scholarly journals A 540° posterior-anterior-posterior approach for 360° fused rigid severe cervical kyphosis: patient series

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Posterior Approach ◽  
Tumor Resection ◽  
Case Series ◽  
Combined Approach ◽  
Cervical Kyphosis ◽  
Anterior Plate ◽  
Bone Fusion ◽  
Posterior Anterior ◽  
Anterior Posterior

BACKGROUND Treatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion. OBSERVATIONS Four patients with iatrogenic 360° fused severe rigid CK (Cobb angle ≥40°) were enrolled for this retrospective analysis. All patients in the case series were female, with an average age of 27 years. All patients previously underwent posterior laminectomy/laminoplasty and cervical tumor resection when they were children (13–17 years). They underwent correction surgery with a 540° posterior-anterior-posterior approach. Preoperative and final follow-up radiography and computed tomography (CT) were used to evaluate kyphosis correction, internal fixation implants, and bone fusion. The preoperative and final follow-up average C2–7 Cobb angles were −32.4° ± 12.0° and 5.3° ± 7.1°, respectively. Preoperative and final follow-up CK angles averaged −47.2° ± 7.4° and −0.9° ± 16.1°, respectively. The mean correction angle was 46.3° ± 9.6°. At final follow-up, CT showed stable fixation and solid bone fusion. LESSONS The rare iatrogenic severe kyphosis with 360° ankylosis requires a combined approach. The 540° posterior-anterior-posterior approach can completely release the bony fusion, and the CK can be corrected using an anterior plate. This technique can achieve good results and is an effective strategy.

scholarly journals Comparison of the Efficacy of Posterior-Anterior Screws, Anterior-Posterior Screws and a Posterior-Anterior Plate in the Fixation of Posterior Malleolar Fractures with a Fragment Size of ≥15% and <15%

2020 ◽  
Author(s):  
Zheng Wang ◽  
Jianbin Sun ◽  
Jun Yan ◽  
Pengcheng Gao ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Fragment Size ◽  
Plate Fixation ◽  
Anterior Plate ◽  
Malleolar Fractures ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Posterior Anterior ◽  
Anterior Posterior

Abstract Background To investigate the efficacy of posterior-anterior (PA), anterior-posterior (AP) screws and a PA plate in the fixation of posterior malleolar fractures (PMFs) with a fragment size of ≥ 15% and < 15%.MethodsThis is a retrospective study of the clinical data of 243 patients with unilateral ankle fractures involving the posterior malleolus. All patients were divided into two groups based on their fragment size, ≥ 15% (n = 136) and < 15% (n = 107). PA screws, AP screws and a posterior plate were used for fixation of PMF in the two groups. All patients were followed up at 1, 3, 6, and 12 months after surgery and thereafter at 6-month intervals. The primary outcomes were AOFAS and ROM, which were recorded at the final follow-up.Results The average follow-up time for all patients was 18.9 months and all fractures healed. There was no significant difference between the PA plate fixation, PA screw, and AP screw fixations in terms of AOFAS scores or ankle ROM in the fragment size of ≥ 15% group (P > 0.05). In the fragment size of < 15% group, there were statistically significant differences in the AOFAS scores and ankle ROM between the PA plate fixation and PA, AP screw fixation (P < 0.05); while no significant difference was observed between PA and AP screw fixation.Conclusion For PMFs with fragment size ≥ 15%, there was no significant difference in the outcomes between the three fixation methods. For PMF with fragmentation < 15%, the PA and AP screws both provided good fixation.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

2019 ◽  
Vol 33 (08) ◽  
pp. 818-824
Author(s):  
Joseph A. Ippolito ◽  
Megan L. Campbell ◽  
Brianna L. Siracuse ◽  
Joseph Benevenia
Keyword(s):  
Distal Femur ◽  
Weight Bearing ◽  
Tumor Resection ◽  
Case Series ◽  
Full Weight Bearing ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Optimal Function ◽  
Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

scholarly journals Postlaminectomy cervical deformity

2003 ◽  
Vol 15 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Harel Deutsch ◽  
Regis W. Haid ◽  
Gerald E. Rodts ◽  
Praveen V. Mummaneni
Keyword(s):  
Clinical Results ◽  
Surgical Correction ◽  
Surgical Approaches ◽  
Combined Approach ◽  
Cervical Kyphosis ◽  
Cervical Deformity ◽  
Anterior Posterior

Postlaminectomy cervical kyphosis is an important consideration when performing surgery. Identifying factors predisposing to postoperative deformity is essential. The goal is to prevent postlaminectomy cervical kyphosis while exposing the patient to minimal additional morbidity. When postlaminectomy kyphosis does occur, surgical correction is often required and performed via an anterior, posterior, or combined approach. The authors discuss the indications for surgical approaches as well as clinical results.

Sequentially Staged Resection and 2-Column Reconstruction for C2 Tumors Through a Combined Anterior Retropharyngeal–Posterior: Approach Surgical Technique and Results in 11 Patients

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons184-ons194 ◽  
Author(s):  
Xinghai Yang ◽  
Zhipeng Wu ◽  
Jianru Xiao ◽  
Honglin Teng ◽  
Dapeng Feng ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Posterior Approach ◽  
Tumor Resection ◽  
The Other ◽  
Neurological Improvement ◽  
Experienced Pain ◽  
Alive With Disease ◽  
Solid Fusion ◽  
Deep Location

Abstract BACKGROUND Surgical treatment of C2 tumors remains challenging. Because of the deep location and unique anatomical complexity, anterior exposure in this region is considered difficult and dangerous, and few reports concerning anterior tumor resection and reconstruction exist. OBJECTIVE To describe a technique of sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal–posterior approach. METHODS Eleven patients with C2 tumors underwent sequentially staged tumor resection and 2-column reconstruction in our institute. Eight primary lesions and 3 metastases were involved. Tumor resections and anterior reconstructions with conventional constructs were accomplished by an anterior retropharyngeal approach, and occipitocervical fusions through posterior access were performed in the same anesthesia. RESULTS No operative mortality occurred in this series. All patients experienced pain relief and neurological improvement after surgery. Except for 1 incidence of screw pullout, which was corrected by revision surgery, solid fusion was achieved in all patients. A follow-up period of 12 to 37 months was available for this study. Two patients with chordoma relapsed; 1 died of disease, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases. No evidence of local recurrence was found in the other patients. CONCLUSION The anterior retropharyngeal approach is a favorable route to treat tumor lesions of the C2 vertebral body that allows tumor resection and placement of anterior constructs between C1 and the subaxial vertebral body. Tumor resection and 2-column reconstruction could safely be accomplished simultaneously through the combined anterior retropharyngeal–posterior approach.

scholarly journals Triphasic Waves: Clinical Correlates and Morphology

1987 ◽  
Vol 14 (2) ◽  
pp. 136-140 ◽  
Author(s):  
Mecheri B.M. Sundaram ◽  
Warren T. Blume
Keyword(s):  
Senile Dementia ◽  
Single Type ◽  
Metabolic Encephalopathy ◽  
Usual Form ◽  
Conscious Level ◽  
Component Wave ◽  
Metabolic Encephalopathies ◽  
Posterior Anterior ◽  
Anterior Posterior

Abstract:Twenty-six (41%) of 63 consecutive patients with triphasic waves had various types of metabolic encephalopathies while 37 patients (59%) had non-metabolic encephalopathies, usually senile dementia. Triphasic waves were not found to be specific for any single type of metabolic encephalopathy.Etiology was more closely linked to conscious level at recording than any morphological or distributional feature of the triphasic waves themselves. Thus, all 31 alert patients had non-metabolic encephalopathies while all 13 comatose patients had metabolic encephalopathies.The second, positive, component (Wave II) most often had the highest voltage while equally maximal Waves I and II occurred next most commonly. Triphasic waves were most often maximally expressed anteriorly.Among patients with metabolic encephalopathies, a posterior-anterior delay or lag of the wave II peak occurred more commonly than did the better known anterior-posterior lag. Lags occurred with both metabolic and nonmetabolic conditions, but were more common with the former. No difference in quantity or mode of appearance existed between the metabolic and non-metabolic groups when matched for conscious level.Prognosis for patients with either metabolic or non-metabolic encephalopathies was unfavourable. Only 4 of 24 metabolic and one of 35 non-metabolic patients were well at follow-up over 2 years later.Forty percent of EEGs with sharp and slow wave complexes (slow spike waves) had sporadically-appearing triphasic waves. The relative amplitudes of the 3 components differed from triphasic waves in other conditions: equally maximal Waves II and III were the most usual form.

scholarly journals Combined anterior–posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis

2003 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Ross R. Moquin ◽  
Michael K. Rosner ◽  
Patrick B. Cooper
Keyword(s):  
Posterior Approach ◽  
Pedicle Screws ◽  
Posterior Fusion ◽  
Standard Approach ◽  
Morbidity Rate ◽  
Scheuermann Disease ◽  
Scheuermann Kyphosis ◽  
Lower Morbidity ◽  
Anterior Posterior

The authors report their preferred method for correcting Scheuermann disease via a combined anterior–posterior approach; their procedure is associated with a lower morbidity rate than the standard approach. Twenty-month follow-up examination demonstrated excellent maintenance of correction. The results satisfied the requirements to function without restriction in a vigorous military environment.

A Case Series of Surgically Treated Spinal Dumbbell Tumors of Critical Parent Nerve Roots: To Cut or Not to Cut?

2020 ◽  
Author(s):  
Vicki Marie Butenschoen ◽  
Nikolaus Kögl ◽  
Bernhard Meyer ◽  
Claudius Thomé ◽  
Maria Wostrack
Keyword(s):  
Motor Function ◽  
Nerve Root ◽  
Tumor Resection ◽  
Case Series ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Nerve Roots ◽  
Dumbbell Tumor ◽  
Lumbar Level

Abstract BACKGROUND Dumbbell tumors present challenging cases, with either an incomplete tumor resection or a need to sacrifice nerve roots. Published literature suggests encouraging neurological outcomes after nerve root amputation. OBJECTIVE To determine the incidence of postoperative neurological deficits after amputating the parent nerve root. METHODS A retrospective consecutive analysis of all patients treated for dumbbell nerve sheet tumors with a reported amputation of the functional relevant parent nerve roots C5-Th1 and L3-S1. RESULTS Among 21 evaluated patients, minor postoperative neurological motor function deterioration occurred in 4 patients (19%). Most patients recovered to the preoperative level at the follow-up examination, and only one patient retained a new Medical Research Council (MRC) scale of 4/5 for deltoid weakness. The majority of tumors were resected at the lumbar level (nerve root L3: 28.6%, L5: 19%). Gross total resection was achieved in 90.5% of patients. Neuropathic pain was reported in one third of the patients during the long-term follow-up. CONCLUSION Amputating critical parent nerve roots during the dumbbell tumor resections seems to result in a low incidence of postoperative motor deficits and may offer an acceptable sacrifice in otherwise only incompletely resectable dumbbell tumors. The cross-innervation of neighboring nerve roots and its, probably, per-se-reduced functionality may be a possible mechanism for maintaining motor function.

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