scholarly journals Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures

2020 ◽  
Vol 14 (4) ◽  
pp. 466-474
Author(s):  
Shanmuganathan Rajasekaran ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty ◽  
Rishi Mugesh Kanna
Keyword(s):  
Neck Disability Index ◽  
Optimal Placement ◽  
Range Of Movement ◽  
Ct Guided ◽  
Duration Of Surgery ◽  
The Mean ◽  
The Right ◽  
Neck Disability ◽  
Displaced Fracture

Study Design: Prospective observational study.Purpose: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation.Overview of Literature: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes.Methods: The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0–C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years.Results: A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (<i>p</i> <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months.Conclusions: Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.

Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases

2011 ◽  
Vol 15 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Vedat Deviren ◽  
Justin K. Scheer ◽  
Christopher P. Ames
Keyword(s):  
Neck Disability Index ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Cervicothoracic Junction ◽  
Analog Scale ◽  
Radiographic Measurements ◽  
Sf 36 ◽  
The Mean ◽  
Neck Disability

Object Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. This study details the cervicothoracic PSO technique in 11 cases and correlates clinical kyphosis (chin-brow to vertical angle [CBVA]) with radiographic measurements. Methods Between February 2008 and September 2010, 11 patients (mean age 70 years) underwent a modified PSO (10 at C-7, 1 at T-1) for treatment of sagittal imbalance. Preoperative and postoperative sagittal plane radiographic measurements were made. The CBVA was measured on clinical photographs. Operative technique and perioperative correction were reported for all 11 patients and long-term follow-up data was reported for 9 patients, in whom the mean duration of follow-up was 23 months. Outcome measures used for these 9 patients were the Neck Disability Index, the 36-Item Short Form Health Survey (SF-36), and a visual analog scale for neck pain. Results The mean values for estimated blood loss, surgical time, and hospital stay in the 11 patients were 1100 ml, 4.3 hours, and 9.9 days, respectively. The mean preoperative and immediate postoperative values (± SD) for cervical sagittal imbalance were 7.9 ± 1.4 cm and 3.4 ± 1.7 cm. The mean overall correction was 4.5 ± 1.5 cm (42.8%), the mean PSO correction 19.0°, and the mean CBVA correction 36.7°. There was essentially no correlation between preoperative C2–T1 radiographic kyphosis and preoperative CBVA (R2 = 0.0165). There was a moderate correlation with PSO correction angle and postoperative CBVA (R2 = 0.38). There was a significant decrease in both the Neck Disability Index (51.1 to 38.6, p = 0.03) and visual analog scale scores for neck pain (8.1 to 3.9, p = 0.0021). The SF-36 physical component summary scores increased by 18.4% (30.2 to 35.8) with no neurological complications. Conclusions The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in health-related quality-of-life measures even at early time points.

scholarly journals Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
FengNing Li ◽  
ZhongHai Li ◽  
Xuan Huang ◽  
Zhi Chen ◽  
Fan Zhang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Neck Disability ◽  
Cervical Spine Alignment

To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb’s angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.

High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses

2012 ◽  
Vol 17 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Christopher Brenke ◽  
Johann Scharf ◽  
Kirsten Schmieder ◽  
Martin Barth
Keyword(s):  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Analog Scale ◽  
Osteophyte Formation ◽  
High Prevalence ◽  
The Mean ◽  
Neck Disability

Object Cervical disc arthroplasty (CDA) has been increasingly used for the treatment of cervical disc herniations. However, the impact of CDA on adjacent-segment degeneration and the degree of heterotopic ossification (HO) of the treated segment remain a subject of controversy. Due to a product failure of the Galileo-type disc prosthesis, 22 of these devices were explanted. The radiological and clinical course in each case was investigated in detail with an emphasis on the incidence of HO and facet joint degeneration 18 months following the operation. Intraoperative findings regarding ossification and implant fixation were documented. Thus, the authors were able to describe the true rate of adjacent-segment degeneration and HO following CDA and the clinical relevance thereof. Methods In all 22 patients, functional radiographic imaging was performed prior to surgery, 3 and 12 months after surgery, and prior to disc prosthesis explantation. At all time points, the range of motion (ROM) in the operated and adjacent segments was determined. A motion index was calculated using the preoperative and all postoperative ROMs (preoperative ROM/postoperative ROM). Computed tomography was used preoperatively to measure the height of the index segment, extent of HO, and the degree of the progression of facet arthrosis, and was used postoperatively prior to prosthesis explantation. Patients completed clinical questionnaires that included a visual analog scale and the Neck Disability Index. Results The motion index of the index segment declined gradually from 1.4 at 3 months postoperative to 1.2 prior to explantation, while the motion index of the adjacent upper segment increased from 0.9 to 1.3. The mean ROM of the index segment was 10.4° ± 6.7°, and fusion was observed in 2 (9%) of the 22 patients. Prosthesis migration was present in 3 patients (13.6%). Severe HO (Grades 3 and 4) was present in 17.4%. Computed tomography showed a significant increase of segmental height of the index segment (1.6 ± 1.1 mm, p = 0.035), and a significant increase of left-sided lateral osteophytes (1.7 ± 2.1 mm, p = 0.009). The incidence of severe osteophyte formation (> 2 mm) occurred in 40%. Intraoperative findings reflected the results from CT, with primary lateral proliferation of osteophytes found in approximately 25% of patients. The mean visual analog scale scores were 3.8 ± 2.7 (neck) and 2.4 ± 2.5 (arms), and the mean Neck Disability Index score was 30 ± 22. No correlation was found between radiological and clinical parameters. Conclusions In this study, a higher incidence of HO after CDA could be demonstrated using CT, compared with studies using fluoroscopy only. However, patient selection and/or the operative technique might have contributed to the high prevalence of osteophyte formation. Thus, the exact indication for CDA has to be reconsidered. Because implant migration was detected, using fixation in the present CDA model appears suboptimal.

scholarly journals Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

2016 ◽  
Vol 18 (3) ◽  
pp. 281-286 ◽  
Author(s):  
S. Alex Rottgers ◽  
Subash Lohani ◽  
Mark R. Proctor
Keyword(s):  
Hospital Stay ◽  
Head Circumference ◽  
Major Complication ◽  
Csf Leak ◽  
Perioperative Morbidity ◽  
Syndromic Craniosynostosis ◽  
Duration Of Surgery ◽  
Coronal Synostosis ◽  
The Mean

OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses

2018 ◽  
Vol 100-B (12) ◽  
pp. 1640-1646 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. Clark ◽  
L. M. Jeys
Keyword(s):  
Minimally Invasive ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Range Of Movement ◽  
Musculoskeletal Tumor Society ◽  
Non Invasive ◽  
Length Discrepancy ◽  
The Mean

AimsThe aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.Patients and MethodsA total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.ResultsThe overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).ConclusionThe survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

Morphological Analysis of the Right Ventricular Endocardial Wall in Pulmonary Hypertension

2021 ◽  
Vol 143 (7) ◽  
Author(s):  
Alifer Bordones-Crom ◽  
Sourav S. Patnaik ◽  
Prahlad G. Menon ◽  
Srinivas Murali ◽  
Ender Finol
Keyword(s):  
Pulmonary Hypertension ◽  
Mean Curvature ◽  
Main Pulmonary Artery ◽  
Magnetic Resonance Images ◽  
Pulmonary Vasculature ◽  
Heart Catheterization ◽  
L2 Norm ◽  
The Mean ◽  
The Right

Abstract Pulmonary hypertension (PH) is a chronic progressive disease diagnosed when the pressure in the main pulmonary artery, assessed by right heart catheterization (RHC), is greater than 25 mmHg. Changes in the pulmonary vasculature due to the high pressure yield an increase in the right ventricle (RV) afterload. This starts a remodeling process during which the ventricle exhibits changes in shape and eventually fails. RV models were obtained from the segmentation of cardiac magnetic resonance images at baseline and 1-year follow-up for a pilot study that involved 12 PH and 7 control subjects. The models were used to create surface meshes of the geometry and to compute the principal, mean, and Gaussian curvatures. Ten global curvature indices were calculated for each of the RV endocardial wall reconstructions at the end-diastolic volume (EDV) and end-systolic volume (ESV) phases of the cardiac cycle. Statistical analysis of the data was performed to discern if there are significant differences in the curvature indices between controls and the PH group, as well as between the baseline and follow-up phases for the PH subjects. Six curvature indices, namely, the Gaussian curvature at ESV, the mean curvature at EDV and ESV, the L2-norm of the mean curvature at ESV, and the L2-norm of the major principal curvature at EDV and ESV, were found to be significantly different between controls and PH subjects (p &lt; 0.05). We infer that these geometry measures could be used as indicators of RV endocardial wall morphology changes. Two global parameters, the Gaussian and mean curvatures at ESV, showed significant changes at the one-year follow-up for the PH subjects (p &lt; 0.05). The aforementioned geometry measures to assess changes in RV shape could be used as part of a noninvasive computational tool to aid clinicians in PH diagnostic and progression assessment, and to evaluate the effectiveness of treatment.

Long-term Follow-up of Patients Treated with Percutaneous Radiofrequency Thermocoagulation via the Foramen Rotundum for Isolated Maxillary Nerve Idiopathic Trigeminal Neuralgia

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1370-1378 ◽  
Author(s):  
Bing Ran ◽  
Jun Wei ◽  
Qiong Zhong ◽  
Min Fu ◽  
Jun Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Sagittal Plane ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation ◽  
Complete Pain Relief ◽  
Idiopathic Trigeminal Neuralgia ◽  
Foramen Rotundum ◽  
The Mean

Abstract Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

scholarly journals McKENZIE NECK EXERCISE LEBIH BAIK DALAM MENURUNKAN DISABILITAS LEHER DARIPADA DYNAMIC NECK EXERCISE PADA PENJAHIT DENGAN MYOFASCIAL PAIN SYNDROME OTOT UPPER TRAPEZIUS

2020 ◽  
Vol 8 (2) ◽  
pp. 41
Author(s):  
Boki Jaleha ◽  
I Putu Gede Adiatmika ◽  
Sugijanto Sugijanto ◽  
I Made Muliarta ◽  
Ketut Tirtayasa ◽  
...  
Keyword(s):  
Myofascial Pain ◽  
Neck Disability Index ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
T Test ◽  
Upper Trapezius ◽  
Paired Samples ◽  
Post Test ◽  
Neck Disability

Pendahuluan: Myofascial pain syndrome otot upper trapezius merupakan gangguan muskuloskeletal pada otot upper trapezius akibat penggunaan otot secara berlebihan, postur yang jelek, dan repetitif mikrotrauma sehingga menyebabkan nyeri, taut band, kelemahan otot dan disabilitas pada daerah leher. Tujuan Penelitian: Untuk mengetahui perbedaan efek kedua intervensi, Mckenzie Neck Exercise dan Dynamic Neck Exercise dalam menurunkan disabilitas leher pada penjahit dengan myofascial pain syndrome otot upper trapezius. Metode: Penelitian eksperimental ini menggunakan rancangan randomized pre and post test two group design. Sampel penelitian sebanyak 18 orang yang dibagi secara acak menjadi 2 kelompok, masing-masing kelompok berjumlah 9 orang. Kelompok I diberikan McKenzie Neck Exercise sedangkan Kelompok II diberikan Dynamic Neck Exercise. Perlakuan dilakukan 3 kali seminggu selama 6 minggu dengan evaluasi menggunakan kuesioner penilaian Neck Disability Index (NDI). Hasil: Hasil uji statistik menggunakan paired-samples t test pada Kelompok I dengan rerata skor sebelum intervensi (23,8±2,1)% dan sesudah intervensi yaitu (16,4±2,4)% dengan nilai (p < 0,05) dan Kelompok II dengan rerata skor sebelum intervensi (23,6±2,2)% dan sesudah intervensi (20,9±2,3)% dengan nilai (p < 0,05). Uji beda hipotesis antara Kelompok I dengan Kelompok II menggunakan independent-samples t test diperoleh nilai (p < 0,05). Simpulan: McKenzie Neck Exercise lebih baik dalam menurunkan disabilitas leher daripada Dynamic Neck Exercise dengan myofascial pain syndrome otot upper trapezius. Saran: Penelitian selanjutnya diharapkan dapat mengontrol aktivitas pekerja dilingkungan kerja maupun tempat tinggal dan diperlukan adanya tindak lanjut ataupun pengawasan (follow up) sampel penelitian setelah berakhirnya program penelitian pada masing-masing sampel, untuk mengetahui hasil intervensi yang diberikan dapat memberikan efek jangka panjang.  

scholarly journals A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

2016 ◽  
Vol 40 (6) ◽  
pp. E7 ◽  
Author(s):  
Syed F. Abbas ◽  
Morgan P. Spurgas ◽  
Benjamin S. Szewczyk ◽  
Benjamin Yim ◽  
Ashar Ata ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Neck Disability Index ◽  
Case Series ◽  
Patient Characteristics ◽  
Short Term ◽  
Instrumented Fusion ◽  
Minimally Invasive Surgical ◽  
Neck Disability

OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.

scholarly journals Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Julien Lucas ◽  
Olivier Laffenetre
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Subjective Rating ◽  
Outpatient Basis ◽  
Range Of Movement ◽  
Aofas Score ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.

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