scholarly journals Evaluation Du Traitement Chirurgical Des Fractures De Type Burst Non Deficitaire

2016 ◽  
Vol 12 (9) ◽  
pp. 100
Author(s):  
Essossinam Kpelao ◽  
Mikael Meyer ◽  
Vivien Mendes Martins ◽  
Jean-Paul Chirossel ◽  
Tchin Darre ◽  
...  
Keyword(s):  
Burst Fracture ◽  
Traitement Chirurgical ◽  
Loss Of Correction ◽  
The Mean

Introduction: The difficulty in treating of burst fracture is marked by secondary kyphosis. We expose our results in this challenge. Material and Methods: We retrospectively evaluated on preoperative, postoperative, and follow up scanners of 40 patients operated between 2007 and 2012 in the neurosurgery department of the CHU Grenoble these parameters: vertebral kyphosis (CV), regional kyphosis (CR), traumatic regional angulation (ART) and the inter-pedicular distance. The follow-up should be at least a year. Results: The mean age of patients was 39.2 years. Average postoperative distraction was 5.8 mm, and angular reduction was 8.5 ° on the CV and 9.8 ° on ART. At follow-up, the loss of correction was respectively 3.2 ° and 6.1 ° on CV and ART. The secondary compaction was 2.5 mm. Secondary regional kyphosis was higher in short instrumentation (7 ° against 5.2 °) as well as for patients with a BMI ≥ 25.

scholarly journals Results of using Thoracolumbar Injury Classification and Severity Score (TLICS) in Treatment of Thoracolumbar Fractures

2021 ◽  
Author(s):  
Serdar Kabataş ◽  
Erdinç Civelek ◽  
Erek Öztürk ◽  
Eyüp Can Savrunlu ◽  
Murat Kahraman ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Case Reports ◽  
Burst Fracture ◽  
Loss Of Correction ◽  
Thoracolumbar Injury ◽  
Intensity Changes ◽  
Vas Scores ◽  
The Mean

Aim: To compare short and long term pain intensity changes and long term loss of correction rates in patients who were treated either by kyphoplasty or posterior segmentation due to their TLICS and LSC scores, therefore evaluate the specificity of these classifications. Material and Methods: Medical records of 106 patients operated due to thoracolumbar compression or burst fracture in our clinics between years 2012 to 2015 have been evaluated retrospectively. The patients were evaluated with postoperative radiography (loss of reduction) and visual analogue scale (VAS) in their follow-ups. Results: The average stay on hospital was 6.53 ± 4.51 days in kyphoplasty group. The mean preoperative cobb angle was 10.76±11.67 degrees, which improved to 10.19±10.66 degrees at postoperative 1th month. Beside this, the mean preoperative VAS score was 7.93±0.68 then improved to 4.25±0.77 and 2.75 ± 1.43 at postoperative 6th, 12th month follow-ups respectively. There were 42 patients in instrumentation group. The mean hospitalization was 13.47±10.43 days. The mean preoperative cobb angle was 15.84±10.52 and it improved to 11.86±8.15 degrees at the postoperative 1th-month follow-up. The preoperative VAS scores of the patients improved from 7.71±0.71 to 4.09±0.79 and 4.26±1.23 at 6th and 12th month follow-ups. Conclusion: In long term follow up the kyphoplasty group showed more loss of correction however lesser VAS scores comparing to the instrumentation group. Although evaluating TLICS scores to kyphoplasty patients is still based on case reports in our series it was performed to 64 patients.

scholarly journals The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

2014 ◽  
Vol 60 (3) ◽  
pp. 99-101
Author(s):  
S. Anghel ◽  
D. Márton
Keyword(s):  
Anterior Approach ◽  
Burst Fracture ◽  
Regression Equations ◽  
Kyphosis Angle ◽  
Short Segment ◽  
Loss Of Correction ◽  
Short Segment Fixation ◽  
Lumbar Fractures ◽  
Fracture Level

Abstract Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11-L1 or L1-L2) and surgery type (short segment fi xation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients. Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11-L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1-L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11-L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1-L2 level fracture vertebrae treated by anterior approach. Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The bestfit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11-L1 and L2-L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

scholarly journals Posterior-approach single-level apical spinal osteotomy in pediatric patients for severe rigid kyphoscoliosis: long-term clinical and radiological outcomes

2018 ◽  
Vol 21 (6) ◽  
pp. 606-614 ◽  
Author(s):  
Ankit Patel ◽  
Sameer Ruparel ◽  
Tarun Dusad ◽  
Gaurav Mehta ◽  
Vishal Kundnani
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Pediatric Patients ◽  
Inclusion Criteria ◽  
Single Level ◽  
Loss Of Correction ◽  
Spinal Osteotomy ◽  
Average Loss ◽  
The Mean

OBJECTIVESpinal osteotomy in pediatric patients is challenging due to various factors. For correction of severe rigid kyphoscoliosis in children, numerous techniques with anterior or posterior or combined approaches, as well as multilevel osteotomies, have been described. These techniques are associated with prolonged operative times and large amounts of blood loss. The purpose of this study was to evaluate the clinical and radiologically confirmed efficacy of a modification of the apical spinal osteotomy (ASO) technique—posterior-only single-level asymmetric closing osteotomy—in pediatric patients with severe rigid kyphoscoliosis.METHODSThe authors performed a retrospective study of a case series involving pediatric patients with severe spinal deformity operated on by a single surgeon at a single institution over a period of approximately 5 years. The inclusion criteria were age < 14 years, rigid thoracic/thoracolumbar/lumbar kyphosis (> 70°) with or without neurological deficit and with or without scoliosis, and a minimum of 2 years of follow-up. Patients with cervical or lumbosacral kyphoscoliosis were excluded from the study. Demographic and clinical parameters, including age, sex, etiology of kyphoscoliosis, neurological examination status (Frankel grade), and visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were noted. Operative parameters (level of osteotomy, number of levels fused, duration of surgery, blood loss, and complications) were also recorded. Radiological assessment was done for preoperative and postoperative kyphosis and scoliosis as well as the final Cobb angle. Similarly, sagittal vertical axis (SVA) correction was calculated. Fusion was assessed in all patients at the final follow-up evaluation.RESULTSA total of 26 pediatric patients (18 male and 8 female) with a mean age of 9 years met the inclusion criteria and had data available for analysis, and all of these patients had severe scoliosis as well as kyphosis. Comparison of preoperative and postoperative values showed a significant improvement (p < 0.05) in radiological, clinical, and functional parameters (Cobb angle for scoliosis and kyphosis, SVA, VAS, and ODI). With respect to kyphosis, the mean preoperative Cobb angle was 96.54°, the mean postoperative angle was 30.77°, and the mean angle at final follow-up was 34.81° (average loss of correction of 4.23°), for a final average correction of 64.15%. With respect to scoliosis, the mean preoperative angle was 52.54°, the mean postoperative angle was 15.77°, and the mean angle at final follow-up was 19.42° (average loss of correction of 3.66°), for a final average correction of 60.95%. The preoperative SVA averaged 7.6 cm; the mean SVA improved to 3.94 cm at the end of 2 years. Bony fusion was achieved in all patients. The mean number of levels fused was 5.69. The mean operative time was 243.46 minutes, with an average intraoperative blood loss of 336.92 ml. Nonneurological complications occurred in 15.39% of patients (2 dural tears, 1 superficial infection, 1 implant failure). At the 2-year follow-up, 25 of the 26 patients had maintained or improved their neurological status. One patient developed paraplegia immediately after the operation and recovered only partially.CONCLUSIONSAnalysis of data from this series of 26 cases indicates that this posterior-approach single-level technique is effective for the correction of severe rigid kyphoscoliosis in pediatric patients, providing good clinical and radiological results in most cases.

Surgical Treatment With Nonunion Of The Lateral Humeral Condyle Of Humerus With Cubitus Valgus In Children Using Apparat Ilizarov

2010 ◽  
Vol 1 ◽  
Author(s):  
Ilkhom Khujanazarov ◽  
Iskandar Khodjanov
Keyword(s):  
Surgical Treatment ◽  
Operative Procedure ◽  
Lateral Condyle ◽  
Cubitus Valgus ◽  
X Ray ◽  
Loss Of Correction ◽  
The Mean ◽  
Humeral Condyle ◽  
Degrees Of Severity

Background. Nonunion of the lateral humeral condyle  are of the complex pathology of the elbow joint, occurring relatively often and resulting in disability of children.The treatment of nonunion of the lateral humeral condyle of humerus with cubitus valgus remains controversial. Purpose of this report was improvement of the results of surgical treatment of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus with use of differential approach to the surgical strategy.Material and methods. We were observing 28 children (17 boys and 11 girls) with nonunion and long-standing nonunion of lateral condyle of humerus, with various degrees of severity. There were used MRI and X-ray investigations for differential study of the patients divided into 3 groups in relation to stability and non-stability of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus.Results. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarov’s technique. The mean postoperative humerus-ulna angle was 6,0 degrees of cubitus valgus. All of reverse T-osteothomies healed uneventfully, and there was no loss of correction postoperatively.  The mean duration of follow-up was 7 years. The overall results were excellent in 15(53,5%) patients,  good in 11(39,3%) patients, and fair in 2(7,2%) patients. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarov’s technique. The mean postoperative humerus-ulna angle was 6,0 degrees of cubitus valgus. All of reverse T-osteothomies healed uneventfully, and there was no loss of correction postoperatively.  The mean duration of follow-up was 7 years. The overall results were excellent in 15(53,5%) patients,  good in 11(39,3%) patients, and fair in 2(7,2%) patients.

scholarly journals Posterior fixation including the fractured vertebra in short segment fixation of unstable thoracolumbar junction burst fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 81
Author(s):  
Md. Kamrul Ahsan ◽  
Zabed Zahangiri ◽  
M. A. Awwal ◽  
Naznin Zaman ◽  
Md. Hamidul Haque ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Junction ◽  
Vertebral Height ◽  
Short Segment ◽  
The Mean ◽  
Short Segment Fixation

<p>The aim of this study was to evaluate the efficacy of inclusion of the fractured vertebra in short segment fixation in terms of clinical and the radiological outcomes in unstable thoracolumbar junction burst fractures at a minimum of 1 year follow-up. Records of 52 patients (age: 21-50 years) with thoracolumbar burst fracture (T10–L2) in Magerl Type A fractures underwent posterior pedicle screw fixation including the fractured vertebra. Clinical parameters were back pain using Visual Analogue Score (VAS) and disability using Oswestry disability index (ODI), neurological deficit (using ASIA grade) and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were measured before surgery and at 3, 6 and 12 months  post-operatively. The presence of screw breakage, screw pullout, peri-implant loosening, and rod breakage were considered as criteria for implant failure. The majority of fractures resulted due to falls (31 cases), and the remaining cases resulted from car accidents (21 cases). The fractured vertebral body level was L1, T12, L2, T11, and T10 in 23, 17, 6, 4 and 2 cases and achieved satisfactory clinical outcomes according to the modified Mcnab criteria 18, 25, 6 and 3 cases were considered to have excellent, good, fair, and poor outcome. The mean kyphotic angle at pre-, post-operative and final follow-up was 13.5 ± 6.3, 13.4 ± 4.3, 8.5 ± 6.  The average loss of kyphosis correction was 6.4 ± 5.2° at the final follow-up. The mean pre- and post-operative kyphotic deformation of vertebral body was 5.1 ± 3.2, 4.8 ± 2.3 and at final follow-up was 4.5 ± 4.0 (p&gt;0.05). The mean anterior and posterior vertebral height also showed significant improvements post-operatively, which were maintained at the final follow-up. The mean ODI and VAS scores at the end of 1 year were 17.4%, 1.7 respectively. There was no case of major complication after surgery and during the follow-up period. In conclusion, reduction of unstable thoracolumbar junction burst fracture can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction.</p><p> </p>

scholarly journals Long-segment Fixation VS Short-segment Fixation Combined With Kyphoplasty for Osteoporotic Thoracolumbar Burst Fracture

2021 ◽  
Author(s):  
Oujie Lai ◽  
Xinliang Zhang ◽  
Yong Hu ◽  
Xiaoyang Sun ◽  
Binke Zhu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Burst Fracture ◽  
Body Height ◽  
Thoracolumbar Burst Fracture ◽  
Short Segment ◽  
Radiological Results ◽  
The Mean ◽  
Short Segment Fixation ◽  
Clinical And Radiological Results

Abstract BackgroundTo compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. ResultsThe mean operative time and blood loss were 89.71±7.62min and 143.75±42.51ml for SFK group, respectively; 111.69±12.25min (P<0.01) and 259.38±49.05 ml (P<0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, the loss of Cobb angle and AVH ratio were significant different between immediately postoperative and final follow-up evaluations for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. ConclusionsFor the treatment of OTBF, SSFK shows similar clinical and radiological results as LF. Comparatively, SSFK is less invasive and can preserve more motion segments, which is a more valuable surgical option in selected elderly patients.

scholarly journals Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

2014 ◽  
Vol 60 (2) ◽  
pp. 49-52
Author(s):  
S Anghel ◽  
D Márton
Keyword(s):  
Blood Loss ◽  
Traditional Approach ◽  
Burst Fracture ◽  
Pedicle Screws ◽  
Operation Time ◽  
Short Segment ◽  
Hardware Failure ◽  
Loss Of Correction ◽  
Short Segment Fixation

Abstract Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF), is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS). This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction. Methods: After a systematic literature review over research papers published between 2000 and 2012, 14 articles which met the criteria were included in the meta-analysis. The relevant data extracted and compared for each subgroup of patients treated either with SSF or SSF+IS, were the weighted averages for the pre-operative, post-operative and last follow up kyphosis angles. We also considered common associated complications, operation time, and blood loss values for each surgical subgroups. Results: The values for the loss of correction at the last follow-up were: 5.5° for SS and 7.4° for SSF+IS, which didn’t prove to be statistically different. With reference to other parameters, such as operation time, blood loss and correction attainment, the values did not present statistically significant differences, either. Regarding complications, we noticed that both SSF and SSF+IS display a similar incidence for hardware failure, screw breakages, superficial infections, deep venous thrombosis. Conclusions: This paper concludes that, adding one or two screws at the fractured vertebra level (SSF+IS) does not bring forth a significant improvement compared to the traditional approach (SSF). Apparently, the blood loss depends mostly on the approach type (open or percutaneous) and less on the surgery type.

scholarly journals FRACTURE OF SPINE:

2017 ◽  
Vol 24 (07) ◽  
pp. 1002-1007
Author(s):  
Faisal Abdul Jabbar ◽  
Muhammad Hashim ◽  
Abdul Ali Khan ◽  
Shahid Ahmed ◽  
Rehana Ali Shah
Keyword(s):  
Posterior Approach ◽  
Burst Fracture ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Centre ◽  
Neurological Improvement ◽  
Study Population ◽  
The Mean ◽  
Unstable Fractures

Objectives: In this study we analyze and study the effectiveness of pediclescrew and rod fixation for the management of unstable fractures of the thoracolumbar spine.The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 toSeptember 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods:N= 35 patients were operated at our institute and included in the study. The inclusion criteriawas all those patients who presented to us with unstable fractures of the thoracolumbar spinevia the accident and emergency department of the hospital, and were operated upon and gavefull informed consent to partake in the research were included in this study. All the patientswere operated under general anesthesia. The short segment fixation with pedicle screw rodfixation using the posterior approach was the technique utilized for treatment. Rehabilitationwas started immediately after the surgical procedure. Data was analyzed using SPSS version23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) weremales and n= 10 (28.57%) were females, the mean age of the study population was 33.5years. A history of fall from height was the most common cause of injury in n= 26 (74.28%)of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture wasthe most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O postoperatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittalindex values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (finalfollow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%)showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n=1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show anyimprovement. The mean duration between injury and surgical intervention was 5.5 days witha range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. Themost common complication observed was pressure sores in n= 4 (11.42%) and urinary tractinfections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%)patients. Conclusion: According to the results of our study unstable burst fractures was themost prevalent type of fracture observed, there was a marked improvement in the radiologicalparameters post operatively, while the neurological improvement was decent. The technique ofpedicle screw rod and fixation using the posterior approach provides good surgical outcomeand better stabilization, with a fair amount of neurological improvement for these patients.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

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