Expandable titanium cages for anterior column cervical reconstruction and their effect on sagittal profile: a review of 48 cases

Purpose of the study was to determine the possibility of asymmetric transforaminal lumbar interbody fusion (TLIF) application for dorsal spine correction and fixation in patients with idiopathic scoliosis. Dorsal spine correction and fixation using technique of asymmetric transforaminal lumbar interbody fusion on the concave side of lumbar spine deformity was performed in patients, aged 14—58 years, with idiopathic scoliosis. Average preoperative deformity angle made up 78.25° versus 30.25° postoperatively; average correction was 61.6%. For TLIF performance combined implants, i.e. interbody titanium cages filled with autobone, were used. Use of asymmetric TLIF enabled to reduce the slope of lower instrumented vertebra and thus to perform the correction of spine frontal balance. Lordosing effect of cage improved the sagittal profile of the vertebral column while more rapid formation of lumbar corporodesis under conditions of interbody fixation prevented rods and screws fractures in the lower pole of metal constructions.

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Anterior Cervical Reconstruction Using Titanium Cages With Anterior Plating

Spine ◽

10.1097/00007632-199908010-00016 ◽

1999 ◽

Vol 24 (15) ◽

pp. 1604 ◽

Cited By ~ 158

Author(s):

Mohammad E. Majd ◽

Mukta Vadhva ◽

Richard T. Holt

Keyword(s):

Anterior Plating ◽

Cervical Reconstruction ◽

Titanium Cages

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Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

Scientific Reports ◽

10.1038/s41598-020-79523-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Scaramuzzo ◽

Antonino Zagra ◽

Giuseppe Barone ◽

Stefano Muzzi ◽

Leone Minoia ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Profile ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04033-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ang Gao ◽

Yongqiang Wang ◽

Miao Yu ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Normal Population ◽

Sagittal Profile ◽

Sacral Slope ◽

Type I ◽

Type Ii ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters. Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The sagittal profile was similar to that of the normal population in type I, presenting the apex of the thoracic kyphotic curve located in the middle thoracic spine. The well aligned thoracic-lumbar curve was disrupted in type II, presenting the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9 ± 24.8°, 8.2 ± 7.3° and 6.2 ± 4.9°, respectively. There was significant difference (p < 0.001) of thoracolumbar angle between type I (14.9 ± 7.9°) and type II patients (29.1 ± 13.7°). Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In type I patients, disc degeneration was accelerated by regional kyphosis in the thoracolumbar junction and eventually caused disc herniation. In type II patients, excessive mechanical stress was directly loaded at the top of the curve (thoracolumbar apex region) rather than being diverted by an arc as in a normal population or type I patients. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

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Determining the Difference in Clinical and Radiologic Outcomes Between Expandable and Nonexpandable Titanium Cages in Cervical Fusion Procedures: A Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2021.01.027 ◽

2021 ◽

Author(s):

Ronan J. Doherty ◽

Waseem Wahood ◽

Yagiz U. Yolcu ◽

Mohammed Ali Alvi ◽

Benjamin D. Elder ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cervical Fusion ◽

The Difference ◽

Titanium Cages

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Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

European Spine Journal ◽

10.1007/s00586-021-06772-w ◽

2021 ◽

Author(s):

Tom P. C. Schlösser ◽

René M. Castelein ◽

Pierre Grobost ◽

Suken A. Shah ◽

Kariman Abelin-Genevois

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Inflection Point ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Three Dimensional ◽

Sagittal Profile ◽

Thoracolumbar Kyphosis ◽

C7 Slope ◽

Sagittal Malalignment

Abstract Purpose The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine’s sagittal profile. Recently, three specific patterns of thoracic sagittal ‘malalignment’ were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. Methods Lateral spinal radiographs of 192 mild (10°–20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4–T12 thoracic kyphosis, T10–L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. Results Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of the nonscoliosis adolescents were hypokyphotic. In severe AIS, 63% had a sagittal malalignment. Hypokyphosis + thoracolumbar kyphosis occurred more frequently in high-PI and primary lumbar curves, whereas cervicothoracic kyphosis occurred more in double thoracic curves. Conclusions Pathological sagittal patterns are often already present in curves 10°–20°, whereas those are rare in non-scoliotic adolescents. This suggests that sagittal ‘malalignment’ patterns are an integral part of the early pathogenesis of AIS.

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