scholarly journals A comparison of monoaxial and polyaxial pedicle screws in thoracolumbar fracture

2020 ◽  
Author(s):  
Wenye Yao ◽  
Runsheng Guo ◽  
Qi Lai ◽  
Banglin Xie ◽  
Zhi Yi ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Thoracolumbar Fracture ◽  
Posterior Fixation ◽  
Vertebral Endplate ◽  
Short Segment ◽  
Thoracolumbar Injury ◽  
Group A ◽  
Group B ◽  
Fracture Level

Abstract Purpose: To evaluate the use of short-segment posterior fixation with monoaxial and polyaxial pedicle screws in thoracolumbar fractures Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2) in our hospital between June 2012 and December 2018 were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). We compared the Thoracolumbar Injury Severity Score (TLISS), American Spinal Injury Association (ASIA) score, the fracture level, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, hospital stay, injury-to-operation interval, and associated injuries between the two groups. In addition, the prevertebral height ratio, the injured vertebra Cobb angle, and the injured vertebral endplate centre ratio were measured preoperatively, postoperatively, and at the final follow-up. Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years. Compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A. Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up effect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

scholarly journals Comparison of the Therapeutic Effects of Short-Segment Posterior Fixation With Monoaxial Pedicle Screws or Polyaxial Pedicle Screws via Injured Vertebra on Thoracolumbar Fracture

2020 ◽  
Author(s):  
Wenye Yao ◽  
Runsheng Guo ◽  
Qi Lai ◽  
Bin Zhang
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Thoracolumbar Fracture ◽  
Posterior Fixation ◽  
Therapeutic Effects ◽  
Vertebral Endplate ◽  
Short Segment ◽  
Group A ◽  
Group B ◽  
Fracture Level

Abstract Purpose: To evaluate the therapeutic effects of short-segment posterior fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture.Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2). The clinical and radiological data such as the correction of deformity, sagittal profle and record of the perioperative morbidity of the patients were analyzed.Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years and were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). There were no significant differences in age, gender, fracture site, TLISS Score, ASIA Score, AO Classification, hospital stay, Injury-to-operation intereval, and associated injury between the two groups (P>0.05). Howere, compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A.Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up ffect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

scholarly journals Modified mini-open SRS-Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation in post-traumatic thoracolumbar kyphosis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Wubo Liu ◽  
Yiwei Zhao ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Xinyu Liu
Keyword(s):  
Back Pain ◽  
Pedicle Screws ◽  
Neurological Dysfunction ◽  
Control Group ◽  
Thoracolumbar Kyphosis ◽  
Estimated Blood Loss ◽  
Group A ◽  
Post Traumatic ◽  
Group B

Abstract Background We aimed to analyze the clinical results of Schwab grade 4 osteotomy combined with percutaneous pedicle screws (PPS) fixation for treatment of post-traumatic thoracolumbar kyphosis (PTK). Methods Thirty four patients with PTK (group A) were included in our study. The average age was 54.9 ± 3.3 years. All patients had severe back pain with 8.6 ± 1.3 VAS scores. The affected level was T12 in 16 patients and L1 in 18 patients. The average preoperative regional kyphosis angle (RKA) was 30.7 ± 6.00. Three patients had neurological dysfunction with ASIA grade D. All patients underwent Schwab grade 4 osteotomy combined with PPS fixation. The control group (Group B) were 26 PTK patients treated with Schwab grade 4 osteotomy and open pedicle screws fixation in our institution. Results Operation time in groups A and B was 280 ± 50 min and 210 ± 30 min, respectively (P < 0.05). Estimated blood loss in groups A and B was 310 ± 70 ml and 630 ± 40 ml, respectively (P < 0.05). No cerebral spinal fluid leakage, segmental nerve function damage, and other complications observed during and after the operations in both groups. RKA, SVA, and LL improved significantly after surgery in both groups (P < 0.05). The average correction rate in groups A and B was 64.5 and 66.3% (P > 0.05). CT showed that the misplacement rate in groups A and B was 5.5 and 6.6% (P > 0.05). The average follow-up in groups A and B was 25.2 ± 7.6 months and 30.6 ± 2.7 months. No fracture and other complications were observed in both groups. Solid bone fusion was showed in all cases at 6 months follow-up. In groups A and B, all patients with preoperative neurological dysfunction recovered to ASIA grade E at the last follow-up. The VAS score of back pain improved significantly from 8.6 ± 1.3 to 1.6 ± 1.0 at the last follow-up in group A (P < 0.05), while it improved significantly from 8.3 ± 1.2 to 3.0 ± 1.1 at the last follow-up in group B (P < 0.05). VAS of back pain was better in group A than that in group B. Conclusion Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation is a minimally invasive, safe and effective method for PTK treatment.

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.

scholarly journals Biomechanical comparison of short-segment posterior fixation including the fractured level and circumferential fixation for unstable burst fractures of the lumbar spine in a calf spine model

2016 ◽  
Vol 25 (5) ◽  
pp. 602-609 ◽  
Author(s):  
Azad Sait ◽  
Nadipi Reddy Prabhav ◽  
Vijay Sekharappa ◽  
Reshma Rajan ◽  
N. Arunai Nambi Raj ◽  
...  
Keyword(s):  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Lateral Flexion ◽  
Short Segment ◽  
Burst Fractures ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE There has been a transition from long- to short-segment instrumentation for unstable burst fractures to preserve motion segments. Circumferential fixation allows a stable short-segment construct, but the associated morbidity and complications are high. Posterior short-segment fixation spanning one level above and below the fractured vertebra has led to clinical failures. Augmentation of this method by including the fractured level in the posterior instrumentation has given promising clinical results. The purpose of this study is to compare the biomechanical stability of short-segment posterior fixation including the fractured level (SSPI) to circumferential fixation in thoracolumbar burst fractures. METHODS An unstable burst fracture was created in 10 fresh-frozen bovine thoracolumbar spine specimens, which were grouped into a Group A and a Group B. Group A specimens were instrumented with SSPI and Group B with circumferential fixation. Biomechanical characteristics including range of motion (ROM) and load-displacement curves were recorded for the intact and instrumented specimens using Universal Testing Device and stereophotogrammetry. RESULTS In Group A, ROM in flexion, extension, lateral flexion, and axial rotation was reduced by 46.9%, 52%, 49.3%, and 45.5%, respectively, compared with 58.1%, 46.5%, 66.6%, and 32.6% in Group B. Stiffness of the construct was increased by 77.8%, 59.8%, 67.8%, and 258.9% in flexion, extension, lateral flexion, and axial rotation, respectively, in Group A compared with 80.6%, 56.1%, 82.6%, and 121.2% in Group B; no statistical difference between the two groups was observed. CONCLUSIONS SSPI has comparable stiffness to that of circumferential fixation.

scholarly journals Short Segment versus Long Segment Posterior Pedicle Screws Fixation for Treatment of Thoracolumbar Burst Fracture: A Comparative Prospective Study

2020 ◽  
Vol 9 (2) ◽  
pp. 1-6
Author(s):  
Arvind Singh ◽  
Shiv Kumar Bali ◽  
Subhajit Maji ◽  
Kaustubh Ahuja ◽  
Nagaraj Manju Moger ◽  
...  
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Posterior Fixation ◽  
Short Segment ◽  
Kyphosis Correction ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B ◽  
Anterior Column Reconstruction

Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results:  The operative time Group A (159.85 min  22.5) was significantly shorter than Group B (198.7  31.5).  Blood loss was significantly less in Group A (478 ml   259.3) than Group B (865ml   275.7). Kyphosis Correction loss at 6th month follow up in Group A (subgroup A1: 10.7deg  6.2, subgroup A2: 7.1deg  7.4 and subgroup A3: Subgroup A3: 6.1deg  5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6th month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.

scholarly journals Outcomes in Thoracolumbar and Lumbar Traumatic Fractures: Does Restoration of Unfused Segmental Mobility Correlated to Implant Removal Time？：a retrospective study

2021 ◽  
Author(s):  
Jian Wu ◽  
Jun Zhu ◽  
Zhong Wang ◽  
Huaijian Jin ◽  
Yingbo Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Implant Removal ◽  
Pain Patient ◽  
Posterior Fixation ◽  
Removal Time ◽  
Group A ◽  
Group B

Abstract Background Posterior fixation without fusion can treat thoracolumbar and lumbar traumatic fractures effectively. However, whether patients benefit from implant removal, as well as the correlation between the range of motion (ROM) of the involved segments and the removal time, has not been determined. Methods Fifty consecutive cases with thoracolumbar traumatic fractures that had undergone implant removal at different times were enrolled. We found 17 patients (Group A), 21 patients (Group B), and 12 patients (Group C) underwent implant removal following the index surgery within 12 months, between 12 to 24 months, and over 24 months, respectively. Clinical and radiological outcomes, including visual analog scale (VAS) for back pain, patient satisfaction, the Oswestry disability index (ODI) and EuroQol five dimensions questionnaire (EQ-5D) for quality of life and segmental ROM were analyzed. Results The average follow-up time was 9.1 ± 5.7 months after implant removal. There were no significant differences in VAS and patient satisfaction among the three groups at the same observation time points. Patients of group A gained the lowest ODI and highest EQ-5D scores after removal and at final follow-up than those in group B and C. The best ROM was obtained in Group A followed by Group B and C (11.5 ± 6.2°, 5.5 ± 1.6° and 2.4 ± 0.6°, respectively). Conclusions Immobilization of the involved segments over 24 months may lead to ankylosis. Regained segmental ROM is correlated negatively with implant removal time. Patients have implant removal within 12 months can gain a better quality of life.

Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery

2010 ◽  
Vol 13 (5) ◽  
pp. 612-621 ◽  
Author(s):  
Kenzo Uchida ◽  
Hideaki Nakajima ◽  
Takafumi Yayama ◽  
Tsuyoshi Miyazaki ◽  
Takayuki Hirai ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Posterior Fixation ◽  
Vertebral Collapse ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Anterior Surgery ◽  
Posterior Surgery ◽  
Group B ◽  
Osteoporotic Vertebral Collapse

Object The surgical approach and treatment of thoracolumbar osteoporotic vertebral collapse with neurological deficit have not been documented in detail. Anterior surgery provides good decompression and solid fusion, but the surgery-related risk is relatively higher than that associated with the posterior approach. In posterior surgery, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to loss of correction of kyphosis. The aim of this study was to evaluate the efficacy of reinforcing short-segment posterior fixation with vertebroplasty and to compare the outcome with those of posterior surgery without vertebroplasty and anterior surgery, retrospectively. Methods The authors studied 83 patients who underwent surgical treatment for a single thoracolumbar osteoporotic vertebral collapse with neurological deficit. Twenty-eight patients treated by posterior surgery combined with vertebroplasty (Group A), 25 patients treated by posterior surgery without vertebroplasty (Group B), and 30 patients treated by anterior surgery (Group C) were followed up for a mean postoperative period of 4.4 years. Neurological outcome, visual analog scale pain score, and radiographic results were compared in the 3 groups. Results Postoperative (4–6 weeks) and follow-up neurological outcome and visual analog scale scores were not significantly different among the 3 groups. Postoperative kyphotic angle was significantly reduced in Group B compared with Group C (p = 0.007), whereas the kyphotic angle was not significantly different among the 3 groups at follow-up. The mean ± SD loss of correction at follow-up was 4.6° ± 4.5°, 8.6° ± 6.2°, and 4.5° ± 5.9° in Groups A, B, and C, respectively. The correction loss at follow-up in Group B was significantly higher compared with Groups A and C (p = 0.0171 and p = 0.0180, respectively). Conclusions The results suggest that additional reinforcement with vertebroplasty reduces the kyphotic loss and instrumentation failure, compared with patients without the reinforcement of vertebroplasty. Vertebroplasty-augmented short-segment fixation seems to offer immediate spinal stability in patients with thoracolumbar osteoporotic vertebral collapse; the effect seems equivalent to that of anterior reconstruction.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

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