Short Monocortical Screws at C4-C6 Lateral Masses as Novel Mid-cervical Anchor in Cervical Laminoplasty with Instrumented Fusion: Surgical Outcomes Compared with C5 Pedicle Screws as Mid-cervical Anchor

<sec><title>Study Design</title>Retrospective analysis.</sec><sec><title>Purpose</title>We evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.</sec><sec><title>Overview of Literature</title>For surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.</sec><sec><title>Methods</title>A total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.</sec><sec><title>Results</title>Mean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.</sec><sec><title>Conclusions</title>Transpedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.</sec>

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Compression fracture in the middle of a chronic instrumented fusion that developed into pseudarthrosis after balloon kyphoplasty

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine13799 ◽

2014 ◽

Vol 20 (6) ◽

pp. 705-708 ◽

Cited By ~ 1

Author(s):

Stephen M. Pirris ◽

Sherri M. Kimes

Keyword(s):

Lumbar Fusion ◽

Compression Fracture ◽

Pedicle Screws ◽

Balloon Kyphoplasty ◽

Vertebral Compression Fractures ◽

Adjacent Segment ◽

Rare Occurrence ◽

Instrumented Fusion ◽

Compression Fractures ◽

Surgical Options

There are only 2 documented cases of vertebral compression fractures occurring within a solid lumbar fusion mass: one within the fusion mass after hardware removal and the other within the levels of the existing instrumentation 1 year postoperatively. The authors report a case of fracture occurring in a chronic (> 30 years) solid instrumented fusion mass in a patient who underwent kyphoplasty. The pain did not improve after the kyphoplasty procedure, and the patient developed a posterior cleft in the fusion mass postoperatively. The patient, a 46-year-old woman, had undergone a T4–L4 instrumented fusion with placement of a Harrington rod when she was 12 years old. Adjacent-segment breakdown developed, and her fusion was extended to the pelvis, with pedicle screws placed up to L-3 to capture the existing fusion mass. Almost 2 years after fusion extension, she fell down the stairs and suffered an L-2 compression fracture, which is when kyphoplasty was performed without pain relief, and she then developed a cleft in the posterior fusion mass that was previously intact. She refused further surgical options. This case report is meant to alert surgeons of this possibility and allow them to consider the rare occurrence of fracture within the fusion mass when planning extension of chronic spinal fusions.

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Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children: technical note

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds17240 ◽

2018 ◽

Vol 21 (2) ◽

pp. 190-196 ◽

Cited By ~ 3

Author(s):

Jonathan N. Sellin ◽

Jeffrey S. Raskin ◽

Kristen A. Staggers ◽

Alison Brayton ◽

Valentina Briceño ◽

...

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Spine Surgery ◽

Intraoperative Complications ◽

Thoracolumbar Spine ◽

Pedicle Screws ◽

Instrumented Fusion ◽

Cortical Bone Trajectory ◽

Estimated Blood Loss ◽

Posterior Instrumented Fusion

Thoracic and lumbar cortical bone trajectory pedicle screws have been described in adult spine surgery. They have likewise been described in pediatric CT-based morphometric studies; however, clinical experience in the pediatric age group is limited. The authors here describe the use of cortical bone trajectory pedicle screws in posterior instrumented spinal fusions from the upper thoracic to the lumbar spine in 12 children. This dedicated study represents the initial use of cortical screws in pediatric spine surgery.The authors retrospectively reviewed the demographics and procedural data of patients who had undergone posterior instrumented fusion using thoracic, lumbar, and sacral cortical screws in children for the following indications: spondylolysis and/or spondylolisthesis (5 patients), unstable thoracolumbar spine trauma (3 patients), scoliosis (2 patients), and tumor (2 patients).Twelve pediatric patients, ranging in age from 11 to 18 years (mean 15.4 years), underwent posterior instrumented fusion. Seventy-six cortical bone trajectory pedicle screws were placed. There were 33 thoracic screws and 43 lumbar screws. Patients underwent surgery between April 29, 2015, and February 1, 2016. Seven (70%) of 10 patients with available imaging achieved a solid fusion, as assessed by CT. Mean follow-up time was 16.8 months (range 13–22 months). There were no intraoperative complications directly related to the cortical bone trajectory screws. One patient required hardware revision for caudal instrumentation failure and screw-head fracture at 3 months after surgery.Mean surgical time was 277 minutes (range 120–542 minutes). Nine of the 12 patients received either a 12- or 24-mg dose of recombinant human bone morphogenic protein 2. Average estimated blood loss was 283 ml (range 25–1100 ml).In our preliminary experience, the cortical bone trajectory pedicle screw technique seems to be a reasonable alternative to the traditional trajectory pedicle screw placement in children. Cortical screws seem to offer satisfactory clinical and radiographic outcomes, with a low complication profile.

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Comparison of Surgical Outcomes After Cervical Laminoplasty

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e31828bb296 ◽

2013 ◽

Vol 26 (6) ◽

pp. E198-E203 ◽

Cited By ~ 17

Author(s):

Dong-Geun Lee ◽

Sun-Ho Lee ◽

Se-Jun Park ◽

Eun-Sang Kim ◽

Sung-Soo Chung ◽

...

Keyword(s):

Surgical Outcomes ◽

Cervical Laminoplasty

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Use of subtransverse process polyester bands in pediatric spine surgery: a case series of 4 patients with a minimum of 12 months’ follow-up

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.6.peds15255 ◽

2016 ◽

Vol 17 (2) ◽

pp. 208-214 ◽

Cited By ~ 5

Author(s):

Ben A. Strickland ◽

Christina Sayama ◽

Valentina Briceño ◽

Sandi K. Lam ◽

Thomas G. Luerssen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Series ◽

Pedicle Screws ◽

Transverse Process ◽

Lessons Learned ◽

Minimal Risk ◽

Instrumented Fusion ◽

Cord Injury ◽

Posterior Instrumented Fusion

OBJECT In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients. METHODS The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands. RESULTS Four patients, ranging in age from 11 to 22 years, underwent posterior instrumented fusion for neuromuscular scoliosis (3 patients) and thoracic hyperkyphosis (1 patient). There were 3 instances of transverse process fracture, with application and tensioning of the polyester band in 1 patient. Importantly, there was no instance of spinal cord injury with subtransverse process passage of the polyester band. The lessons learned from this technique are discussed. CONCLUSIONS This study has shown the “Eleghia” technique of passing subtransverse process bands to be a technically straightforward and neurologically safe method of spinal fixation. Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires/bands have been incorporated into posterior spinal constructs; they have been widely reported and used in the thoracic and lumbar spines and sacrum or ilium with varying success. This report demonstrates the promising results of hybrid posterior spinal constructs that include the Eleghia technique of passing subtransverse process polyester bands. This technique incorporates technical ease with minimal risk of neurological injury and biomechanical stability.

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Which factors predict the loss of cervical lordosis following cervical laminoplasty? A review of various indices and their clinical implications

Surgical Neurology International ◽

10.25259/sni_339_2019 ◽

2019 ◽

Vol 10 ◽

pp. 147 ◽

Cited By ~ 1

Author(s):

Ravi Sharma ◽

Sachin A. Borkar ◽

Revanth Goda ◽

Shashank S. Kale

Keyword(s):

Cervical Spine ◽

Surgical Outcomes ◽

Thoracic Kyphosis ◽

Clinical Implications ◽

Cervical Laminoplasty ◽

Cervical Lordosis ◽

Radiological Parameters ◽

Increased Risk ◽

Cobb’S Angle ◽

The Relationship

Background: Many patients undergoing laminoplasty develop postoperative loss of cervical lordosis or kyphotic alignment of cervical spine despite sufficient preoperative lordosis. This results in poor surgical outcomes. Methods: Here, we reviewed the relationship between multiple radiological parameters of cervical alignment that correlated with postoperative loss of cervical lordosis in patients undergoing laminoplasty. Results: Patient with a high T1 slope (T1S) has more lordotic alignment of the cervical spine preoperatively and is at increased risk for the loss of cervical lordosis postlaminoplasty. Those with lower values of difference between T1S and Cobb’s angle (T1S-CL) and CL-T1S ratio have higher risks of developing a loss of the cervical lordosis postoperatively. Alternatively, C2-C7 lordosis, neck tilt, cervical range of motion, and thoracic kyphosis had no role in predicting the postlaminoplasty kyphosis. Conclusion: Among various radiological parameters, the preoperative T1S is the most important factor in predicting the postoperative loss of the cervical lordosis/alignment following laminoplasty.

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Treatment of Vertebral Hemangiomas With Absolute Alcohol (Ethanol) Embolization, Cord Decompression, and Single Level Instrumentation: A Pilot Study

Neurosurgery ◽

10.1227/neu.0b013e3181fc60e9 ◽

2011 ◽

Vol 68 (1) ◽

pp. 78-84 ◽

Cited By ~ 16

Author(s):

Pankaj. Singh ◽

Nalin K. Mishra ◽

Hari Har. Dash ◽

Rajender K. Thyalling ◽

Bhawani S. Sharma ◽

...

Keyword(s):

Spinal Injury ◽

Pedicle Screws ◽

Cord Compression ◽

Absolute Alcohol ◽

Alcohol Injection ◽

Instrumented Fusion ◽

Single Level ◽

Vertebral Hemangiomas ◽

Ethanol Embolization

Abstract BACKGROUND: Vertebral hemangiomas (VH) are the most common lesions of the vertebral column. OBJECT: To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy. METHODS: This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS: Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years. CONCLUSION: This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.

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Pott’s Disease in a 2-Year-Old Child Treated by Decompression and Anterior-Posterior Instrumented Fusion

Case Reports in Orthopedics ◽

10.1155/2014/252973 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Mehmet Nuri Erdem ◽

Cem Sever ◽

Mehmet Fatih Korkmaz ◽

Sinan Karaca ◽

Ferit Kirac ◽

...

Keyword(s):

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Vertebral Osteomyelitis ◽

Pedicle Screws ◽

Early Mobilization ◽

Instrumented Fusion ◽

Pott’S Disease ◽

Rod System ◽

Paraspinal Abscess ◽

Anterior Posterior

Introduction. Paraplegia and kyphotic deformity are two major disease-related problems of spinal tuberculosis, especially in the early age disease. In this study a 2-year-old boy who underwent surgical decompression, correction, and 360° instrumented fusion via simultaneous anterior-posterior technique for Pott’s disease was reported.Case Report. A 2-year-and-9-month-old boy presented with severe back pain and paraparesis of one-month duration. Thoracic magnetic resonance imaging demonstrated destruction with a large paraspinal abscess involving T5-T6-T7 levels, compressing the spinal cord. The paraspinal abscess drained and three-level corpectomy was performed at T5-6-7 with transthoracic approach. Anterior instrumentation and fusion was performed with structural 1 autogenous fibula and rib graft using screw-rod system. In prone position pedicle screws were inserted at T4 and T8 levels and rods were placed. Six months after surgery, there was no weakness or paraparesis and no correction loss at the end of follow-up period.Discussion. In cases of vertebral osteomyelitis with severe anterior column destruction in the very early child ages the use of anterior structural grafts and instrumentation in combination with posterior instrumentation is safe and effective in maintenance of the correction achieved and allows efficient stabilization and early mobilization.

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Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2012.3.spine11631 ◽

2012 ◽

Vol 16 (6) ◽

pp. 585-593 ◽

Cited By ~ 10

Author(s):

Ben B. Pradhan ◽

Alexander W. L. Turner ◽

Michael A. Zatushevsky ◽

G. Bryan Cornwall ◽

Sean S. Rajaee ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Spinous Process ◽

Pedicle Screws ◽

Axial Rotation ◽

Pedicle Screw Fixation ◽

Biomechanical Analysis ◽

Instrumented Fusion ◽

Lumbar Spinal ◽

Flexion And Extension

Object Traditional posterior pedicle screw fixation is well established as the standard for spinal stabilization following posterior or posterolateral lumbar fusion. In patients with lumbar spinal stenosis requiring segmental posterior instrumented fusion and decompression, interlaminar lumbar instrumented fusion (ILIF) is a potentially less invasive alternative with reduced morbidity and includes direct decompression assisted by an interlaminar allograft spacer stabilized by a spinous process plate. To date, there has been no biomechanical study on this technique. In the present study the biomechanical properties of the ILIF construct were evaluated using an in vitro cadaveric biomechanical analysis, and the results are presented in comparison with other posterior fixation techniques. Methods Eight L1–5 cadaveric specimens were subjected to nondestructive multidirectional testing. After testing the intact spine, the following conditions were evaluated at L3–4: bilateral pedicle screws, bilateral laminotomy, ILIF, partial laminectomy, partial laminectomy plus unilateral pedicle screws, and partial laminectomy plus bilateral screws. Intervertebral motions were measured at the index and adjacent levels. Results Bilateral pedicle screws without any destabilization provided the most rigid construct. In flexion and extension, ILIF resulted in significantly less motion than the intact spine (p < 0.05) and no significant difference from the laminectomy with bilateral pedicle screws (p = 0.76). In lateral bending, there was no statistical difference between ILIF and laminectomy with unilateral pedicle screws (p = 0.11); however, the bilateral screw constructs were more rigid (p < 0.05). Under axial rotation, ILIF was not statistically different from laminectomy with unilateral or bilateral pedicle screws or from the intact spine (p > 0.05). Intervertebral motions adjacent to ILIF were typically lower than those adjacent to laminectomy with bilateral pedicle screws. Conclusions Stability of the ILIF construct was not statistically different from bilateral pedicle screw fixation following laminectomy in the flexion and extension and axial rotation directions, while adjacent segment motions were decreased. The ILIF construct may allow surgeons to perform a minimally invasive, single-approach posterior decompression and instrumented fusion without the added morbidity of traditional pedicle screw fixation and posterolateral fusion.

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