Krónikus dialízis kapcsán kialakult destruktív cervicalis spondylarthropathia esete

2021 ◽  
Vol 74 (5-6) ◽  
pp. 211-215
Author(s):  
Balázs Berta ◽  
Hedvig Komáromy ◽  
Attila Schwarcz ◽  
Béla Kajtár ◽  
András Büki ◽  
...  
Keyword(s):  
Bone Graft ◽  
Vertebral Body ◽  
Posterior Instrumentation ◽  
Plate Fixation ◽  
Neurological Deficits ◽  
Pulmonary Insufficiency ◽  
Unstable Fracture ◽  
Pathologic Fractures ◽  
Vertebral Bodies

A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.

Continuous Incremental Heavy Halo Traction Combined with Posterior-only Approach for Severe Cervical Kyphosis with Neurofibromatosis-1.

2019 ◽  
Author(s):  
Chaofeng Guo ◽  
Hongqi Zhang ◽  
Zhenhai Zhou ◽  
Jinyang Liu ◽  
Ang Deng
Keyword(s):  
Posterior Instrumentation ◽  
Neurological Status ◽  
Neurofibromatosis 1 ◽  
Neurological Deficits ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Halo Traction ◽  
Key Words Neurofibromatosis ◽  
Correction Result

Abstract Background Surgical management of cervical kyphosis in patients with NF-1 is a challenging task. Presently, anterior-only (AO), posterior-only (PO) and combined anterior-posterior (AP) spinal fusion are common surgical strategies. However, the choice of surgical strategy and application of Halo traction remain controversial. Few studies have shown and recommended posterior-only approach for cervical kyphosis correction in patients with NF-1. The aim of this study is to evaluate the safety and the effectiveness of Continuous-Incremental-Heavy Halo Traction (CIH-HT) combined with posterior-only approach for treatment of cervical kyphosis with NF-1. Methods 19 patients with severe cervical kyphosis due to NF-1 were reviewed retrospectively between January 2010 and April 2017. All the cases underwent CIH-HT combined with posterior instrumentation and fusion surgery. Correction result, neurologic status and complications were analyzed. Results In this study, cervical kyphosis Cobb angle decreased from initial 63.0 ± 21.0 degrees to postoperative 10.8 ± 4.0 degrees(P＜0.01),with total correction rate of 92%, which consist of 44% from CIH-HT and 48% from surgical correction. JOA scores were improved from preoperative 13.6±1.6 to postoperative 16.0±1.0(P＜0.01). Neurological status was also improved. There was no correction loss and the neurological status was stable in mean 3.7 years follow-up. The incidence of complications was 36.8% (7/19). Six patients underwent local complications and one patient underwent a second surgery. Conclusion CIH-HT combined PO approach is safe and effective method for cervical kyphosis correction in patients with NF-1. A satisfied correction result, and successful bone fusion can be achieved via this procedure, even improvement of neurological deficits can also be obtained. Our study suggested that CIH-HT combined PO approach is another consideration for cervical kyphosis correction in patients with NF-1. Key words : Neurofibromatosis-1; Cervical kyphosis; Continuous-Incremental-Heavy Halo Traction; posterior-only approach;

scholarly journals Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures

2012 ◽  
Vol 15 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Chul Hyun Cho ◽  
Hyung Gyu Jang
Keyword(s):  
Bone Graft ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Arthroscopic Surgery ◽  
Iliac Bone ◽  
Dash Score ◽  
Structural Support ◽  
Iliac Bone Graft ◽  
Quick Dash

PURPOSE: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures.MATERIALS AND METHODS: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed.RESULTS: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection.CONCLUSION: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.

scholarly journals Open reduction and fixation with a supporting plate for treatment of unstable fractures of distal radius with volar displacement

2002 ◽  
Vol 10 (4) ◽  
pp. 05-09
Author(s):  
Luís Eduardo Lima de Andrade ◽  
Décio José de Oliveira ◽  
José Wagner de Barros
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Plate Fixation ◽  
Functional Results ◽  
Unstable Fracture ◽  
Wrist Function ◽  
Supporting Plate ◽  
Buttress Plate ◽  
Unstable Fractures

Eigtheen patients with unstable fracture of the distal radius were evaluated. They have undergone open reduction and buttress plate fixation. The average follow-up was 21 months. Radiographies and wrist function were analysed. It was concluded that this technique was good, allowing good functional results.

Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors

2002 ◽  
Vol 96 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Chang Hun Rhee ◽  
Seung Hoon Lee
Keyword(s):  
Vertebral Column ◽  
Screw Fixation ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Complete Relief ◽  
Content Type ◽  
Vertebral Bodies ◽  
The Mean ◽  
Fine Print

✓ Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors.

Pathogenesis and Prophylaxis of Postlaminectomy Deformity of the Spine after Multiple Level Laminectomy

Neurosurgery ◽  
1981 ◽  
Vol 9 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Shozo Yasuoka ◽  
Hamlet A. Peterson ◽  
Edward R. Laws ◽  
Collin S. MacCarty
Keyword(s):  
Spinal Fusion ◽  
Vertebral Body ◽  
Spinal Deformity ◽  
Adult Patients ◽  
Anterior Fusion ◽  
Multiple Level ◽  
Follow Up Study ◽  
Prophylactic Measures ◽  
Vertebral Bodies

Abstract The pathogenesis of postlaminectomy spinal deformity and instability in children was evaluated by reviewing appropriate roentgenographic findings. First, we reviewed spine roentgenograms of patients below 40 years of age who underwent spinal fusion for deformity and instability of the spine developing after a multiple level laminectomy. Two types of deformity were recognized on the roentgenograms: increased mobility between the vertebral bodies and wedging deformity of the ventral aspect of the vertebral bodies. Second, we did a follow-up study of another group of patients who had undergone laminectomy. We found the same two types of deformity in children, but not in adult patients. The incidence of deformity was higher after laminectomies of the cervical or cervicothoracic region than after lumbar laminectomies. Our data suggest that postlaminectomy spinal deformity can develop in children without irradiation or facet injury. The deformity is due to a wedging change in the cartilaginous portion of the vertebral body and to the viscoelasticity of ligaments in children. When treatment of this complication becomes necessary, anterior fusion may be effective in arresting progression. Prophylactic measures against the development of deformity are discussed. Our hypothesis concerning the mechanism of development of this complication supports the rationale of osteoplastic laminar resection and reconstruction instead of laminectomy, particularly in the management of children.

Posterior instrumentation of the unstable cervicothoracic spine

1996 ◽  
Vol 84 (4) ◽  
pp. 552-558 ◽  
Author(s):  
Jens R. Chapman ◽  
Paul A. Anderson ◽  
Christopher Pepin ◽  
Sean Toomey ◽  
David W. Newell ◽  
...  
Keyword(s):  
Posterior Instrumentation ◽  
Plate Fixation ◽  
Pulmonary Complications ◽  
Hardware Removal ◽  
Postoperative Treatment ◽  
Content Type ◽  
Hardware Complications ◽  
Flexion Extension ◽  
Fine Print

✓ Fractures, tumors, and other causes of instability at the cervicothoracic junction pose diagnostic and treatment challenges. The authors report on 23 patients with instability of the cervicothoracic region, which was treated with posterior plate fixation and fusion between the lower cervical and upper thoracic spine. During operation AO reconstruction plates with 8- or 12-mm hole spacing were affixed to the spine using screws in the cervical lateral masses and the thoracic pedicles. Postoperative immobilization consisted of the patient's wearing a simple external brace for 2 months. The following parameters were analyzed during the pre- and postoperative treatment period: neurological status, spine anatomy and reconstruction, and complications. Follow up consisted of clinical and radiographic examinations (mean duration of follow up, 15.4 months; range, 6–41 months). No neurovascular or pulmonary complications arose from surgery. All patients achieved a solid arthrodesis based on flexion-extension radiographs. There was no significant change in angulation during the postoperative period, but one patient had an increase in translation that was not clinically significant. There were no hardware complications that required reoperation. One patient requested hardware removal in hopes of reducing postoperative pain in the cervicothoracic region. One postoperative wound infection required debridement but not hardware removal. The authors conclude that posterior plate fixation is a satisfactory method of treatment of cervicothoracic instability.

Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases

2005 ◽  
Vol 3 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Feyza Karagöz Güzey ◽  
Erhan Emel ◽  
N. Serdar Bas ◽  
Selim Hacisalihoglu ◽  
Hakan Seyithanoglu ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Neurological Deficits ◽  
Easy Access ◽  
Tuberculous Spondylitis ◽  
Content Type ◽  
The Mean ◽  
Posterior Debridement ◽  
Fine Print

Object. Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. Methods. Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16–125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2° (range 5–42°) preoperatively; this was reduced to 17.3° (range 0–42°) after surgery. There was a 2.8° loss of correction (range 2–5°) after 44.3 months (16–64 months). Kyphosis did not progress beyond 15 months in any patient. Conclusions A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.

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