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      Dynamic Stabilization for Challenging Lumbar Degenerative Diseases of the Spine: A Review of the Literature

      review-article
      1 , 2 , *
      Advances in Orthopedics
      Hindawi Publishing Corporation

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          Abstract

          Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies.

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          Most cited references137

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          Clinical spinal instability and low back pain.

          Clinical instability is an important cause of low back pain. Although there is some controversy concerning its definition, it is most widely believed that the loss of normal pattern of spinal motion causes pain and/or neurologic dysfunction. The stabilizing system of the spine may be divided into three subsystems: (1) the spinal column; (2) the spinal muscles; and (3) the neural control unit. A large number of biomechanical studies of the spinal column have provided insight into the role of the various components of the spinal column in providing spinal stability. The neutral zone was found to be a more sensitive parameter than the range of motion in documenting the effects of mechanical destabilization of the spine caused by injury and restabilization of the spine by osteophyle formation, fusion or muscle stabilization. Clinical studies indicate that the application of an external fixator to the painful segment of the spine can significantly reduce the pain. Results of an in vitro simulation of the study found that it was most probably the decrease in the neutral zone, which was responsible for pain reduction. A hypothesis relating the neutral zone to pain has been presented. The spinal muscles provide significant stability to the spine as shown by both in vitro experiments and mathematical models. Concerning the role of neuromuscular control system, increased body sway has been found in patients with low back pain, indicating a less efficient muscle control system with decreased ability to provide the needed spinal stability.
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            Rupture of the Intervertebral Disc with Involvement of the Spinal Canal

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              Morbidity at Bone Graft Donor Sites

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                Author and article information

                Journal
                Adv Orthop
                Adv Orthop
                AOP
                Advances in Orthopedics
                Hindawi Publishing Corporation
                2090-3464
                2090-3472
                2013
                15 April 2013
                : 2013
                : 753470
                Affiliations
                1Department of Neurosurgery, School of Medicine, Istanbul Medeniyet University, 34730 Istanbul, Turkey
                2Department of Neurosurgery, School of Medicine, Koc University, 34365 Istanbul, Turkey
                Author notes

                Academic Editor: Mehdi Sasani

                Article
                10.1155/2013/753470
                3639681
                23662211
                59fb7666-93e0-4928-b28e-f618bad2eece
                Copyright © 2013 T. Kaner and A. F. Ozer.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 November 2012
                : 7 March 2013
                Categories
                Review Article

                Orthopedics
                Orthopedics

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