scholarly journals Short lever arm, bipedicular handlebar construct for correction of acute angular kyphosis in spondylodiscitis-induced kyphotic deformity: illustrative case

2021 ◽  
Vol 1 (24) ◽  
Author(s):  
Meng Huang ◽  
Iahn Cajigas ◽  
Steven Vanni
Keyword(s):  
Structural Integrity ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Sagittal Imbalance ◽  
Illustrative Case ◽  
Effective Treatment Option ◽  
Pyogenic Spondylodiscitis ◽  
Lever Arm ◽  
Angular Correction ◽  
Angular Kyphosis

BACKGROUND Pyogenic spondylodiscitis diminishes spinal structural integrity via disruption of the anterior and middle column, sometimes further compounded by iatrogenic violation of the posterior tension band during initial posterior decompressive surgeries. Although medical management is typically sufficient, refractory infection or progressive deformity may require aggressive debridement and reconstructive arthrodesis. Although anterior debridement plus reconstruction with posterior stabilization is an effective treatment option, existing techniques have limited efficacy for correcting focal deformity, leaving patients at risk for long-term sagittal imbalance, pain, and disability. OBSERVATIONS The authors present a case of chronic lumbar pyogenic spondylodiscitis in a patient in whom initial surgical debridement failed and pronounced angular kyphosis and intractable low back pain developed. A novel bipedicular handlebar construct was used to achieve angular correction of the kyphosis through simultaneous anterior interbody grafting and posterior instrumentation with the patient in the lateral position. LESSONS Leveraging both pedicle screws at the same level to transmit controlled corrective distraction forces through the segment allows for kyphosis correction without relying on long posterior constructs for cantilever reduction. Simultaneous anterior reconstruction with a posterior short lever arm, bipedicular handlebar construct is an effective technique for achieving high angular correction during circumferential reconstructive approaches to postinfectious focal kyphotic deformities.

Optimizing Pedicle Subtraction Osteotomy Techniques: A New Reduction Plier to Increase Technical Safety and Angular Reduction Efficiency

2018 ◽  
Vol 16 (3) ◽  
pp. 383-388 ◽  
Author(s):  
Antonio Faundez ◽  
Jean-Charles Le Huec ◽  
Lars V Hansen ◽  
Fong Poh Ling ◽  
Martin Gehrchen
Keyword(s):  
Sagittal Balance ◽  
Intraoperative Complications ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Neurologic Complication ◽  
Angular Correction ◽  
The Mean ◽  
Osteotomy Line

Abstract BACKGROUND Pedicle subtraction osteotomy (PSO) is a technically demanding surgery. There is room for development of osteotomy reduction instruments like the one we present in this study, to better guide angular correction and closure of the osteotomy line. OBJECTIVE To present a new surgical instrument that optimizes PSOs of the thoracolumbar spine. METHODS Seventeen consecutive patients have been treated at 3 different European University Hospitals. All underwent a PSO of the lumbar spine to treat major sagittal imbalance. The amount of vertebral angular correction needed was calculated using the full balance integrated (FBI) method. A special plier, which allows to safely control the angular correction, was used intraoperatively. Preoperative and early postoperative global sagittal balance parameters were compared. RESULTS The mean preoperative calculated correction angle (FBI) was 33.8°; the mean postoperative correction obtained was 32.1°. Lumbar lordosis was statistically greater than preoperatively (55.8° vs 19.4°, P < .0001). The global sagittal balance was improved, as shown by the increase of the spino-sacral angle from 122° preoperatively to 128° postoperatively (P = .0547). None of the patients had an intraoperative or early postoperative neurologic complication. There were no mechanical intraoperative complications during correction nor at the first postoperative follow-up. CONCLUSION The advantages of the instrument are safe, precise, and efficient reduction, by a rotation of the pedicle screws close to the osteotomy line, thus avoiding collapse and lack of correction, complications usually seen with the conventional technique. Further prospective studies are needed to confirm these results.

scholarly journals Single Position Lateral Lumbar Fusion Utilizing Robot Guided Screw Placement

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
George V Huffmon
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Structural Integrity ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Position ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement

Abstract INTRODUCTION Lateral position interbody lumbar fusion surgery has become popular as an excellent modality for obtaining lumbar fusion and achieving sagital balance. Posterior instrumentation with pedicle screw fixation adds structural integrity to the construct. Maintaining the patient in the lateral position for pedicle screw placement decreases the time that the patient is under general anesthesia. Since August 2017 we have successfully performed 32 single position pedicle screw fixations utilizing robotic guidance. METHODS The lateral position was utilized for interbody fusion using a variety of techniques; oblique lumbar interbody fusion, extreme lateral lumbar interbody fusion, and lateral anterior lumbar interbody fusion. The Mazor X robot (Medtronic) was utilized for guidewire placement maintaining the patient in the lateral position. Pedicle screws of various manufacturers were placed over the guide wires and connecting rods were placed in the lateral position. RESULTS Since August 2017 we have successfully placed pedicle screws in 1 and 2 level single position lateral lumbar fusions in 32 of 39 cases attempted. There were no nerve root injuries nor any complications related to pedicle screw placement. CONCLUSION Single position lateral lumbar fusion cases utilizing robotic guidance for pedicle screw placement is a viable surgical procedure. Placement of the pedicle screws in the lateral position can reduce intraoperative anesthetic time by eliminating the placement of the patient into the prone position. Utilization of robotic guidance can decrease intraoperative fluoroscopy exposure.

scholarly journals Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation

2021 ◽  
Vol 24 ◽  
pp. 77-81
Author(s):  
Andrea Perna ◽  
Domenico Alessandro Santagada ◽  
Maria Beatrice Bocchi ◽  
Gianfranco Zirio ◽  
Luca Proietti ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Early Loss ◽  
Kyphosis Correction ◽  
Angular Kyphosis

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

An Evaluation of the Stryker 90D Pedicle Screw for Use as a Revision Screw

2007 ◽  
Author(s):  
Ferris M. Pfeiffer ◽  
Dennis L. Abernathie
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Relative Motion ◽  
Bone Growth ◽  
Posterior Instrumentation ◽  
Pedicle Screws

The success of a spinal fusion is often judged by the amount of relative motion between vertebrae following surgery. Proper fusion is aided by fixation instrumentation as well as bone growth subsequent to surgery. In order to allow for proper fusion it is necessary for instrumentation to properly fix the vertebrae until sufficient bone growth has occurred. In many cases pedicle screws are used to provide posterior support. It is the purpose of posterior instrumentation to increase the rate of fusion [1]. However, due to deterioration in the holding capacity of the posterior instrumentation; the quality of the fixed joint can begin to degrade. If this deterioration is significant enough it requires removal or revision of the fixation instrumentation.

The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood

2010 ◽  
Vol 13 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Andre Tomasino ◽  
Karishma Parikh ◽  
Heiko Koller ◽  
Walter Zink ◽  
A. John Tsiouris ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Safe Zone ◽  
Transverse Foramen ◽  
Sagittal Diameter ◽  
Entry Points ◽  
Cervical Pedicle ◽  
The Mean

Object The purpose of this retrospective study was to quantify the anatomical relationship between the vertebral artery (VA), the cervical pedicle, and its surrounding structures, including the incidence of irregularities. Additionally, data delineating a “safe zone,” and these data's application during instrumentation with transpedicular cervical screw fixation were considered. The anatomical proximity of the VA to the cervical pedicle prevents spine surgeons from preferring cervical pedicle screws (CPSs) over lateral mass screws at levels C3–6. Accurate placement of CPSs is often difficult to determine, because this definition can vary between 1 and 4 mm of lateral “noncritical” and “critical” pedicle breaches. No previous study in a western population has investigated the VA's proximity to the cervical pedicle, its percentage of occupancy in the transverse foramen (TF), and the incidence of irregular VA pathways. Methods One hundred twenty-seven consecutive patients who underwent CT angiography of the neck were enrolled in this study. The measurements included the following: medial pedicle border to VA; lateral pedicle border to VA; pedicle diameter (PD); sagittal diameter of the VA; coronal diameter of the VA; sagittal diameter of the TF; and coronal diameter of the TF. The cross-sections of the VA and the TF were measured to determine the occupation ratio of the VA. In addition, a safe zone was defined based on all lateral pedicle border to VA measurements in which the VA was within the TF. The level of entry of the VA into the TF as well as irregularities of the VA and the cervical pedicles were recorded. Results Vertebral artery dominance on the left side was seen in 69.3% of cases. The mean PD increased from 4.9 to 6.5 mm (from C-3 to C-7, respectively). Statistically significantly bigger PDs were seen in males. The mean PD at C-2 was 5.6 mm. Entry of the VA at C-6 was seen in approximately 80% of cases. The TF occupation ratio of the VA was found to be the greatest in C-4 and C-7 (37.1 and 74.2%, respectively). The safe zone increased from C-2 to C-6 (1.1 to 1.7 mm, respectively), but was only 0.65 mm at C-7. In 23.6% of cases, an irregular pathway of the VA or irregular anatomy of a cervical pedicle was seen, with the highest incidence of irregularities found at C-2. Conclusions Computed tomography angiography is a valuable tool that can help determine the relationships between cervical pedicles and the VA as well as irregular VA pathways. Pedicle diameter, safe zone, and occupational ratio of the VA in the foramen determine the risk associated with instrumentation and should be assessed individually. Based on the authors' measurements, C-4 and C-7 can be considered critical levels for CPS placement. Because of this and the high incidence of irregular VA pathways and different entry points, it may be helpful to review neck CT angiography studies before considering posterior instrumentation procedures in the cervical spine.

scholarly journals 3D point cloud in the evaluation of processes that generate instability of the lumbar spine

2015 ◽  
Vol 14 (1) ◽  
pp. 27-32 ◽  
Author(s):  
José Luis González Gallegos ◽  
Tania del Socorro Vergara Gómez ◽  
Armando García Hernández ◽  
Ana Karen Ibarra Martínez ◽  
Alejandro García González ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Posterior Instrumentation ◽  
Overweight And Obesity ◽  
Adult Patients ◽  
Sagittal Imbalance ◽  
Abdominal Muscles ◽  
Depth Cameras ◽  
Diagnosis And Prognosis ◽  
Lower Back ◽  
Sensor Platform

OBJECTIVE: To integrate patients with lumbar instability in a multisensor platform in the process of assessment and diagnosis, assigning quantitative parameters for the sagittal balance (SB) and muscle function. METHODS: Experimental study involving adult patients diagnosed with diseases that cause alterations in the SB, that were or were not submitted to surgery with posterior instrumentation and fusion. Each patient underwent anthropometric measurements in body composition scale; a kinesiological analysis using a multisensor platform consisting of depth camera to static/dynamic analysis for the quantitative measurement of SB, and surface electromyography to capture the level of abdominal and lumbar muscles activation and through flexion and extension. RESULTS: Seven adult patients: five females (62.5%)and two men (37.5%) with a mean age 48 years. Images with depth cameras resulted in a SB of from -6.4 to +5.3cm (average -5.7cm). In individuals with positive sagittal balance the percentage of activation (PA) of the abdominal muscles was 58.5% and the lower back lumbar was 75.25%; patients with negative SB integrated the PA of the abdominal muscles of 70.25% and lumbar of 65%; the patient with neutral SB exhibited activation of the abdominal muscles of 87.75% and lumbar muscles of 78.25%. CONCLUSIONS: We observed a trend towards positive SB in patients with overweight and obesity by BMI, as well as increased activation of the abdominal muscles. The multi sensor platform is a useful tool for the diagnosis and prognosis of diseases involving sagittal imbalance.

scholarly journals Revision thoracolumbar surgery for flat back deformity: staged ALIF and posterior column osteotomies to avoid three-column osteotomy

2020 ◽  
Vol 2 (1) ◽  
pp. V5
Author(s):  
Alexandria C. Marino ◽  
Thomas J. Buell ◽  
Rebecca M. Burke ◽  
Tony R. Wang ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Leg Pain ◽  
Sagittal Imbalance ◽  
Illustrative Case ◽  
Complication Rates ◽  
Posterior Surgery ◽  
Significant Alignment ◽  
Alignment Correction ◽  
Operative Planning ◽  
Flat Back

Three-column osteotomies (3COs) can achieve significant alignment correction when revising fixed sagittal plane deformities; however, the technique is associated with high complication rates. The authors demonstrate staged anterior-posterior surgery with L5–S1 ALIF (below a prior L3–5 fusion) and multilevel Smith-Petersen osteotomies to circumvent the morbidity associated with 3CO. The patient was a 67-year-old male with three prior lumbar surgeries who presented with back and leg pain. Imaging demonstrated lumbar flat back deformity and sagittal imbalance. The narrated video details key radiological measurements, operative planning and rationale, surgical steps, and outcomes. The patient provided written, informed consent for publication of this illustrative case.The video can be found here: https://youtu.be/wv4W9D9fUPc.

Biomechanics of posterior instrumentation in L1–L3 lateral interbody fusion: Pedicle screw rod construct vs. transfacet pedicle screws

2016 ◽  
Vol 31 ◽  
pp. 59-64 ◽  
Author(s):  
Kingsley R. Chin ◽  
Anna G.U. Newcomb ◽  
Marco T. Reis ◽  
Phillip M. Reyes ◽  
Grace A. Hickam ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Interbody Fusion ◽  
Lateral Interbody
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