scholarly journals Evaluation of Transpedicular Surgical Decompression withLong Segment Stabilization in Thoracic and Thoracolumbar SpinalTuberculosis

2018 ◽  
Vol 43 (3) ◽  
pp. 138-142
Author(s):  
Anowarul Islam ◽  
Fahad Goni ◽  
Naimur Rahman
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Neurological Deficit ◽  
Screw Fixation ◽  
Spinal Tuberculosis ◽  
Pedicle Screw Fixation ◽  
Surgical Decompression ◽  
Posterior Decompression ◽  
Pott’S Disease

Pott’s disease is a common cause of neurological complications and kyphotic deformity.When deformity progressed that may lead to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality andlongevity oflife. The treatmentstrategy is to avoid neurological complication and achieve a near normal spine. In tuberculosis, spinal column may become unstable. Pathological fracture or dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression causefurther instability.The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old Pott’s disease is a most suitable device.This prospective interventionalstudywas conducted in BanglabandhuSheikh Mujib Medical University (BSMMU) for aperiod of 60 monthsfrom July 2011, with at leasttwo years follow-up period. Twentycases (13 males and 7 females) of thoracolumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 9–28 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.The mean age of patients was 50.9 and kyphosis improved from 17.85±1.37 degrees to 10.85±2.66 degrees (p=0.0206).Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean visual analogue score (VAS) score improved from 5.5 to 0.75 (p=0.0031).So, posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the thoracic and thoracolumbar TB in patients with vertebral body destruction and <30degree kyphosis.

scholarly journals Evaluation of Surgical Decompression by Laminectomy and Fusion by Strut Graft 3 with Stabilization by Pedicle Screw and Rod in Lumbar Spinal Tuberculosis

2018 ◽  
Vol 28 (Number 1) ◽  
pp. 3-10
Author(s):  
Md. A Islam ◽  
Md. S Alam ◽  
Md. Q Parvez ◽  
S Batajoo ◽  
M Shrestha
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Neurological Deficit ◽  
Screw Fixation ◽  
Spinal Tuberculosis ◽  
Pedicle Screw Fixation ◽  
Surgical Decompression ◽  
Posterior Decompression ◽  
Lumbar Spinal

Potts disease is a common cause of neurological complications and kyphotic deformity in our country. When deformity progressed that may leads to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality, longevity of life. The treatment strategy is to avoid neurological complication and achieve a near normal spine. In TB, spinal column may become unstable. Pathological fracture/dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression cause further instability. The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old polls disease is a most suitable device. This prospective interventional study was done on BSMMU for the period of 60 months with minimum follow up period of 2 years. 20 cases (13 males and 7 females) of lumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 5-15 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. The mean age of patients was 50.9 and kyphosis improved from 10.4+,2.9 degrees to 4.0±1.2 degrees Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean VAS score improved from 5.5 to 0.75. So posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the lumbar TB in patients with vertebral body destruction.

scholarly journals Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression, Short Segment Pedicle Screw Fixation, and Interlaminar Fusion

2017 ◽  
Vol 11 (6) ◽  
pp. 951-958 ◽  
Author(s):  
Sachin Kumar ◽  
Satish Kumar ◽  
Rajender Kumar Arya ◽  
Avinash Kumar
Keyword(s):  
Pedicle Screw ◽  
Neurological Deficit ◽  
Sagittal Plane ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Prospective Clinical Study ◽  
Kyphosis Angle ◽  
Posterior Decompression ◽  
Short Segment ◽  
Post Traumatic

<sec><title>Study Design</title><p>Prospective clinical study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the effect of interlaminar fusion and short segment pedicle screw fixation on thoracolumbar vertebral injuries for preventing pain and post-traumatic kyphosis.</p></sec><sec><title>Overview of Literature</title><p>The treatment of thoracolumbar injuries continues to be one of the most controversial areas in spine care. The main aim of surgical treatment is to decompress the spinal cord or nerve roots, realign the spine, and correct or prevent post-traumatic kyphosis. We evaluated the outcome of interlaminar fusion along with posterior decompression and short segment pedicle screw fixation in patients with thoracolumbar fractures with neurological deficit.</p></sec><sec><title>Methods</title><p>Twenty-two patients with traumatic thoracolumbar vertebral injuries and neurological deficit underwent short segment pedicle screw fixation above and below the fractured vertebrae, posterior decompression, and interlaminar fusion using a bone graft.</p></sec><sec><title>Results</title><p>All patients were followed up for 12 months postoperatively. The average operative time and blood loss was 142 minutes and 214 mL, respectively. Of the 22 patients, 14 recovered completely. Of the nine patients with American Spinal Injury Association (ASIA) grade A disease, two improved by 1 grade, whereas one each improved by grades 2, 3, and 4, and four did not recover. Radiologically, vertebral kyphosis angle improved from 20.91 preoperatively to 15.73 postoperatively, sagittal index improved from 24.77 to 18.73, the sagittal plane kyphosis angle improved from 17.45 to 11.41, regional angle kyphosis improved from 14.73 to 10.14, the superior inferior end plate angle from 16.14 to 13.00, and mean anterior body compression improved from 36.26 to 27.64 postoperatively. No implant failed and no patient had neurological deterioration.</p></sec><sec><title>Conclusions</title><p>Short segment pedicle screw fixation with posterior decompression and interlaminar fusion provided considerable reduction in kyphosis, restored the vertebral height of patients with thoracolumbar vertebral injuries and neurological deficit, and prevented development of delayed kyphotic deformity.</p></sec>

scholarly journals Percutaneous Injection of Strontium Containing Hydroxyapatite versus Polymethacrylate Plus Short-Segment Pedicle Screw Fixation for Traumatic A2- and A3/AO-Type Fractures in Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Panagiotis Korovessis ◽  
Eva Mpountogianni ◽  
Vasileios Syrimpeis ◽  
Andreas Baikousis ◽  
Vasileios Tsekouras
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Screw Fixation ◽  
Body Height ◽  
Pedicle Screw Fixation ◽  
Percutaneous Injection ◽  
Vertebral Bone ◽  
Vertebral Body Fractures ◽  
Percutaneous Pedicle Screw

Introduction. Polymethacrylate (PMMA) is commonly used in vertebroplasty and balloon kyphoplasty, but its use has been associated with complications. This study tests three hypotheses: (1) whether strontium hydroxyapatite (Sr-HA) is equivalent to PMMA for restoring thoracolumbar vertebral body fractures, (2) whether the incidence of PMMA leakage is similar to that of Sr-HA leakage, and (3) whether Sr-HAis is resorbed and substituted by new vertebral bone. Materials and Methods. Two age- and sex-matched groups received short percutaneous pedicle screw fixation plus PEEK implant (Kiva, VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA) filled with either Sr-HA (Group A) or PMMA (Group B) after A2- and A3/AO-type thoracolumbar vertebral body fractures. The Visual Analog Scale (VAS) score and imaging parameters, which included segmental kyphosis angle (SKA), vertebral body height ratios (VBHr), spinal canal encroachment (SCE), bone cement leakage, and Sr-HA resorption, were compared between the two groups. Results. The average follow-up was 28 months. No differences in VAS scores between Groups A and B were observed at baseline. Baseline back pain in both groups improved significantly three months postoperatively. Anterior, middle, and posterior VBHr did not differ between the two groups at any time point. SKA was improved insignificantly in both groups. SCE decreased insignificantly in both groups on 12-month follow-up using computed tomography (CT). PMMA leakage was observed in one patient, while no Sr-HA paste leakages occurred. Sr-HA resorption and replacement with vertebral bone were observed, and no new fractures were observed. Conclusions. As all hypotheses were confirmed, the authors recommend the use of Sr-HA instead of PMMA in traumatic spine fractures, although more patients and longer follow-up will be needed to strengthen these results. This trial is registered with NCT03431519.

scholarly journals Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beixi Bao ◽  
Qingjun Su ◽  
Yong Hai ◽  
Peng Yin ◽  
Yaoshen Zhang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Congenital Scoliosis ◽  
Pedicle Screw Fixation ◽  
Rigid Fixation ◽  
Short Segment ◽  
Hemivertebra Resection ◽  
Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

scholarly journals Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series

2016 ◽  
Vol 02 (04) ◽  
pp. e131-e138 ◽  
Author(s):  
Nitin Agarwal ◽  
Phillip Choi ◽  
Raymond Sekula
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fracture ◽  
Thoracolumbar Burst Fractures ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Introduction Traumatic thoracolumbar burst fracture is a common pathology without a clear consensus on best treatment approach. Minimally invasive approaches are being investigated due to potential benefits in recovery time and morbidity. We examine long-term resolution of symptoms of traumatic thoracolumbar burst fractures treated with percutaneous posterior pedicle screw fixation. Methods Retrospective clinical review of seven patients with spinal trauma who presented with thoracolumbar burst fracture from July 2012 to April 2013 and were treated with percutaneous pedicle screw fixation. Electronic patient charts and radiographic imaging were reviewed for initial presentation, fracture characteristics, operative treatment, and postoperative course. Results The patients had a median age of 29 years (range 18 to 57), and 57% were men. The median Thoracolumbar Injury Classification and Severity Scale score was 4 (range 2 to 9). All patients had proper screw placement and uneventful postoperative courses given the severity of their individual traumas. Five of seven patients were reached for long-term follow-up of greater than 28 months. Six of seven patients had excellent pain control and stability at their last follow-up. One patient required revision surgery for noncatastrophic hardware failure. Conclusion Percutaneous pedicle screw fixation for the treatment of unstable thoracolumbar burst fracture may provide patients with durable benefits and warrants further investigation.

scholarly journals The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up

2019 ◽  
Vol 13 (3) ◽  
pp. 39-44 ◽  
Author(s):  
Tamburrelli FC ◽  
Perna A ◽  
Proietti L ◽  
Zirio G ◽  
Santagada DA ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screw Fixation

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.

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