scholarly journals Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901990047
Author(s):  
Barbara Cappelletto ◽  
Fabrizia Giorgiutti ◽  
Massimo Balsano
Keyword(s):  
Vertebral Body ◽  
Primary Stability ◽  
Clinical Results ◽  
Kyphosis Angle ◽  
Analog Scale ◽  
Traumatic Injuries ◽  
Expandable Cage ◽  
Clinical Observations ◽  
Anterior Support ◽  
Expandable Cages

Purpose: For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. Methods: Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single ( n = 34), double ( n = 4), or triple ( n = 1) corpectomy. Pathologies were tumors ( n = 21), fractures, or deformities in traumatic injuries ( n = 14), degenerative pathology ( n = 2), and infection ( n = 2). Levels were cervical ( n = 10), thoracic ( n = 14), and lumbar ( n = 15). All patients were evaluated clinically and radiographically. Results: There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative ( p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. Conclusions: In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.

scholarly journals Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection

2003 ◽  
Vol 15 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Issada Thongtrangan ◽  
Raju S. V. Balabhadra ◽  
Hoang Le ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Vertebral Body ◽  
Tumor Resection ◽  
Anterior Column ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Wide Resection ◽  
Primary Tumors ◽  
Expandable Cage ◽  
Expandable Cages

Object The authors report their clinical experience with expandable cages used to stabilize the spine after verte-brectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR). Methods Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20°. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage. Conclusions The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.

scholarly journals Our first experience with cervical expandable cage for vertebral body reconstruction

2016 ◽  
Vol 30 (1) ◽  
pp. 41-46
Author(s):  
A. Chiriac ◽  
Z. Faiyad ◽  
C. Popescu ◽  
B. Costachescu ◽  
I. Poeata
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Surgical Procedure ◽  
Expandable Cage ◽  
Thoracic Level ◽  
Expandable Cages ◽  
Cervical Vertebral Body

Abstract Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM)

VERTEBRAL BODY REPLACEMENT SYSTEMS WITH EXPANDABLE CAGES IN THE TREATMENT OF VARIOUS SPINAL PATHOLOGIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 537-545 ◽  
Author(s):  
Mark P. Arts ◽  
Wilco C. Peul
Keyword(s):  
Vertebral Body ◽  
Case Series ◽  
Clinical Results ◽  
Herniated Disc ◽  
Vertebral Body Replacement ◽  
Traumatic Fracture ◽  
Circumferential Fusion ◽  
Favorable Clinical Outcome ◽  
Reoperation Rates ◽  
Expandable Cages

ABSTRACT OBJECTIVE Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications. METHODS Sixty patients underwent single or multilevel corpectomy for degenerative stenosis (13 patients), herniated disc (7 patients), deformity (14 patients), traumatic fracture (3 patients), infection (1 patient), or tumor (22 patients). Six different expandable vertebral body systems were used in the cervical spine (41 patients), thoracic spine (15 patients), and lumbar spine (4 patients). All patients were evaluated clinically and radiographically. RESULTS Thirty-nine patients underwent single-level corpectomy, 18 patients underwent two-level corpectomy, and 3 patients underwent three-level corpectomy. Anterior reconstruction alone was performed in 30 patients; circumferential reconstruction was performed in 30 patients, 9 of whom underwent reconstruction through a posterior approach only. At the time of the final follow-up examination (mean, 9 mo), the Nurick grade improved significantly. Ninety-five percent of the patients maintained or improved their Frankel score and 67% had good clinical results. The regional angulation was corrected significantly (4.0 ± 9.0 degrees, P = 0.002), and the segment height increased significantly (3.5 ± 8.0 mm, P = 0.002). Bony fusion was achieved in 93% of the cases. Subsidence was documented in nearly half of the patients (1.4 ± 2.0 mm) and was reduced after circumferential fusion (0.9 ± 1.9 mm, P = 0.08). Eighteen patients (30%) had complications and 12 patients (20%) underwent revision surgery. CONCLUSION Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.

Adjacent-level vertebral body fractures after expandable cage reconstruction

2008 ◽  
Vol 8 (6) ◽  
pp. 584-588 ◽  
Author(s):  
Dean Chou ◽  
Daniel C. Lu ◽  
Philip Weinstein ◽  
Christopher P. Ames
Keyword(s):  
Vertebral Body ◽  
Spinal Column ◽  
Fracture Pattern ◽  
Coronal Plane ◽  
Adjacent Level ◽  
Vertebral Body Fracture ◽  
Expandable Cage ◽  
Vertebral Body Fractures ◽  
Body Fracture ◽  
Expandable Cages

✓Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. The forces that are used to expand these cages can be large, depending upon the mechanism of expansion. To the authors' knowledge, there have been no reports of adjacent-level vertebral body fracture after placement of expandable cages. The authors report 4 cases of adjacent-level vertebral body fractures after placement of expandable cages. This study found that the fracture pattern in the coronal plane was similar in all cases.

scholarly journals Comparison of the clinical outcomes of skin bridge loop ileostomy and traditional loop ileostomy in patients with low rectal cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hui Ye ◽  
Shujuan Huang ◽  
Jie Yu ◽  
Qichang Zhou ◽  
Changlei Xi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Low Anterior Resection ◽  
Clinical Evidence ◽  
Loop Ileostomy ◽  
Loop Group ◽  
Clinical Results ◽  
Low Rectal Cancer ◽  
Analog Scale ◽  
Traditional Group ◽  
Bridge Group

AbstractTo compare the clinical results of patients with low rectal cancer who underwent skin bridge loop ileostomy and traditional loop ileostomy, and provide clinical evidence for choosing a better ostomy method. We retrospectively collected data of 118 patients with rectal cancer who underwent low anterior resection and loop ileostomy. To investigate the patients characteristics, postoperative stoma-related complications and the frequency of exchanged ostomy bags. The differences of these indicators between the two groups of patients who underwent skin bridge loop ileostomy and traditional loop ileostomy were compared. The Visual Analog Scale (VAS) score of the skin bridge loop ileostomy group was lower than that of the traditional ileostomy loop group (P < 0.05). The skin bridge group had a lower Discoloration, Erosion, Tissue overgrowth (DET) score and incidence of mucocutaneous separation than the traditional group at the 1st and 2nd weeks after operation (P < 0.05). The average number of weekly exchanged ostomy bags was significantly less in the skin bridge group than in the traditional group within 4 weeks after surgery (P < 0.05). Our experience demonstrates that the skin bridge loop ileostomy may significantly reduce early postoperative stoma-related complications, the frequency of exchanged ostomy bags and patients’ medical costs after discharge.

Optimisation of the drill-in behaviour of the EcoFit® SC threaded cup

2020 ◽  
Vol 65 (4) ◽  
pp. 477-484
Author(s):  
Christoph Thorwächter ◽  
Matthias Woiczinski ◽  
Inês Santos ◽  
Florian Schmidutz ◽  
Alexander Paulus ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Primary Stability ◽  
Clinical Results ◽  
Clinical Applications ◽  
Testing System ◽  
Clinical Use ◽  
Maximum Torque ◽  
3D Images ◽  
Universal Testing ◽  
Biomechanical Investigation

AbstractThreaded cups show good clinical results when implanted correctly. In clinical use, multiple cases with an incomplete placement of the EcoFit threaded cup (implantcast) were observed. This behaviour could not be explained intra- and postoperatively. The aim of this study was to compare and optimise the drill-in-behaviour of the EcoFit cup in a biomechanical investigation. EcoFit cup sizes 46, 50 and 54 mm were compared with the SC cup (Aesculap) size 50 mm. Foam blocks (Sawbones) of density 0.16 g/ml (pcf 10), 0.32 g/ml (pcf 20) and 0.48 g/ml (pcf 30) were used. After standardised placement using a universal testing system (n = 8 per group), the primary stability, the overhang of the cups and the drill-in behaviour were measured. Overreamings of 1 and 2 mm were performed (pcf 20, n = 8) for the EcoFit cup size 50 and the primary stability as well as the overhang measurements were examined. Measurements of the cup diameter, thread depth and thread pitch were performed on three-dimensional (3D) images of the cup size 50 mm. The drill-in behaviour was different between the EcoFit and the SC cups. Even with maximum torque, the EcoFit cup could not be positioned as deep as the SC cup in standard reaming conditions (overhang of 1.1 ± 0.4 mm for the EcoFit size 50 in pcf 20 and of −0.01 ± 0.2 mm for the SC cup). The primary stability was lower for the EcoFit cup in comparison to the SC cup (128.8 ± 3.2 Nm vs. 138.6 ± 9.1 Nm, p = 0.0291). With overreaming to 51 mm, a deeper positioning of the EcoFit was possible (overlap of −0.3 ± 0.1, comparable to the SC cup). The overreaming of the cavity also led to a significantly higher primary stability of 143.4 ± 3.7 Nm (p < 0.001) comparable to the unaltered condition (128.8 ± 3.2 Nm). Overreaming to 52 mm had no further advantage in terms of primary stability or overhang. The geometric measurements showed significant differences as well. The previously clinically observed difficulties in inserting the cup were confirmed by this study. By overreaming to 51 mm, the drill-in behaviour, the primary stability and the measured overhang were comparable to the reference cup. The obtained results suggest that the extension of the acetabulum cavity to 51 mm while using the implantcast EcoFit size 50 should be implemented in clinical applications.

scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Plantar Flexion ◽  
Clinical Results ◽  
Analog Scale ◽  
Silicone Prosthesis ◽  
Prosthesis Replacement ◽  
Freiberg Disease ◽  
Metatarsophalangeal Joints ◽  
Late Stages ◽  
Dorsal Flexion

Category: Lesser Toes Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease in their late stages. They underwent double stemmed flexible silicone prosthesis replacement for metatarsophalangeal joints. The average age was 63.8 (range 30~88) years. The average follow up period was 26 (range 18–42) months. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), AOFAS and Maryland metatarsophalangeal joints scale before surgery and at the latest follow-up. Results: The average ROM of dorsal flexion improved from 39.3±6.1° before surgery to 75.4±8.6° at latest follow-up (p<0.001). The average ROM of plantar flexion improved from 19.0±11.4° before surgery to 20.2±9.3° at latest follow-up (p=0.14). The average VAS significantly improved from 8.1±0.5 before surgery to 2.6±0.2 at latest follow-up (p<0.001). The average Maryland metatarsophalangeal joints score significantly improved from 65.3±9.3 points before surgery to 90.3±4.1 points at the latest follow-up (p<0.001). The average AOFAS was 89.4±8.5 after surgery compared 56.3±6.4 preoperatively (p<0.005). Conclusion: A flexible silicone prosthesis replacement was carried out to treat Freiberg disease in its late stages. The function was observed in all cases with improved clinical results. The silicone prosthesis was considered to be useful in certain cases.

Revision characteristics of cement-augmented, cannulatedfenestrated pedicle screws in the osteoporotic vertebral body: a biomechanical in vitro investigation

2009 ◽  
Vol 11 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Thomas R. Blattert ◽  
Stefan Glasmacher ◽  
Hans-Joachim Riesner ◽  
Christoph Josten
Keyword(s):  
Bone Tissue ◽  
Vertebral Body ◽  
Pedicle Screws ◽  
Clinical Results ◽  
Mineral Density ◽  
In Vitro Investigation ◽  
Human Cadaver Model ◽  
Surrounding Bone ◽  
Severe Grade

In generalized osteoporosis, instrumentation with cement-augmented pedicle screws is an amplification of the therapeutic spectrum. Early clinical results are promising for both solid and cannulated screws; however, there are concerns regarding the revision characteristics of these screws, especially for the cannulated-fenestrated type with its continuous cement interconnection from the core of the screw to surrounding bone tissue. In a human cadaver model, bone mineral density (BMD) was assessed radiographically. Spinal levels T9–L4 were instrumented left unilaterally, transpedicularly by using cannulated-fenestrated pedicle screws with the dimensions 6.5 × 45 mm. Polymethylmethacrylate cement (1.5 ml) was injected through the screws into each vertebra. After polymerization of the cement, the extraction torque was recorded. For both implantation and explantation of the screws, a fluoroscope was used to guarantee correct screw and cement positioning and to observe possible co-movements—that is, any movement of the cement mass within the vertebral body upon removal of the screw. For comparison, the extraction torque of same-dimension pedicle screws was recorded in a nonosteoporotic, non–cement-augmented instrumentation. The BMD was 0.60 g/cm2, a level that corresponds to a severe grade of osteoporosis. For removal of the screws, the median and mean extraction torques were 34 and 49 ± 44 Ncm, respectively. No co-movements of the cement mass occurred within the vertebral body. In the nonosteoporotic control, BMD was 1.38 g/cm2. The median and mean extraction torques were 123 and 124 ± 12 Ncm, respectively. Thus, the revision characteristics of cement-augmented, cannulated-fenestrated pedicle screws are not problematic, even in cases of severe osteoporosis. The winglike cement interconnection between the screw core and surrounding bone tissue is fragile enough to break off in the event of an extraction torque and to release the screw. There is no proof to support the theoretical fear that while trying to remove a screw, the composite of screw and cement would not break but instead would rotate as a whole in the osteoporotic vertebral body.

Short stems in total hip replacement: evidence on primary stability according to the stem type

2018 ◽  
Vol 29 (2) ◽  
pp. 118-127 ◽  
Author(s):  
Georgios I Drosos ◽  
Panagiotis Touzopoulos
Keyword(s):  
Total Hip Replacement ◽  
Clinical Studies ◽  
Hip Replacement ◽  
Primary Stability ◽  
Clinical Results ◽  
Migration Patterns ◽  
Total Hip ◽  
Short Stems ◽  
Stem Migration

Background: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently – mechanical and clinical studies – concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. Method: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems – as expressed by implant micromotion and stem subsidence – according to our previously proposed short-stem classification. Results: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 “partial collum” short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. Conclusion: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.

scholarly journals Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Naohisa Miyakoshi ◽  
Akira Horikawa ◽  
Yoichi Shimada
Keyword(s):  
Vertebral Fracture ◽  
Fracture Healing ◽  
Clinical Experience ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Surgical Intervention ◽  
Osteoporotic Vertebral Fracture ◽  
Kyphosis Angle ◽  
Osteoporotic Vertebral Fractures

Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA) at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12°) and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

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