Minimum 5-year Follow-up Results for Occipitocervical Fusion Using the Screw-Rod System in Craniocervical Instability

2017 ◽  
Vol 30 (5) ◽  
pp. E628-E632 ◽  
Author(s):  
Kei Ando ◽  
Shiro Imagama ◽  
Zenya Ito ◽  
Kazuyoshi Kobayashi ◽  
Hideki Yagi ◽  
...  
Keyword(s):  
Occipitocervical Fusion ◽  
Rod System ◽  
Craniocervical Instability

Extreme lateral—transatlas approach for resection of the dens of the axis

2002 ◽  
Vol 96 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Uğur Türe ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Clinical Experiences ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Alternative Approach ◽  
Craniocervical Instability ◽  
Fine Print

Object. Various approaches have been described for resection of the dens of the axis, each of which has potential advantages and disadvantages. Anterior approaches such as the transoral route or its modifications are the most commonly used for resection of this structure. The transcondylar approach, however, which allows the surgeon to view the craniovertebral junction (CVJ) from a lateral perspective, has been introduced by Al-Mefty, et al., as an alternative approach. In this report, the authors describe the surgical technique of the extreme lateral—transatlas approach and their clinical experiences. Methods. The authors first examined the surgical approach to the dens from a lateral perspective in five cadaveric heads. They found that removal of the lateral mass of the atlas provided adequate exposure for resection of the dens. Following this cadaveric study, the extreme lateral—transatlas approach was successfully performed at the authors' institution over a 1-year period (September 1998–August 1999) in five patients with basilar invagination due to congenital anomaly of the CVJ and rheumatoid arthritis. Furthermore, during the same procedure, unilateral occipitocervical fusion was performed following resection of the dens. In all cases complete resection of the dens was achieved using the extreme—lateral transatlas approach. This procedure provides a sterile operative field and the ability to perform occipitocervical fusion immediately following the resection. No postoperative complications or craniocervical instability were observed. The mean follow-up period was 17.2 months (range 13–24 months). Conclusions. The extreme lateral—transatlas approach for resection of the dens was found to be safe and effective. Knowledge of the anatomy of this region, especially of the V3 segment of the vertebral artery, is essential for the success of this procedure.

Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients

2020 ◽  
Vol 32 (3) ◽  
pp. 366-372
Author(s):  
Sandro M. Krieg ◽  
Nele Balser ◽  
Haiko Pape ◽  
Nico Sollmann ◽  
Lucia Albers ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interbody Fusion ◽  
Smooth Transition ◽  
Lumbar Pain ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Rod System ◽  
Reoperation Rates ◽  
Topping Off

OBJECTIVESemi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach.METHODSThe authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw–based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system.RESULTSImplantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1–5 segments) were included and a median of 2 motion segments (range 0–4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%.CONCLUSIONSThe PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.

scholarly journals Analysis of serum levels of titanium and aluminium ions in patients with early onset scoliosis operated upon using the magnetic growing rod—a single centre study of 14 patients

2021 ◽  
Author(s):  
Mandar Deepak Borde ◽  
Sarang Sapare ◽  
Emile Schutgens ◽  
Chadi Ali ◽  
Hilali Noordeen
Keyword(s):  
Early Onset ◽  
Serum Levels ◽  
Early Onset Scoliosis ◽  
Ion Concentration ◽  
Long Term Effects ◽  
Blood Concentrations ◽  
Growing Rod ◽  
Rod System ◽  
Rod Breakage

Abstract Study design A cross-sectional retrospective Level 3 study. Objective To study the serum levels of Titanium and Aluminium ions in patients operated using the magnetically controlled growing rod (MCGR) system. Summary of background data 14 consecutive patients of early onset scoliosis with varying etiology managed with MCGR system with a minimum follow-up of 24 months were selected for the study. The group consisted of two boys (14.3%) and 12 girls (85.7%). The average age of the patients at the time of surgery was 10.4 years (5–15 years). The average period of follow-up was 43.7 months (28–79 months). After informed consent of the subjects and their caretakers, serum levels of titanium and aluminium were measured. These levels were then assessed with regards to the number of screws used, number of distractions and complications. Methods The concentration of titanium and aluminium ions in the serum was measured using high resolution inductively coupled plasma mass spectrometry. Results For the sake of ease of assessment, patients were divided into three etiology-based groups—idiopathic (n = 6), neuromuscular (n = 2) and syndromic (n = 6). The mean serum titanium level was 15.9 μg/L (5.1–28.2 μg/L) while that of aluminium was 0.1 μmol/L (0.1–0.2 μmol/L). Of the 14 patients, 2 (14.2%) patients had mechanical failure (actuator pin dysfunction), 3 (21.4%) had rod breakage requiring revision surgery and one patient (7.1%) had surgical site infection managed with appropriate antibiotics. Patients undergoing revision for rod breakage did not show any metallosis of the tissues during surgery. Conclusion Analysis of patients with scoliosis operated using the magnetic growing rod system concludes that it is accompanied by presence of titanium in the blood but whether clinically significant or not needs to be ascertained by comparison of preoperative and postoperative blood concentrations of the titanium ions in individual subjects. The aluminium ion concentration remains within normal limits. Though implant malfunction may raise the titanium levels in the blood, its clinical significance needs to be determined. The aluminium levels are not affected irrespective to the presence or absence of complications. The long-term effects of raised titanium levels in the blood also warrant further prospective studies designed for precise and deeper analyses.

Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease

2013 ◽  
Vol 20 (3) ◽  
pp. 394-399 ◽  
Author(s):  
Zhonghai Li ◽  
Fengning Li ◽  
Shunzhi Yu ◽  
Hui Ma ◽  
Zhaohui Chen ◽  
...  
Keyword(s):  
Degenerative Disease ◽  
Lumbar Degenerative Disease ◽  
Rod System ◽  
Rigid Rod

Occipitocervical Fusion with Posterior Plate and Screw Instrumentation: A Long-term Follow-up Study

Spine ◽  
1994 ◽  
Vol 19 (20) ◽  
pp. 2364-2368 ◽  
Author(s):  
Rick C. Sasso ◽  
Bernard Jeanneret ◽  
Klaus Fischer ◽  
F. Magerl
Keyword(s):  
Occipitocervical Fusion ◽  
Follow Up Study ◽  
Long Term Follow Up

Nonfusion stabilization of the degenerative lumbar spine

2011 ◽  
Vol 15 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Alberto Maleci ◽  
Rafael Donatus Sambale ◽  
Michele Schiavone ◽  
Franz Lamp ◽  
Fahir Özer ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Donor Site ◽  
Visual Analog Scale Score ◽  
Clinical Results ◽  
Degenerative Disease ◽  
Operative Trauma ◽  
Implant Complications ◽  
Rod System ◽  
Adjacent Disc

Object The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system). Methods A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform. Results The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression. Conclusions The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results.

scholarly journals The far-lateral approach: destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability

2016 ◽  
Vol 125 (1) ◽  
pp. 196-201 ◽  
Author(s):  
Ehab Shiban ◽  
Elisabeth Török ◽  
Maria Wostrack ◽  
Bernhard Meyer ◽  
Jens Lehmberg
Keyword(s):  
Extent Of Resection ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Occipitocervical Fusion ◽  
Anterior Portion ◽  
Far Lateral Approach ◽  
Clinical Instability ◽  
Craniocervical Instability ◽  
Far Lateral

OBJECT Far-lateral or extreme-lateral approaches to the skull base allow access to the lateral and anterior portion of the lower posterior fossa and foramen magnum. These approaches include a certain extent of resection of the condyle, which potentially results in craniocervical junction instability. However, it is debated what extent of condyle resection is safe and at what extent of condyle resection an occipitocervical fusion should be recommended. The authors reviewed cases of condyle resection/destruction with regard to necessity of occipitocervical fusion. METHODS The authors conducted a retrospective analysis of all patients in whom a far- or extreme-lateral approach including condyle resection of various extents was performed between January 2007 and December 2014. RESULTS Twenty-one consecutive patients who had undergone a unilateral far- or extreme-lateral approach including condyle resection were identified. There were 10 male and 11 female patients with a median age of 61 years (range 22–83 years). The extent of condyle resection was 25% or less in 15 cases, 50% in 1 case, and greater than 75% in 5 cases. None of the patients who underwent condyle resection of 50% or less was placed in a collar postoperatively or developed neck pain. Two of the patients with condyle resection of greater than 75% were placed in a semirigid collar for a period of 3 months postoperatively and remained free of pain after this period. At last follow-up none of the cases showed any clear sign of radiological or clinical instability. CONCLUSIONS The unilateral resection or destruction of the condyle does not necessarily result in craniocervical instability. No evident instability was encountered even in the 5 patients who underwent removal of more than 75% of the condyle. The far- or extreme-lateral approach may be safer than generally accepted with regard to craniocervical instability as generally considered and may not compel fusion in all cases with condylar resection of more than 75%.

scholarly journals Minimum Two-Year Follow-Up of Cases with Recurrent Disc Herniation Treated with Microdiscectomy and Posterior Dynamic Transpedicular Stabilisation

2010 ◽  
Vol 4 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Tuncay Kaner ◽  
Mehdi Sasani ◽  
Tunc Oktenoglu ◽  
Ahmet Levent Aydin ◽  
Ali Fahir Ozer
Keyword(s):  
Disc Herniation ◽  
Clinical Results ◽  
Prospective Clinical Study ◽  
Low Back ◽  
Failed Back Syndrome ◽  
Recurrent Disc Herniation ◽  
Rod System ◽  
Disc Herniations ◽  
Vas Scores

The objective of this article is to evaluate two-year clinical and radiological follow-up results for patients who were treated with microdiscectomy and posterior dynamic transpedicular stabilisation (PDTS) due to recurrent disc herniation. This article is a prospective clinical study. We conducted microdiscectomy and PDTS (using a cosmic dynamic screw-rod system) in 40 cases (23 males, 17 females) with a diagnosis of recurrent disc herniation. Mean age of included patients was 48.92 ± 12.18 years (range: 21-73 years). Patients were clinically and radiologically evaluated for follow-up for at least two years. Patients’ postoperative clinical results and radiological outcomes were evaluated during the 3rd, 12th, and 24th months after surgery. Forty patients who underwent microdiscectomy and PDTS were followed for a mean of 41 months (range: 24-63 months). Both the Oswestry and VAS scores showed significant improvements two years postoperatively in comparison to preoperative scores (p<0.01). There were no significant differences between any of the three measured radiological parameters (α, LL, IVS) after two years of follow-up (p > 0.05). New recurrent disc herniations were not observed during follow-up in any of the patients. We observed complications in two patients. Performing microdiscectomy and PDTS after recurrent disc herniation can decrease the risk of postoperative segmental instability. This approach reduces the frequency of failed back syndrome with low back pain and sciatica.

scholarly journals Posterior Temporary Fixation of C1-2 Screw-rod System for Unstable C1 Burst Fracture

2020 ◽  
Author(s):  
Yun-lin Chen ◽  
Xu-dong Hu ◽  
Yang Wang ◽  
Wei-yu Jiang ◽  
Wei-hu Ma
Keyword(s):  
Burst Fracture ◽  
Implant Removal ◽  
Alternative Technique ◽  
Lateral Mass ◽  
Age At Surgery ◽  
Rod System ◽  
C2 Fixation ◽  
Type 3 ◽  
Rotation Function

Abstract Background Whether an unstable C1 burst fracture should be treated surgically or conservatively is controversial. The purpose of this study is to evaluate the effectiveness and motion-preserving function of temporary fixation of C1-2 screw-rod system for the reduction and fixation of unstable C1 burst fracture (type 3 and 4 according to the Gehweiler classification).Patients and Methods We retrospectively reviewed 10 patients who were treated with posterior temporary C1-C2 fixation. We assessed age at surgery, gender, pre- and post-operative VAS, NDI, atlanto-dens interval, lateral mass distance and rotation function of C1-C2 complex.Results 6 males and 4 females were included in our study. The average follow-up duration was 14.1± 1.37 months. The left-to-right ROMs of C1-C2 rotation was 9.6±1.42°. The pre-operative cervical VAS was 8.30±0.48; the post-operative cervical VAS of C1-C2 fusion was 2.90±0.57. The pre-operative VAS for removal was 2.0±0.00, the post-operative VAS for removal was 2.3±0.48; The pre-operative cervical NDI was 81.40%±2.07%, the post-operative cervical NDI of C1-C2 fusion was 18.10%±1.52%. The preoperative NDI for removal was 15.9%±1.20%, The post-operative NDI for removal was 14.5%±1.08%. The pre-operative ADI was 4.43±0.34mm, post-operative ADI was 1.94±0.72mm. The pre-operative LMD was 6.36±0.58mm, post-operative LMD was 1.64±0.31mm.Conclusion Posterior temporary C1-2 fixation can achieve a good fusion, satisfied reduction of C1 burst fracture, relieve the pain, improve the cervical function outcome, but may reduce the rotational ROM of C1-2. Temporary C1- C2 fixation is an alternative technique to manage the C1 burst fracture, but the need for implant removal needs to be questioned. For patients with CT scan before implant removal showing spontaneous fusion, they may potentially not profit from implant removal.

Sign in / Sign up

Export Citation Format

Share Document