Specific selection of osteosynthetic material in the treatment of thoracic or lumbar spinal injuries by the posterior approach

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Methods It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p > 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

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Appropriate selection of patients with lumbar spinal stenosis for interspinous process decompression with the X STOP device

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.1.5 ◽

2007 ◽

Vol 22 (1) ◽

pp. 1-7 ◽

Cited By ~ 22

Author(s):

Carl Lauryssen

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Neurogenic Intermittent Claudication ◽

Anatomical Structures ◽

Conservative Care ◽

Number Of Patients ◽

Spinous Processes ◽

Lumbar Spinal ◽

Selection Of Patients ◽

Selection Of

✓With the aging of the population, the number of patients suffering from progressive lumbar spinal stenosis with symptomatic neurogenic intermittent claudication is projected to increase. Unfortunately, these patients are limited to a choice between nonsurgical conservative care and more invasive decompressive surgical procedures such as laminectomy with or without fusion. The X STOP interspinous process decompression system is a commercially available device that provides a minimally invasive alternative treatment, an intermediate option within the continuum of care for these patients. The X STOP is appropriate for patients with moderately severe functional impairment whose symptoms are exacerbated in extension and relieved in flexion. Implanted between the spinous processes without disrupting the normal anatomical structures, the X STOP limits narrowing of the spinal canal and neural foramina by reducing extension at the symptomatic level(s). In this report the author details the approved indications for use of the X STOP and discusses several illustrative cases.

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Selection of Surgical Methods in Degenerative Lumbar Spinal Stenosis

Spinal Surgery ◽

10.2531/spinalsurg.9.55 ◽

1995 ◽

Vol 9 (0) ◽

pp. 55-63

Author(s):

Tetsuya Morimoto ◽

Tomonori Yamada ◽

Hidemori Tokunaga ◽

Toshio Kakizaki ◽

Hidehiro Hirabayashi ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Degenerative Lumbar Spinal Stenosis ◽

Surgical Methods ◽

Lumbar Spinal ◽

Selection Of

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Post-operative Morbidity and Mortality of Lumbar Spinal Stenosis at one Teaching Hospital in North-eastern Benin.

Iranian Journal of Neurosurgery ◽

10.32598/irjns.6.1.3 ◽

2020 ◽

Vol 6 (1) ◽

pp. 13-20

Author(s):

Holden Olatoundji Fatigba ◽

◽

Luphin Hode ◽

Kisito Quenum ◽

Thierry Alihonou ◽

...

Keyword(s):

Spinal Stenosis ◽

Surgical Management ◽

Lumbar Spinal Stenosis ◽

Teaching Hospital ◽

Cauda Equina ◽

Canal Stenosis ◽

Republic Of Benin ◽

The Republic ◽

Lumbar Spinal ◽

Selection Of

Background and Aim: Surgical management of Lumbar Spinal Stenosis (LSS) is a common practice. This study aimed to report the morbidities and mortalities observed during surgical treatment of LSS and the outcome of these patients after management over an 8-year study period. Methods and Materials/Patients: It was a retrospective, descriptive, and transversal study performed at the Departmental Teaching Hospital of Borgou in the Republic of Benin (West Africa) from January 2010 to December 2018. This study included the patients who underwent surgical management for LSS. Type of complication, its management, and the patient’s outcomes was registered. Results: During the study period and based on the selection criteria, 239 patients were selected. These patients were divided into 135 men (56.5%) and 104 women (43.5%). The mean age of the patients was 52.3±10.9 years. Laminectomy was performed on one, two, and three lumbar spinal segments in 17.6%, 55.6% and 26.8% of cases, respectively. Laminectomy was associated with discectomy in 6.3% of the cases. No arthrodesis with spinal fixation was performed. Ninety percent of patients had no post-operative complications. Functional post-operative results were considered excellent, good, acceptable and poor in 32.1%, 52.1%, 10.9% and 4.9% of cases, respectively. Five types of complications were observed in 22 patients (9.2%). A reoperation was performed in 1.6% of cases. These different complications included dural tear (4.6%), wound infection (3.3%), stroke (0.8%), cauda equina syndrome (0.4%) and pseudomeningocele (0.4%). The mortality rate was 0.8% (n=2). Conclusion: Lumbar canal stenosis surgery is not without complications. Careful selection of patients, consideration of risk factors, and selection of an appropriate surgical strategy can reduce or avoid these complications.

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