scholarly journals Management of fractures of thoraco lumbar spine with pedicle screw fixation

2021 ◽  
Vol 7 (2) ◽  
pp. 285
Author(s):  
A. Palanivel
Keyword(s):  
Pedicle Screw ◽  
Randomized Study ◽  
Wedge Angle ◽  
Body Height ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Neurological Deficits ◽  
Significant Difference ◽  
Rod System ◽  
Lumbar Fractures

<p class="abstract"><strong>Background:</strong> Thoraco-lumbar fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. To study the efficacy of pedicular screw and rod fixation system (ZETA system) in achieving ‘stabilization’ in thoracic and lumbar fractures of the spine.</p><p class="abstract"><strong>Methods:</strong> This was a prospective comparative on-randomized study of 20 patients who underwent  pedicle screws and rod fixation in Goverment District headquarters hospital Nagapattinam with a follow-up ranging from September 2018 to December 2018 duration of 4 months. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system (ZETA).<strong></strong></p><p class="abstract"><strong>Results:</strong> In 75% of the patients, the fractures were reduced by using polyaxial implants and in 25% of the patients both monoaxial and polyaxial implants were used. The average regional angle during the pre-operative stage was 16.50±5.020 and 4.450±4.150 during the 1-year post-operative period. There was a significant difference between pre-op and post-operative regional angles.</p><p class="abstract"><strong>Conclusions:</strong> There is a very high statistical significant restoration of vertebral body height, mean regional angle, and mean anterior wedge angle with this procedure in thoracolumbar fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together.</p>

scholarly journals Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

2017 ◽  
Vol 3 (4) ◽  
pp. 681
Author(s):  
Naushad Hussain ◽  
Nirmal Dhananjay Patil ◽  
Hiren Patel ◽  
Akash Shakya
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Wedge Angle ◽  
Body Height ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Screw Insertion

<p class="abstract"><strong>Background:</strong> Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.</p><p class="abstract"><strong>Methods:</strong> 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.</p><p class="abstract"><strong>Conclusions:</strong> Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.</p>

Cable-Strengthened C2 Pedicle Screw Fixation in the Treatment of Congenital C2-3 Fusion, Atlas Occipitalization, and Atlantoaxial Dislocation

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 976-984 ◽  
Author(s):  
Shenglin Wang ◽  
Chao Wang ◽  
Huijie Leng ◽  
Weidong Zhao ◽  
Ming Yan ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Atlantoaxial Dislocation ◽  
C2 Pedicle Screw ◽  
Significant Difference ◽  
Solid Fusion ◽  
C2 Fixation

Abstract BACKGROUND: Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2PS) sustain considerable cephalic shearing force during the reduction procedure. Therefore, a novel technique has been developed to augment the C2 pedicle screw fixation with a strengthening cable. OBJECTIVE: To introduce and assess this new technique. METHODS: Seventy-six patients who underwent this procedure were reviewed. The position of the instrument and resultant fusion were examined retrospectively. In the biomechanical test, 6 fresh specimens were subjected to 2 types of fixation in the order of Oc-C2 screw-plate fixation followed by additional use of strengthening cable. Under 3 loading modes (extension-flexion, lateral bending, and axial rotation), the relative movement between the occiput and C2 was measured and compared in the form of range of motion. RESULTS: The average follow-up time was 26 months. Solid fusion was achieved in 75 patients (98.7%) as assessed radiologically. The only patient who experienced hardware failure eventually obtained solid fusion between the occiput and C2 after revision. Biomechanically, there was significant difference between the occiput and C2 fixation and cable-strengthened fixation in range of motion for all modes. CONCLUSION: This technique is a promising option for the treatment of AAD with congenital C2-3 fusion and occipitalization. Biomechanically, this technique can reduce the occipital-axial motion significantly compared with occiput-C2 fixation.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

scholarly journals Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

2017 ◽  
Vol 11 (1) ◽  
pp. 150-160 ◽  
Author(s):  
Tarek Ahmed Aly
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Pedicle Screw Fixation ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Significant Difference

<p>Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.</p>

scholarly journals Is It Necessary to Reduce Thoracolumbar Compression Fractures  with Intermediate Screws in the Fractured Vertebra?

2021 ◽  
Author(s):  
ZeJun Xing ◽  
Shuai Hao ◽  
XiaoFei Wu
Keyword(s):  
Blood Loss ◽  
Body Height ◽  
Pedicle Screws ◽  
Operation Time ◽  
Short Segment ◽  
Compression Fractures ◽  
Significant Difference ◽  
Before And After ◽  
Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

Anterior transvertebral interbody cage with posterior transdiscal pedicle screw instrumentation for high-grade spondylolisthesis

2006 ◽  
Vol 20 (3) ◽  
pp. 1-7 ◽  
Author(s):  
Will Forest Beringer ◽  
Jean-Pierre Mobasser ◽  
Dean Karahalios ◽  
Eric Alfred Potts
Keyword(s):  
Pedicle Screw ◽  
Degenerative Spondylolisthesis ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Technical Note ◽  
Slip Angle ◽  
Fibular Graft ◽  
High Grade ◽  
Shear Forces

✓Adult high-grade degenerative spondylolisthesis represents the extreme end of the spectrum for spondylolisthesis and is consequently rarely encountered. Surgical management of high-grade spondylolisthesis requires constructs capable of resisting the shear forces at the slipped L5–S1 interspace. The severity of the slip, sacral inclination, and slip angle may make conventional approaches to 360° fusion difficult or hazardous. Transdiscal pedicle screw fixation, transvertebral fibular graft fusion, and transvertebral cage fixation are techniques that have been developed to establish anterior column load sharing and to resist shear forces at the L5–S1 interspace, given the anatomical constraints accompanying high-grade spondylolisthesis. In this technical note the authors describe the procedure for implanting an in situ anterior L5–S1 transvertebral cage and performing L4–5 anterior lumbar interbody fusion, followed by placement of posterior S1–L5 vertebral body transdiscal pedicle screws for management of high-grade spondylolisthesis.

scholarly journals Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao
Keyword(s):  
Retrospective Study ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Correction Rate ◽  
Burst Fractures ◽  
The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

scholarly journals Initial academic experience and learning curve with robotic spine instrumentation

2017 ◽  
Vol 42 (5) ◽  
pp. E4 ◽  
Author(s):  
Timur M. Urakov ◽  
Ken Hsuan-kan Chang ◽  
S. Shelby Burks ◽  
Michael Y. Wang
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Academic Experience ◽  
Robot Assisted ◽  
Spine Instrumentation ◽  
Significant Difference

OBJECTIVESpine surgery is complex and involves various steps. Current robotic technology is mostly aimed at assisting with pedicle screw insertion. This report evaluates the feasibility of robot-assisted pedicle instrumentation in an academic environment with the involvement of residents and fellows.METHODSThe Renaissance Guidance System was used to plan and execute pedicle screw placement in open and percutaneous consecutive cases performed in the period of December 2015 to December 2016. The database was reviewed to assess the usability of the robot by neurosurgical trainees. Outcome measures included time per screw, fluoroscopy time, breached screws, and other complications. Screw placement was assessed in patients with postoperative CT studies. The speed of screw placement and fluoroscopy time were collected at the time of surgery by personnel affiliated with the robot’s manufacturer. Complication and imaging data were reviewed retrospectively.RESULTSA total of 306 pedicle screws were inserted in 30 patients with robot guidance. The average time for junior residents was 4.4 min/screw and for senior residents and fellows, 4.02 min/screw (p = 0.61). Among the residents dedicated to spine surgery, the average speed was 3.84 min/screw, while nondedicated residents took 4.5 min/screw (p = 0.41). Evaluation of breached screws revealed some of the pitfalls in using the robot.CONCLUSIONSNo significant difference regarding the speed of pedicle instrumentation was detected between the operators’ years of experience or dedication to spine surgery, although more participants are required to investigate this completely. On the other hand, there was a trend toward improved efficiency with more cases performed. To the authors’ knowledge, this is the first reported academic experience with robot-assisted spine instrumentation.

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