Short-Segment Minimally Disruptive Anterior Column Release for Focal Sagittal Deformity Correction of the Thoracolumbar Spine

Introduction: Blood loss with spinal surgery is common potential cause of morbidity and often requires blood transfusion. Tranexamic acid (TXA), is effective in reducing bleeding in patients undergoing knee arthroplasty. TXA used in spine surgery studies have included different cases leading to inconsistence of surgical procedures. Purpose of this prospective observational study was to examine effect of TXA decreasing bleeding in short segment pedicle screw fixation for thoracolumbar fractures. Methods: 38 patients' undergoing short segment pedicle screw for thoracolumbar fractures were enrolled in study from July to August 2013. There were 28 male and 10 female patients, with an average age of 36.5 years. Patients received 10 mg/kg of TXA or a control 30 minutes intravenously before skin incision and 3 hours post-operative and oral medication for three days. Intraoperative bleeding was estimated by weighing surgical sponges, blood collected by suction container and by subtracting all irrigation fluid. Postoperative bleeding was measured from volume in vacuum drainage bag. Results: Twenty (20) patients were in control group and eighteen(18) to TXA group. There were no statistical differences between groups in terms of age, gender, co-morbidities, and operating time, preoperative Hemoglobin, PT and INR. Intra-operative bleeding in TXA group was significant than in control group. Post-operative drainage and Hemoglobin in first 48 h was reduced compared with placebo in TXA group. Need for post-operative transfusion was nil in TXA group. Conclusions: Administration of TXA before surgery significantly reduces perioperative bleeding in patients undergoing short segment pedicle screw fixation for thoracolumbar spine fractures. Keywords: bleeding; spinal surgery; tranexamic acid.

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Adult Spinal Deformity Correction with Multi-level Anterior Column Releases

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000377 ◽

2016 ◽

Vol 29 (4) ◽

pp. 141-149 ◽

Cited By ~ 9

Author(s):

Gokhan Demirkiran ◽

Alexander A. Theologis ◽

Murat Pekmezci ◽

Christopher Ames ◽

Vedat Deviren

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Anterior Column ◽

Multi Level

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A Systematic Review of Treatment Strategies for the Prevention of Junctional Complications After Long-Segment Fusions in the Osteoporotic Spine

Global Spine Journal ◽

10.1177/2192568220939902 ◽

2020 ◽

pp. 219256822093990 ◽

Cited By ~ 1

Author(s):

Murray Echt ◽

William Ranson ◽

Jeremy Steinberger ◽

Reza Yassari ◽

Samuel K. Cho

Keyword(s):

Systematic Review ◽

Thoracolumbar Spine ◽

Surgical Techniques ◽

Treatment Strategies ◽

Compression Fracture ◽

Deformity Correction ◽

Preventive Treatment ◽

Cement Augmentation ◽

Mineral Density ◽

Junctional Kyphosis

Study Design: Systematic review Objectives: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-known complications after long-segment fusions in the thoracolumbar spine of osteoporotic patients. Recent advances in anti-resorptive and anabolic medications, instrumentation, surgical technique, and cement augmentation have all aided in the avoidance of junctional kyphosis. In this article, current literature on the prevention of PJK and PJF in the osteoporotic spine is reviewed. Methods: A systematic literature review was conducted using the PubMed/MEDLINE and Embase databases in order to search for the current preventive treatment methods for PJK and PJF published in the literature (1985 to present). Inclusion criteria included (1) published in English, (2) at least 1-year mean and median follow-up, (3) preoperative diagnosis of osteoporosis, (4) at least 3 levels instrumented, and (5) studies of medical treatment or surgical techniques for prevention of junctional kyphosis. Results: The review of the literature yielded 7 studies with low levels of evidence ranging from level II to IV. Treatment strategies reviewed addressed prophylaxis against ligamentous failure, adjacent vertebral compression fracture, and/or bone-implant interface failure. This includes studies on the effect of osteoporosis medication, cement augmentation, multi-rod constructs, and posterior-tension band supplementation. The role of perioperative teriparatide therapy maintains the highest level of evidence. Conclusions: Perioperative teriparatide therapy represents the strongest evidence for preventive treatment, and further clinical trials are warranted. Use of cement augmentation, sublaminar tethers, and multi-rod constructs have low or insufficient evidence for recommendations. Future guidelines for adult spinal deformity correction may consider bone mineral density–adjusted alignment goals.

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Current status of short segment fixation in thoracolumbar spine injuries

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.06.008 ◽

2020 ◽

Vol 11 (5) ◽

pp. 770-777

Author(s):

Rohit Jindal ◽

Vinay Jasani ◽

Dinesh Sandal ◽

Sudhir Kumar Garg

Keyword(s):

Thoracolumbar Spine ◽

Current Status ◽

Short Segment ◽

Spine Injuries ◽

Short Segment Fixation

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6:0256. Less Invasive Treatment of Unstable Thoracolumbar Burst Fractures With Short Segment Fixation Balloon Assisted Reduction and Anterior Column Reconstruction With Calcium Phosphate Cement

The Spine Journal ◽

10.1016/j.spinee.2006.06.077 ◽

2006 ◽

Vol 6 (5) ◽

pp. 28S

Author(s):

Rex A.W. Marco ◽

Vivek P. Kushwaha

Keyword(s):

Calcium Phosphate ◽

Calcium Phosphate Cement ◽

Anterior Column ◽

Invasive Treatment ◽

Short Segment ◽

Thoracolumbar Burst Fractures ◽

Less Invasive ◽

Burst Fractures ◽

Short Segment Fixation ◽

Anterior Column Reconstruction

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CONGENITAL THORACOLUMBAR SPINE DEFORMITIES

Neurosurgery ◽

10.1227/01.neu.0000313144.11433.0c ◽

2008 ◽

Vol 63 (suppl_3) ◽

pp. A78-A85 ◽

Cited By ~ 3

Author(s):

Hamidreza Aliabadi ◽

Gerald Grant

Keyword(s):

Surgical Treatment ◽

Spinal Deformity ◽

Congenital Anomalies ◽

Thoracolumbar Spine ◽

Deformity Correction ◽

Spinal Deformities ◽

Spine Deformities ◽

Frequent Reason

ABSTRACT CONGENITAL THORACOLUMBAR SPINAL deformities are a common and frequent reason for referral to spine surgeons. Neurosurgeons also treat many neurological diagnoses which may result in a progressive spinal deformity, such as scoliosis. Here we review a variety of congenital anomalies and address the maldevelopments associated with each, as well as the appropriate evaluation of such patients including nonoperative and operative approaches. Advances in the field of spinal deformity correction now allow us to better treat individuals with these types of deformities. It is important for the practicing neurosurgeon to be knowledgeable of surgical and nonsurgical treatments of patients with congenital thoracolumbar spinal deformities in order to better understand which patients will ultimately progress and necessitate surgical treatment.

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Crossed-screw fixation of the unstable thoracic and lumbar spine

Journal of Neurosurgery ◽

10.3171/jns.1995.82.1.0011 ◽

1995 ◽

Vol 82 (1) ◽

pp. 11-16 ◽

Cited By ~ 16

Author(s):

Edward C. Benzel ◽

Nevan G. Baldwin

Keyword(s):

Vertebral Body ◽

Screw Fixation ◽

Three Dimensional ◽

Deformity Correction ◽

Pedicle Screws ◽

Short Segment ◽

Content Type ◽

Thoracic And Lumbar Spine ◽

Spinal Segments ◽

Fine Print

✓ An ideal spinal construct should immobilize only the unstable spinal segments, and thus only the segments fused. Pedicle fixation techniques have provided operative stabilization with the instrumentation of a minimal number of spinal segments; however, some failures have been observed with pedicle instrumentation. These failures are primarily related to excessive preload forces and limitations caused by the size and orientation of the pedicles. To circumvent these problems, a new technique, the crossed-screw fixation method, was developed and is described in this report. This technique facilitates short-segment spinal fixation and uses a lateral extracavitary approach, which provides generous exposure for spinal decompression and interbody fusion. The technique employs two large transverse vertebral body screws (6.5 to 8.5 mm in diameter) to bear axial loads, and two unilateral pedicle screws (placed on the side of the exposure) to restrict flexion and extension deformation around the transverse screws and to provide three-dimensional deformity correction. The horizontal vertebral body and the pedicle screws are connected to rods and then to each other via rigid crosslinking. The transverse vertebral body screws are unloaded during insertion by placing the construct in a compression mode after the interbody bone graft is placed, thus optimizing the advantage gained by the significant “toe-in” configuration provided and further decreasing the chance for instrumentation failure. The initial results of this technique are reported in a series of 10 consecutively treated patients, in whom correction of the deformity was facilitated. Follow-up examination (average 10.1 months after surgery) demonstrated negligible angulation. Chronic pain was minimal. The crossed-screw fixation technique is biomechanically sound and offers a rapid and safe form of short-segment three-dimensional deformity correction and solid fixation when utilized in conjunction with the lateral extracavitary approach to the unstable thoracic and lumbar spine. This approach also facilitates the secure placement of an interbody bone graft.

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