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While most spinal conditions do not require surgery, there are
times when surgery is necessary. Implant systems utilizing specially
designed spinal instrumentation are often used in these surgical
procedures.The implants are used to facilitate fusion, correct
deformities, and stabilize and strengthen the spine.
Conditions that often require instrumented fusion surgery include
slippage of the spine (spondylolisthesis), chronic degenerative
disc disease, traumatic fracture, and other forms of spinal instability
including scoliosis.
Implants: What are they?
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Most spinal implants are made of metals such as titanium,
titanium-alloy or stainless steel; some are made of non-metallic
compounds. They come in many different shapes and sizes
to accommodate different patients of all ages.
Scientists and surgeons around the world are constantly
working to develop and refine implants to improve patient
outcomes. In recent years there have been huge advances,
including the advent of hook, rod and screw systems that
enable surgeons to 3-dimensionaly correct spinal deformities;
the development of special plates and cages that help promote
spinal fusion; and the creation of small but strong implants
for children.
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Spinal implants can be summarized into several groups:
- Rods - one of the original implants used in
the spine. Rods are used, along with hooks and screws,
to immobilize involved spinal levels, and to contour the
spine into correct alignment. The rods are strong, yet
have some flexibility so that the surgeon can shape the
rod to match the contours of the patient's spine
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- Pedicle Screws - these specially designed screws
are carefully implanted into the pedicles of the spinal
vertebrae. They have traditionally been used in the lumbar
spine, and with recent advances in technology and technique,
surgeons are now using them in the thoracic spine too.
Screws provide strong "anchorage" points to which rods
can be attached. Rods can then be contoured to correct
deformities, and to facilitate fusion.
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- Hooks - used with rods and other implants to
anchor them to vertebrae.
- Plates - often used in the cervical spine. Plates
are manufactured to conform to the contour of the spine
and are held in place by screws set into adjacent vertebrae.
When the plate requires adjustment, a contouring tool
is used to customize the fit to the patient's anatomy.
- Cages - often called "interbody" cages because
they are most often placed between two vertebrae. Cages
are small hollow devices with perforated walls. Bone graft
or BMP is often packed into the cage to promote bone growth
between the adjacent vertebrae. Cages are used to restore
lost disc height resulting from a collapsed disc and to
relieve pressure on nerve roots.
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What CCSI uses
At CCSI, we choose implants very carefully to ensure they are
the best choice for the specific patient. For example, for patients
who are slim, we choose "low profile" implants so they are not
visible through the skin. We also use "low volume" implants because
they reduce muscle irritation and cause less post-operative pain.
In addition, we tend to use titanium implants as they are strong,
light and, unlike stainless steel implants, can be used with MRIs.
When suitable, we use radiolucent materials such as carbon fiber
cages. Carbon-fiber implants cannot be seen on a scan but allow
us to see if bone is forming and fusion is taking place.
Finally, as part of our commitment to patient safety and the
development of new technologies, CCSI is very involved in the
early use and development of bio-resorbable implants. Like other
implants, these are used to facilitate fusion. However, after
a year or so (when fusion should be complete) most implants are
no longer needed but are left in the body. Bio-resorbable implants
are designed to break down when they come in to contact with water
(such as in the body). In 1 year, most decrease in size by 50%
and are completely gone in 2-3 years. Thus the implant is present
in the body while it is needed to promote fusion, and then it
simply "fades-away" over a 12-36 month period.
Conclusion
In the past 20 years, there have been major breakthroughs in
the development of spinal implants. The result is better treatment
for patients. At CCSI we utilize the implants that are most suitable
for each individual patient. We are also heavily involved in the
research and development of new implants that will carry the field
forward in the coming years.
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