Clenching Reduction Technique for Osteosynthesis of Atypical C2 Fractures with the Combining Use of Laminar and Pedicle Screw: A Technical Note

2018 ◽  
Vol 79 (02) ◽  
pp. 169-172
Author(s):  
Suk-Joong Lee ◽  
Hyun-Joo Lee ◽  
Jong-Uk Mun ◽  
Ji-Yeon Choi ◽  
Woo-Kie Min
Keyword(s):  
Pedicle Screw ◽  
Technical Note ◽  
Reduction Technique ◽  
Effective Technique ◽  
Odontoid Fractures ◽  
Posterior Displacement ◽  
C2 Fracture ◽  
Fracture Types ◽  
Traumatic Spondylolisthesis

AbstractAtypical C2 fractures refer to all fracture types of the C2 body excluding odontoid fractures and traumatic spondylolisthesis of C2. A 55-year-old male patient presented with neck pain after a vehicular accident. Computed tomography (CT) showed an oblique fracture line of the C2 vertebral body through the pedicle and lamina with fracture gap and posterior displacement. We used a clenching reduction technique to treat this fracture by using an ipsilateral laminar screw and contralateral pedicle screw. The final follow-up CT scan showed complete bone union. Neck motion was preserved including rotation. For this unstable atypical C2 fracture, the clenching reduction technique proved to be a safe and effective technique while salvaging neck motion.

scholarly journals Full endoscopic resection of a lumbar osteoblastoma: technical note

2020 ◽  
Vol 33 (2) ◽  
pp. 252-255
Author(s):  
William C. Newman ◽  
Max Vaynrub ◽  
Mark H. Bilsky ◽  
Ilya Laufer ◽  
Ori Barzilai
Keyword(s):  
Endoscopic Resection ◽  
Structural Integrity ◽  
Technical Note ◽  
Effective Technique ◽  
Primary Bone Tumor ◽  
Primary Bone Tumors ◽  
Muscle Sparing ◽  
Primary Bone ◽  
Neurologically Intact

Osteoblastomas are a rare, benign primary bone tumor accounting for 1% of all primary bone tumors, with 40% occurring within the spine. Gross-total resection (GTR) is curative, although depending on location, this can require destabilization of the spine and necessitate instrumented fixation. Through the use of minimally invasive, muscle-sparing approaches, these lesions can be resected while maintaining structural integrity of the spine. The authors present a case report and technical note of a single patient describing the use of a purely endoscopic technique to resect a right L5 superior articulating process osteoblastoma in a 45-year-old woman. The patient underwent an image-guided endoscopic resection of her superior articulating facet osteoblastoma. Intraoperative CT demonstrated GTR. On postoperative examination, she remained neurologically intact with resolution of her pain. At follow-up, she remained pain free. Resection of lumbar osteoblastoma through a fully endoscopic approach was a safe and effective technique in this patient. This technique allowed for GTR without compromising spinal structural integrity, thus eliminating the need for instrumented fixation.

Safe placement of pedicle screw in lumbar spine with minimum three year follow-up: a case series and technical note

2018 ◽  
Vol 42 (3) ◽  
pp. 567-573 ◽  
Author(s):  
Di Zhang ◽  
Xianda Gao ◽  
Jiang Jiang ◽  
Yong Shen ◽  
Wenyuan Ding ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Case Series ◽  
Technical Note

Odontoid fractures in elderly patients

1993 ◽  
Vol 78 (1) ◽  
pp. 32-35 ◽  
Author(s):  
William C. Hanigan ◽  
Frank C. Powell ◽  
Patrick W. Elwood ◽  
John P. Henderson
Keyword(s):  
Motor Vehicle ◽  
Bed Rest ◽  
Fracture Site ◽  
Routine Activity ◽  
Neurological Injury ◽  
Content Type ◽  
Odontoid Fractures ◽  
Non Union ◽  
Posterior Displacement

✓ This retrospective analysis describes the clinical characteristics, treatment, and outcome of 19 patients aged 80 years or older with odontoid fractures. The fractures were due to falls in 15 patients (78.9%) and were associated with motor-vehicle accidents in four. Type III fractures were seen in three patients and type II fractures in 16. No patient suffered a neurological injury associated with the fracture. Five patients (26.3%) died during hospitalization; factors contributing to their death included prolonged bed rest, associated injuries, and concomitant medical illnesses. The mean follow-up period in the remaining 14 patients was 28.8 months (range 5 to 72 months). Eight patients with a posterior displacement of 5 mm or less were treated with cervical immobilization, three of whom showed a stable non-union of the fracture site at follow-up review. One patient with 10-mm displacement refused operative treatment. Three of the patients without surgical treatment subsequently died from unrelated causes; all remaining patients resumed their routine activity. Five patients with displacement of 5 mm or greater and instability at the fracture site were treated with posterior cervical fusion of C1–2 using wire and autologous iliac bone grafts. In this group, no operative morbidity or mortality occurred and stable constructs developed in all patients; one patient died from an unrelated cause during the follow-up period and the other patients resumed their normal activity. Prolonged bed rest caused respiratory complications in two of six patients who survived initial hospitalization; two of three patients treated with rigid immobilization developed complications that required alternative treatments.

scholarly journals Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beixi Bao ◽  
Qingjun Su ◽  
Yong Hai ◽  
Peng Yin ◽  
Yaoshen Zhang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Congenital Scoliosis ◽  
Pedicle Screw Fixation ◽  
Rigid Fixation ◽  
Short Segment ◽  
Hemivertebra Resection ◽  
Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

scholarly journals An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

2021 ◽  
Author(s):  
Samir Kumar Kalra ◽  
Krishna Shah ◽  
Sneyhil Tyagi ◽  
Suviraj John ◽  
Rajesh Acharya
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Operation Time ◽  
Complication Rates ◽  
Effective Technique ◽  
Common Procedure ◽  
Shunt System ◽  
Shunt Tube ◽  
Csf Diversion ◽  
Median Operation Time

Abstract Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

scholarly journals C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Anna-Lena Robinson ◽  
Anders Möller ◽  
Yohan Robinson ◽  
Claes Olerud
Keyword(s):  
Cervical Vertebra ◽  
Epidemiological Studies ◽  
Treatment Allocation ◽  
Odontoid Fractures ◽  
And Gender ◽  
C2 Fracture ◽  
Type 3 ◽  
Gender Specific

The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman’s fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72±19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman’s fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

2021 ◽  
pp. 1-11
Keyword(s):  
Scale Score ◽  
Neck Disability Index ◽  
Implant Removal ◽  
Odontoid Fractures ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

scholarly journals Endoscopic Sural Nerve Removal in Obstetric Brachial Plexopathy Using Basic Endoscopy Instruments: Technical Note

2017 ◽  
Vol 36 (02) ◽  
pp. 075-079
Author(s):  
José Malheiros ◽  
Sérgio Cançado ◽  
João Belo ◽  
Luiz Garcia ◽  
Marcelo Oliveira ◽  
...  
Keyword(s):  
Sural Nerve ◽  
Prospective Observational Study ◽  
Technical Note ◽  
Consecutive Series ◽  
Brachial Plexopathy ◽  
Technical Aspects ◽  
Scar Size ◽  
Belo Horizonte ◽  
Nerve Harvesting

Introduction The sural nerve (SN) is commonly used for grafting following resection of a neuroma-in-continuity in neonatal brachial plexus lesions (NBPL). The main drawbacks of the current open techniques are large scars and contractures in the late postoperative stage, which may, in severe cases, cause equinovarus contractures. Objective To describe the feasibility and the technical aspects of endoscopic SN harvesting with the use of basic endoscopy instruments and small incisions. Methods Prospective observational study of NBPL subjected to endoscopic nerve harvesting between February of 2012 and February of 2014 in a consecutive series. Patients were operated at the Felício Rocho Hospital (Hospital Felício Rocho) and the Clinical Hospital, Federal University of Minas Gerais (Hospital das Clínicas UFMG), Belo Horizonte/MG, in Brazil. The study outcomes assessed were: scar size, presence or absence of contractures in the calf, bleeding volume (measured by the number of gauzes used) and number of incisions. Only patients with a follow-up longer than 6 months were included. Results Seven patients were selected and twelve endoscopic nerves were endoscopically harvested. The average surgery time was 45 minutes. Nine SNs were harvested through two incisions, and three nerves through three incisions. The estimated bleeding was less than 5ml and there were no complications or contractures during the follow-up period of 6 months to 4 years. Conclusion Sural nerve harvesting in children with NBPL is feasible and it offers the advantage of needing only two or three small incisions using basic endoscopy instruments.

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