Mini-open lateral retropleural/retroperitoneal approaches for thoracic and thoracolumbar junction anterior column pathologies

OBJECTIVEAdvancements in less invasive lateral retropleural/retroperitoneal approaches aim to address the limitation of posterolateral approaches and avoid complications associated with anterior open thoracotomy or thoracoabdominal approaches.METHODSConsecutive patients treated with a mini-open lateral approach for thoracic or thoracolumbar anterior column pathologies were analyzed in a retrospective case series including clinical and radiographic outcomes. Special attention is given to operative techniques and surgical nuances.RESULTSEleven patients underwent a mini-open lateral retropleural or combined retropleural/retroperitoneal approach for thoracic or thoracolumbar junction lesions. Surgical indications included chronic fracture/deformity (n = 5), acute fracture (n = 2), neoplasm (n = 2), and osteomyelitis (n = 2). The mean length of postoperative hospital stay was 7.2 days (range 2–19 days). All patients ultimately had successful decompression and reconstruction with a mean follow-up of 16.7 months (range 6–29 months). Axial back pain assessed by the visual analog scale improved from a mean score of 8.2 to 2.2. Complications included 1 patient with deep venous thrombosis and pulmonary embolism and 1 with pneumonia. One patient developed increased leg weakness, which subsequently improved. One patient undergoing corpectomy with only lateral plate fixation developed cage subsidence requiring posterior stabilization.CONCLUSIONSMini-open lateral retropleural and retroperitoneal corpectomies can safely achieve anterior column reconstruction and spinal deformity correction for various thoracic and thoracolumbar vertebral pathologies.

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Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

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Surgical Technique for Management of Severe Calcaneofibular Impingement: Case Series

Foot & Ankle Orthopaedics ◽

10.1177/2473011420953793 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142095379

Author(s):

Jay M. Levin ◽

James K. DeOrio

Keyword(s):

Surgical Technique ◽

Case Series ◽

Lateral Wall ◽

Patient Characteristics ◽

Calcaneal Fracture ◽

Lateral Approach ◽

Emergency Department Visits ◽

Retrospective Case ◽

Level Of Evidence ◽

Calcaneal Osteotomy

Background: Calcaneofibular impingement is characterized by lateral hindfoot pain and is commonly resulting from calcaneal fracture malunion or severe flatfoot deformity. Lateral calcaneal wall decompression has been used successfully to relieve pain in patients who have calcaneofibular impingement. However, in cases of severe impingement and hindfoot valgus, lateral wall excision may leave only a small remnant of calcaneal bone for weightbearing and can lead to chronic heel pain. We describe a surgical technique using a medial displacement calcaneal osteotomy (MDCO) combined with a lateral wall exostectomy and report on the outcomes from our series of patients. Methods: Retrospective study of a single surgeon’s patients was done from 2010 to 2020 who underwent medial slide calcaneal osteotomy and lateral wall exostectomy for calcaneofibular impingement. Descriptive statistics were used to summarize patient characteristics. Our study included 9 patients, 6 females and 3 males, with a mean age of 59 years (range: 19-77) and a mean follow-up of 62 weeks (range: 6-184). Results: Five had an Achilles split approach, 2 had an oblique lateral approach, and 1 had an extensile lateral approach. Patients achieved radiographic relief of impingement and improvement in pain. Minor skin and soft tissue complications occurred in 3 patients, all of which were associated with laterally based incisions, and all resolved after a 10-day course of oral antibiotics. No major complications, emergency department visits, or readmissions occurred. Conclusions: MDCO and lateral wall exostectomy was a safe and effective treatment for severe calcaneofibular impingement. Level of Evidence: Level IV, retrospective case series.

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Derotation of the Talus and Arthrodesis Treatment of Stages II-V Müller-Weiss Disease: Midterm Results of 36 Cases

Foot & Ankle International ◽

10.1177/1071100719829457 ◽

2019 ◽

Vol 40 (5) ◽

pp. 506-514 ◽

Cited By ~ 1

Author(s):

Chengjie Yuan ◽

Chen Wang ◽

Chao Zhang ◽

Jiazhang Huang ◽

Xu Wang ◽

...

Keyword(s):

Case Series ◽

Deformity Correction ◽

Stage Iv ◽

Staging System ◽

Functional Improvement ◽

Midterm Results ◽

Retrospective Case ◽

Level Of Evidence ◽

Metatarsal Angle

Background: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. Methods: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). Results: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from −6.7 (range, −26.4 to 17.7) to 0.7 (range, −5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar–first metatarsal angle decreased from −15.8 (range, −30.1 to −13.7) to −7.0 (range, −25.9 to −8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from −27.0 (range, −40.4 to −13.3) to −7.8 degrees (range, −20.7 to −1.8) degrees ( P < .001). Conclusion: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. Level of Evidence: Level IV, retrospective case series.

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Orthopedic Management of Patients with Pompe Disease: A Retrospective Case Series of 8 Patients

The Scientific World JOURNAL ◽

10.1155/2014/963861 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Gerrit Haaker ◽

Jürgen Forst ◽

Raimund Forst ◽

Albert Fujak

Keyword(s):

Surgical Treatment ◽

Pompe Disease ◽

Neuromuscular Disorders ◽

Young Patients ◽

Case Series ◽

Deformity Correction ◽

Lysosomal Storage ◽

Retrospective Case ◽

Enzyme Replacement ◽

Spine Stabilization

Introduction.Pompe disease (PD), a lysosomal storage disease as well as a neuromuscular disorder, is a rare disease marked by progressive muscle weakness. Enzyme replacement therapy (ERT) in recent years allowed longer survival but brought new problems to the treatment of PD with increasing affection of the musculoskeletal system, particularly with a significantly higher prevalence of scoliosis. The present paper deals with the orthopedic problems in patients with PD and is the first to describe surgical treatment of scoliosis in PD patients.Patients and Methods.The orthopedic problems and treatment of eight patients with PD from orthopedic consultation for neuromuscular disorders are retrospectively presented. We analyzed the problems of scoliosis, hip dysplasia, feet deformities, and contractures and presented the orthopedic treatment options.Results.Six of our eight PD patients had scoliosis and two young patients were treated by operative spine stabilization with benefits for posture and sitting ability. Hip joint surgery, operative contracture release, and feet deformity correction were performed with benefits for independent activity.Conclusion.Orthopedic management gains importance due to extended survival and musculoskeletal involvement under ERT. Surgical treatment is indicated in distinct cases. Further investigation is required to evidence the effect of surgical spine stabilization in PD.

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Minimally Invasive Lateral Approach for Anterior Spinal Cord Decompression in Thoracic Myelopathy

10.5772/intechopen.97669 ◽

2021 ◽

Author(s):

Edna E. Gouveia ◽

Mansour Mathkour ◽

Erin McCormack ◽

Jonathan Riffle ◽

Olawale A. Sulaiman ◽

...

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Disc Herniation ◽

Interbody Fusion ◽

Case Series ◽

Lateral Approach ◽

Spinal Instability ◽

Decompression Procedure ◽

Thoracic Disc ◽

Mini Open

Myelopathy can result from a thoracic disc herniation (TDH) compressing the anterior spinal cord. Disc calcification and difficulty in accessing the anterior spinal cord pose an operative challenge. A mini-open lateral approach to directly decompress the anterior spinal cord can be performed with or without concomitant interbody fusion depending on pre-existing or iatrogenic spinal instability. Experience using stand-alone expandable spacers to achieve interbody fusion in this setting is limited. Technical advantages, risks and limitations of this technique are discussed. We conducted a retrospective chart review of all patients with thoracic and upper lumbar myelopathy treated with a lateral mini-open lateral approach. Review of the literature identified 6 other case series using similar lateral minimally invasive approaches to treat thoracic or upper lumbar disc herniation showing efficient and safe thoracic disc decompression procedure for myelopathy. This technique can be combined with interbody arthrodesis when instability is suspected.

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Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

Foot & Ankle International ◽

10.1177/1071100719833928 ◽

2019 ◽

Vol 40 (7) ◽

pp. 803-807 ◽

Cited By ~ 4

Author(s):

Abdel-Salam Abdel-Aleem Ahmed ◽

Mahmoud Ibrahim Kandil ◽

Eslam Abdelshafi Tabl

Keyword(s):

Treatment Options ◽

Case Series ◽

Deformity Correction ◽

Functional Results ◽

The Body ◽

Retrospective Case ◽

Level Of Evidence ◽

Duration Of Symptoms ◽

The Mean ◽

Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

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A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011416s00119 ◽

2016 ◽

Vol 1 (1) ◽

pp. 2473011416S0011

Author(s):

Caleb W. Jones ◽

Andres O’Daly ◽

Kenneth S. Smith ◽

Ashish Shah

Keyword(s):

Carbon Fiber ◽

Plate Fixation ◽

Case Series ◽

Ankle Fractures ◽

Retrospective Case ◽

Retrospective Case Series ◽

Fiber Plate

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Surgical outcomes of Ahmed glaucoma valve implantation with plate fixation using vicryl sutures or no plate fixation

European Journal of Ophthalmology ◽

10.1177/11206721211012869 ◽

2021 ◽

pp. 112067212110128

Author(s):

Reut Singer ◽

Noa Kapelushnik ◽

Ygal Rotenstreich ◽

Ari Leshno ◽

Yaniv Barkana ◽

...

Keyword(s):

Surgical Outcomes ◽

Plate Fixation ◽

Case Series ◽

High Rate ◽

Ahmed Glaucoma Valve ◽

Retrospective Case ◽

Fixation Group ◽

Absorbable Sutures ◽

Vicryl Suture ◽

Valve Implantation

Purpose: To summarize the surgical outcomes of Ahmed glaucoma valve (AGV) implantation with plate fixation with vicryl absorbable sutures or no plate suturing. Methods: This study was a retrospective case series that included all glaucoma patients who underwent AGV implantation surgery with vicryl absorbable sutures for plate fixation or without plate fixation by a single surgeon between 2014 and 2019. We reviewed their medical records and retrieved clinical data on intra- and postoperative complications, best-corrected visual acuity, intraocular pressure (IOP), and number of IOP-lowering medications. Results: Twenty out of 29 eyes (29 patients, mean age 61.04 ± 27.1 years, 17 men) underwent AGV implantation without plate fixation and nine had AGV implantation with fixation with vicryl sutures. Complications were observed in 15 cases (51.7%). Nine of these were defined as failure due to the need for removal or repositioning of the AGV or for further surgery for uncontrolled IOP, of which five were no-fixation cases (5/20, 25%) and four were vicryl-fixation cases (4/9, 44.4%). Six of all surgical failures were related to AGV migration (6/9, 66.6%). There were three cases of extrusion and one case of plate migration in the no-fixation group, and two cases of plate migration and one case of extrusion in the vicryl-fixation group. Conclusion: AGV implantation without suture plate fixation or with vicryl suture fixation had a high complication and failure rate, often necessitating reoperation and AGV removal. The high rate of tube-related complications observed after both techniques does not favor either of them. The use of non-absorbable sutures for suturing of the AGV plate is recommended.

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Plate fixation in the treatment of adults with distal femoral fractures: history, present time, and prospects (world literature overview)

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-1-104-111 ◽

2021 ◽

Vol 27 (1) ◽

pp. 104-111

Author(s):

N.I. Cherevaty ◽

◽

L.N. Solomin ◽

◽

Keyword(s):

Minimally Invasive ◽

World Literature ◽

Plate Fixation ◽

Deformity Correction ◽

Femoral Fractures ◽

Limb Lengthening ◽

Severe Injuries ◽

Lateral Plate ◽

Invasive Approach ◽

Distal Femoral Fractures

Introduction Distal femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed. Aim of study was to analyze the world literature and summarize the information regarding the use of plate fixation in the treatment of distal femoral fractures, identifying unresolved issues and promising directions. Materials and methods The following sources were used for collecting the information: Pubmed and E-library databases, publications of Elsevier, Springer and other publishing companies, materials of the Russian National Library, AO Surgery Reference on line. Results A review of global literature demonstrated that a minimally invasive approach which allows for bone fragment blood flow and stable fixation with a locking compression plate (LCP) are the most important factors that can improve the quality of treatment with plating. Discussion Plate fixation is still the most preferred method in the treatment of distal femoral fractures. In most severe injuries, accompanied by the medial support loss (33–A3, 33–C2 and 33–C3 fracture types according to AO classification), the use of not only the lateral but also the medial plate to achieve stable osteosynthesis has been discussed. Conclusion Further advance of the technology for treating these injures may be associated with designing an “anatomical” medial plate and a method for its minimally invasive implantation. Development of a lateral plate which could provide the stability similar to bilateral osteosynthesis seems even more prospective. Undoubtedly, such a plate would be useful in limb reconstruction surgery as well, for changing the external fixation to internal one after deformity correction and limb lengthening.

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