Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up.

Disc prosthesis is the new treatment for degenerative disc disease in the lumbar spine. Key to assessing the interest in this new motion technique is evaluating the results in terms of functional and radiologic outcomes. This prospective study reports the outcome of 64 Maverick devices implanted between January 2002 and November 2003. The degree of improvement was equivalent to that obtained with anterior fusion cages using the mini-invasive technique. Radiographic follow-up in this series showed a degree of mobility close to normal. The technique is safe because the intra- and postoperative complication rate is low. The Oswestry score improved for 75% of patients. This improvement is significantly correlated with facet arthrosis and muscle fatty degeneration.

The effect of single-level, total disc arthroplasty on sagittal balance parameters: a prospective study.

A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis. Clinically, postfusion pain has been shown to be significantly related to a decreased ST, increased PT, and decreased lumbar lordosis, independent of other factors such as pseudoarthrosis. To our knowledge, the influence of total disc replacement on spinal sagittal balance has not yet been reported in the literature. This is a prospective study of 35 patients who received a single level disc replacement using the Maverick Total Disc Arthroplasty system (Medtronic Sofamor Danek, Memphis, Tennessee) by a single surgeon at one institution from March 2002 to September 2003. The preoperative and postoperative radiographic evaluation included standing anteroposterior and lateral full spine films that included the femoral heads. The parameters studied were ST, PT, global and segmental lordosis, and global kyphosis. The average age of the 35 patients studied was 44.3 years (range 35-57). There were 18 females and 17 males. The disc arthroplasty was performed at the L4-L5 level in 19 patients and at the L5-S1 level in 16 patients. The average follow-up was 14 months (range 6-22 months). The preoperative values of global lordosis, ST, and PT were 51.5 degrees , 37.8 degrees , 16.9 degrees and, at last follow-up, they were 51.4 degrees , 37.4 degrees , and 17.5 degrees , respectively. These changes were not significantly different. When the groups were separated according to the level operated, there was still no statistical difference with regard to the overall lordosis, ST, PT or kyphosis from pre- to postoperative period or when the two groups were compared with each other. The level above the prosthesis has always significantly less lordosis. In the present study with use of a motion-preserving Maverick prosthesis, it appears that the patient is able to maintain the preoperative sagittal balance. The prosthesis has enough freedom of motion to allow the patient to maintain the natural sagittal and spinopelvic balance needed to prevent potential undue stress on the muscles and the sacroiliac joint. Although the number of patients is small, this is the first study to our knowledge that evaluates the sagittal balance after motion-preserving total disc arthroplasty.

Fractionation of gliadin hydrolysates in water-ethanol by ultrafiltration with modified or unmodified membranes.

Ultrafiltration was applied to the fractionation of neutral vs. charged peptides of similar size. The peptides, produced from gliadins, a major fraction of wheat storage proteins, were obtained by limited hydrolysis with alpha-chymotrypsin in water-ethanol 80/20 (v/v). Peptides, according to their elution by RP-HPLC, were quasineutral (repetitive peptides) irrespective of pH, or positively charged (nonrepetitive peptides) at pH below 5. The transmission through the membranes of the nonrepetitive peptides was less (until sevenfold) than that of the repetitive ones, because of the role of electrostatic repulsion involved in the retention of charged solutes. The difference of transmission was more efficient at acidic pH (3) and low ionic strength with inorganic membranes and in a wider range of pH and ionic strength with membranes modified by coating of positively charged polymers (polyvinylimidazole PVI, polyethyleneimine PEI). A continuous diafiltration process using an inorganic membrane of low molecular cut-off permitted the selective enrichment of the retentate in nonrepetitive peptides (up to 80%) and of the permeate in repetitive peptides (up to 80%) from hydrolysate feed containing about 60/40% of repetitive and nonrepetitive peptides, respectively, with a diafiltration volume of 4.