Single-Stage Transpedicular Approach for Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures

Abstract Background Traumatic vertebral burst fractures can be surgically approached via different approaches (anterior/posterior, or combined). Posterior transpedicular approach (PTA) is a posterior approach that has the advantage of achieving circumferential arthrodesis via single posterior-only approach. The purpose of this study was to analyze our experience with PTA in management of traumatic lumbar burst fractures (TLBFs). Methods All consecutive patients with TLBFs managed with PTA over 3 years’ duration were included in this retrospective study. Correction of kyphotic deformity and change in neurologic status were analyzed to assess outcome. Cobb’s angle and American Spinal Injury Association (ASIA) grade were used for this purpose. Results There were 12 males and 8 females. Five patients had complete (ASIA-A) while 12 had incomplete injury. The mean preoperative Cobb’s angle was 14.23 degrees that improved to–3.21 degrees postoperatively (mean kyphosis correction: 17.44 degrees). None of the patients developed iatrogenic nerve root injury. There was no perioperative mortality. The mean Cobb’s angle was 1.45 degrees at 36 months’ follow-up. Four patients developed cage subsidence but none required revision surgery. Postoperatively, 13 (65%) patients showed neurologic improvement and none deteriorated. The average ASIA score improved from 2.82 to 4.23. A fusion rate of 96% was observed at last follow-up. Conclusion The advantages of PTA including sense of familiarity with posterior approach among spine surgeons, lesser approach-related morbidity, and results comparable to anterior/combined approaches, make the PTA an attractive option for managing TLBFs. Although technically difficult, it can be successfully used for circumferential arthrodesis in the lumbar region without sacrificing nerve roots.

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THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

Coluna/Columna ◽

10.1590/s1808-185120161503157849 ◽

2016 ◽

Vol 15 (3) ◽

pp. 213-218 ◽

Cited By ~ 1

Author(s):

MURILO TAVARES DAHER ◽

PEDRO FELISBINO JUNIOR ◽

ADRIANO PASSÁGLIA ESPERIDIÃO ◽

BRENDA CRISTINA RIBEIRO ARAÚJO ◽

ANDRÉ LUIZ PASSOS CARDOSO ◽

...

Keyword(s):

Disc Herniation ◽

Posterior Approach ◽

Surgical Decompression ◽

Thoracic Disc Herniation ◽

Transpedicular Approach ◽

Partial Body ◽

The Mean ◽

Thoracic Disc ◽

A La Carte

ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte). Methods: We evaluated thirteen patients (14 hernias) treated by the posterior approach. Eight (61.5%) patients were male and the mean age was 53 years (34-81). Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months). Of the 14 operated hernias, six (43%) were lateral, 2 (14%) paramedian, and 6 (43%) central. Seven were soft (50%) and seven were calcified. The transfacet approach was carried out in 5 cases (36%), transpedicular in 1 case (7%), transpedicular + partial body resection in 4 (29%), costotransversectomy in 3 (21%), and costotransversectomy + CAGE in one case (7%). The majority of patients with lateral hernia (5/6) were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

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Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy

BioMed Research International ◽

10.1155/2020/1573589 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ke-Xiao Yu ◽

Wei-Zhong Lu ◽

Chang-Ming Xiao ◽

Lei Chu ◽

Rui Deng ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Effects ◽

Nerve Root Injury ◽

Single Segment ◽

Transpedicular Approach ◽

Minimal Trauma ◽

Cord Injury ◽

Vas Scores ◽

The Mean

Background. Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. Objective. This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. Methods. In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. Results. All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52–130 min). The fluoroscopy duration was 5.88 ± 1.05 (4–7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively ( P < 0.05 ). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up ( P < 0.05 ). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. Conclusions. The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.

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Anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181672 ◽

2018 ◽

Vol 4 (3) ◽

pp. 421

Author(s):

Anurag Tiwari ◽

Ankit Thora ◽

Mukul Mohindra ◽

Amit Sharma ◽

Sumit Sural ◽

...

Keyword(s):

Blood Loss ◽

Posterior Approach ◽

Japanese Orthopaedic Association ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Thoracolumbar Injury ◽

Duration Of Surgery ◽

The Mean ◽

Anterior Reconstruction

Background: The purpose of this study is to evaluate neurological, functional and radiological outcome of the anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures.Methods: Ten patients with acute unstable burst fractures at thoracolumbar junction (T-11 to L-3) with partial or complete neurological deficit in the age group of 18-50 years with McCormack’s score six or more and thoracolumbar injury severity score (TLISS) five or more were included. Neurological status, Japanese Orthopaedic association score (JOA score), visual analogue scale (VAS), angle of kyphotic deformity, McCormack’s score and TLISS score were evaluated.Results: The mean duration of surgery was 282 minutes. The mean blood loss was 1885 ml. Five patients with neurologic deficit recovered an average of 1.40 ASIA grades at last 24 months’ follow-up. The JOA score improved from -6 preoperatively to 11 at 24 months follow up. The mean kyphotic angle was 19 degrees preoperative improved to -0.6o postoperatively. Visual analogue score improved from 6.1 to 1.7.Conclusions: The familiar posterior approach is a safe and reliable surgical approach for reconstruction of all the columns of spine. It has the advantage of doing anterior decompression and reconstruction with posterior instrumentation in single stage, reducing the operative time and blood loss. It reduces the morbidity of anterior approach (isolated or two staged) in the hands of an average orthopaedic surgeon.

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Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study

Asian Spine Journal ◽

10.4184/asj.2017.11.4.618 ◽

2017 ◽

Vol 11 (4) ◽

pp. 618-626

Author(s):

Suryakant Singh ◽

Hitesh Dawar ◽

Kalidutta Das ◽

Bibhudendu Mohapatra ◽

Somya Prasad

Keyword(s):

Retrospective Study ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Decompression ◽

Posterior Stabilization ◽

Bony Fusion ◽

Transpedicular Approach ◽

The Mean

<sec><title>Study Design</title>This is a retrospective study.</sec><sec><title>Purpose</title>To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.</sec><sec><title>Overview of Literature</title>Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.</sec><sec><title>Methods</title>The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.</sec><sec><title>Results</title>The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.</sec><sec><title>Conclusions</title>Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.</sec>

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Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04078-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

The Mean ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

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Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

Global Spine Journal ◽

10.1177/2192568220964453 ◽

2020 ◽

pp. 219256822096445

Author(s):

Azmi Hamzaoglu ◽

Mustafa Elsadig ◽

Selhan Karadereler ◽

Ayhan Mutlu ◽

Yunus Emre Akman ◽

...

Keyword(s):

Neurological Deficit ◽

Vertebral Column ◽

Single Stage ◽

Anterior Column ◽

Vertebral Column Resection ◽

Posterior Vertebral Column Resection ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

The Mean

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

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Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3038-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Xuhong Xue ◽

Sheng Zhao

Keyword(s):

Retrospective Study ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Thoracolumbar Burst Fractures ◽

Correction Rate ◽

Burst Fractures ◽

The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

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CHALLENGING DEGENERATIVE LUMBAR SCOLIOSIS WITH SEGMENTAL CORRECTIVE FUSION SURGERY

Journal of Musculoskeletal Research ◽

10.1142/s0218957706001807 ◽

2006 ◽

Vol 10 (03) ◽

pp. 141-150 ◽

Cited By ~ 1

Author(s):

Takahiro Iizuka ◽

S. Yamada

Keyword(s):

Spinal Curvature ◽

Degenerative Lumbar Scoliosis ◽

Spinal Alignment ◽

Poor Bone Quality ◽

Fusion Surgery ◽

Lumbar Scoliosis ◽

Cobb’S Angle ◽

Correction Surgery ◽

The Mean

Changes in the curvature have not been reported in degenerative lumbar scoliosis (DLS) when the correction surgery was performed. The purpose of our study was to clarify the influence of the correction surgery of DLS. Twenty-one patients underwent corrective lumbar reconstruction surgery (1998–2003) only at the neurologically affected levels. The spinal curvature was retrospectively evaluated in these 21 patients with DLS using Cobb's methods. The mean preoperative Cobb's angle was 17.7° while the mean postoperative Cobb's angle was 6.1° (p < 0.0001) at 1 month after the surgery and 9.0° at the final follow-up. The correction rate was 65.2% at 1 month after the surgery and 50.2% at the final follow-up. Cobb's angle increased by 2.9°/43.4 months (mean, 0.80°/year) in these procedure. The surgical goals of DLS are the relief of neurological disorders and the cessation of the deterioration of spinal alignment. Strategies for DLS may include complete decompression, or correction of the spinal alignment in elderly patients with poor bone quality. Decompression and correction in the PLIF procedure only at neurologically affected levels may be one of the surgical procedures to challenge DLS.

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Lumbar and para-iliac hernias: an alternative technique

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20213029 ◽

2021 ◽

Vol 48 ◽

Author(s):

MARIA PESSOLE BIONDO SIMÕES ◽

ALEXANDRE CONTIN MANSUR ◽

SILVANIA KLUG PIMENTEL

Keyword(s):

Bone Graft ◽

Blunt Trauma ◽

Iliac Crest ◽

Aortic Surgery ◽

Iliac Bone ◽

Lumbar Region ◽

Alternative Technique ◽

Iliac Bone Graft ◽

The Mean

ABSTRACT Lumbar and para-iliac hernias are rare and occur after removal of an iliac bone graft, nephrectomies, retroperitoneal aortic surgery, or after blunt trauma to the abdomen. The incidence of hernia after the removal of these grafts ranges from 0.5 to 10%. These hernias are a problem that surgeons will face, since bone grafts from the iliac crest are being used more routinely. The goal of this article was to report the technique to correct these complex hernias, using the technique of fixing the propylene mesh to the iliac bone and the result of this approach. In the period of 5 years, 165 patients were treated at the complex hernia service, 10 (6%) with hernia in the supra-iliac and lumbar region, managed with the technique of fixing the mesh to the iliac bone with correction of the failure. During the mean follow-up of 33 months (minimum of 2 and maximum of 48 months), there was no recurrence of the hernias.

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Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

10.21203/rs.3.rs-27905/v1 ◽

2020 ◽

Author(s):

Chao Lou ◽

Weiyang Yu ◽

Zhenzhong Chen ◽

Kangtao Jin ◽

Jiawei Gao ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Titanium Mesh ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Percutaneous Pedicle Screw ◽

The Mean ◽

Percutaneous Pedicle Screw Fixation

Abstract Objective: This study aimed to assess the feasibility as well as the clinical and radiological outcomes of posterior percutaneous pedicle screw fixation (PPSF) combined with anterior monosegmental column reconstruction in unstable thoracolumbar burst fractures. Methods: From January 2011 to August 2017, thirty-five patients with unstable thoracolumbar burst fractures were enrolled in this study. The patients underwent posterior PPSF combined surgery with delayed anterior monosegmental reconstruction utilizing titanium mesh cages. Clinical outcomes, radiological parameters, and treatment-related complications were assessed. Results: The mean age of the patients was 44.8 years. The mean operative time and blood loss were 205 min and 560 ml, respectively. The mean follow-up period was 25.2 months. The Visual analog scale (VAS) pain score was significantly improved postoperatively, and the improvement was maintained until the final follow-up. The mean sagittal kyphosis was corrected from 16.3 preoperatively to 1.5 postoperatively, which increased slightly to 2.6 at the final follow-up. In 24 patients with neurologic dysfunction, 21 (87.5 %) patients had improvement after surgery. None obvious subsidence of the titanium mesh cage and none dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Solid bony fusion was achieved in all patients. Conclusions: Combined posterior PPSF with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.

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