The sequential hook insertion technique for universal spine instrumentation application

1993 ◽  
Vol 79 (4) ◽  
pp. 608-611 ◽  
Author(s):  
Edward C. Benzel ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
Erich P. Marchand
Keyword(s):  
Lumbar Spine ◽  
Operative Time ◽  
Deformity Correction ◽  
Insertion Technique ◽  
Content Type ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
A New Technique ◽  
Texas Scottish Rite Hospital ◽  
Fine Print

✓ A new technique of universal spine instrumentation insertion for the management of thoracic and lumbar spine instability is presented and the results in 10 patients are described. The technique involves the sequential insertion of Texas Scottish Rite Hospital (TSRH) central-post hooks, followed by hook fixation to the rod; force is then applied with correction of deformity, if needed. This allows for methodical, safe, and rapid instrumentation insertion. The new TSRH central-post hook configuration permits manipulation of the hook/rod relationships to the advantage of the surgeon (and patient) by providing more room for both hook insertion and hook/rod fixation. This technique has reduced operative time, facilitated case of deformity correction, and provided uniformly acceptable early postsurgical results.

Texas Scottish Rite Hospital rod instrumentation for thoracic and lumbar spine trauma

1991 ◽  
Vol 75 (3) ◽  
pp. 382-387 ◽  
Author(s):  
Edward C. Benzel ◽  
Lee Kesterson ◽  
Erich P. Marchand
Keyword(s):  
Lumbar Spine ◽  
Treatment Plan ◽  
Spine Trauma ◽  
Content Type ◽  
Spinal Implant ◽  
Thoracic And Lumbar Spine ◽  
Long Rod ◽  
Instrumentation Failure ◽  
Texas Scottish Rite Hospital ◽  
Fine Print

✓ The authors present their experience with 28 patients who had incurred unstable thoracic or lumbar spine fractures and who were intraoperatively stabilized with the Texas Scottish Rite Hospital (TSRH) universal instrumentation system. These patients were treated over a 1-year period and reflect an evolving insight into the treatment of thoracic and lumbar spine trauma with universal instrumentation. The TSRH instrumentation system appears equivalent to the more established Cotrel-Dubousset system in most respects. The construct design of the TSRH system facilitates the safe application of a rigid spinal implant. No cases of instability or pseudoarthrosis were observed during an average follow-up period of 9 months, (minimum 3 months). As the surgical treatment plan evolved, shorter and more compact constructs were increasingly utilized. There were no cases of instrumentation failure, regardless of the number of spinal levels fused or the number of levels instrumented. The value of using short rods when possible is emphasized: they may decrease the incidence of delayed instability and discomfort related to loosening at the hook/bone interface compared to that observed when long-rod systems are used in association with short spine fusions causing a fusion/instrumentation mismatch.

Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw technique

1993 ◽  
Vol 79 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Edward C. Benzel
Keyword(s):  
Lumbar Spine ◽  
Fracture Site ◽  
Spine Fractures ◽  
Short Segment ◽  
Content Type ◽  
Scoliotic Deformity ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
Fine Print

✓ The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3°. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6°. Two patients had a preoperative scoliotic deformity at the fracture site. and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable. however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

The “open book” technique for preparation of the lumbar transverse process for posterolateral fusion

2000 ◽  
Vol 93 (2) ◽  
pp. 332-334
Author(s):  
H. Gordon Deen
Keyword(s):  
Lumbar Spine ◽  
Cancellous Bone ◽  
Dorsal Surface ◽  
Transverse Process ◽  
Open Book ◽  
Content Type ◽  
Dorsal Aspect ◽  
Technical Details ◽  
A New Technique ◽  
Fine Print

✓ A new technique is reported for preparation of the recipient graft bed for posterolateral intertransverse process fusion of the lumbar spine. The dorsal surface of each transverse process is reflected open like the pages of a book. This increases the surface area of cancellous bone in the recipient bed, thereby promoting better contact with the grafted bone. This maneuver also preserves much of the periosteal blood supply to the dorsal aspect of the transverse process and much of the cortical bone that would normally be drilled away during decortication. The technical details are described.

Crossed-screw fixation of the unstable thoracic and lumbar spine

1995 ◽  
Vol 82 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Edward C. Benzel ◽  
Nevan G. Baldwin
Keyword(s):  
Vertebral Body ◽  
Screw Fixation ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Short Segment ◽  
Content Type ◽  
Thoracic And Lumbar Spine ◽  
Spinal Segments ◽  
Fine Print

✓ An ideal spinal construct should immobilize only the unstable spinal segments, and thus only the segments fused. Pedicle fixation techniques have provided operative stabilization with the instrumentation of a minimal number of spinal segments; however, some failures have been observed with pedicle instrumentation. These failures are primarily related to excessive preload forces and limitations caused by the size and orientation of the pedicles. To circumvent these problems, a new technique, the crossed-screw fixation method, was developed and is described in this report. This technique facilitates short-segment spinal fixation and uses a lateral extracavitary approach, which provides generous exposure for spinal decompression and interbody fusion. The technique employs two large transverse vertebral body screws (6.5 to 8.5 mm in diameter) to bear axial loads, and two unilateral pedicle screws (placed on the side of the exposure) to restrict flexion and extension deformation around the transverse screws and to provide three-dimensional deformity correction. The horizontal vertebral body and the pedicle screws are connected to rods and then to each other via rigid crosslinking. The transverse vertebral body screws are unloaded during insertion by placing the construct in a compression mode after the interbody bone graft is placed, thus optimizing the advantage gained by the significant “toe-in” configuration provided and further decreasing the chance for instrumentation failure. The initial results of this technique are reported in a series of 10 consecutively treated patients, in whom correction of the deformity was facilitated. Follow-up examination (average 10.1 months after surgery) demonstrated negligible angulation. Chronic pain was minimal. The crossed-screw fixation technique is biomechanically sound and offers a rapid and safe form of short-segment three-dimensional deformity correction and solid fixation when utilized in conjunction with the lateral extracavitary approach to the unstable thoracic and lumbar spine. This approach also facilitates the secure placement of an interbody bone graft.

Simultaneous anterior—posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization

2001 ◽  
Vol 94 (2) ◽  
pp. 232-244 ◽  
Author(s):  
Daryl R. Fourney ◽  
Dima Abi-Said ◽  
Laurence D. Rhines ◽  
Garrett L. Walsh ◽  
Frederick F. Lang ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
Malignant Tumors ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Rank Test ◽  
Content Type ◽  
Thoracic And Lumbar Spine ◽  
Anterior Posterior ◽  
Fine Print

Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior—posterior approach. Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported. The mean survival determined by Kaplan—Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96%) of 24 patients who complained of pain preoperatively reported improvements (p < 0.001, Wilcoxon signed-rank test), and eight (62%) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8%) later underwent surgery for recurrent tumor. Conclusions. The simultaneous anterior—posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.

En bloc petrosectomy using a Gigli saw for petroclival lesions

1995 ◽  
Vol 83 (3) ◽  
pp. 559-560 ◽  
Author(s):  
Tomio Sasaki ◽  
Makoto Taniguchi ◽  
Ichiro Suzuki ◽  
Takaaki Kirino
Keyword(s):  
Facial Nerve ◽  
Semicircular Canals ◽  
Petrous Bone ◽  
New Technique ◽  
En Bloc ◽  
Content Type ◽  
A New Technique ◽  
Transtentorial Approach ◽  
Fine Print

✓ The authors report a new technique for en bloc petrosectomy using a Gigli saw as an alternative to drilling the petrous bone in the combined supra- and infratentorial approach or the transpetrosal—transtentorial approach. It is simple and easy and avoids postoperative cosmetic deformity. This technique has been performed in 11 petroclival lesions without injuring the semicircular canals, the cochlea, or the facial nerve.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Beta—tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 350-354 ◽  
Author(s):  
Takashiro Ohyama ◽  
Yoshichika Kubo ◽  
Hiroo Iwata ◽  
Waro Taki
Keyword(s):  
Lumbar Spine ◽  
Tricalcium Phosphate ◽  
Interbody Fusion ◽  
Donor Site ◽  
Posterolateral Approach ◽  
Content Type ◽  
Spine Model ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site—related complications can still occur. In this study a synthetic ceramic, β—tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. Methods. In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. Conclusions. Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

A new technique for exposure of the cervical spine laminae

2002 ◽  
Vol 96 (1) ◽  
pp. 122-126 ◽  
Author(s):  
Tateru Shiraishi
Keyword(s):  
Cervical Spine ◽  
New Technique ◽  
Diverse Range ◽  
Content Type ◽  
Spinous Processes ◽  
Technical Details ◽  
A New Technique ◽  
Fine Print

✓ The author describes a new technique for exposure of the cervical spine laminae in which the attachments of the semispinalis cervicis and multifidus muscles to the spinous processes are left untouched. It provides a conservative exposure through which a diverse range of posterior cervical surgeries can be performed. In contrast to conventional cervical approaches, none of the muscular attachments to the spinous processes is compromised. In this paper the author describes the technical details and discusses the applications of the procedure.

Impaction fracture of the lumbar vertebrae with dural tear

1980 ◽  
Vol 53 (6) ◽  
pp. 765-771 ◽  
Author(s):  
Carole A. Miller ◽  
Richard C. Dewey ◽  
William E. Hunt
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina ◽  
Lumbar Vertebrae ◽  
Dural Tear ◽  
Mechanism Of Injury ◽  
Content Type ◽  
X Ray ◽  
Jefferson Fracture ◽  
Vertical Impaction ◽  
Fine Print

✓ The authors describe a lumbar spine fracture that is characterized on anteroposterior x-ray views by separation of the pedicular shadows. It is almost invariably associated with posterior interlaminar herniation of the cauda equina through a dorsal dural split, and anterolateral entrapment or amputation of the nerve root. The fracture is unstable and requires internal fixation and fusion at the time of neurolysis. Fractures meeting these criteria should be explored as soon as the patient's condition permits. Myelography is usually unnecessary and may be contraindicated in some cases. The postulated mechanism of injury is hyperextension with vertical impaction and rupture of the ring made up of the lamina, pedicle, and vertebral body. The ring is fractured in several places in a manner similar to that seen in “Jefferson fracture” of C-1. The special anatomical relationships of the thoracolumbar junction and the plane of the lumbar facets are also discussed.

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