Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

Mapping Intimacies ◽

10.21203/rs.3.rs-31598/v1 ◽

2020 ◽

Author(s):

hongheng lin ◽

Xiaoting Ou ◽

Wenchao Li ◽

Minyuan Chen ◽

Caijun Liu ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Operation Time ◽

Clinical Results ◽

Radiographic Evaluation ◽

Correction Loss ◽

Short Segment ◽

Significant Correction ◽

Short Segment Fixation

Abstract BackgroundThis is a retrospective study to evaluate the efficacy of percutaneous short segment fixation (PSSF) with or without intermediate screws in Magerl A3 thoracolumbar (TL) fractures accompanied with low bone mineral density (BMD).Methods From January 2017 to December 2018, 30 patients diagnosed with Magerl A3 TL fractures having a BMD between 0.5/cm2 and 1g/cm2 in the lumbar vertebrae with intact neurological functions and a history of major trauma who underwent PSSF with or without intermediate screws were enrolled in this study. The patients were divided into two groups of those with intermediate screws (group F) or without (group S). The operation time and intra-operation blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) were employed as clinical assessments and quantified. Radiographic follow-up assessed according to the Cobb angle (CA), Vertebral wedge angle (VWA), and anterior vertebral body height (AVBH).ResultsLoose screws were observed in 4 of the 30 enrolled patients. Significant differences were observed in operation time and intra-operative blood loss between the two groups. The enrolled patients’ clinical results (VAS and ODI scores) were good, however, no significant differences during all follow-up periods were present between the two groups. Radiographic evaluation (CA, VWA and AVBH) improved immediately after surgery, but significant correction loss was observed in the follow-up periods, especially in the first month. Radiographic evaluation demonstrated no significant differences between the two groups.Conclusion Although the patients’ clinical results were satisfactory, PSSF could not resist the correction loss in Magerl A3 TL fractures accompanied with BMD below 1g/cm2. Accordingly, the use of intermediate pedicle screws may be unnecessary due to their limited ability in resisting correction loss and increasing operation time as well as intra-operation blood loss.

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

Acta Medica Marisiensis ◽

10.2478/amma-2014-0011 ◽

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.

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

10.21203/rs.3.rs-542387/v1 ◽

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.

Hemivertebra Resection Combined With Wedge Osteotomy for Treatment of Severe Rigid Congenital Kyphoscoliosis in Adolescence

10.21203/rs.3.rs-17556/v1 ◽

2020 ◽

Author(s):

Xinhua Yin ◽

Liang Yan ◽

Baorong He ◽

Ding Jun Hao ◽

Zhongkai Liu

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operation Time ◽

Radiographic Evaluation ◽

Wedge Osteotomy ◽

Sagittal Imbalance ◽

Operative Blood Loss ◽

Hemivertebra Resection ◽

Questionnaire Score

Abstract Background There was a controversy about surgery approach of severe rigid congenital kyphoscoliosis in adolescence treatment. Aim of the study is to compare the clinical efficacy of surgical treatement by hemivertebra resection (HR) and hemivertebra resection combined with wedge osteotomy (HRWO) for severe rigid congenital kyphoscoliosis in adolescence. Methods Twenty-five patients with severe rigid congenital kyphoscoliosis between Jan 2006 and Dec 2011 were studied in our center. The patients were divided into hemivertebra resection group (group HR) or hemivertebra resection combined with wedge osteotomy group (group HRWO). The clinical and radiographic evaluation in terms of operation time, blood loss, correction rate, fusion time, hospital stay, complications and SRS-24 questionnaire score were compared between Group A and Group B. Results It is obvious that group HR achieved much better results in time of operation time, intra-operative blood loss, and hospital stay than group HRWO (P < 0.05). But meanwhile, group HRWO was significantly better than group HR in the times of coronal Cobb angle, kyphosis, the sagittal imbalance, coronal imbalance and SRS-24 questionnaire score (P < 0.05). There were no significant differences between the two groups in the age, mean flexibility, follow-up time, fusion time, and complications in the last follow-up (P > 0.05). Conclusion The outcomes of follow-up showed that the hemivertebra resection combined with wedge osteotomy approach obtained better clinical outcomes hemivertebra resection surgery. It might be a better surgical treatment for severe rigid congenital kyphoscoliosis in adolescence patients, but it needs longer operation time, more intra-operative blood loss, and extended hospital stay.

Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

10.21203/rs.2.22709/v1 ◽

2020 ◽

Author(s):

Zhijun Xin ◽

Guoquan Zheng ◽

Xinwen Feng ◽

Peng Huang ◽

Xuesong Zhang ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Blood Loss ◽

Vertebral Column ◽

Perioperative Complications ◽

Operation Time ◽

Clinical Results ◽

Kyphotic Deformity ◽

Thoracolumbar Kyphosis ◽

Complete Paralysis

Abstract Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.

Minimum 5-year follow-up results of skipped pedicle screw fixation for flexible idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2011.4.spine10321 ◽

2011 ◽

Vol 15 (2) ◽

pp. 146-150 ◽

Cited By ~ 39

Author(s):

Chang Ju Hwang ◽

Choon-Ki Lee ◽

Bong-Soon Chang ◽

Min-Seok Kim ◽

Jin S. Yeom ◽

...

Keyword(s):

Blood Loss ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Sagittal Balance ◽

Screw Fixation ◽

Operation Time ◽

Pedicle Screw Fixation ◽

Correction Loss ◽

The Mean

Object The aim of this study was to evaluate after more than 5 years the outcome of surgical treatment for flexible idiopathic scoliosis using skipped pedicle screw fixation. Methods For patients with spine curves < 90° and flexibility > 20%, pedicle screws had been inserted into every other segment on the corrective side and 2–4 screws per curve had been inserted on the supportive side. The authors analyzed the results in 57 patients, including the correction rate of coronal curvature and rotational deformity, correction loss, sagittal balance, complications, blood loss, operation time, and implant costs. Results The mean Cobb angle was 54° preoperatively and 17° immediately after surgery (69% correction). At the last follow-up, the mean Cobb angle was 18° (2% correction loss). Rotation of the apical vertebra was corrected by 50% on average and showed only a 6% correction loss at the last follow-up. None of the patients had problems in maintaining sagittal balance. An adding-on phenomenon was detected in 4 patients (7%). Twelve of 14 patients with coronal decompensation showed improvement after surgery, whereas postoperative decompensation developed in 3 patients. Four patients had implant failures, and 4 had postoperative infections. The mean blood loss during surgery was 832 ml, and the mean operation time was 167 minutes. Compared with conventional methods, the authors' method used up to 48% fewer screws. Conclusions Skipped pedicle screw fixation of flexible idiopathic scoliosis showed satisfactory results. This method has several advantages, including reduced blood loss, shorter operation time, and reduced cost.

Clinical and radiographic evaluation of implant‐supported single‐unit crowns with cantilever extension in posterior areas: A retrospective study with a follow‐up of at least 10 years

Clinical Implant Dentistry and Related Research ◽

10.1111/cid.12973 ◽

2021 ◽

Author(s):

Eric Schmid ◽

Andrea Roccuzzo ◽

Michele Morandini ◽

Christoph A. Ramseier ◽

Anton Sculean ◽

...

Keyword(s):

Retrospective Study ◽

Single Unit ◽

Radiographic Evaluation

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2013.11.spine13479 ◽

2014 ◽

Vol 20 (2) ◽

pp. 150-156 ◽

Cited By ~ 52

Author(s):

Petr Vanek ◽

Ondrej Bradac ◽

Renata Konopkova ◽

Patricia de Lacy ◽

Jiri Lacman ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Cobb Angle ◽

Control Group ◽

Working Ability ◽

Short Segment ◽

Transpedicular Screw ◽

Significant Difference ◽

Screw Group

Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04348-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fangning Hu ◽

Xi Liu ◽

Fanxiao Liu ◽

Honglei Jia ◽

Xiaolong Lv ◽

...

Keyword(s):

Blood Loss ◽

Rating Scale ◽

Clavicle Fracture ◽

Operation Time ◽

Clinical Results ◽

Intraoperative Blood Loss ◽

Traditional Group ◽

Significant Difference ◽

Clavicle Fractures ◽

Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

10.21203/rs.2.15560/v2 ◽

2019 ◽

Author(s):

Yiliang Cui ◽

Xingyi Hua ◽

Florian Schmidutz ◽

Jian Zhou ◽

Zongsheng Yin ◽

...

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Functional Outcomes ◽

Operation Time ◽

Tibial Shaft ◽

Shaft Fractures ◽

Significant Difference ◽

Special Surgery ◽

Tibial Shaft Fractures

Abstract Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss. Results: A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM. Conclusions: Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.