scholarly journals Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years

2015 ◽  
Vol 55 (7) ◽  
pp. 599-604 ◽  
Author(s):  
Satoshi OGIHARA ◽  
Junichi KUNOGI
Keyword(s):  
Sagittal Alignment ◽  
Single Stage ◽  
Posterior Fusion ◽  
Kyphotic Deformity ◽  
Lateral Mass ◽  
Fusion Surgery ◽  
Postoperative Changes ◽  
Lateral Mass Screws

scholarly journals Differences in Postoperative Changes of Cervical Sagittal Alignment and Balance After Laminoplasty Between Cervical Spondylotic Myelopathy and Cervical Ossification of the Posterior Longitudinal Ligament

2018 ◽  
Vol 9 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Hironobu Sakaura ◽  
Atsunori Ohnishi ◽  
Akira Yamagishi ◽  
Tetsuo Ohwada
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Posterior Longitudinal Ligament ◽  
Kyphotic Deformity ◽  
Sagittal Imbalance ◽  
Patient Age ◽  
Neurologic Recovery ◽  
Postoperative Changes ◽  
Cervical Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: To compare postoperative changes of cervical sagittal alignment (CSA) and cervical sagittal balance (CSB) after laminoplasty between cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to examine impacts of these radiologic changes on neurologic outcomes. Methods: A total of 168 consecutive patients with CSM (CSM group) and 51 consecutive patients with OPLL (OPLL group) were included. As indicators of CSA and CSB, the C2-7 angle and C1-C7 sagittal vertical axis (SVA) were, respectively, measured before surgery and at 2-year follow-up. Neurologic status was assessed using the Japanese Orthopaedic Association score before surgery and at 2-year follow-up. Results: Whereas both postoperative loss of C2-7 angle and increase of C1-C7 SVA were significantly greater in the elderly subgroup of the CSM group, patient age did not significantly affect these changes in the OPLL group. Preservation of C7 maintained C1-C7 SVA at postoperative 2 years only in the CSM group. Postoperative cervical kyphosis and sagittal imbalance significantly decreased neurologic improvement in the CSM group but not in the OPLL group. Conclusions: Elderly patients with CSM have significantly greater postoperative loss of lordosis and increase in C1-C7 SVA than nonelderly patients, and both postoperative kyphotic deformity and sagittal imbalance significantly deteriorate neurologic recovery. On the other hand, although patients with OPLL, irrespective of patient age and preservation of C7, have significantly more loss of lordosis and increase in C1-C7 SVA than CSM patients, neither postoperative kyphotic deformity nor sagittal imbalance significantly deteriorates neurologic recovery in OPLL patients.

Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

2021 ◽  
pp. 1-10
Author(s):  
Tomohiro Banno ◽  
Yu Yamato ◽  
Hiroki Oba ◽  
Tetsuro Ohba ◽  
Tomohiko Hasegawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Pelvic Obliquity ◽  
Posterior Fusion ◽  
Lumbar Curve ◽  
Fusion Surgery ◽  
The Right ◽  
Coronal Decompensation

OBJECTIVE Pelvic obliquity is frequently observed in patients with adolescent idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curve. This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes of posterior fusion surgery. METHODS Data in 80 patients (69 with type 5C and 11 with type 6C adolescent idiopathic scoliosis) who underwent posterior fusion surgery were retrospectively analyzed. Pelvic obliquity was defined as an absolute pelvic obliquity angle (POA) value of ≥ 3°. The patients were divided into groups according to preoperative pelvic obliquity. Moreover, patients with preoperative pelvic obliquity were divided based on POA change from preoperative values versus 2 years postoperatively. Patients were divided based on the presence of selective or nonselective TL/L fusion. Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 80 patients, 41 (51%) showed preoperative pelvic obliquity, and its direction was upward to the right for all cases. Coronal decompensation 2 years postoperatively was significantly elevated in patients with preoperative pelvic obliquity (p < 0.05). Thirty-two patients (40%) displayed pelvic obliquity 2 years postoperatively. Among 41 patients with preoperative pelvic obliquity, 22 patients (54%) were in the group with a decrease in POA, and 19 were in the group with no decrease. The group with no decrease in POA showed significant TL/L curve progression throughout the postoperative follow-up period. The patients with nonselective fusion showed a significantly lower incidence of pelvic obliquity at 2 years postoperatively. CONCLUSIONS Postoperative coronal decompensation more frequently occurred in patients with preoperative pelvic obliquity than in those without pelvic obliquity preoperatively. In addition, postoperative pelvic obliquity changes may be related to residual lumbar curve behavior.

Clinical Outcome of Dorsal Cervical C1–C2 Fusion Using C1 Lateral Mass Screws, C2 Lamina Screws, and Interarcual Bone Graft Technique

2019 ◽  
Vol 81 (03) ◽  
pp. 200-206
Author(s):  
Dominik Baschera ◽  
Lazar Tosic ◽  
Joachim Oberle ◽  
Jagos Golubovic ◽  
Alex Alfieri
Keyword(s):  
Neck Pain ◽  
Bone Graft ◽  
Clinical Results ◽  
Fusion Rate ◽  
Implant Failure ◽  
Bony Union ◽  
Lateral Mass ◽  
Root Injury ◽  
Lateral Mass Screws

Aims To evaluate the clinical and radiologic results of patients treated with dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft. Methods We retrospectively analyzed the clinical and radiologic results of eight patients treated from 2011 to 2016. Neck pain, neurologic deficits, use of analgesics, vertebral artery injury, C2 root injury, radiologic fusion rate, malposition of screws, and implant failure were examined on day 3 and at 3 and 12 months postoperatively. Results One patient required revision surgery for a right-sided medial cutout of a lamina screw. None of the patients had vascular or neurologic complications. All patients were pain free and had ceased all analgesic therapy at the first follow-up examination. At the 1-year follow-up there were no complaints of neck pain, no radiologic signs of implant failure were found, and a bony union between C1 and C2 was present in all patients. Conclusion Dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft are less common techniques, although they can be used safely and demonstrated excellent clinical results with regard to pain relief and a high fusion rate. The technique is an ideal alternative when other techniques are not safe for anatomical reasons.

scholarly journals Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases

2016 ◽  
Vol 25 (6) ◽  
pp. 675-680 ◽  
Author(s):  
Umesh Srikantha ◽  
Kiran S. Khanapure ◽  
Aniruddha T. Jagannatha ◽  
Krishna C. Joshi ◽  
Ravi G. Varma ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Conventional Approach ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Correct Position ◽  
Vertebral Canal ◽  
Atlantoaxial Fusion ◽  
Lateral Mass Screws ◽  
Clinical Cases

OBJECTIVE Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion. MATERIALS Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail. RESULTS Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1–2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case. CONCLUSIONS Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.

scholarly journals C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

2006 ◽  
Vol 64 (3b) ◽  
pp. 762-767 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Charles Jermani ◽  
Bruno P. Braga
Keyword(s):  
Cervical Spine ◽  
New Method ◽  
Fixation Method ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
Stable Fusion

OBJECTIVE: To describe our experience with C1 lateral mass screws as part of a construct for C1-2 stabilization and report an alternate method of C1-C2 complex three-point fixation. METHOD: All patients that had at least one screw placed in the lateral mass of C1 as part of a construct for stabilization of the C1-C2 complex entered this study. In selected patients who had a higher chance of nonunion an alternate construct was used: transarticular C1-C2 screws combined with C1 lateral mass screws. RESULTS: Twenty-one C1 lateral mass screws were placed in 11 patients. In three patients the alternate construct was used. All patients had a demonstrable solid and stable fusion on follow-up. CONCLUSION: C1 lateral mass screws are safe and provide immediate stability. The use of C1-C2 transarticular screws combined with C1 lateral mass screws is a feasible and also an excellent alternative for a three-point fixation of the C1-C2 complex.

scholarly journals Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

2018 ◽  
Vol 22 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Weiguo Zhu ◽  
Zhen Liu ◽  
Shifu Sha ◽  
Jing Guo ◽  
Hongda Bao ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Posterior Fusion ◽  
Sacral Slope ◽  
Sitting Position ◽  
Fusion Surgery ◽  
Sitting Posture ◽  
Spinopelvic Alignment ◽  
Postoperative Changes ◽  
The Mean

OBJECTIVEPrevious studies have reported spinal straightening and pelvic retroversion when changing from erect to sitting posture in patients with adolescent idiopathic scoliosis (AIS), which were thought to be related to low-back pain after sitting for long periods. However, the sitting sagittal alignment after posterior spinal fusion has not been evaluated. This study aims to assess the influence of posterior fusion surgery upon sitting sagittal spinopelvic alignment in adolescents with idiopathic thoracic curves (thoracic AIS [T-AIS]).METHODSA total of 44 T-AIS patients (30 Lenke I and 14 Lenke II) from the authors’ center were included in this study. Preoperative and postoperative long-cassette lateral radiographs of the spine and pelvis were obtained with the patients in standing and sitting positions. Thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured on standing and sitting lateral radiographs. Patients were divided into selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) groups.RESULTSAt baseline, TK, LL, and SS decreased by 27.5%, 42.1%, and 31.1%, respectively, from the standing to the sitting position, while PT increased by 193.6%. After posterior spinal fusion, increased TK, LL, and SS and corresponding decreased PT were observed compared to baseline parameters in the sitting position. Comparison of postoperative sitting and standing values for the whole cohort showed that the mean LS and SS values were significantly lower in the sitting position (decreased by 14.0% and 13.9%, respectively, compared to standing), whereas the mean PT value was significantly greater (increased by 39.0%, compared to standing). Similar changes were also observed in the STF group: postoperatively the mean LL value was 15.6% lower in sitting than in standing, while the mean SS value was 11.5% lower. However, no obvious changes of the postoperative values in sitting were found in the NSTF group.CONCLUSIONSNonselective thoracic fusion surgery in T-AIS patients diminished spinal straightening and pelvic retroversion during sitting. Reducing distal fusion levels was of special value in not only saving more lumbar mobility, but also preserving the function of pelvic posterior rotation.

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