scholarly journals A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

2015 ◽  
Vol 23 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Jin Hoon Park ◽  
Sung Woo Roh ◽  
Seung Chul Rhim
Keyword(s):  
Pedicle Screw ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Posterior Approach ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Herniated Disc ◽  
The Mean ◽  
Cervical Facet

OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

A Comparative Outcome Analysis of Two Posterior Only Approach for Thoracolumbar Fracture

2018 ◽  
Vol 15 (02/03) ◽  
pp. 106-112
Author(s):  
Deepak Kumar Singh ◽  
Surendra Kumar Gupta ◽  
Rakesh Kumar ◽  
Faran Ahmad ◽  
Kuldeep Yadav ◽  
...  
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Pedicle Screw ◽  
Posterior Approach ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Posterior Decompression ◽  
Average Operative Time

Abstract Objectives Most common surgical intervention in thoracolumbar fracture is pedicle screw fixation with posterior decompression through traditional posterior approach. Nowadays, we are doing combined anteroposterior decompression with anteroposterior fixation through posterior only approach. So, we attempt to compare these two approaches in terms of surgical and functional outcome. Method This is a retrospective study. We included 47 patients of traumatic thoracolumbar fracture between September 2016 and January 2018. Fourteen patients were treated by three-column fixation through posterior only approach and 33 patients were treated with traditional posterior approach. In three-column fixation, transpedicular corpectomy with dynamic mesh cage placement with B/L pedicle screw fixation with 360 canal decompression was done, whereas in traditional posterior approach, only posterior decompression with B/L pedicle screw fixation was done. Parameters for comparison include patients’ parameters, fracture types, operative duration, average blood loss, kyphotic correction, and neurological and functional improvement after 1 week and 3 months postoperatively. Result The average operative time (150 ± 13.01 minutes) and blood loss (263 ± 40.84 mL) in combined decompression and fixation through posterior only approach were higher than average operative time (120.3 ± 25.43 minutes) and average blood loss (108 ± 27.32 mL) in traditional posterior approach. In traditional surgeries, there was an observed correction of 11.7° ± 3.6° in kyphosis, while in combined surgeries the observed correction in kyphosis was 15.3° ± 4.3°. There is no statistically significant neurological and functional outcome than traditional posterior approach. Conclusion Combined anteroposterior decompression and stabilization through posterior only approach is convenient for complete decompression of cord, stabilization, and restoration of vertebral height, and there is statistically significant kyphotic correction, pain relief (visual analogue scale), but there is no statistically significant neurological and functional outcome than traditional posterior approach. Most neurosurgeons are familiar to posterior approach; hence, they should be used in unstable thoracolumbar fracture whenever needed, while avoiding various dreaded complication of combined approach.

scholarly journals Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao
Keyword(s):  
Retrospective Study ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Correction Rate ◽  
Burst Fractures ◽  
The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

scholarly journals Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

2020 ◽  
Author(s):  
Chao Lou ◽  
Weiyang Yu ◽  
Zhenzhong Chen ◽  
Kangtao Jin ◽  
Jiawei Gao ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Titanium Mesh ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Percutaneous Pedicle Screw ◽  
The Mean ◽  
Percutaneous Pedicle Screw Fixation

Abstract Objective: This study aimed to assess the feasibility as well as the clinical and radiological outcomes of posterior percutaneous pedicle screw fixation (PPSF) combined with anterior monosegmental column reconstruction in unstable thoracolumbar burst fractures. Methods: From January 2011 to August 2017, thirty-five patients with unstable thoracolumbar burst fractures were enrolled in this study. The patients underwent posterior PPSF combined surgery with delayed anterior monosegmental reconstruction utilizing titanium mesh cages. Clinical outcomes, radiological parameters, and treatment-related complications were assessed. Results: The mean age of the patients was 44.8 years. The mean operative time and blood loss were 205 min and 560 ml, respectively. The mean follow-up period was 25.2 months. The Visual analog scale (VAS) pain score was significantly improved postoperatively, and the improvement was maintained until the final follow-up. The mean sagittal kyphosis was corrected from 16.3 preoperatively to 1.5 postoperatively, which increased slightly to 2.6 at the final follow-up. In 24 patients with neurologic dysfunction, 21 (87.5 %) patients had improvement after surgery. None obvious subsidence of the titanium mesh cage and none dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Solid bony fusion was achieved in all patients. Conclusions: Combined posterior PPSF with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.

scholarly journals Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4002
Author(s):  
Masashi Uehara ◽  
Shugo Kuraishi ◽  
Shota Ikegami ◽  
Hiroki Oba ◽  
Takashi Takizawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Patient Questionnaire ◽  
The Mean

Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4°, 23.4°, 25.8°, and 25.60°, respectively, and was significantly improved at all post-surgical time points (all p < 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores.

Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion

2006 ◽  
Vol 5 (6) ◽  
pp. 534-539 ◽  
Author(s):  
Aaron R. Cutler ◽  
Saquib Siddiqui ◽  
Mohan Avinash L. ◽  
Virany H. Hillard ◽  
Franco Cerabona ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Peek Cage ◽  
Disc Space ◽  
The Mean

Object Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs). The authors compared the clinical and radiographic outcomes of patients who underwent TLIF with pedicle screw fixation, in whom either a PEEK cage or an FCA was placed as an interbody spacer. Methods The charts and x-ray films obtained in 39 patients (age range 33–68 years, mean 44.7 years) who underwent single-level TLIF between October 2001 and April 2004 and in whom either a PEEK cage (18 patients) or FCA (21 patients) was placed as an interbody spacer were evaluated in a retrospective study. Radiological outcome was based on fusion rate and a comparison of the initial postoperative lordotic angle on standing lateral radiographs with that at long-term follow up (mean follow up 15.1 months, minimum 12 months). To control for variations in radiographic magnification, the authors used lordotic angle as an indirect measure of disc space height. Clinical outcome was assessed using the Oswestry Disability Index (ODI). There were no major complications in either group. Radiographically documented fusion occurred in all patients in the PEEK group and 95.2% of those in the FCA group. Pseudarthrosis developed in one patient in the FCA group, and this patient underwent additional surgery. In both groups, the mean lordotic angle changed by less than 2.20° during the postoperative period, and the mean postoperative ODI score was more than 40 points lower than the mean preoperative score. There was no significant difference between the two groups in mean change in lordotic angle (p = 0.415) and mean change in ODI score (p = 0.491). Conclusions Both PEEK cages and FCAs are highly effective in promoting interbody fusion, maintaining postoperative disc space height, and achieving desirable clinical outcomes in patients who undergo TLIF with pedicle screw fixation. The advantages of PEEK cages include a lower incidence of subsidence and their radiolucency, which permits easier visualization of bone growth.

scholarly journals Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096031
Author(s):  
Zhida Chen ◽  
Hui Yu ◽  
Chao Song ◽  
Li Zhang ◽  
Jin Wu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Operation Time ◽  
Pedicle Screw Fixation ◽  
Upper Cervical Spine ◽  
Upper Cervical ◽  
The Mean ◽  
Posterior Laminectomy

Objective This study was performed to introduce posterior laminectomy and pedicle screw fixation for the treatment of upper cervical spinal cord tumors and investigate the curative effects. Methods Eighteen patients (11 men, 7 women) who underwent surgical treatment of an upper cervical intraspinal tumor from January 2008 to June 2013 were reviewed. Clinical parameters including age, sex, affected spinal levels, lesion location, duration and type of symptoms, and pathological features were retrospectively investigated. Results The mean operation time was 181.9 ± 25.5 minutes (range, 135–240 minutes), and the mean blood loss volume was 1038.9 ± 284.2 mL (range, 750–1530 mL). The Frankel grade, Japanese Orthopaedic Association score, and Karnofsky performance status score were significantly better postoperatively than preoperatively. The radiographic examination revealed good bone graft fusion. Two patients developed tumor recurrence, while four patients developed intraoperative or postoperative complications. Conclusions Management of upper cervical intraspinal tumors by posterior laminectomy and pedicle screw fixation can relieve compression of the cervical cord and nerve root, thoroughly remove the tumor lesion, reconstruct the stability of the upper cervical spine, and improve patients’ quality of life.

scholarly journals Posterior fixation including the fractured vertebra in short segment fixation of unstable thoracolumbar junction burst fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 81
Author(s):  
Md. Kamrul Ahsan ◽  
Zabed Zahangiri ◽  
M. A. Awwal ◽  
Naznin Zaman ◽  
Md. Hamidul Haque ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Junction ◽  
Vertebral Height ◽  
Short Segment ◽  
The Mean ◽  
Short Segment Fixation

<p>The aim of this study was to evaluate the efficacy of inclusion of the fractured vertebra in short segment fixation in terms of clinical and the radiological outcomes in unstable thoracolumbar junction burst fractures at a minimum of 1 year follow-up. Records of 52 patients (age: 21-50 years) with thoracolumbar burst fracture (T10–L2) in Magerl Type A fractures underwent posterior pedicle screw fixation including the fractured vertebra. Clinical parameters were back pain using Visual Analogue Score (VAS) and disability using Oswestry disability index (ODI), neurological deficit (using ASIA grade) and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were measured before surgery and at 3, 6 and 12 months  post-operatively. The presence of screw breakage, screw pullout, peri-implant loosening, and rod breakage were considered as criteria for implant failure. The majority of fractures resulted due to falls (31 cases), and the remaining cases resulted from car accidents (21 cases). The fractured vertebral body level was L1, T12, L2, T11, and T10 in 23, 17, 6, 4 and 2 cases and achieved satisfactory clinical outcomes according to the modified Mcnab criteria 18, 25, 6 and 3 cases were considered to have excellent, good, fair, and poor outcome. The mean kyphotic angle at pre-, post-operative and final follow-up was 13.5 ± 6.3, 13.4 ± 4.3, 8.5 ± 6.  The average loss of kyphosis correction was 6.4 ± 5.2° at the final follow-up. The mean pre- and post-operative kyphotic deformation of vertebral body was 5.1 ± 3.2, 4.8 ± 2.3 and at final follow-up was 4.5 ± 4.0 (p&gt;0.05). The mean anterior and posterior vertebral height also showed significant improvements post-operatively, which were maintained at the final follow-up. The mean ODI and VAS scores at the end of 1 year were 17.4%, 1.7 respectively. There was no case of major complication after surgery and during the follow-up period. In conclusion, reduction of unstable thoracolumbar junction burst fracture can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction.</p><p> </p>

A comparison of long-term outcomes of translaminar facet screw fixation and pedicle screw fixation: a prospective study

2007 ◽  
Vol 7 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Jayshree Tuli ◽  
Sagun Tuli ◽  
Marc E. Eichler ◽  
Eric J. Woodard
Keyword(s):  
Prospective Study ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Long Term Outcomes ◽  
Time To Surgery ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Object In this paper, the authors compare the long-term outcomes of translaminar facet screw fixation (TFSF) and pedicle screw fixation (PSF) in the treatment of degenerative lumbosacral disease. Methods This prospective analytical study was performed to compare the long-term outcomes of TFSF and PSF for degenerative lumbosacral disease. Outcomes were defined as the need for reoperation for the development of a nonunion, end-fusion degeneration, or for explantation of hardware. Results A total of 77 patients were analyzed. Thirty-seven patients underwent PSF and 40 received TFSF. Twenty-three of the 77 patients required a reoperation: 13 (32.5%) of the 40 patients in the TFSF group and 10 (27%) of the 37 the patients in the PSF group. The overall mean time to reoperation (regardless of outcome) was 4.05 years. For patients in the TFSF group the mean time to reoperation was 2.94 years, whereas it was 4.35 years in the PSF group (p = 0.34). Nonunion was noted in seven of the 40 patients in the TFSF group and one of 37 in the PSF group. The mean time to surgery for nonunion for patients in the TFSF group was 3.46 years and for those in the PSF group it was 6.27 years (p = 0.04). Surgery for end-fusion degeneration was performed in two patients in the TFSF group and five in the PSF group (p = 0.43). Explantation of hardware was performed in two patients with TFSF and four patients with PSF. Multivariable analysis revealed a statistically significant difference in the time to surgery for nonunion between PSF and TFSF (p = 0.048), with a hazard ratio of 0.097 (95% confidence interval 0.01–0.98). Conclusions Findings from the current prospective study suggest that there is an increased risk of requirement for a reoperation for nonunion among TFSF cases compared with PSF cases.

scholarly journals The technical feasibility and preliminary results of minimally invasive endoscopic-TLIF based on electromagnetic navigation: a case series

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Derong Xu ◽  
Shuo Han ◽  
Chao Wang ◽  
Kai Zhu ◽  
Chuanli Zhou ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Electromagnetic Navigation ◽  
Vas Score ◽  
Percutaneous Pedicle Screw ◽  
The Mean ◽  
Percutaneous Pedicle Screw Fixation

Abstract Background Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved. Methods This retrospective study explored the effects of electromagnetic navigation on improving Endo-TLIF with percutaneous pedicle screw fixation. Clinical information from 42 patients who had received Endo-TLIF with percutaneous pedicle screw fixation from May 2019 to November 2020 was analyzed retrospectively. The procedures were assisted under electromagnetic navigation. The rate of adjustment for guide wires, frequency of X-ray exposure, operative time, accuracy of pedicle screw location, and clinical outcomes were recorded. Results The mean follow-up for 42 patients was 11.9 ± 3.1 months. The mean age of the patients was 56.1 ± 9.26 years, with a female/male ratio of 25:17. According to postoperative CT scans and 3D reconstructions, the excellent and good rate of pedicle screws was 96.4%. The rate of adjustment for guide wires under the assistance of electromagnetic navigation was 1.78%, and the frequency of X-ray exposure was 8.27 ± 1.83. The operative time was 167.25 ± 28.16 min, including the duration of guide wire insertion (14.63 ± 5.45 min) and duration of decompression and cage placement (75.43 ± 13.97 min). The duration of hospitalization after operation was 2.59 ± 1.16 days. The preoperative VAS score was 7.51 ± 1.91, and the preoperative ODI was 82.42 ± 8.7%. At the last follow-up, the VAS score was 2.09 ± 0.59, and the ODI was 11.09 ± 3.2%. There were statistically significant improvements in the VAS score and ODI in all patients at the follow-up (p < 0.05). Conclusions Electromagnetic navigation can provide accurate positioning and guidance in real time, which improves the surgical efficiency of percutaneous pedicle screw placement and endoscopic decompression in Endo-TLIF with reduced radiation exposures.

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