Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 1/2016

01-01-2016 | Original Article • LUMBAR - FUSION

Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study

Authors: Stéphane Litrico, Geoffrey Recanati, Antoine Gennari, Cédric Maillot, Mo Saffarini, Jean-Charles Le Huec

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2016

Login to get access

Abstract

Purpose

Single-use surgical instruments were recently introduced to improve OR efficiency and reduce infection risks. This study aimed to investigate clinical results 1 year after instrumented lumbar fusion, with the aid of single-use surgical instruments, with particular attention to surgical site infection and Oswestry Disability Index (ODI).

Method

This prospective bi-centric study included 21 men and 28 women, aged 61.6 ± 12.8 years, that underwent short instrumented lumbar fusion for degenerative disc disease, canal stenosis, or degenerative spondylolisthesis. All patients underwent posterior or transforaminal lumbar interbody fusion, using the SteriSpine™ PS Pedicle Screw System, available in multiple traceable sterile kits.

Results

Instrumented fusion was performed at one level in 31, two levels in 11, three levels in 5, and four levels in 2 patients. The mean follow-up was 16.4 ± 2.1 months, during which the ODI improved by 20 or more points in 28 patients (57 %), improved by less than 20 points in 17 patients (35 %), and remained unchanged or worsened in 4 patients (8 %). Only one infection (2 %) was observed in a 60-year-old man with previous spine surgery and two additional risk factors (diabetes mellitus and BMI 38). Compared to an older series, using reusable instrumentation, performed by the same team for the same indications, the clinical outcomes were similar but the infection rate was 6 %.

Discussion

Single-use instrumentation could reduce the incidence of surgical site infections following lumbar fusion to acceptable levels as in hip and knee arthroplasties. The preservation of screws and rods in sterile packs until ready for insertion reduces their exposure to air-borne bacteria in the OR and eliminates their contamination through repetitive hospital sterilization. The short operation time and minimal blood loss achieved could also contribute to the reduction in infection risks.

Level of evidence

Level II, prospective randomized bi-centric study.
Literature
1.
go back to reference Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34(13):1422–1428PubMedCrossRef Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34(13):1422–1428PubMedCrossRef
4.
go back to reference Andreshak TG, An HS, Hall J, Stein B (1997) Lumbar spine surgery in the obese patient. J Spinal Disord 10(5):376–379PubMed Andreshak TG, An HS, Hall J, Stein B (1997) Lumbar spine surgery in the obese patient. J Spinal Disord 10(5):376–379PubMed
5.
go back to reference Capen DA, Calderone RR, Green A (1996) Perioperative risk factors for wound infections after lower back fusions. Orthop Clin N Am 27(1):83–86 Capen DA, Calderone RR, Green A (1996) Perioperative risk factors for wound infections after lower back fusions. Orthop Clin N Am 27(1):83–86
6.
go back to reference Dahners LE, Mullis BH (2004) Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg 12(3):139–143PubMed Dahners LE, Mullis BH (2004) Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg 12(3):139–143PubMed
7.
go back to reference Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine 32(20):2272–2277PubMedCrossRef Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine 32(20):2272–2277PubMedCrossRef
8.
go back to reference McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 23(6):726–732 (discussion 732–723)PubMedCrossRef McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 23(6):726–732 (discussion 732–723)PubMedCrossRef
9.
go back to reference Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98(2 Suppl):149–155PubMed Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98(2 Suppl):149–155PubMed
10.
go back to reference Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25(19):2461–2466PubMedCrossRef Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25(19):2461–2466PubMedCrossRef
11.
go back to reference Wimmer C, Gluch H (1996) Management of postoperative wound infection in posterior spinal fusion with instrumentation. J Spinal Disord 9(6):505–508PubMed Wimmer C, Gluch H (1996) Management of postoperative wound infection in posterior spinal fusion with instrumentation. J Spinal Disord 9(6):505–508PubMed
12.
go back to reference Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11(2):124–128PubMed Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11(2):124–128PubMed
13.
go back to reference Nunez-Pereira S, Pellise F, Rodriguez-Pardo D, Pigrau C, Sanchez JM, Bago J, Villanueva C, Caceres E (2011) Individualized antibiotic prophylaxis reduces surgical site infections by gram-negative bacteria in instrumented spinal surgery. Eur Spine J 20(Suppl 3):397–402PubMedPubMedCentralCrossRef Nunez-Pereira S, Pellise F, Rodriguez-Pardo D, Pigrau C, Sanchez JM, Bago J, Villanueva C, Caceres E (2011) Individualized antibiotic prophylaxis reduces surgical site infections by gram-negative bacteria in instrumented spinal surgery. Eur Spine J 20(Suppl 3):397–402PubMedPubMedCentralCrossRef
14.
go back to reference Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH (2000) Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13(1):42–45PubMedCrossRef Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH (2000) Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13(1):42–45PubMedCrossRef
15.
go back to reference Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24(4):558–561PubMedCrossRef Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24(4):558–561PubMedCrossRef
16.
go back to reference Banco SP, Vaccaro AR, Blam O, Eck JC, Cotler JM, Hilibrand AS, Albert TJ, Murphey S (2002) Spine infections: variations in incidence during the academic year. Spine 27(9):962–965PubMedCrossRef Banco SP, Vaccaro AR, Blam O, Eck JC, Cotler JM, Hilibrand AS, Albert TJ, Murphey S (2002) Spine infections: variations in incidence during the academic year. Spine 27(9):962–965PubMedCrossRef
17.
go back to reference Gruenberg MF, Campaner GL, Sola CA, Ortolan EG (2004) Ultraclean air for prevention of postoperative infection after posterior spinal fusion with instrumentation: a comparison between surgeries performed with and without a vertical exponential filtered air-flow system. Spine 29(20):2330–2334PubMedCrossRef Gruenberg MF, Campaner GL, Sola CA, Ortolan EG (2004) Ultraclean air for prevention of postoperative infection after posterior spinal fusion with instrumentation: a comparison between surgeries performed with and without a vertical exponential filtered air-flow system. Spine 29(20):2330–2334PubMedCrossRef
18.
go back to reference Chen S, Anderson MV, Cheng WK, Wongworawat MD (2009) Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467(7):1670–1673PubMedPubMedCentralCrossRef Chen S, Anderson MV, Cheng WK, Wongworawat MD (2009) Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467(7):1670–1673PubMedPubMedCentralCrossRef
19.
go back to reference Kim HS, Lee SG, Kim WK, Park CW, Son S (2013) Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine 10(3):121–125PubMedPubMedCentralCrossRef Kim HS, Lee SG, Kim WK, Park CW, Son S (2013) Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine 10(3):121–125PubMedPubMedCentralCrossRef
20.
go back to reference Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg 115(9):1766–1769PubMedCrossRef Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK (2013) Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg 115(9):1766–1769PubMedCrossRef
21.
go back to reference Ohtori S, Suzuki M, Koshi T, Takaso M, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Toyone T, Takahashi K (2011) Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. Eur Spine J 20(4):635–639PubMedPubMedCentralCrossRef Ohtori S, Suzuki M, Koshi T, Takaso M, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Toyone T, Takahashi K (2011) Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. Eur Spine J 20(4):635–639PubMedPubMedCentralCrossRef
22.
go back to reference Bhadra AK, Kwiecien GJ, Harwin SF, Johnson AJ, Mont MA, Malkani AL (2012) Procedure simplification: the role of single-use instruments in total knee arthroplasty. Surg Technol Int 22:326–330PubMed Bhadra AK, Kwiecien GJ, Harwin SF, Johnson AJ, Mont MA, Malkani AL (2012) Procedure simplification: the role of single-use instruments in total knee arthroplasty. Surg Technol Int 22:326–330PubMed
23.
go back to reference Mont MA, Johnson AJ, Issa K, Pivec R, Blasser KE, McQueen D, Puri L, Dethmers DA, Miller DW, Ireland PH, Shurman JR, Bonutti P (2013) Single-use instrumentation, cutting blocks, and trials decrease contamination during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases. J Knee Surg 26(4):285–290PubMedCrossRef Mont MA, Johnson AJ, Issa K, Pivec R, Blasser KE, McQueen D, Puri L, Dethmers DA, Miller DW, Ireland PH, Shurman JR, Bonutti P (2013) Single-use instrumentation, cutting blocks, and trials decrease contamination during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases. J Knee Surg 26(4):285–290PubMedCrossRef
24.
go back to reference Mont MA, McElroy MJ, Johnson AJ, Pivec R (2013) Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases. J Arthroplasty 28(7):1135–1140PubMedCrossRef Mont MA, McElroy MJ, Johnson AJ, Pivec R (2013) Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases. J Arthroplasty 28(7):1135–1140PubMedCrossRef
25.
go back to reference Thienpont E, Bellemans J, Delport H, Van Overschelde P, Stuyts B, Brabants K, Victor J (2013) Patient-specific instruments: industry’s innovation with a surgeon’s interest. Knee Surg Sports Traumatol Arthrosc 21(10):2227–2233PubMedCrossRef Thienpont E, Bellemans J, Delport H, Van Overschelde P, Stuyts B, Brabants K, Victor J (2013) Patient-specific instruments: industry’s innovation with a surgeon’s interest. Knee Surg Sports Traumatol Arthrosc 21(10):2227–2233PubMedCrossRef
26.
go back to reference Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, Wybier M (2011) Standardized way for imaging of the sagittal spinal balance. Eur Spine J 20(Suppl 5):602–608PubMedPubMedCentralCrossRef Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, Wybier M (2011) Standardized way for imaging of the sagittal spinal balance. Eur Spine J 20(Suppl 5):602–608PubMedPubMedCentralCrossRef
27.
go back to reference Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25(22):2940–2952 discussion 2952 PubMedCrossRef Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25(22):2940–2952 discussion 2952 PubMedCrossRef
28.
go back to reference Anand N, Hamilton JF, Perri B, Miraliakbar H, Goldstein T (2006) Cantilever TLIF with structural allograft and RhBMP2 for correction and maintenance of segmental sagittal lordosis: long-term clinical, radiographic, and functional outcome. Spine 31(20):E748–E753PubMedCrossRef Anand N, Hamilton JF, Perri B, Miraliakbar H, Goldstein T (2006) Cantilever TLIF with structural allograft and RhBMP2 for correction and maintenance of segmental sagittal lordosis: long-term clinical, radiographic, and functional outcome. Spine 31(20):E748–E753PubMedCrossRef
29.
go back to reference Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20(Suppl 5):699–703PubMedPubMedCentralCrossRef Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20(Suppl 5):699–703PubMedPubMedCentralCrossRef
30.
go back to reference Le Huec JC, Roussouly P (2011) Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J 20(Suppl 5):556–557PubMedPubMedCentralCrossRef Le Huec JC, Roussouly P (2011) Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J 20(Suppl 5):556–557PubMedPubMedCentralCrossRef
31.
go back to reference Nilsson KG, Lundholm R, Friberg S (2010) Assessment of horizontal laminar air flow instrument table for additional ultraclean space during surgery. J Hosp Infect 76(3):243–246PubMedCrossRef Nilsson KG, Lundholm R, Friberg S (2010) Assessment of horizontal laminar air flow instrument table for additional ultraclean space during surgery. J Hosp Infect 76(3):243–246PubMedCrossRef
32.
go back to reference Sadrizadeh S, Tammelin A, Nielsen PV, Holmberg S (2014) Does a mobile laminar airflow screen reduce bacterial contamination in the operating room? A numerical study using computational fluid dynamics technique. Patient Saf Surg 8:27PubMedPubMedCentralCrossRef Sadrizadeh S, Tammelin A, Nielsen PV, Holmberg S (2014) Does a mobile laminar airflow screen reduce bacterial contamination in the operating room? A numerical study using computational fluid dynamics technique. Patient Saf Surg 8:27PubMedPubMedCentralCrossRef
33.
go back to reference Sossai D, Dagnino G, Sanguineti F, Franchin F (2011) Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty. J Orthop Traumatol 12(4):207–211PubMedPubMedCentralCrossRef Sossai D, Dagnino G, Sanguineti F, Franchin F (2011) Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty. J Orthop Traumatol 12(4):207–211PubMedPubMedCentralCrossRef
34.
go back to reference Amaral AM, Diogo Filho A, Sousa MM, Barbosa PA, Gontijo Filho PP (2013) The importance of protecting surgical instrument tables from intraoperative contamination in clean surgeries. Revista latino-americana de enfermagem 21(1):426–432PubMedCrossRef Amaral AM, Diogo Filho A, Sousa MM, Barbosa PA, Gontijo Filho PP (2013) The importance of protecting surgical instrument tables from intraoperative contamination in clean surgeries. Revista latino-americana de enfermagem 21(1):426–432PubMedCrossRef
35.
go back to reference Gaetani P, Aimar E, Panella L, Levi D, Tancioni F, Di Ieva A, Debernardi A, Pisano P, Rodriguez y Baena R (2006) Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study. Functional Neurol 21(1):31–37 Gaetani P, Aimar E, Panella L, Levi D, Tancioni F, Di Ieva A, Debernardi A, Pisano P, Rodriguez y Baena R (2006) Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study. Functional Neurol 21(1):31–37
36.
go back to reference Wu CH, Kao YH, Yang SC, Fu TS, Lai PL, Chen WJ (2008) Supplementary pedicle screw fixation in spinal fusion for degenerative spondylolisthesis in patients aged 65 and over: outcome after a minimum of 2 years follow-up in 82 patients. Acta Orthop 79(1):67–73PubMedCrossRef Wu CH, Kao YH, Yang SC, Fu TS, Lai PL, Chen WJ (2008) Supplementary pedicle screw fixation in spinal fusion for degenerative spondylolisthesis in patients aged 65 and over: outcome after a minimum of 2 years follow-up in 82 patients. Acta Orthop 79(1):67–73PubMedCrossRef
37.
go back to reference Fritzell P, Hagg O, Wessberg P, Nordwall A (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27(11):1131–1141PubMedCrossRef Fritzell P, Hagg O, Wessberg P, Nordwall A (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27(11):1131–1141PubMedCrossRef
38.
go back to reference Bjarke Christensen F, Stender Hansen E, Laursen M, Thomsen K, Bunger CE (2002) Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine 27(12):1269–1277PubMedCrossRef Bjarke Christensen F, Stender Hansen E, Laursen M, Thomsen K, Bunger CE (2002) Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine 27(12):1269–1277PubMedCrossRef
39.
go back to reference Dai LY, Jiang LS, Jiang SD (2009) Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures: a five to seven-year prospective randomized study. J Bone Joint Surg 91(5):1033–1041PubMedCrossRef Dai LY, Jiang LS, Jiang SD (2009) Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures: a five to seven-year prospective randomized study. J Bone Joint Surg 91(5):1033–1041PubMedCrossRef
40.
go back to reference Fernandez-Fairen M, Sala P, Ramirez H, Gil J (2007) A prospective randomized study of unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis. Spine 32(4):395–401PubMedCrossRef Fernandez-Fairen M, Sala P, Ramirez H, Gil J (2007) A prospective randomized study of unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis. Spine 32(4):395–401PubMedCrossRef
41.
go back to reference McLain RF, Burkus JK, Benson DR (2001) Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 1(5):310–323PubMedCrossRef McLain RF, Burkus JK, Benson DR (2001) Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 1(5):310–323PubMedCrossRef
42.
go back to reference Tokuhashi Y, Ajiro Y, Umezawa N (2008) Outcomes of posterior fusion using pedicle screw fixation in patients 70 years with lumbar spinal canal stenosis. Orthopedics 31(11):1096PubMedCrossRef Tokuhashi Y, Ajiro Y, Umezawa N (2008) Outcomes of posterior fusion using pedicle screw fixation in patients 70 years with lumbar spinal canal stenosis. Orthopedics 31(11):1096PubMedCrossRef
43.
go back to reference Abudu A, Sivardeen KA, Grimer RJ, Pynsent PB, Noy M (2002) The outcome of perioperative wound infection after total hip and knee arthroplasty. Int Orthop 26(1):40–43PubMedPubMedCentralCrossRef Abudu A, Sivardeen KA, Grimer RJ, Pynsent PB, Noy M (2002) The outcome of perioperative wound infection after total hip and knee arthroplasty. Int Orthop 26(1):40–43PubMedPubMedCentralCrossRef
44.
go back to reference Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMed Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMed
Metadata
Title
Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study
Authors
Stéphane Litrico
Geoffrey Recanati
Antoine Gennari
Cédric Maillot
Mo Saffarini
Jean-Charles Le Huec
Publication date
01-01-2016
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2016
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-015-1692-4

Other articles of this Issue 1/2016

European Journal of Orthopaedic Surgery & Traumatology 1/2016 Go to the issue

General Review • FUSION - DEVICE

Porous tantalum in spinal surgery: an overview