantity)
2) providing proper patterns of motion (quality)
3) providing proper stiffness in motion
4) postoperative stability, immediately and long
term
5) providing shock absorption property
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
35. Total Disc Prosthesis
Prosthesis for motion:
Unconstrained; semi-constrained
Prosthesis for motion & shock absorption:
Fluid-filled cavity;
springs;
fiber-reinforced composite; and
elsatomeric polymer (AcroFlex Disc)
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
36. Selection criteria
DDD resulting in pain
arising from the disc that
has not been adequately
relieved with non-operative
care.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
37. Exclusion criteria include
-spondylolisthesis
-Osteoporosis
- vertebral body fracture
- allergy to the materials in the device
-spinal tumor
-spinal infection
-morbid obesity
-significant changes of the facet joints
- pregnancy or child-bearing period
-chronic steroid use
- autoimmune problems.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
38. „Constrained“ vs. „Unconstrained“
„unconstrained“replicating the anatomical (healthy) situation.
The prosthesis
allows only limited
axial rotation.
Constrained
Semi-
constrained
Unconstrained
The prosthesis allows
full axial rotation. No
translation due to ball
and socket joint.
Translation
possible. No
restriction in axial
rotation. bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
39. Total Disc Prosthesis for Motion
Clinical data:
Successful pain relief, functional recovery and
shorter recovery period comparable to that of
spinal fusion
Griffith, et al 1994
Cinotti, et al 1996
Guyer, et al 2003
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
42. The SB Charite´ III—Disc (Depuy Spine; Raynham,
MA, USA)
This artificial disc is the most widely used
implant currently available in the world
The device has a bi-convex ultrahigh molecular
weight polyethylene (UHMWPE) spacer that acts
as a mobile core.
The two end-plates are cobalt chrome
molybdenum alloy (Co-Cr Mo alloy). There are
ventral and dorsal teeth on the device and the
latest version of the device has titanium as well as
hydroxyapatite coating.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
44. The ProDisc (Synthes Inc., Paoli,
PA)
It is constructed of superior
and inferior titanium endplates
with a polyethylene articulating
bearing. The endplates have a
plasmapore titanium coating.
The prosthesis was manufactured
in two sizes, three heights and
two lordosis angles to reconstruct
the individual patient anatomybahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
47. The Maverick Disc (Medtronic,
Minneapolis, MN, USA)
This Design includes the use of
a highly polished Co-Cr-Mo ball-and-
socket (metal-on-metal design).
The center of rotation is fixed and
located in the posterior third of the disc
space.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
50. The Flexicore Disc (Stryker, Kalamazoo,
MA, USA)
FlexiCore is also a Co-Cr-Mo highly
polished ball-and-socket metal-on-metal
prosthesis.
The endplates are dome shaped and thus
adapt to the concavity of the vertebral
endplates.
The surfaces of the endplates are titanium
plasma-sprayed to promote bone on-growth
fixation. There are fixation spikes on both
upper and lower base plates.bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
52. The Mobidisc (LDR medical;
Troyes, France)
This disc consists of
three pieces, two flat metal
endplates with porous
coated surfaces and a keel
to provide immediate and
long-term stability
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
54. Activ L (Aesculap AG
Tuttlingen, Germany)
This implant has a sliding
nucleus, which is anchored in
the lower endplate.
The endplates are available with
spikes and/or keels to allow for
different types of primary fixation.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
56. Kineflex (Spinal Motion, South
Africa)
This is another metal-on-metal
semi-constrained disc
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
57. Total Disc Prosthesis for motion & shock
absorption
Lack of shock absorption can produce
abnormal stress concentration on
surrounding structures within the
segment and at the adjacent segment.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
58. Total Disc Prosthesis for motion & shock
absorption
Fluid-filled cavity: with metal or polymer
encasement
Springs: with hinge joint or polymer bag
Fiber-reinforced composite structure
Elastomeric polymer disc prosthesis: silicone,
rubber and
polyurethane sandwitched
between metal end plates
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
59. Known Complications for Total Disc Prosthesis
(Charite III)
Subsidence (3-9%)
Dislocation (2-9%)
A large portion of the unsatisfactory results were
attributed to the surgical learning curve
and improper patient selection.bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
62. Some designs include hydro gels
developed by Bao et al and Ray. The Ray
device is a pair of interdiscal, double-
woven prosthetic nuclei inserted from a
posterior approach .
The devices will swell after insertion
because of hydroscopic gel (hyaluronic
acid) held within a semipermeable
membrane lying inside each woven
jacket.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
63. Disc Prosthesis
• Bulky
• Complicated design
• Hard to mimic all
functions
• Fixed to vertebra
• More invasive and only
for anterior approach
• More difficult to
implant and revise –
more risk
• Should be only for late
stage DDD
Nucleus Prosthesis
• Small dimension
• Simple design
• Easy to mimic all
functions
• Not fixed to vertebra
• Less invasive and can be
used for all approaches
• Easy implantation,
revision – less risk
• Early to Moderate DDD
Nucleus Vs Total Disc
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
65. Prosthetic disc nucleus
pellet and encasing
polyethylene jacket.
Shown is a wedge-shaped
anterior component
designed to fit the anterior
portion of the vacated disc
nucleus.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
67. PDN-SOLO device in
dehydrated and hydrated
states. The PDN-SOLO device
is designed to swell both in
height and in width within the
disc space. The porous
polyethylene weave allows
fluid to pass into the
hydrophilic core, which causes
the device to expand vertically
and horizontally. This process
maximizes the device’s
footprint on the vertebral end-
plates.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
68. Nuclear replacements may be placed
At the time of discectomy for sciatica, or
Poster laterally as a treatment for painful
early stage disc degeneration.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
69. Advantages
Small annular incision
Implant conformity
Challenges
Potentially leakable
Implant property consistency
DASCOR –Disc Dynamics
In situ cured PU with PU balloon
Preclinical study
CE marked
Early clinical
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
70. Advantages
Same as preformed hydrogel
Ability to implant through small annular incision
Challenges
Same as preformed hydrogel
Leakage through annular defect during injection
Nucore by Spine Wave
Silk protein
Early OUS clinical
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
73. :
Interspinous Spacer
Devices
By keeping the spine
in a rather flexed position,
the interspinous devices
1. increase the total canal
and foraminal size,
2. decompressing the quada
equina
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
75. Selection criteria
-Lumbar spinal stenosis at one or
two levels
-Degenerative disc disease at a
segment adjacent to fusion
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
77. The Coflex, ExtendSure, and CoRoent Devices:
It is a U-shaped metallic device that is inserted
between the spinous processes. As with other
interspinous devices, this one is designed to
increase the cross-sectional diameter of the stenotic
canal in patients suffering from neurogenic
claudication. ExtendSure and CoRoent are other
interspinous dynamic stabilization devices that were
recently launched, in 2005 and 2006, respectively.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
79. Lumbar spinal stenosis failed to respond to
conservative treatment(one or two levels
between L1 andL4)
Degenerative disc disease with arthritic facet
joint and chronic low back pain
Voluminous herniated disc
Degenerative spondylolithesis grade1
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
80. Severe osteoporosis
Previous surgery that altered the morphology
of the spine
L5-S1 as the spinous process of S1 is deficient
Spine deformity(Scoliosis or kyphosis)
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
82. The Wallis System:
In 1986 the first interspinous device.
The device's original design was a block
(titanium or Peek) that was inserted
between adjacent processes and held in
place with a flat Dacron cord or ribbon
wrapped around the spinous process
above and below the block. T
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
85. The X STOP Device:
This device is an oval titanium metal spacer . This
implant is designed to fit between two adjacent lumbar
spinous processes. The X STOP device is placed
between the spinous processes while the patient is in a
slight flexion position. The supraspinous ligament is
carefully protected. Although the implant is not rigidly
attached to the osseous anatomy, it is restricted from
migrating posteriorly by the supraspinous ligament,
anteriorly by the lamina, cranially and caudally by the
spinous processes, and laterally by the device's wings
on each side.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
88. The DIAM System:
The DIAM Spinal Stabilization System is a soft
interspinous spacer .
The core is made of silicone, which is covered by a
polyethylene coating.
The surgical technique consists of identifying the
interspinous space, removing the remnants of the
interspinous ligament down to the ligamentum
flavum, and using a distracter of the spinous processes
to facilitate the insertion of the device. It is secured in
place with two laces, one around the spinous process
above, and another around the one below.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
92. Pedicle Screw/Rod-Based
Stabilization Devices ((Posterior
dynamic stabilization))
By unloading the pressure on the
degenerated discs and facets, pedicle-
based dynamic devices have the
potential to reduce pain associated with
these anatomical structures.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
93. Motion Preservation Therapy in the Spine
Posterior dynamic stabization
1. Interspinous distraction devices
2. Interspinous ligament device
3. Pedicle based ligament devices
4. Pedicle based dynamic metallic device
•
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
95. For relief of chronic back pain in
DDD
For stabilization as well as motion
preservation with/without
decompression surgery
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
96. Indications
Controlled Motion in the Iatrogenically Destabilized
Spine
Protection of Degenerated Facet Joints and
Intervertebral Discs
In Combination With Anterior Motion Preservation
for 360° Circumferential Motion Segment
Reconstruction
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
98. The Graf System:
The Graf system is the only pedicle-based device with
polyester bands instead of rods.
It is composed of 5- to 7-mm titanium pedicle screws and
looped 8-mm braided polyester bands.
After the spine is exposed and pedicle screws inserted, the
bands are connected under applied compressive force
between the pedicle screws as a ligamentoplasty. The tension
and compression force used is determined by the length of
the bands.
The product was conceived to immobilize the lumbar
spine in lordosis; alter the load bearing on the annulus and
endplate; compress the posterior annulus, splint the motion
segment, allowing healing of damaged tissue to occur; and
relax over time, allowing some return to movement.
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EGYPT
101. The Dynesys System:
The Dynesys Spine System , like standard
frame devices, is fixed in place by using
standard pedicle screws made of a titanium
alloy . The whole system is stabilized by
polyester cords that connect the screw heads
through a hollow spacer and hold the screws
in place.
The stabilizing cords resist flexion
movements, and the spacers resist
compressive forces.
The Dynesys devices restabilize and realign
the segments in physiological position and
neutralize the excessive forces.
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EGYPT
106. The AccuFlex, PEEK, and Isobar
Rods:
Other semi rigid rods being used in
the US include the AccuFlex ,
PEEK rod, and Isobar rods .
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
107. the Isobar semi rigid rod system.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
108. SoftFlex™ system consists of 6-mm diameter
titanium rods, with spiral cuts, which makes
it flexible.
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EGYPT
109. Photograph of a spine model showing the proper
placement of the AccuFlex construct at the L5– S1
position.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
110. Photograph of a spine model showing the proper
placement of the AccuFlex construct at the L5– S1
position.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
111. Photograph of a spine model showing the proper
placement of the AccuFlex construct at the L5– S1
position.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
116. Total Facet Replacement Systems
Total facet replacement is an
emerging new technology designed to
completely restore facet joints
functionally.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
117. Indications
Moderate to severe lumbar
spinal stenosis, with or
without spondylolisthesis
(up to grade 1) and with or
without facet hypertrophy.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
118. TOTAL FACET REPLACEMENT SYSTEMS
Anatomic Facet Replacement System (AFRS)
The implant is made from a super-alloy with highly
polished articulating surfaces. The backing of the
implant that interfaces with the bone is coated with
material to promote bony in-growth. The implant is
secured to the bone with conventional pedicle screws.
Separate implants are used for both the top and
bottom facets.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
125. Surrounding Boot
Avoids impingement of
soft tissues
Pedicle Screw Based Design
Standard surgical approach
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EGYPT
126. Total Posterior System, the TOPS
Implant:
composed of a titanium construct with an
interlocking PCU articulating core. The
design allows relative movement between
the titanium plates to enable axial rotation,
lateral bending, extension, and flexion.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
128. AUTOLOGUS DISC CHONDROCYTE
TRANSPLANTATION
Disc material removed during open microdiscectomy
was placed into sterile buffered saline.
Cells were transported immediately to the culturing
facility.
Transplantation was scheduled approximately 3
months following initial surgery.
Cells were not transplanted until intradiscal pressure
could be assured through a pressure volume test.
A pressure of 300mmHg was kept over 2 minutes to
demonstrate complete healing of the annulus. Central
positioning in the center of the nucleus was
ascertained using fluoroscopy prior to transplanting
cells. Patients remained strictly supine for 12 hours
following transplantation, after which they were
mobilized and an orthosis was provided for 3 weeks.
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT
130. Advantages:
Elimination of the need for bone graft
Reduction in surgical morbidity
RCT of TDR vs. 360º fusion (Zigler et al. 2003)
Elimination of pseudoarthrosis
One of the most significant advantages Reduction of
adjacent level degeneration
The most significant potential advantage motion
preservation
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EGYPT
131. Potential Disadvantages:
“New technology brings the possibility of
new modes of failure”
Mechanical failure, dissociation, migration
Subsidence
Same level degeneration
bahaa Ali kornah-Al.Azhar Un.-Cairo-
EGYPT