- 1. Is the use of bone substitutes such as BMP (bone morphogenetic protein) safe and
effective in lumbosacral arthrodesis?
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It is safe due to lack of complications.
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Complications include osteolysis and heterotopic ossification.
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The routine use is recommended in spondylolisthesis.
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Clinical results with iliac grafts are superior.
- 2. Bone substitutes are equal or superior to autografts in this situation?
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The removal of autologous bone graft from the iliac bone is radiologically superior.
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Bone substitutes are contraindicated in this clinical situation.
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The association of local bone graft (from the posterior vertebral elements) and beta-tricalcium phosphate is a therapeutic option.
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The removal of autologous bone graft from the iliac bone is clinically superior.
- 3. What is the most appropriate diagnostic study in this clinical context?
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In the presence of symptomatic lumbar stenosis, the most sensitive and specific radiologic examination is computed tomography (CT).
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Plain radiographs in the standing position does not determine the diagnosis.
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Magnetic Resonance Imaging (MRI) is more sensitive and specific in identifying the narrowing of the spinal canal.
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The most appropriate diagnostic test in this situation is plain radiography.
- 4. Is it necessary to refer the patient to arthrodesis with use of rigid pedicle
screws (non-dynamic)?
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Instrumentation does not increase fusion rate.
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Instrumented fusion produces less progression and improved walking ability.
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A side effect of fusion is increased radicular pain.
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There is subjective improvement independent of solid fusion.
- 5. How long should conservative treatment (non-surgical) be maintained?
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In treatment failure after 1 year of therapy.
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Medical and surgical treatments have similar results, differing in required time.
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After 12 weeks of failure in conservative treatment.
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Spondylolisthesis is an absolute indication for surgical treatment.
Publication Dates
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Publication in this collection
Nov-Dec 2014