scholarly journals 不安定型大腿骨転子部骨折に対するAnterior Support Screwの有効性

2020 ◽  
Vol 69 (3) ◽  
pp. 695-698
Keyword(s):  
Anterior Support

Minimally invasive anteroposterior combined surgery using lateral lumbar interbody fusion without corpectomy for treatment of lumbar spinal canal stenosis associated with osteoporotic vertebral collapse

2021 ◽  
pp. 1-9
Author(s):  
Kentaro Fukuda ◽  
Hiroyuki Katoh ◽  
Yuichiro Takahashi ◽  
Kazuya Kitamura ◽  
Daiki Ikeda
Keyword(s):  
Interbody Fusion ◽  
Combined Surgery ◽  
Vertebral Collapse ◽  
Short Segment ◽  
Canal Stenosis ◽  
The Mean ◽  
Osteoporotic Vertebral Collapse ◽  
Anterior Support ◽  
Lumbar Spinal

OBJECTIVE Various reconstructive surgical procedures have been described for lumbar spinal canal stenosis (LSCS) with osteoporotic vertebral collapse (OVC); however, the optimal surgery remains controversial. In this study, the authors aimed to report the clinical and radiographic outcomes of their novel, less invasive, short-segment anteroposterior combined surgery (APCS) that utilized oblique lateral interbody fusion (OLIF) and posterior fusion without corpectomy to achieve decompression and reconstruction of anterior support in patients with LSCS-OVC. METHODS In this retrospective study, 20 patients with LSCS-OVC (mean age 79.6 years) underwent APCS and received follow-up for a mean of 38.6 months. All patients were unable to walk without support owing to severe low-back and leg pain. Cleft formations in the fractured vertebrae were identified on CT. APCS was performed on the basis of a novel classification of OVC into three types. In type A fractures with a collapsed rostral endplate, combined monosegment OLIF and posterior spinal fusion (PSF) were performed between the collapsed and rostral adjacent vertebrae. In type B fractures with a collapsed caudal endplate, combined monosegment OLIF and PSF were performed between the collapsed and caudal adjacent vertebrae. In type C fractures with severe collapse of both the rostral and caudal endplates, bisegment OLIF and PSF were performed between the rostral and caudal adjacent vertebrae, and pedicle screws were also inserted into the collapsed vertebra. Preoperative and postoperative clinical and radiographical status were reviewed. RESULTS The mean number of fusion segments was 1.6. Walking ability improved in all patients, and the mean Japanese Orthopaedic Association score for recovery rate was 65.7%. At 1 year postoperatively, the mean preoperative Oswestry Disability Index of 65.6% had significantly improved to 21.1%. The mean local lordotic angle, which was −5.9° preoperatively, was corrected to 10.5° with surgery and was maintained at 7.7° at the final follow-up. The mean corrective angle was 16.4°, and the mean correction loss was 2.8°. CONCLUSIONS The authors have proposed using minimally invasive, short-segment APCS with OLIF, tailored to the morphology of the collapsed vertebra, to treat LSCS-OVC. APCS achieves neural decompression, reconstruction of anterior support, and correction of local alignment.

Fractures Involving the Orbit

2011 ◽  
Author(s):  
Don O. Kikkawa ◽  
Christine C. Annunziata
Keyword(s):  
Lateral Wall ◽  
Medial Wall ◽  
Orbital Floor ◽  
Trauma Patients ◽  
Posterior Aspect ◽  
Orbital Roof ◽  
Life Threatening ◽  
Interior Walls ◽  
Anterior Support ◽  
Orbital Rim

Orbital and periorbital injury can occur with localized trauma to the eye or in the setting of multiple trauma associated with injury to other vital organs. A reported 16% of major trauma patients have ocular or orbital injury, and 55% of patients with facial injury have associated ocular or orbital injury. In general, the amount of ocular, soft tissue, and bony damage is related to the amount, duration, and direction of force applied to the orbit and face. Nevertheless, orbital injury is common and can be a subtle finding in the context of other facial or life-threatening injuries. Geometrically, the bony orbit most closely resembles a four-sided pyramid consisting of an apex, a base, and four sides: roof, floor, medial wall, and lateral wall. The absence of the orbital floor posteriorly and the inclination of the lateral wall toward the medial wall changes the geometric shape from a four-sided pyramid to a three-sided pyramid at the orbital apex. The bony margin circumscribes the orbital entrance and provides anterior support for the thin bones of the interior walls of the orbit. Rounding of the orbital walls blends demarcation of the superior, medial, inferior, and lateral walls. The entrance measures 40 mm horizontally and 32 mm vertically. The widest portion of the orbital margin lies about 1 cm behind the anterior orbital rim. In adults, the depth from orbital rim to apex varies from 40 to 45 mm. Safe subperiosteal dissection may be accomplished along the lateral wall and orbital floor for 22 mm and along the medial wall and orbital roof for 30 mm. The volume of the orbit is approximately 30 cc. The triangular floor of the orbit serves as the roof of the maxillary sinus. Several areas of thin bone create weak points in the orbital floor that are susceptible to fracture. The thinnest portion is medial to the infraorbital groove and canal, particularly posteriorly, where the medial wall has no bony support. In the posterior aspect of the floor, the infraorbital fissure extends as the infraorbital canal.

scholarly journals Treatment of subacute thoracic spine fracture-dislocation by total vertebrectomy and spine shortening

2013 ◽  
Vol 18 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Alecio C. E. S. Barcelos ◽  
Ricardo V. Botelho
Keyword(s):  
Posterior Approach ◽  
Posterior Instrumentation ◽  
Complete Recovery ◽  
Current Treatment ◽  
Fracture Dislocation ◽  
Fracture Dislocations ◽  
Thoracic Spine Fracture ◽  
Surgical Teams ◽  
Anterior Support ◽  
Vertebral Resection

Vertebral resection with spine shortening has been primarily reported for the treatment of demanding cases of nontraumatic disorders. Recently, this technique has been applied to the treatment of traumatic disorders. The current treatment of vertebral fracture-dislocation when there is partial or total telescoping of the involved vertebrae is a combined anterior-posterior approach with corpectomy, anterior support implant, and further posterior instrumentation. These procedures usually require 2 surgical teams, involve longer operating times and greater risk of surgical complications related to the anterior approach, and commonly entail longer postoperative care before discharge. The authors report on 2 patients with high thoracic fracture-dislocations with telescoping (T-2 and T-4) who were treated in the subacute phase with total spondylectomy (T-3 and T-5, respectively) and spine shortening by using only a posterior approach. Complete recovery of the sagittal balance was achieved with this technique and the postoperative periods were clinically uneventful. One patient presented with asymptomatic hemothorax that did not require drainage. In paraplegic patients with anterior thoracic dislocation fractures in which one vertebral body blocks the reduction of the other, total spondylectomy and spine shortening seem to be a reasonably safe and effective technique.

scholarly journals Finite Element Analysis of Stability of Internal Fixation Reconstruction Methods for Lumbar Total Vertebral Resection

2020 ◽  
Author(s):  
Shengcheng Wan ◽  
Zhaoyi Wu ◽  
Yuanwu Cao ◽  
Xiaoxing Jiang ◽  
Zixian Chen ◽  
...  
Keyword(s):  
Finite Element ◽  
Lumbar Spine ◽  
Internal Fixation ◽  
Vertebral Body ◽  
Spinal Stability ◽  
Lateral Bending ◽  
Short Segment ◽  
Short Segment Fixation ◽  
Anterior Support ◽  
Artificial Vertebral Body

Abstract Objective To compare the effect of different fixation methods on spinal stability after total en bloc spondylectomy(TES) of lumbar spine.Method The finite element models were established based on the CT scan of a healthy volunteer. After the validity of the models was confirmed, the models with different posterior fixation methods of the lumbar spine were established with and without the artificial vertebral body, respectively. The motions of flexion, extension, lateral bending and rotation under supine and standing conditions were simulated. The angular displacement of T11-L3 and stress of internal fixations were compared and analyzed.Results The finite element models of spinal reconstruction after TES were obtained. When the anterior support existed, the movement of the spine after TES was not affected by the gravity of the upper body. The movements in the opposite direction on the same plane were similar. All three methods provided enough stability to the spine. The improved short-segment fixation shared stress of the artificial vertebral body with no obvious negative effect. The long-segment fixation had stronger fixation effect with the huge loss of the range of motion of lumbar spine. When the anterior support failed, obvious rotation showed in lateral bending in all models. The short-segment fixation and the long-segment fixation failed to maintain the spinal stability with fixations breakage or functional loss. The improved short-segment fixations showed strong ability in maintaining the spinal stability. The vertebral body screws can prevent the failure of anterior fixation by sharing great stress of the whole internal fixation system. The improved short-segment had huge advantages over the others.Conclusion After TES, the improved short-segment fixation can provide more stability to the spine. The vertebral body screws can prevent the failure of the internal fixation by reducing the stress of the anterior support. This fixation method should be promoted in clinical practice while the effect requires more observation.

scholarly journals COMPLICATED LUMBAR TUBERCULOUS SPONDYLODISCITIS IN DISSEMINATED TUBERCULOSIS, TREATED USING A NON-CONVENTIONAL ANTERIOR SUPPORT SYSTEM FOR HYDROSTATIC DISTRACTION: A CASE REPORT

2018 ◽  
Vol 26 (6) ◽  
pp. 401-405
Author(s):  
Alex Oliveira de Araujo ◽  
Thiago Queiroz Soares ◽  
Alessandro Gonzalez Torelli ◽  
Allan Hiroshi de Araujo Ono ◽  
Raphael Martus Marcon ◽  
...  
Keyword(s):  
Case Report ◽  
Support System ◽  
Extrapulmonary Tuberculosis ◽  
Psoas Muscle ◽  
Spinal Instability ◽  
Lumbar Region ◽  
Level Of Evidence ◽  
Disseminated Tuberculosis ◽  
Anterior Support ◽  
Tuberculous Spondylodiscitis

ABSTRACT Objective: To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system. Background: Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique. Methods and results: The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction. Conclusions: Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve. Level of evidence IV, Case report.

Anterior support reduces the stresses on the posterior instrumentation after pedicle subtraction osteotomy: a finite-element study

2017 ◽  
Vol 26 (S4) ◽  
pp. 450-456 ◽  
Author(s):  
Andrea Luca ◽  
Claudia Ottardi ◽  
Alessio Lovi ◽  
Marco Brayda-Bruno ◽  
Tomaso Villa ◽  
...  
Keyword(s):  
Finite Element ◽  
Posterior Instrumentation ◽  
Pedicle Subtraction Osteotomy ◽  
Finite Element Study ◽  
Anterior Support ◽  
Element Study

scholarly journals Design and Development of a Wearable Exoskeleton System for Stroke Rehabilitation

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 18
Author(s):  
Yang-Kun Ou ◽  
Yu-Lin Wang ◽  
Hua-Cheng Chang ◽  
Chun-Chih Chen
Keyword(s):  
Daily Living ◽  
Human Factor ◽  
Assistive Device ◽  
Loss Of Function ◽  
Stroke Patients ◽  
Motor Activities ◽  
Task Training ◽  
Wearable Exoskeleton ◽  
Anterior Support ◽  
Exoskeleton Device

For more than a decade, many countries have been actively developing robotic assistive devices to assist in the rehabilitation of individuals with limb disability to regain function in the extremities. The exoskeleton assistive device in this study has been designed primarily for hemiplegic stroke patients to aid in the extension of fingers to open up the palm to simulate the effects of rehabilitation. This exoskeleton was designed as an anterior-support type to achieve palmar extension and acts as a robotic assistive device for rehabilitation in bilateral upper limb task training. Testing results show that this wearable exoskeleton assistive device with human factor consideration using percentile dimensions can provide comfortable wear on patients as well as adequate torque to pull individual fingers into flexion towards the palm for rehabilitation. We hope this exoskeleton device can help stroke patients with loss of function in the upper extremities to resume motor activities in order to maintain activities of daily living.

scholarly journals Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Sébastien Pesenti ◽  
Benjamin Blondel ◽  
Emilie Peltier ◽  
Tarek Adetchessi ◽  
Henry Dufour ◽  
...  
Keyword(s):  
Infectious Complications ◽  
Thoracolumbar Fracture ◽  
Public Health Issue ◽  
Thoracolumbar Fractures ◽  
Pull Out ◽  
Aging Spine ◽  
The Difference ◽  
Anterior Support ◽  
Percutaneous Osteosynthesis

Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws.Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan.Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°,P=0.0006). No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed.Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

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