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Ralph Bingham Cloward (September 24, 1908 — November 13, 2000) was an American neurosurgeon, best known for his innovations in spinal neurosurgery.Cloward is known for the development of the Posterior Lumbar Interbody Fusion and Anterior Cervical Discectomy and Fusion. [1]
Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. [1] This procedure can be performed at any level in the spine (cervical, thoracic, lumbar, or sacral) and prevents any movement between the fused vertebrae.
X-ray of interbody fusion cage in cervical vertebrae, Juliet system. X-ray of interbody fusion cage in L5S1 vertebrae. An interbody fusion cage (colloquially known as a "spine cage") is a prosthesis used in spinal fusion procedures to maintain foraminal height and decompression. They are cylindrical or square-shaped devices, and usually threaded.
The Charité, a mobile core device for use in the lumbar spine, was approved first, in 2004, but is no longer in use. prodisc, the longest continually used disc replacement device in the US, is a fixed core device manufactured by Centinel Spine and was approved in 2006 for the lumbar spine with a cervical device approved in 2007.
While rhBMPs are approved for specific applications (spinal lumbar fusions with an anterior approach and tibia nonunions), up to 85% of all BMP usage is off-label. [ 11 ] rhBMP-2 is used extensively in other lumbar spinal fusion techniques (e.g., using a posterior approach, anterior or posterior cervical fusions [ 11 ] ).
It involves fusion of two or more levels utilizing screws, rods, and an interbody graft. It has a theoretical advantage over instrumented posterolateral fusion (iPLF) in that it provides better support for the vertebra along with several potential neurological benefits, but as of 2011 evidence demonstrating actual improved clinical outcomes was ...
Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. [2] [3] There are reports of this therapy causing swelling of soft tissue which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract.
The number of vertebrae in a region can vary but overall the number remains the same. In a human spinal column, there are normally 33 vertebrae. [3] The upper 24 pre-sacral vertebrae are articulating and separated from each other by intervertebral discs, and the lower nine are fused in adults, five in the sacrum and four in the coccyx, or tailbone.