scholarly journals A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

2021 ◽  
Author(s):  
Kun He ◽  
Chunke Dong ◽  
Hongyu Wei ◽  
Feng Yang ◽  
Haoning Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cortical Bone ◽  
Clinical Efficacy ◽  
Revision Surgery ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
3D Printed

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

scholarly journals Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

2020 ◽  
pp. 1-6
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Jeremy M. V. Guinn ◽  
Joshua Rivera ◽  
Sigurd H. Berven ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Demographic Data ◽  
Degenerative Spondylolisthesis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fat Infiltration ◽  
Single Level ◽  
Goutallier Classification ◽  
Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

scholarly journals A Modified Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Yibing Li ◽  
Dingjun Hao ◽  
Wenjie Gao
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Modified Method ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

scholarly journals A modified method to treat severe asymptomatic pre‐existing degeneration of adjacent segment: a retrospective case‐control study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Yibing Li ◽  
Dingjun Hao ◽  
Wenjie Gao
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Modified Method ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. Methods We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last–follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last–follow-up value of 15.9 ± 9.3 % (P < 0.05). Conclusions This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.

scholarly journals Surgical Strategy and Clinical Efficacy Analysis of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

2020 ◽  
Author(s):  
Yangyang Chen ◽  
Guofu Pi ◽  
Yu Han ◽  
Jianguang Sun ◽  
Shilei Huang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Operation Time ◽  
Adjacent Segment ◽  
Intraoperative Blood Loss ◽  
Titanium Plate ◽  
Intervertebral Fusion ◽  
Plate Group ◽  
Significant Difference

Abstract Background: There are relatively few studies on the treatment of symptomatic adjacent segment disease(ASD) after anterior cervical discectomy and fusion(ACDF). The purpose of this study to compare the clinical efficacy of zero-profile(zero-p) intervertebral fusion and titanium plate combined with cage fusion for treating ASD after ACDF. Methods: Retrospective analysis was performed on patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019. Among them, 12 cases underwent anterior cervical decompression with zero-p intervertebral fusion (zero-p group), and 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion (titanium plate group). Operative time, intraoperative blood loss, postoperative Japanese 0rthopaedic Association (JOA) score, visual analogue scale (VAS) scores, neck disability index (NDI), dysphagia Bazaz grade, bone graft fusion Eck grade, C2-C7 Cobb Angle, and related complications were compared between the two groups. Results: The intraoperative blood loss difference between the two groups was not statistically significant (P>0.05). The operation time of the zero-p group was shorter than that of the titanium plate group, with significant differences(P<0.05). The Bazaz classification of dysphagia in the zero-p group was superior to the titanium plate group 1 month after the operation, and the difference was statistically significant (P<0.05); However, there was no statistically significant difference between the two groups in the Bazaz classification of dysphagia and the bone graft fusion Eck grade at the last follow-up (P>0.05). At the last follow-up, the JOA score, VAS score, NDI index, C2-C7 Cobb Angle were significantly different between the zero-P group and the titanium plate group (P<0.05). However, no significant difference was found between the two groups (P>0.05). During the follow-up period, all the patients did not have a rupture of the settler screw and esophageal injury and other related diseases.Conclusions: Both methods can achieve good clinical efficacy in the treatment of symptomatic ASD, and can restore and maintain the physiological curvature of the cervical spine to a certain extent. However, the advantages of zero-p intervertebral fusion including shorter operation time, reducing soft tissue injury, and less postoperative dysphagia.

Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation

2020 ◽  
Vol 32 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Hironobu Sakaura ◽  
Daisuke Ikegami ◽  
Takahito Fujimori ◽  
Tsuyoshi Sugiura ◽  
Yoshihiro Mukai ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Disc Height ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level

OBJECTIVECortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.METHODSThe medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.RESULTSOne hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.CONCLUSIONSCBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.

scholarly journals Three‐dimensional‐printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow‐up of 24 months

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuqi Zhang ◽  
Li Min ◽  
Minxun Lu ◽  
Jie Wang ◽  
Yitian Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Operation Time ◽  
Pubic Bone ◽  
Type Iii ◽  
3D Printed ◽  
The Mean

Abstract Background Pubic defects resulting from type III hemipelvectomy are commonly not reconstructed due to the need to preserve the weight-bearing axis. However, the opening of the anterior pelvic ring will inevitably lead to increased pelvic instability. To improve long-term pelvic stability, three-dimensional (3D)-printed customized prostheses were designed to reconstruct pubic defects. This study presents and evaluates the short-term clinical outcomes and complications from the use of this construct. Methods Five patients who underwent type III hemipelvectomy and 3D-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analysed. Operation time and blood loss during the operation were recorded. Local and functional recovery was assessed. Prosthetic position and osseointegration were evaluated. Oncology results and complications were recorded. Results The prostheses consisted of three with stems and two without. The mean follow-up time was 23.6 months. At the last follow-up, all five patients were alive with no evidence of disease. No deep infections or local recurrence had occurred. The mean blood loss and mean intraoperative time were 1680 ml and 294 min, respectively. The mean functional MSTS score at the final follow-up was 29.8. Fretting wear around the prosthetic stem was found in 3 patients, while bone wear on the normal-side pubis was found in 2 patients. Osseointegration was observed in all patients. Conclusions 3D-printed customized prostheses for reconstructing pubic bone defects after type III hemipelvectomy showed acceptable early outcomes. The good outcomes were inseparable from the precision prosthesis design, strict surgical procedures, and sensible postoperative management.

scholarly journals Feasibility of cortical bone trajectory screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration

Medicine ◽  
2021 ◽  
Vol 100 (28) ◽  
pp. e26666
Author(s):  
Long Wang ◽  
Yong-Hui Zhao ◽  
Xing-Bo Cai ◽  
Jin-Long Liang ◽  
Hao-Tian Luo ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Revision Surgery ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Cortical Bone Trajectory

scholarly journals Comparison of Minimally Invasive Reduction Combined With Medial and External Fixation in the Treatment of Intra-articular Calcaneal Fractures

2020 ◽  
Author(s):  
wang jianchuan ◽  
Liu jibin ◽  
wang zongpu
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
External Fixation ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Efficacy Evaluation ◽  
Sf 36 ◽  
Length Width ◽  
Minimally Invasive Reduction

Abstract BackgroundComparison of percutaneous minimally invasive replacement joint inside external fixation technique and tarsal sinus approach to treat Sanders Ⅱ and Ⅲ clinical effect of intra-articular calcaneal fractures.MethodsThe clinical data of 64 cases of calcaneal fracture admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed.According to different surgical methods,they were divided into the percutaneous minimally invasive reduction and internal and external fixation group (30 cases) and the tarsal sinus approach (34 cases).Comparison of two groups of patients with operation time,intraoperative blood loss,hospital stay, postoperative complications and radiographic evaluation including heel bone length,width,height,Bohler Angle,Angle of Gissane,calcaneal varus Angle,clinical efficacy evaluation including the American Orthopaedic Foot and Ankle Society (AOFAS),the visual analogue score for pain(VAS) score,health survey profiles (SF - 36) score and score Maryland ankle function.ResultsPatients in both groups were followed up for 12 to 50 months,an average of 24.8 months.All fractures obtained bone union.The waiting time,hospital stay,intraoperative blood loss and incision complications in the percutaneous minimally invasive medial and external fixation group were lower than those in the tarsal sinus group,and the differences were statistically significant (P<0.01).At the last follow-up,the length,width,height,Angle of Bohler,Angle of Gissane,and Angle of calcaneal varus were significantly increased in both groups (P<0.01),the calcaneal width was significantly lower than that before surgery (P<0.01),and the difference between the two groups was not statistically significant (P > 0.05).Clinical efficacy evaluation The AOFAS,VAS,SF-36 and Maryland scores were (85.28±8.21),(0.84±1.21),(82.95±3.25) and (83.56±3.32) at the last follow-up in the percutaneous minimally invasive medial and external fixation group.The AOFAS, VAS, SF-36 and Maryland scores of the tarsal sinus group were (83.32 ± 7.69),(1.85 ± 1.32),(80.71 ± 5.42),(81.85 ± 2.41) points,and there was no significant difference between the two groups (P > 0.05).ConclusionUnder the condition of having a good command of surgical indications and surgical skills,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with medial and external fixation for treatment of intra-articular calcaneoplasty fractures can achieve similar clinical effects as the tarsal sinus approach.However,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages such as fewer complications, less blood loss,and shorter operation time,etc,which is of good safety and worthy of clinical promotion.

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