Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been pro...Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management:(1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and(2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.展开更多
Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anter...Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anterior cervical fusion provides excellent clinical results, it has been implicated in abnormal kinematic strain on adjacent disc level resulting in symptomatic adjacent segment disease. Anterior cervical disc replacement (ACDR) is an alternative procedure to anterior cervical discectomy and fusion. The aims of cervical disc replacement were to preserve the motion at the index level and to protect the adjacent levels from accelerated symptomatic degeneration. The aim of this systematic review was to evaluate the outcomes of cervical disc replacement published in MEDLINE indexed literature. A literature search was carried out in medical electronic database MEDLINE. Keywords used for the search were Cervical vertebrae, Cervical spine, Neck, Intervertebral disc, Total disc replacement, Arthroplasty, Replacement, Treatment outcome. Two authors reviewed titles and abstracts of all two hundred and thirty six hits. The articles that satisfied the inclusion criteria were critically appraised while remaining articles were discarded. Anterior cervical disc replacement is a relatively new technology in spinal surgery. There are several short and intermediate term follow-up studies to prove the safety and efficacy of ACDR with satisfactory clinical and radiological outcomes. More intermediate to long-term follow-up studies are needed to prove the safety and efficacy of ACDR.展开更多
文摘Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management:(1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and(2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.
文摘Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anterior cervical fusion provides excellent clinical results, it has been implicated in abnormal kinematic strain on adjacent disc level resulting in symptomatic adjacent segment disease. Anterior cervical disc replacement (ACDR) is an alternative procedure to anterior cervical discectomy and fusion. The aims of cervical disc replacement were to preserve the motion at the index level and to protect the adjacent levels from accelerated symptomatic degeneration. The aim of this systematic review was to evaluate the outcomes of cervical disc replacement published in MEDLINE indexed literature. A literature search was carried out in medical electronic database MEDLINE. Keywords used for the search were Cervical vertebrae, Cervical spine, Neck, Intervertebral disc, Total disc replacement, Arthroplasty, Replacement, Treatment outcome. Two authors reviewed titles and abstracts of all two hundred and thirty six hits. The articles that satisfied the inclusion criteria were critically appraised while remaining articles were discarded. Anterior cervical disc replacement is a relatively new technology in spinal surgery. There are several short and intermediate term follow-up studies to prove the safety and efficacy of ACDR with satisfactory clinical and radiological outcomes. More intermediate to long-term follow-up studies are needed to prove the safety and efficacy of ACDR.
