Spinous Process Combined with a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

Abstract Background. To investigate the clinical efficacy of one-stage posterior debridement using the spinous process (SP) combined with titanium mesh cages (TMCs) as interbody grafts for the treatment of single-segment lumbar or lumbosacral spinal tuberculosis.Methods. From 2010 to 2018, 69 patients who underwent one-stage posterior debridement using grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. 12 cases using the SP combined with a TMC (SP+TMC, group A), 30 cases using a TMC only (group B), and 27 cases using allografts (group C) were included. Measurements including operative time, blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analysed using SPSS 25.Results. We found that group A had fewer fixation segments (1.67±0.64 vs 2.81±0.94, pAC<0.01), fewer pedicle screws implanted (5.05±1.29 vs 6.85±1.37, pAC<0.01), a shorter operative time (166.43±44.11 min vs 205.93±51.73 min, pAC<0.01), reduced blood loss (543.81±230.81 ml vs 803.70±446.78 ml, pAC<0.01), and a strikingly lower hospital cost (14710.42±2354.55$ vs 19260.34±3310.75$, pAC<0.01) than group C.Compared to group B, group A had a lower economic cost (16680.23±3614.73$ vs 14710.42±2354.55$, pAB=0.03). There was no significant difference in bony fusion time among the three groups (8.90 ±2.11 months vs 8.60±2.39 months vs 9.59 ±2.04 months, p>0.01). No significant difference was observed with respect to pre- or postoperative ESR and CRP (p>0.01). There was no significant difference among the 3 groups with respect to the ODI, VAS score or ASIA grade during any period. No differences regarding the hospital stay, rate of complications, loss of PI-LL, correction or loss of Cobb angle were observed among the three groups (p>0.01).Conclusion. Our study demonstrates that compared to a TMC or allograft, the use of the SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to good restoration of spinal stability. Furthermore, this approach is an economical structural bone grafting method, especially for patients in developing countries or areas.

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Comparison between bundled multi-segment rib graft and titanium mesh bone graft in the treatment of thoracic and lumbar spinal tuberculosis

10.21203/rs.2.15387/v1 ◽

2019 ◽

Author(s):

Yifan Wang ◽

Shiyuan Shi ◽

Qi Zheng ◽

Mingfeng Zheng ◽

Yanghui Jin

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Titanium Mesh ◽

Significant Difference ◽

Group A ◽

Group B ◽

Lumbar Spinal

Abstract Background: To investigate the two different methods including bone grafting with bundled multi-segment ribs and titanium mesh bone grafting through posterior approach in patients with thoracic and lumbar spinal tuberculosis. Methods: 38 patients with thoracic spinal tuberculosis in our hospital were divided into group A (19 cases of titanium mesh bone grafting) and group B (19 cases of bone grafting with bundled multi-segment ribs). The transverse costal process approach was firstly initiated, then the necrotic tissue of tuberculosis lesions was removed thoroughly. Finally, titanium mesh bone grafting and bone grafting with bundled multi-segment ribs was applied, respectively. Results: The data demonstrated that 12 to 24 months of follow-up revealed that the operation time of Titanium mesh bone grafting in group A was 21.2+2.3 min, and that of bundled rib bone grafting in group B was 7.2+2.4 min. Compared to group A, the time in group B was significantly shorter. The amount of bleeding in group A not distinct from that in group B. There was no significant difference in Cobb angle. The fusion time in the two groups was similar. There was no significant difference in Oswestry dysfunction index between the two groups at the last follow-up. Conclusions: Bone grafting with bundled multi-segment ribs could stable the function quickly after thoracic tuberculosis lesion clearance, indicating as an alternative and development prospects of bone graft strategy.

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Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

10.21203/rs.3.rs-49502/v1 ◽

2020 ◽

Author(s):

Weiyang Zhong ◽

Xinjie Liang ◽

Xiaolin Wang ◽

Ke Tang ◽

Tianji Huang ◽

...

Keyword(s):

Hospital Stay ◽

Spinous Process ◽

Bone Grafts ◽

Clinical Results ◽

Single Segment ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Segmental Angle

Abstract Background: A retrospective study investigated and compared the results of a lamina withspinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic discitis (LPD) through one-stage-posterior-only approach with radical debridement and internal instrumentation.Methods: Data from 37 patients were reviewed. A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were reviewed. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU.Results: All patients were followed-up for a mean of 27.94±2.35 months in group A and 30.29±1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P<0.05). The surgery time, surgery hemorrhage, and hospitalization cost were lower in group A than in group B (P<0.05), except for the hospital stay and drainage time. Fever occurred in 10 patients in group A and 12 patients in group B. The ESR, CRP level, and VAS and ODI scores were significantly decreased, and there were no significant differences between the groups at the final FU. The distribution of bacterial agents in blood culture was 1 case of Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus，1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU between the groups.Conclusion: The use of LSP as a new bone graft is reliable, safe, and effective for surgical management for the LPD while surgery is proposed as a good management strategy for LPD in carefully selected patients.

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What is the best choice for repair of distal penile hypospadias: The tubularized incised plate urethroplasty or anterior urethral advancement technique?

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699200 ◽

2007 ◽

Vol 40 (02) ◽

pp. 182-188

Author(s):

Mohamed M.S Awad ◽

Adel M Tolba ◽

Khaled M Saad ◽

Zaghlol R Mahmoud ◽

Ahmed Ezzat Rozigque ◽

...

Keyword(s):

Operative Time ◽

Good Choice ◽

Short Operative Time ◽

Tubularized Incised Plate ◽

Significant Difference ◽

Good Cosmetic ◽

Group A ◽

Tubularized Incised Plate Urethroplasty ◽

Fistula Rate ◽

Group B

ABSTRACT Background and Aim: Numerous ingenious methods have been introduced to repair hypospadias with variable results. we tried to evaluate the two techniques, tubularized incised plate urethroplasty (tip) and anterior urethral advancement (aua) for repair of distal hypospadias and choose the best method to treat the distal type of penile hypospadias with the least complications.Materials and methods :A total of 140 boys with distal penile hypospadias were divided into two groups. group a (68 patients) was treated with tip and group b (72 patients) was treated with aua. all the patients had an average age of three years (2-19) with variable meatal sites coronal (44) sub coronal (53) and anterior penile hypospadias (43). there was no significant difference between both groups with respect to the age and meatal sites.Results: The fistula rate in group a was 8.8% versus 1.3% in group b. there was no urethral stricture in both procedures. wound dehiscence did not occur in group a versus one case in group b (1.3%). in group a, 26 cases (38.3%) had mild glanular torsion and five (7.3%) had moderate glanular torsion versus none in group b postoperatively. no postoperative chordee or binding in group a, versus four patients (5.5%) in group b. no significant difference was observed in both groups with respect to meatal stenosis (7.3% versus 5.5% respectively). there was a significant difference between both groups with regard to the operative time in favour of group b. good cosmetic appearance of the glans was achieved in both techniques.Conclusion: Both techniques can treat this anomaly with a high success rate but the modified aua technique appears to be a good choice due to its simplicity, short operative time and less fistula rate with good cosmetic results.

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Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

10.21203/rs.2.15859/v1 ◽

2019 ◽

Author(s):

Yongchun Zhou ◽

Weiwei Li ◽

Liqun Gong ◽

Jiao Zhou ◽

Jing Luo

Keyword(s):

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Debridement ◽

Thoracic Spinal ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

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Laparoscopic versus open hysterectomies in obese patients

International Surgery Journal ◽

10.18203/2349-2902.isj20185014 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3893

Author(s):

Soliman A. El Shakhs ◽

Moharam A. Mohamed ◽

Mahmoud A. Shahin ◽

Ahmed M. Eid

Keyword(s):

Blood Loss ◽

Surgical Procedure ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Obese Patients ◽

Optimal Route ◽

Significant Difference ◽

Group A ◽

Prospective Comparative Study ◽

Group B

Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.

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Nonstructural Versus Structural Bone Grafting for Interbody Fusion in the Treatment of Lumbar Tuberculosis by a Single Posterior Approach

10.21203/rs.3.rs-1023139/v1 ◽

2021 ◽

Author(s):

Zenghui Zhao ◽

Jianxiao Li ◽

Wei Luo ◽

Yong Zhu ◽

Xing Du ◽

...

Keyword(s):

Cobb Angle ◽

Bone Grafting ◽

Interbody Fusion ◽

Spinal Tuberculosis ◽

Pedicle Screws ◽

Surgical Trauma ◽

Single Segment ◽

One Stage ◽

Significant Difference ◽

Posterior Debridement

Abstract Background Many types of bone grafting have been reported for successful use in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the clinical efficacy of nonstructural with structural bone graft for interbody fusion in the surgical treatment of single segment lumbar tuberculosis after one stage posterior debridement.Methods We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g., Visual Analog Scale for back pain, the Oswestry Disability Index) were collected and analyzed before and after surgery. Results Both nonstructural and structural bone grafting were associated with significant improvements in the life quality parameters, the laboratory tests, and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting exhibited the advantages of less operation duration, blood loss and lower bone fusion rate compared with structural bone grafting. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups.Conclusions In conclusion, nonstructural bone grafting can achieve comparable interbody fusion to structural bone grafting but has less surgical trauma and simpler surgical procedure than structural bone grafting in the treatment of single segment lumbar tuberculosis after one stage posterior debridement and pedicle screws fixation.

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Three-dimensional printing technology for localised thoracoscopic segmental resection for lung cancer

10.21203/rs.3.rs-19927/v1 ◽

2020 ◽

Author(s):

Yangming Chen ◽

Jiguang Zhang ◽

Qianshun Chen ◽

Tian Li ◽

Kai Chen ◽

...

Keyword(s):

3D Printing ◽

Operative Time ◽

Three Dimensional ◽

Ct Reconstruction ◽

Printing Technology ◽

3D Printing Technology ◽

Significant Difference ◽

Group A ◽

Group B ◽

Ground Glass Nodules

Abstract Background Three-dimensional (3D) CT reconstruction technology has gained increasing attention owing to its potential in locating ground glass nodules in the lung. The 3D printing technology additionally allows visualising the surrounding anatomical structure and variations. However, the clinical utility of these techniques is not known. We aimed to establish a lung tumour and an anatomical lung model using three-dimensional (3D) printing and 3D chest computed tomography (CT) reconstruction and to evaluate the clinical potential of 3D printing technology in uniportal video-assisted thoracoscopic segmentectomy. Methods Eighty-nine patients with ground glass nodules who underwent uniportal video-assisted thoracoscopic segmentectomy were divided into the following groups: Group A, lung models for pre-positioning and simulated surgery that were made with 3D chest CT reconstruction and 3D printing; Group B, patients who underwent chest CT scans with image enhancement for 3D reconstruction. The differences in the surgery approach transfer rate, surgical method conversion rate, operative time, intraoperative blood loss, and postoperative complication rate were compared between the groups. Results The surgery approach transfer rate was 0% and 10.5% for Groups A and B, respectively, showing a significant difference (p = 0.030). The operative time was 2.07 ± 0.24 hours and 2.55 ± 0.41 hours, respectively, showing a significant difference (p<༜0.001). Intraoperative blood loss volume was 43.25 ± 13.63 and 96.68 ± 32.82 ml, respectively, showing a significant difference (p<༜0.001). The postoperative complication rate was 3.9% and 13.2%, respectively, showing a non-significant difference (P = 0.132). The rate of surgical method conversion to lobectomy in Group A was 0%, which was significantly lower than that of 10.5% in group B (p < 0.030). Conclusions 3D printing technology helps surgeons to locate the nodules more accurately, as it is based on 2D and 3D imaging findings, thereby improving the accuracy and safety of surgery. This technique is worth for application in clinical practice. Trial registration: Retrospectively registered.

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Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae

Journal of Neurosurgery Spine ◽

10.3171/2010.4.spine09764 ◽

2010 ◽

Vol 13 (4) ◽

pp. 469-476 ◽

Cited By ~ 52

Author(s):

Odysseas Paxinos ◽

Parmenion P. Tsitsopoulos ◽

Michael R. Zindrick ◽

Leonard I. Voronov ◽

Mark A. Lorenz ◽

...

Keyword(s):

Failure Mechanism ◽

Bone Quality ◽

Thoracic Spine ◽

Pedicle Screws ◽

Pullout Strength ◽

Pullout Force ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Object There is limited data on the pullout strength of spinal fixation devices in the thoracic spine among individuals with different bone quality. An in vitro biomechanical study on the thoracic spine was performed to compare the pullout strength and the mechanism of failure of 4 posterior fixation thoracic constructs in relation to bone mineral density (BMD). Methods A total of 80 vertebrae from 11 fresh-frozen thoracic spines (T2–12) were used. Based on the results from peripheral quantitative CT, specimens were divided into 2 groups (normal and osteopenic) according to their BMD. They were then randomly assigned to 1 of 4 different instrumentation systems (sublaminar wires, pedicle screws, lamina claw hooks, or pedicle screws with wires). The construct was completed with 2 titanium rods and 2 transverse connectors, creating a stable frame. The pullout force to failure perpendicular to the rods as well as the pattern of fixation failure was recorded. Results Mean pullout force in the osteopenic Group A (36 vertebrae) was 473.2 ± 179.2 N and in the normal BMD Group B (44 vertebrae) was 1414.5 ± 554.8 N. In Group A, no significant difference in pullout strength was encountered among the different implants (p = 0.96). In Group B, the hook system failed because of dislocation with significantly less force than the other 3 constructs (931.9 ± 345.1 N vs an average of 1538.6 ± 532.7 N; p = 0.02). In the osteopenic group, larger screws demonstrated greater resistance to pullout (p = 0.011). The most common failure mechanism in both groups was through pedicle base fracture. Conclusions Bone quality is an important factor that influences stability of posterior thoracic implants. Fixation strength in the osteopenic group was one-fourth of the value measured in vertebrae with good bone quality, irrespective of the instrumentation used. However, in normal bone quality vertebrae, the lamina hook claw system dislocated with significantly less force when compared with other spinal implants. Further studies are needed to investigate the impact of different transpedicular screw designs on the pullout strength in normal and osteopenic thoracic spines.

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Comparison between endoscope assisted powered and conventional adenoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20205619 ◽

2020 ◽

Vol 7 (1) ◽

pp. 50

Author(s):

Dimple Sahni ◽

Gurleen Kaur ◽

Sanjeev Bhagat ◽

Parvinder Singh ◽

Peeyush Verma ◽

...

Keyword(s):

Random Sampling ◽

Recovery Time ◽

Operative Time ◽

Randomized Study ◽

Intraoperative Blood Loss ◽

Systematic Random Sampling ◽

Medical College ◽

Significant Difference ◽

Group A ◽

Group B

Background: Adenoidectomy is one of the commonest operations done on children. It is conventionally performed using the curettage method. This present study was done to compare the results of endoscopic powered adenoidectomy and conventional adenoidectomy.Methods: The present prospective randomized study was conducted among 50 patients between 4-16 years of age requiring adenoidectomy with or without tonsillectomy in department of ENT in Government Medical College and Rajindra Hospital, Patiala. All the 50 patients were divided into two groups (group A and group B) by systematic random sampling. Group A consisted of 25 patients who underwent conventional curettage adenoidectomy and group B consisted of 25 patients who underwent Microdebrider-Assisted Adenoidectomy. Results: In group A and B, mean±SD intraoperative blood loss (in ml) was 20.60±7.96 and 30.60±7.96 respectively. Mean±SD operative time (in minutes) was 28.60±4.71 in group A, while in group B it was 39.60±4.71 with statistically significant difference. Complete adenoid removal was found in 52% of the subjects in group A while it was found in 96% of the subjects in group B with statistically significant difference. In group A, mean±SD recovery time (in hrs) observed was 33.52±10.58 while in group B, recovery time (in hours) observed was 36.22±11.31.Conclusions: Based on the results of this study, it can be concluded that the new method of microdebrider assisted powered adenoidectomy was found to be safer and more useful tool for adenoidectomy than conventional method.

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Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

10.21203/rs.2.13914/v2 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Spinal Tuberculosis ◽

Thoracolumbar Junction ◽

Surgical Approaches ◽

Instrumented Fusion ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Multicentre Retrospective Study

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three surgical approaches through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion in a single- or two-stage procedure (Group B) and 80 underwent posterior debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Operations at each centre were performed by the same senior medical team in each centre. Results: All three surgical approaches achieved bone fusion and pain relief. All patients with neurological deficits had different degrees of recovery after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The mean loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is superior to the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as the anterior-only or combined procedure but with shorter operation times, less trauma and less blood loss. Keywords: Spinal tuberculosis; Thoracolumbar junction lesion; Surgical treatment; Outcome.

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