Analysis of Cervical Sagittal Alignment After Screw-Rod Fixation

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 983-922 ◽  
Author(s):  
Robert F. Heary ◽  
Osamah J. Choudhry ◽  
Devesh Jalan ◽  
Nitin Agarwal
Keyword(s):  
Computed Tomography ◽  
Sagittal Alignment ◽  
Posterior Instrumentation ◽  
Deformity Correction ◽  
Magnetic Resonance Images ◽  
Cervical Sagittal Alignment ◽  
Computed Tomography Scans ◽  
Long Term Follow Up

Abstract BACKGROUND: The use of posterior instrumentation constructs is well established for subaxial cervical stabilizations/fusions. The importance of global and regional sagittal alignment has become increasingly recognized. OBJECTIVE: To perform an analysis using computed tomography scans to determine the effect of posterior instrumentation on postoperative cervical sagittal alignment at long-term follow-up. METHODS: Over a period of 6 years, 56 consecutive patients (38 male and 18 female patients; mean age, 47 years) underwent cervical screw-rod fixation. Plain radiographs, computed tomography scans, and magnetic resonance images were analyzed preoperatively to assess sagittal alignment (C2-C7). Postoperatively, computed tomography scans and serial radiographs were obtained in all patients. With the use of independent observers, changes in sagittal alignment were determined by comparing the preoperative and postoperative imaging studies. RESULTS: In total, 390 screws were placed in the cervical spines of 56 patients. Definitive radiographic fusion was detected in all 56 patients (100%). There were no incidences of instrumentation failures or lucencies surrounding any screws. Patients with preoperative kyphosis (n = 19; mean, +9.9°) improved their sagittal alignment by 6.5° (final mean, +3.4°), whereas patients with preoperative lordosis (n = 37; mean −15.44°) maintained their lordosis (final mean, −15.3°). Mean duration of follow-up was 32.5 months. CONCLUSION: Radiographic analysis showed lateral mass fixation to be safe and effective. Certain operative techniques allowed substantial deformity correction and maintenance of long-term correction of deformity. Screw-rod fixation may be an effective method for maintaining lordotic cervical alignment in previously lordotic patients and for significantly correcting kyphotic deformity in patients with a preoperative kyphosis.

Long-term follow up after bony mastoid and epitympanic obliteration: radiological findings

2009 ◽  
Vol 124 (1) ◽  
pp. 37-43 ◽  
Author(s):  
J-P Vercruysse ◽  
B De Foer ◽  
T Somers ◽  
J Casselman ◽  
E Offeciers
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Canal Wall ◽  
Resonance Imaging ◽  
High Resolution Computed Tomography ◽  
Long Term Follow Up ◽  
Echo Planar ◽  
Canal Wall Up

AbstractObjective:The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma.Patients:Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8–113.6 months).Intervention:All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging).Results:Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids.Conclusion:Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

2006 ◽  
Vol 5 (4) ◽  
pp. 313-319 ◽  
Author(s):  
Hideki Sudo ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Tatsuto Takeuchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Posterior Instrumentation ◽  
Survival Rates ◽  
Spinal Instability ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Spine Disorders

Object As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. Methods Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. Conclusions Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.

Stackable Carbon Fiber Cages for Thoracolumbar Interbody Fusion After Corpectomy: Long-term Outcome Analysis

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 810-819 ◽  
Author(s):  
Robert F Heary ◽  
Arvin Kheterpal ◽  
Antonios Mammis ◽  
Sanjeev Kumar
Keyword(s):  
Computed Tomography ◽  
Carbon Fiber ◽  
Vertebral Body ◽  
Additional Patient ◽  
Preoperative Imaging ◽  
Plain Films ◽  
Computed Tomography Scans ◽  
The Mean

Abstract BACKGROUND: Reconstruction of the thoracolumbar spine after corpectomy is a challenge for fractures, infections, and tumors. OBJECTIVE: To analyze fusion rates, clinical outcomes, and the percent of vertebral body coverage achieved by using stackable carbon fiber–reinforced polyetheretherketone cages in thoracolumbar corpectomies, and to measure the actual size of the cages and compare this measurement with the size of the vertebra(e) replaced by the cage. METHODS: A retrospective study of 40 patients who underwent thoracolumbar corpectomies was performed. Preoperative imaging included plain films, computed tomography scans, and magnetic resonance imaging. Postoperatively, plain films and computed tomography scans were obtained, and the width of decompression and cross-sectional area of the cage were measured. The ratio of the area of the cage to the calculated area of the replaced vertebral body was used to determine the percent of vertebral body coverage. RESULTS: The mean follow-up period was 43 months. Successful fusion was observed in 39 patients. One patient experienced cage subsidence with kyphosis. One additional patient incurred a neurological complication that was corrected without long-term consequence. The mean correction of sagittal alignment was 10°, and the mean width of bony decompression was 20 mm. The mean ratio of the area of the carbon fiber cage to the area of the resected vertebral body was 60%. CONCLUSION: Stackable carbon fiber cages are effective devices for achieving thoracolumbar fusions. No failures of the cages occurred over long-term follow-up. Excellent clinical and radiographic results were achieved by covering a mean of 60% of the vertebral body with the cage.

scholarly journals Surgical treatment of kyphosis in children with scheuermann’s diseaseusing 3D-CT navigation

2015 ◽  
Vol 3 (1) ◽  
pp. 5-14
Author(s):  
Sergei Valentinovich Vissarionov ◽  
Dmitriy Nikolaevich Kokushin ◽  
Sergei Mikhailovich Belyanchikov ◽  
Vladislav Valerievich Murashko
Keyword(s):  
Surgical Treatment ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
3D Ct ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease ◽  
Transpedicular Fixation ◽  
Long Term Follow Up

The purpose of the study is to describe features of the surgical technique for correction of kyphotic deformity of the spine and to analyze the results of surgical treatment of juvenile kyphosis in children with the use of 3D-CT navigation.— Materials and methods. We observed 11 patientsaged 14-17 years old (2 girls and 9 boys) with kyphoticdeformity of the spine, developed on the backgroundof Scheuermann’s disease. The deformity amount aver-aged 73,9° (60 to 90°). Surgery was performed fromthe combined access, carring out discapophysectomyand corporodesis on top of kyphosis and fixing mul-tibasic corrective metal construction. For the insertionof pedicle screws we used 3D-CT navigation.— The results. After surgery kyphosis value decreasedto 32,6° (20 to 45°), the deformity correction averaged41,3° (30 to 50°). Hybrid systems were placed in 5 pa-tients, total transpedicular fixation - in 6 children.Number of fixed vertebrae with hybrid metal construc-tions averaged 14 (13 to 15), in patients with total pediclefixation - 13 (12 to 14). In all cases we observed the correct position of pedicle support elements. Postopera- tive follow-up period was from 1 year and 5 months to5 years and 4 months, on average - 3 years 5 months. The loss of the result achieved in the long-term follow- up period was observed in patients with hybrid metal constructions and averaged 7,2° (4 to 9°).— Conclusion. The use of pedicle screws for thecorrection of juvenile kyphosis in children allows forthe effective correction of the deformity, restoring thephysiological profiles of the spine, eliminating post-operative progression of curvature, and reducing thelength of metal fixation and save the result achievedin the long-term follow-up. The use of active optical3D-CT navigation allows carring out a correct inser-tion of pedicle screws in the vertebral bodies in chil-dren with juvenile kyphosis.— Keywords: Scheuermann’s disease, juvenile ky-phosis, transpedicular fixation, navigation, children,surgical treatment.

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