Spinal fusion is one of the most common clinical indications for bone grafting. However, synthetic bone substitutes are needed to ameliorate limited availability, donor site morbidity, and potential ...disease transmission concerns associated with autograft and allograft. One new synthetic bone substitute, Vitoss (Orthovita, Malvern, Pa), is an ultraporous formulation of beta-tricalcium phosphate (beta-TCP). This study examines 50 patients who received ultraporous beta-TCP bone void filler as an adjunct to autogenous bone graft while undergoing spinal fusion procedures. All patients underwent decompressive laminectomy with bilateral posterolateral intertransverse fusion (PLITF) using bone graft mixed with ultraporous beta-TCP, with and without instrumentation. Some patients also underwent posterior lumbar interbody fusion (PLIF) using cages and bone graft. Thirty-two patients were studied for at least 5-7 months postoperatively. Of these patients, 100% demonstrated good consolidation on follow-up radiographs. The use of iliac crest bone graft (ICBG) was avoided entirely in 7 (14%) of the 50 patients, and 30% less ICBG volume was required on average in others. Only 3 patients (7%) had donor site-associated pain. Controlled studies are being conducted to support the clinical impression that ultraporous beta-TCP used as a bone void filler in spinal arthrodesis facilitates bone healing at both the spinal and donor operative sites, and contributes to less overall morbidity.
Doctors' incomes are decreasing. There is a decrease in reimbursements and an increase in overhead costs. Increasing numbers of doctors are becoming hospital employees. As a result, doctors are ...looking for alternative sources of income. One area that is currently available for most physicians is to become expert witnesses on behalf of plaintiffs or defendants in lawsuits. This article will review what is involved in serving as an expert witness and how to market yourself to attorneys who are in need of expert witnesses.
This is a retrospective study of 67 patients, seen during a 4-year period, with cervical pathology requiring surgical correction. The purpose of this study was to evaluate the usefulness of a new ...physical finding (dynamic Hoffmann's sign) in diagnosing early cervical myelopathy or in suggesting a narrow cervical canal clinically. Hoffman's sign was checked with the head in neutral (static) and during multiple active full flexion to extension as tolerated by the patient (dynamic). Forty patients had negative Hoffman's signs, 20 had positive static Hoffman's signs, and 7 had positive dynamic Hoffman's signs. Canal measurements were made on eight randomly selected negative patients on both plain films and myelographic studies, and on the seven positive patients. A positive dynamic Hoffmann's sign was consistent with a narrow sagittal diameter of the cervical canal, and aided clinically in making the diagnosis of early cervical spondylotic myelopathy or congenital cervical narrowing.
