scholarly journals Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

2020 ◽  
Author(s):  
Xiaochen Zheng ◽  
Jia Liu ◽  
Enze Jiang ◽  
DongYang Niu ◽  
Peng Li ◽  
...  
Keyword(s):  
Posterior Instrumentation ◽  
Posterior Fixation ◽  
Adjacent Segment ◽  
Low Back ◽  
Thoracolumbar Fractures ◽  
Kyphotic Angle ◽  
Articular Process ◽  
Radiographic Outcomes ◽  
Outcome Score ◽  
Selective Fusion

Abstract Objective: This retrospective study investigated the clinical and radiographic outcomes following temporary transpedicular posterior instrumentation between two cohorts of patients with thoracolumbar fractures (TLF) who underwent selective or bi-segments intervertebral articular process fusion.Materials and Methods: Patients with TLF who underwent the temporary posterior fixation with selective fusion (Group SF), or bi-segments fusion (Group BF) were studied. Superior intervertebral articular process and interlaminar fusion were performed in Group SF, whereas in Group BF, the patients underwent bi-segments fusion in both superior and inferior articular processes, as well as interlaminar fusion. We measured the distal and proximal intervertebral mobility, regional kyphotic angle, and vertebral height before and after surgery in both groups. Greenough Low-Back Outcome Score was used to assess the clinical outcomes.Results: Sixty-five patients with TLF from T12 to L2 fractures were enrolled in the study period: 23 patients in the Group SF and 22 patients in the Group BF. All the patients experienced fracture healing (mean follow-up time: 19.7 months). The mean postoperative functional outcomes were 65.0±2.0 points for the Low-Back Outcome Score in the Group SF and 65.2±1.8 for the Group BF. A progressive regional kyphotic angle was observed with time regardless of fusion but was not significantly different between the two groups. There was a statistical difference between unfused inferior proximal adjacent and inferior distal adjacent segment regardless of fracture segments.Conclusion: The strategy of selective fusion is reported to be useful for the treatment of patients with TLF. The motion in the un-fused and adjacent segment could be better regained after instrumentation removal in the selectively fusion group.

scholarly journals Posterior Instrumentation for Unstable Thoracolumbar Fractures

2018 ◽  
Vol 6 (4) ◽  
pp. 150-155
Author(s):  
Bimal Kumar Pandey ◽  
Anjana Rajbhandari
Keyword(s):  
Posterior Instrumentation ◽  
Thoracolumbar Fractures ◽  
Type B ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Medical College ◽  
Loss Of Correction ◽  
Type C

Background: About 90 percent of all spinal injuries involve the thoracolumbar region. Unstable fractures need surgical treatment to achieve a painless, balanced and stable spine preserving or recovering neurological function, highest degree of spinal motion and to allow early patient mobilization.Objective: This study was carried out to evaluate radiological outcome of posterior instrumentation in thoracolumbar fractures.Methodology: A total of 110 patients with thoracolumbar fracture were included in the study, which was carried out at Kathmandu Medical College Teaching Hospital from December 2011 to December 2016. Unstable Arbeitsgemeinschaft fur Osteosynthesefragen type A and type B fractures were treated with short segment instrumentation and type C with long segment instrumentation. Radiological evaluation of postoperative correction of kyphotic angle and vertebral height was measured and was compared with immediate postoperative correction and loss of correction in two years final follow up.Results: Mean postoperative correction of vertebral kyphotic angle was 25° and loss of correction in final follow up was 5°. Mean postoperative vertebral height correction was 24% and its loss in final follow up was 2%. There was no significant difference in loss of correction of vertebral kyphosis and vertebral height in short segment and long segment fi xation in final follow up.Conclusion: Long segment posterior instrumentation results in good reduction and its maintenance for Arbeitsgemeinschaft fur Osteosynthesefragen type C thoracolumbar fractures whereas similar results can be achieved with short segment posterior instrumentation in type A and type B fractures. Journal of Kathmandu Medical College,Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 150-155  

scholarly journals Comparative study of long segment versus short segment posterior fixation of thoracolumbar fractures with pedicle screws

2021 ◽  
Vol 9 (2) ◽  
pp. 77-84
Author(s):  
Vihar SJ ◽  
Naveen DS ◽  
Agrawal NK
Keyword(s):  
Pedicle Screws ◽  
Posterior Fixation ◽  
Rigid Fixation ◽  
Thoracolumbar Fractures ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Duration Of Surgery ◽  
One Year ◽  
Short Segment Fixation

Choice of long or short segment fixation for thoracolumbar fractures, benefits of either of these techniques has been a topic for analysis and assessment. Kyphotic angles in twenty patients diagnosed to have thoracolumbar vertebral fractures between December 2019 to December 2020 in Bapuji hospital and Chigateri general hospital, Davanagere, Karnataka, India were measured pre operatively, post operatively and at one year follow up and assessed. No statistical difference between the degrees of correction of initial kyphotic angle between long segment fixation and short segment posterior fixation in our study was found (p<0.6). Method of fixation of the thoracolumbar vertebral fracture did not correlate with initial degree of kyphosis (p=0.4). Amount of correction loss at one year follow up was found to be statistically significant in short segment fixation (p<0.05). Loss of kyphotic angle at one year follow up was higher in case of short segment fixation than long segment fixation and found to be statistically significant (p<0.005). Our study showed that long segment fixation helps in better correction of the kyphosis angle with lesser chance of loss of correction and can be opted when pedicles aren’t intact at the fracture level, as in cases of burst fractures. Short segment fixation provides better rigid fixation at the site of fracture with increased range of motion at the thoracolumbar segment and can be treatment of choice when the pedicles at the fractured level are intact, as in cases of compression fractures, having benefits of shorter duration of surgery and reduced risks.

Construct Stability of C2 Replacement Strategies

2003 ◽  
Author(s):  
Christian M. Puttlitz ◽  
Robert P. Melcher ◽  
Vedat Deviren ◽  
Dezsoe Jeszenszky ◽  
Ju¨rgen Harms
Keyword(s):  
Repeated Measures ◽  
Posterior Instrumentation ◽  
Statistical Significance ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Camera Motion ◽  
Anterior Plate ◽  
Intact Specimen ◽  
Strut Graft ◽  
Significant Difference

Reconstruction of C2 after tumor destruction and resection remains a significant challenge. Most constructs utilize a strutgraft with plate or screw fixation. A novel C2 prosthesis combining a titanium mesh cage with bilateral C1 shelves and a T-plate has been used successfully in 18 patients. Supplemental posterior instrumentation includes C0-C3 or C1-C3. Biomechanical comparisons of this C2 prosthesis with traditional fixation options have not been reported. Five fresh-frozen human cadaveric cervical spines (C0-C5) were tested intact. Next, the C2 prosthesis, and strut graft and anterior plate constructs were tested with occiput-C3 and C1-C3 posterior fixation. Pure moment loads (up to 1.5 N-m) were applied in flexion and extension, lateral bending, and axial rotation. C1-C3 motion was evaluated using 3 camera motion analysis. Statistical significance was evaluated using one-way repeated measures ANOVA with Student-Newman-Keuls post hoc pairwise comparisons. All constructs provided a statistically significant decrease in motion in this C2 corpectomy model as compared to the intact condition. There was no significant difference in C1-C3 motion between the 4 constructs, regardless of whether the occiput was included in the fixation. Under these loading conditions, both the C2 prostheisis and strut-graft-plate constructs provided initial C1-C3 stability beyond that of the intact specimen. The occiput does not need to be included in the posterior instrumentation.

Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series

2021 ◽  
Author(s):  
Shizumasa Murata ◽  
Akihito Minamide ◽  
Yukihiro Nakagawa ◽  
Hiroshi Iwasaki ◽  
Hiroshi Taneichi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Japanese Orthopaedic Association ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Low Back ◽  
Spinal Decompression ◽  
Analog Scale ◽  
Clinically Important Difference ◽  
Lumbar Spinal

Abstract Background and Study Aims Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. Patients and Methods From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. Results The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Conclusions Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

Late Results of Thoracolumbar Fractures After Posterior Instrumentation and Transpedicular Bone Grafting

Spine ◽  
2001 ◽  
Vol 26 (1) ◽  
pp. 88-99 ◽  
Author(s):  
Christian Knop ◽  
Henry F. Fabian ◽  
Leonard Bastian ◽  
Michael Blauth
Keyword(s):  
Bone Grafting ◽  
Posterior Instrumentation ◽  
Late Results ◽  
Thoracolumbar Fractures ◽  
Transpedicular Bone Grafting

scholarly journals Short vs long posterior fixation of thoracolumbar spine injuries

2016 ◽  
Vol 69 (suppl. 1) ◽  
pp. 15-21
Author(s):  
Milan Stankovic ◽  
Natasa Janjic ◽  
Ivica Lalic ◽  
Nemanja Gvozdenovic ◽  
Igor Elez ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Neurological Deficit ◽  
Anterior Part ◽  
Thoracolumbar Spine ◽  
Posterior Fixation ◽  
Low Back ◽  
Fixation Group ◽  
Clinical Center ◽  
Spine Injuries

Introduction. More than a quarter of total number of posterior fixations of thoracolumbar spine is unsuccessful. Material and methods. The aim is to compare short and long fixation of thoracolumbar spine injuries. During the period of 2006 to 2015 we examined 99 patients at the Department of Orthopedic Surgery and Traumatology of Clinical Center of Vojvodina. Short fixation was performed in 63 cases and long fixation in 36 cases. All patients underwent clinical, radiographic and neurological evaluation. Mean age in the short fixation group was 47 (18-66) and in the long fixation group it was 43 (17-70). Mean follow-up time was 4,5 years. Results. Implants were extracted in 14 cases of short and in 4 cases of long fixation. Collapse of anterior part of vertebral body developed in 28,45% in the short fixation group and in 22,43% in the long fixation group whereas angulation value was 10,2o and 12,3o respectively. Mean low back outcome scale value was 61 points in the short fixation group and 50 in the long fixation group. There were 22 patients with neurological deficit. Full recovery was recorded in 8 patients (36,4%) of the short fixation group and in 17 patients (22,7%) of the long fixation group. Complications developed in 15 patients (23,8%) of the short fixation group and 11 (30,6%) of the long fixation group. Conclusion. Short fixation is biomechanically weaker but provides a better functional recovery than long fixation.

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