scholarly journals Posterior instrumented fusion on lumbar stenosis syndrome can bring benefit to proximal degenerative kyphosis

Medicine ◽  
2021 ◽  
Vol 100 (45) ◽  
pp. e27711
Author(s):  
Shuai Xu ◽  
Chen Guo ◽  
Yan Liang ◽  
Zhenqi Zhu ◽  
Hongguang Zhang ◽  
...  
Keyword(s):  
Lumbar Stenosis ◽  
Instrumented Fusion ◽  
Posterior Instrumented Fusion

Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Timothy J Yee ◽  
Michael J Strong ◽  
Matthew S Willsey ◽  
Mark E Oppenlander
Keyword(s):  
Surface Area ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Patient Specific ◽  
Computer Assisted ◽  
Type Ii ◽  
Instrumented Fusion ◽  
Assisted Navigation ◽  
Patient Consent ◽  
Posterior Instrumented Fusion

Abstract Nonunion of a type II odontoid fracture after the placement of an anterior odontoid screw can occur despite careful patient selection. Countervailing factors to successful fusion include the vascular watershed zone between the odontoid process and body of C2 as well as the relatively low surface area available for fusion. Patient-specific factors include osteoporosis, advanced age, and poor fracture fragment apposition. Cervical 1-2 posterior instrumented fusion is indicated for symptomatic nonunion. The technique leverages the larger posterolateral surface area for fusion and does not rely on bony growth in a watershed zone. Although loss of up to half of cervical rotation is expected after C1-2 arthrodesis, this may be better tolerated in the elderly, who may have lower physical demands than younger patients. In this video, we discuss the case of a 75-yr-old woman presenting with intractable mechanical cervicalgia 7 mo after sustaining a type II odontoid fracture and undergoing anterior odontoid screw placement at an outside institution. Cervical radiography and computed tomography exhibited haloing around the screw and nonunion across the fracture. We demonstrate C1-2 posterior instrumented fusion with Goel-Harms technique (C1 lateral mass and C2 pedicle screws), utilizing computer-assisted navigation, and modified Sonntag technique with rib strut autograft.  Posterior C1-2-instrumented fusion with rib strut autograft is an essential technique in the spine surgeon's armamentarium for the management of C1-2 instability, which can be a sequela of type II dens fracture. Detailed video demonstration has not been published to date.  Appropriate patient consent was obtained.

Surgical Approaches for Degenerative Lumbar Stenosis

2018 ◽  
Author(s):  
Doniel Drazin ◽  
Carlito Lagman ◽  
Christine Piper ◽  
Ari Kappel ◽  
Terrence T. Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Imaging ◽  
Surgical Management ◽  
Surgical Approaches ◽  
Low Back ◽  
Lumbar Stenosis ◽  
Instrumented Fusion ◽  
Common Causes ◽  
Ancillary Studies

This chapter discusses the evaluation of patients presenting with low back pain and the surgical management of three common causes of low back pain in adults: stenosis, spondylolisthesis, and scoliosis. Components of the history and physical examination, diagnostic imaging, and ancillary studies are reviewed. Surgical management includes decompression including laminectomy or laminotomy, and instrumented fusion. Indications, contraindications, general procedural steps, and potential complications are covered. Recent published literature is reviewed when appropriate.

scholarly journals C.04 Comparison of clinical outcomes between posterior instrumented fusion with and without interbody fusion for isthmic spondylolisthesis

2019 ◽  
Vol 46 (s1) ◽  
pp. S12
Author(s):  
V Chan ◽  
A Nataraj
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Research Network ◽  
Leg Pain ◽  
Isthmic Spondylolisthesis ◽  
Instrumented Fusion ◽  
Multivariable Regression ◽  
Secondary Outcomes ◽  
Posterior Instrumented Fusion

Background: The purpose of this study is to compare 1-year postoperative clinical outcomes between posterior instrumented fusion with (P/TLIF) and without (PLF) interbody fusion in patients with isthmic spondylolisthesis. Methods: This is a multi-centre retrospective study using the Canadian Spine Outcomes and Research Network. Adult patients who received surgical management for isthmic spondylolisthesis were included in this study. The primary outcome was change in Oswestry Disability Index at 1-year. Secondary outcomes were change in EQ-5D, SF-12 PCS, back pain, leg pain, estimated blood loss, length of surgery, length of stay, rate of transfusions and adverse events. Descriptive statistics, Student t-test, Chi-Squared test, and stepwise multivariable regression were used for analysis. Results: A total of 300 patients (252 P/TLIF, 48 PLF) were included in this study. The mean age was 50 years. The P/TLIF group had poorer baseline leg pain scores (t=2.02, p=0.01). There were no significant differences in primary and secondary outcomes between the two groups. Addition of interbody fusion was not a significant variable in the stepwise multivariable regression analysis. Conclusions: There were no significant differences in clinical outcomes at 1 year. Addition of interbody fusion was not associated with higher complication rates or length of stay.

scholarly journals Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children: technical note

2018 ◽  
Vol 21 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Jonathan N. Sellin ◽  
Jeffrey S. Raskin ◽  
Kristen A. Staggers ◽  
Alison Brayton ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Spine Surgery ◽  
Intraoperative Complications ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Instrumented Fusion ◽  
Cortical Bone Trajectory ◽  
Estimated Blood Loss ◽  
Posterior Instrumented Fusion

Thoracic and lumbar cortical bone trajectory pedicle screws have been described in adult spine surgery. They have likewise been described in pediatric CT-based morphometric studies; however, clinical experience in the pediatric age group is limited. The authors here describe the use of cortical bone trajectory pedicle screws in posterior instrumented spinal fusions from the upper thoracic to the lumbar spine in 12 children. This dedicated study represents the initial use of cortical screws in pediatric spine surgery.The authors retrospectively reviewed the demographics and procedural data of patients who had undergone posterior instrumented fusion using thoracic, lumbar, and sacral cortical screws in children for the following indications: spondylolysis and/or spondylolisthesis (5 patients), unstable thoracolumbar spine trauma (3 patients), scoliosis (2 patients), and tumor (2 patients).Twelve pediatric patients, ranging in age from 11 to 18 years (mean 15.4 years), underwent posterior instrumented fusion. Seventy-six cortical bone trajectory pedicle screws were placed. There were 33 thoracic screws and 43 lumbar screws. Patients underwent surgery between April 29, 2015, and February 1, 2016. Seven (70%) of 10 patients with available imaging achieved a solid fusion, as assessed by CT. Mean follow-up time was 16.8 months (range 13–22 months). There were no intraoperative complications directly related to the cortical bone trajectory screws. One patient required hardware revision for caudal instrumentation failure and screw-head fracture at 3 months after surgery.Mean surgical time was 277 minutes (range 120–542 minutes). Nine of the 12 patients received either a 12- or 24-mg dose of recombinant human bone morphogenic protein 2. Average estimated blood loss was 283 ml (range 25–1100 ml).In our preliminary experience, the cortical bone trajectory pedicle screw technique seems to be a reasonable alternative to the traditional trajectory pedicle screw placement in children. Cortical screws seem to offer satisfactory clinical and radiographic outcomes, with a low complication profile.

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