Learning Curve for Placement of Thoracic Pedicle Screws in the Deformed Spine

Abstract OBJECTIVE The placement of thoracic pedicle screws, particularly in the deformed spine, poses unique challenges, and a learning curve. We measured the in vivo accuracy of placement of thoracic pedicle screws by computed tomography in the deformed spine by a single surgeon over time. METHODS After obtaining institutional review board approval, we retrospectively selected the first 30 consecutive patients who had undergone a posterior spinal fusion using a pedicle screw construct for adolescent idiopathic scoliosis by a single surgeon. The average patient age was 14 years, and their preoperative thoracic Cobb angle was, on average, 62.6 degrees. Patients were divided into 3 groups: group A, patients 1 to 10; group B, patients 11 to 20; and group C, patients 21 to 30. Intraoperative evaluation of all pedicle screws included probing of the pedicle screw tract, neurophysiologic monitoring, and fluoroscopic confirmation. Postoperative computed tomographic scans were evaluated by 2 spine surgeons, and a consensus read was established, as previously described (Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004;29(3):333–342), as (1) “in,” axis of pedicle screw within the confines of the pedicle; or (2) “out,” axis of pedicle screw outside the confines of the pedicle. RESULTS A total of 553 thoracic pedicle screws were studied (group A, n = 181; group B, n = 189; group C, n = 183) with 64 graded as out (medial, 35; lateral, 29), for an overall breach rate of 11.6%. When the breach rates were stratified by the surgeon's evolving experience, there was a temporal decrease in the breach rate (group A, 15.5%; group B, 10.6%; group C, 8.7%; P < .05). This decreased breach rate was reflected in fewer medial breaches over time (group A, 9.4%; group B, 5.8%; group C, 3.8%; P < .05). Similar trends were observed for the concave periapical screws, although statistical significance was not attained (group A, 21.2%; group B, 16.2%; group C, 10.5%). CONCLUSION The overall accuracy of placement of thoracic pedicle screws in the deformed spine was 88.4%, with no neurologic or visceral complications. One patient from group A returned to the operating room on postoperative day 2 for removal of an asymptomatic left T7 thoracic pedicle screw abutting the aorta. As surgeon experience increased, there was an overall decreased breach rate, which was mainly reflected in fewer medial breaches.

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Accuracy of thoracic pedicle screw placement using freehand technique and triggered EMG in adolescent idiopathic scoliosis: Is it different between concave and convex side?

Journal of Orthopaedic Surgery ◽

10.1177/2309499018784975 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878497 ◽

Cited By ~ 2

Author(s):

Woo-Kie Min ◽

Sang-bong Na ◽

Jin-An Jang

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screws ◽

Convex Side ◽

Pedicle Screw Placement ◽

Freehand Technique ◽

Thoracic Pedicle Screw ◽

Thoracic Pedicle Screws ◽

Group A ◽

Group B

Purpose: To evaluate and compare the accuracy of the placement of thoracic pedicle screws between concave and convex side curve using freehand technique and triggered electromyogram (EMG). Methods: Three-hundred sixty eight thoracic pedicle screws were included for the evaluation of accuracy from postoperative computed tomography (CT) scans in 24 patients with adolescent idiopathic scoliosis with a mean follow-up of 27 months (range 24–58 months). All screws had stimulation thresholds greater than 6 mA. We divided the screws into two groups: (1) group A: concave side curve—254 screws (2) group B: convex side curve—114 screws. Results: The mean age at surgery was 12.8 years (range 11–17 years). The preoperative Cobb angle was 57.5° (range 50–75°). There were 41 total breaches (medial = 21, lateral = 20, p = 0.66) with an overall incidence of 11.1%. The overall breach rate did not attain statistically significant difference (group A = 11.8%, group B = 9.6%, p = 0.59). The rate of medial breaches was also similar for both concave and convex side (group A = 6.1%, group B = 5.9%, p > 0.05). No postoperative neurological or vascular complications were noted in both groups. Conclusion: Thoracic pedicle screw placement using both freehand technique and triggered EMG for adolescent idiopathic scoliosis surgery is safe and reliable. The overall accuracy rate is 88.9% with similar breaches on the concave and convex side on postoperative CT scans.

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Comparison of the Therapeutic Effects of Short-Segment Posterior Fixation With Monoaxial Pedicle Screws or Polyaxial Pedicle Screws via Injured Vertebra on Thoracolumbar Fracture

10.21203/rs.3.rs-53385/v1 ◽

2020 ◽

Author(s):

Wenye Yao ◽

Runsheng Guo ◽

Qi Lai ◽

Bin Zhang

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Thoracolumbar Fracture ◽

Posterior Fixation ◽

Therapeutic Effects ◽

Vertebral Endplate ◽

Short Segment ◽

Group A ◽

Group B ◽

Fracture Level

Abstract Purpose: To evaluate the therapeutic effects of short-segment posterior fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture.Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2). The clinical and radiological data such as the correction of deformity, sagittal profle and record of the perioperative morbidity of the patients were analyzed.Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years and were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). There were no significant differences in age, gender, fracture site, TLISS Score, ASIA Score, AO Classification, hospital stay, Injury-to-operation intereval, and associated injury between the two groups (P>0.05). Howere, compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A.Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up ffect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

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Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

European Journal of Ophthalmology ◽

10.1177/11206721211005320 ◽

2021 ◽

pp. 112067212110053

Author(s):

Moustafa Salamah ◽

Ashraf Mahrous Eid ◽

Hani Albialy ◽

Sherif Sharaf EL Deen

Keyword(s):

Randomized Study ◽

Early Postoperative Period ◽

Polyglactin 910 ◽

Exclusion Criteria ◽

Congenital Ptosis ◽

History Of ◽

Group A ◽

Group B ◽

Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

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The Influence of the Physiotherapeutic Program on Selected Static and Dynamic Foot Indicators and the Balance of Elderly Women Depending on the Ground Stability

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094660 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4660

Author(s):

Joanna Matla ◽

Katarzyna Filar-Mierzwa ◽

Anna Ścisłowska-Czarnecka ◽

Agnieszka Jankowicz-Szymańska ◽

Aneta Bac

Keyword(s):

Elderly Women ◽

Statistical Significance ◽

Exercise Program ◽

Control Group ◽

Balance Assessment ◽

Motor Functions ◽

Static Test ◽

Group A ◽

Group B ◽

The Impact

Seniors are a constantly growing group of people in many societies. It is necessary to develop physiotherapeutic programs to improve their mobility. The aim of this study was to assess the impact of the physiotherapeutic program conducted unstable ground on selected indicators of motor functions of elderly women. Sixty women (60–80 years) participated in the research. Group A (N = 20) underwent a 12-week physiotherapeutic program on stable ground, group B (N = 20) followed an exercise program on unstable ground, and group C (N = 20) (control group) had no therapeutic intervention. The effects of the therapy were assessed by using a FreeMed platform (foot load analysis) and a Biosway balance system. The results were compared using ANOVA (the one-way analysis), the Kruskal–Wallis test and also the post hoc tests (Tukey’s test and the multiple comparison test). In group A, a statistically significant change was observed in the static test and balance assessment, in group B this was observed in the static and dynamic foot tests and balance assessment, in group C, no statistical significance was achieved. The authors’ physiotherapeutic program had a statistically significant effect on changes in the balance and selected indicators of the motor functions of the examined people. Comparing the results before and after the therapy more improvement changes were noted in women training on an unstable ground compared to women training on a stable ground.

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Marginal Integrity of CAD/CAM Ceramic Crowns Using Two Different Finish Line Designs

Medical Principles and Practice ◽

10.1159/000516833 ◽

2021 ◽

Author(s):

Jaber Hussain Akbar ◽

Ridwaan Omar ◽

Yacoub Al Tarakmah

Keyword(s):

Dental Treatment ◽

Statistical Significance ◽

United States Public Health ◽

Finish Line ◽

Marginal Integrity ◽

Computer Aided ◽

Cad Cam ◽

Group A ◽

Group B ◽

Line Design

Statement of problem- Research on evaluation of crowns made by the latest CAD/CAM systems for their marginal adaptation is scarce. Purpose- The purpose of this in vitro study was to evaluate the marginal integrity of crowns fabricated by the latest Chairside Economical Restorations of Esthetic Ceramic (CEREC) system using two different finish line preparation designs: Chamfer and Shoulder. Material and methods- Typhodont teeth were equally divided into two groups, group A and B. The teeth were prepared for full coverage crowns with a shoulder (group A) and chamfer finish line design (group B). An experienced prosthodontist prepared all crown preparations. Evaluation of six sites per sample was completed by two calibrated, experienced prosthodontists using the modified United States Public Health Services (USPHS) criteria. The descriptive statistics and Z-test were used to evaluate the results. Results- A total of 180 teeth were included in the study (90 teeth in each group). Only two crowns in group A and one crown in group B were clinically unacceptable. There was no statistical significance (p=0.282) between the two groups regarding finish-line design. Conclusions- CEREC system provides clinically acceptable crowns and can safely be utilized in dental treatment. Therefore, Contemporary Dental Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) restorations should be considered as a safe treatment modality by dental professionals.

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Prevalence and characteristics of endometrial polyps in patients with abnormal uterine bleeding

Vojnosanitetski pregled ◽

10.2298/vsp0805349d ◽

2008 ◽

Vol 65 (5) ◽

pp. 349-352 ◽

Cited By ~ 1

Author(s):

Biljana Djordjevic ◽

Jelena Milosevic ◽

Zorica Stanojevic

Keyword(s):

Endometrial Carcinoma ◽

Statistical Significance ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Atypical Hyperplasia ◽

Endometrial Polyps ◽

Female Population ◽

Group A ◽

Malignant Changes ◽

Group B

Background/Aim. The prevalence of endometrial polyps (EPs) in the general female population is about 24%. Abnormal uterine bleeding is frequently the presenting symptom of EPs. The aim of this study was to determine the prevalence and characteristics of EPs in patients with abnormal uterine bleeding. Methods. The prevalence and characteristics of EPs were investigated in 961 patients with abnormal uterine bleeding who underwent dilatation and curettage between January and December 2006. Regarding histopathological features of EPs (presence of atypical hyperplasia or endometrial carcinoma), patients were divided into two groups: group A - patients who had EPs and EPs with hyperplasia without atypia (n = 204) and group B - patients who had EPs with atypical hyperplasia and EPs with carcinoma (n = 7). Results. In 211 (21.94%) patients EPs were found with abnormal uterine bleeding. Histopathologically, there were 175 (82.94%) EPs, 29 (13.74%) EPs with hyperplasia without atypia, 5 (2.37%) EPs with atypical hyperplasia, and 2 (0.95%) EPs with endometrial carcinoma. Contrary to the patients with EPs and EPs with hyperplasia without atypia (group A), patients who had EPs with atypical hyperplasia and EPs with carcinoma (group B) were older (p < 0.05), and more commonly postmenopausal (p < 0.05) and with hypertension (p < 0.05), all of statistical significance. Conclusion. The prevalence of endometrial polyps in patients with abnormal uterine bleeding according to our data was 21.95%. Atypical hyperplasia and endometrial carcinoma were rarely confined to a polyp. Older age, postmenopausal period and hypertension may increase the risk of premalignant and malignant changes in endometrial polyps.

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Influence of the primary malignant tumor site on the incidence and features of metastatic ovarian tumors

Vojnosanitetski pregled ◽

10.2298/vsp0710691s ◽

2007 ◽

Vol 64 (10) ◽

pp. 691-696 ◽

Cited By ~ 1

Author(s):

Zorica Stanojevic ◽

Biljana Djordjevic ◽

Danijela Zivanovic

Keyword(s):

Malignant Tumor ◽

Malignant Tumors ◽

Statistical Significance ◽

Menopausal Status ◽

Ovarian Tumors ◽

Metastatic Tumors ◽

Primary Tumors ◽

Primary Malignant Tumor ◽

Group A ◽

Group B

Background/Aim. Ovary is the organ of the female reproductive system most commonly affected by metastases. The aim of the study was to determine the frequency and features of metastatic ovarian tumors (MOT) depending on the site of the primary malignant tumor. Methods. The study group consisted of 488 patients with histopathologically confirmed ovarian cancers treated at the Clinic of Oncology, Clinical Center Nis, in the period from 1 January 1998 to 31 December 2005. MOT were found in 41 patients. Regarding the site of the primary malignant tumor, those with secondary ovarian tumor were divided into two groups: group A - primary malignant tumor involving the genital organs (n = 30) and group B - primary malignant tumor of extragenital origin (n = 11). Results. MOT were confirmed in 8.40% (41/488) of the patients. Secondary ovarian malignancies were the consequence of endometrial carcinoma spreading in 73.17%, breast carcinoma in 19.51%, stomach carcinoma in 4.88% and colon carcinoma in 2.44% of the cases. No significant differences were found between the group A and group B by the factors of age, body mass index, parity and menopausal status. Contrary to the group A, metastatic tumors in the group B patients were more commonly asymptomatic (p < 0.001), bilateral (p < 0.05), with larger ovarian diameter (p < 0.05), associated with ascites (p < 0.001) and abdominal metastases (p < 0.01), all of statistical significance. Conclusions. Metastatic tumors made up 8.40% of ovarian neoplasmas. With non-genital primary tumors, secondary ovarian deposits were frequently asymptomatic, bilateral, associated with larger ovarian diameter, ascites and abdominal metastatic deposits, compared to malignant tumors of genital origin.

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Uniplanar cannulated pedicle screws in the correction of Lenke type 1 adolescent idiopathic scoliosis (AIS)

10.21203/rs.3.rs-34233/v1 ◽

2020 ◽

Author(s):

Yiwei Zhao ◽

Wubo Liu ◽

Suomao Yuan ◽

Yonghao Tian ◽

Xinyu Liu

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screws ◽

Vertebral Rotation ◽

Concave Side ◽

Convex Side ◽

X Rays ◽

Group A ◽

Group B

Abstract Background In the present study, we reported the clinical use of uniplanar cannulated pedicle screws for the correction of Lenke type 1 adolescent Idiopathic scoliosis (AIS), and its safety and clinical outcomes were also evaluated. Methods 68 patients with Lenke type 1 AIS were included, among which 38 patients were treated with uniplanar cannulated screws at the concave side of periapical levels and multiaxial screws at the other levels (group A). Moreover, the remaining 30 patients were treated with all multiaxial screws (group B). The preoperative and postoperative radiographic parameters of the Lenke type 1 AIS, axial vertebral rotation, and the safety of the pedicle screws were evaluated by X-rays and computed tomography (CT). Results Preoperative data was comparable between two groups. The postoperative proximal thoracic (PT) curve, main thoracic (MT) curve, thoracolumbar/lumbar (TL/L) curve, and apical vertebral rotation were significantly improved compared with the preoperative data. The coronal correction rates in group A and B were 83% and 81.9%, respectively (P > 0.05). The derotation rates in group A and B were 60.8% and 43.2%, respectively (P < 0.05). The rotation classification in the group A was also better compared with the group B. The misplacement rate in group A and B was 7.9% and 11.8%, respectively (P < 0.05), and the total misplacement rate on the concave side (11.4%) was higher than that of convex side (8.4%). The lateral perforation was found at the concave side, while the medial perforation was found at the convex side. On the concave side, the misplacement rate in group A and B was 9.7% and 12.3%, respectively (P < 0.05). The grades 2 and 3 perforations were three (3.5%) in the group A and eight (8.2%) in the group B (P < 0.05). On the convex side, the misplacement rate in group A and B was 5.9% and 11.1%, respectively (P < 0.05). The grades 2 and 3 perforations were one (0.9%) in the group A and four (4.4%) in the group B (P < 0.05). Conclusion Collectively, uniplanar cannulated pedicle screws could effectively increase the accuracy of pedicle screws and facilitate the derotation of the apical vertebra compared with the multiaxial pedicle screws. Trial registration retrospectively registered

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P-B02 Does the length of alimentary limb make a significant difference in the weight loss in Roux en y gastric bypass patients?

British Journal of Surgery ◽

10.1093/bjs/znab430.001 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Mayank Bhandari ◽

Sabyasachi Chowdhary ◽

Milind Rao ◽

Gopinath Bussa ◽

Julie Holm

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Statistical Significance ◽

Limb Length ◽

Alimentary Limb ◽

Significant Difference ◽

Alimentary Limb Length ◽

Biliopancreatic Limb ◽

Group A ◽

Group B

Abstract Background Roux en Y gastric bypass (RYGB) surgery for morbid obesity is considered as gold standard, but there can be a difference in the length of alimentary and biliopancreatic limb to achieve optimum weight loss. Till now there is no agreed consensus on the ideal limb lengths and their effect on the weight loss. We would like to evaluate the change in the alimentary limb length on the weight loss after the gastric bypass surgery, as a short to medium term single center study. Methods A retrospective analysis from prospectively maintained database of 523 patients who underwent RYGB from 2012 till 2018 was done. Patient who had at least a follow up of 2 years(n = 388) were included. At our center we use alimentary limb of 120 +/- 10 cm for Body Mass Index (BMI) < 40 kg/m2 (group A) and 150+/-10 cm for the BMI >40 kg/m2 (Group B). The biliopancreatic limb length varies from 50 to 70 cm and this does not change with BMI. The percentage excess weight(EWL) loss was measured and analyzed at 1st and 2nd year post operatively. We used paired t test to check for statistical significance. Results There were 172 patients in Group A and 216 in Group B. The number of females were 330 and males were 58. The average age was 44 years . The mean preoperative BMI for the 120 cm limb group was 37.1 kg/m2 and that for 150 cm limb was 45.3kg/m2. The EWL for the group A at 1 year and 2 year post op was a Mean and standard deviation of 79.3% +/- 39.4% and 78.3% +/- 35.2% respectively and for group B was 58.8% +/- 26.6% and 58.6% +/- 23.2% respectively. The difference was statistically significant (p < 0.001) . The analysis and interpretation for metabolic syndrome is yet to be determined. Conclusions In our study, Increasing the alimentary limb length for higher BMI reduced EWL. This is consistent with few other publications regarding the same. This has resulted in a change in our practice namely keeping the length of alimentary limb constant and varying the BP limb length. We will be analyzing and presenting this data in future.

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A PROSPECTIVE CONSIDERATIONS AND COMPARATIVE EFFICACY BETWEEN IVABRADINE VS BETA BLOCKERS IN SOUTH INDIAN ACUTE CORONARY SYNDROME PATIENTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i1.34480 ◽

2019 ◽

pp. 193-195

Author(s):

Hemanth Kumar Lekkala

Keyword(s):

Heart Rate ◽

Acute Coronary Syndrome ◽

Beta Blockers ◽

Statistical Significance ◽

Reduced Ejection Fraction ◽

Coronary Syndrome ◽

Nyha Classification ◽

South Indian ◽

Group A ◽

Group B

Objectives: the objective of this study was to assess the role of heart rate in acute coronary syndrome with reduced ejection fraction, to assess contraindications for beta blockers, to assess the tolerability between Ivabradine and Beta-Blockers, to assess efficacy between Ivabradine and Beta Blockers, to assess patient condition according to NYHA classification. Methods: A Prospective observational study was conducted for a duration of6 months Study population includes 100 patients in which Group A-50, Group B-50. We were selected the subjects according to inclusion and exclusion criteria. The patients were classified in one of four categories based on their symptoms in regards to normal breathing and varying degrees in shortness of breath by using (The New York Heart Association) NYHA Classification. Results: Majority of the patients were in age group between (55-64)(32%) years of age are highly affected with ACS. Prevalence of ACS is high in Rural (56%). Both drugs decreased the mean heart rate to 89.97±10.27 (Group-A) versus 86.76±13.14 (Group-B) beats per minute (P=0.24). The result obtained are clinically and statistically significant with statistical significance at P>0.05. Conclusion: In the present study we considered and compared the efficacy between Ivabradine and Beta Blockers in south Indian acute coronary syndrome patients shows Ivabradine is as effective as betablockers in reduction of heart rate.

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