Analysis of the length of fixation during hemivertebra resection. A monocentric retrospective cohort

Background: We aimed at reviewing results of surgical correction of spinal deformity due to hemivertebra with regard to the age, severity of deformity and length of instrumentation.Methods. Study comprised 117 patients with congenital spinal deformity treated between 2010 and 2018. Patients’ aged 1 to 18 years. Mean follow-up was 3 years (1 to 8). Posterior approach was used in all cases. Patients were subdivided into 4 groups.Result:Unilateral mono-segmental fixation (Group I) for 15 children with mean age of 48.3 months. Cobb angle for scoliosis and kyphosis were 31.10 + 6.40 and 29.3° + 11.90 corrected to 7.80 + 6.80 and 4.70 + 4.00 respectively. Blood loss was 213.6 mL. Operating time was 165 minutes.Bilateral mono-segmental fixation (Group II) for 24 patients with mean age of 53.1 months. Cobb angle for scoliosis and kyphosis were 32.5° + 8.60 and 30.9° + 4.30 corrected to 5.30 + 2.80 and 0.20 + 11.60 respectively. Blood loss was 215.4 mL. Operating time was 160.5 minutes.Bilateral three-segmental fixation (Group III) for 29 patients with mean age of 78.2 months. Cobb angle for scoliosis and kyphosis were 36.6° + 10.60 and 37.6° + 14.60 corrected to 6.20 + 6.10 and 5.00 + 5.20 respectively. Blood loss was 342.7 mL. Operating time was 197.0 minutes.Bilateral poly-segmental fixation (Group IV) for 49 children with mean age of 112.7 months. Cobb angle for scoliosis and kyphosis were 40.2° + 14.80 and 58.2° + 35.60 corrected to 10.70 + 9.60 and 10.70 + 10.30 respectively. Blood loss was 549.3 mL. Operating time was 288.8 minutes.Conclusion: Choice of spinal fixation technique and the length of fixation were determined on the basis of patient’s age, magnitude of the deformity and concomitant vertebral abnormalities.

Analysis of the length of fixation during hemivertebra resection. A monocentric cohort

Background: We aimed at reviewing results of surgical correction of spinal deformity due to hemivertebra with regard to length of instrumentation. Methods: Study comprised 117 patients with congenital spinal deformity treated between 2010 and 2018. Patients’ aged 1 to 18 years. Mean follow-up was 3 years (1 to 8). Posterior approach was used in all cases. Patients were subdivided into 4 groups. Result: Unilateral monosegmental fixation (Group I) for 15 children with mean age of 48.3 months. Cobb angle for scoliosis and kyphosis were 31.1 0 + 6.4 0 and 29.3° + 11.9 0 corrected to 7.8 0 + 6.8 0 and 4.7 0 + 4.0 0 respectively. Blood loss was 213.6 mL. Operating time was 165 minutes. Bilateral monosegmental fixation (Group II) for 24 patients with mean age of 53.1 months. Cobb angle for scoliosis and kyphosis were 32.5° + 8.6 0 and 30.9° + 4.3 0 corrected to 5.3 0 + 2.8 0 and 0.2 0 + 11.6 0 respectively. Blood loss was 215.4 mL. Operating time was 160.5 minutes. Bilateral three-segmental fixation (Group III) for 29 patients with mean age of 78.2 months. Cobb angle for scoliosis and kyphosis were 36.6° + 10.6 0 and 37.6° + 14.6 0 corrected to 6.2 0 + 6.1 0 and 5.0 0 + 5.2 0 respectively. Blood loss was 342.7 mL. Operating time was 197.0 minutes. Bilateral polysegmental fixation (Group IV) for 49 children with mean age of 112.7 months. Cobb angle for scoliosis and kyphosis were 40.2° + 14.8 0 and 58.2° + 35.6 0 corrected to 10.7 0 + 9.6 0 and 10.7 0 + 10.3 0 respectively. Blood loss was 549.3 mL. Operating time was 288.8 minutes. Conclusion: Choice of spinal fixation technique and the length of fixation were determined on the basis of patient’s age, magnitude of the deformity and concomitant vertebral abnormalities.

Tactics of surgical treatment of patients with lumbar spondylolysis

The bilateral defect of the pars interarticularis (spondylolysis) is often the cause of low back pain syndrome and can lead to development of spondylolistesis. In some cases inefficiency of conservative treatment of this condition forces orthopedists to use surgical technologies. At the same time, in young patients with intact intervertebral discs, the rigid segmental fixation of the spine should be avoided. Where no neural decompression is needed, selective osteosynthesis of the pars defect is an optimal technique. The authors present the results of surgical treatment of 15 patients with single and two-level lumbar spondylolysis, 4 of which revealed minimal I degree lytic spondylolystesis of the L5 vertebrae. Localization of the pathological process in all patients was noted on both sides. In two patients spondylolysis defects of two vertebrae were detected (in one- adjacent L4 and L5, in the other - L2 and L4 vertebrae with sacralization of L5). The average period from the onset of symptoms ranged from 6 months to 2 years (an average of 14 months). All patients undergone bone autoplasty with iliac crest bone graft, and osteosynthesis of vertebral arches by a combined laminar-transpedicular system of the screw - rod - hook type. All patients had excellent and good anatomic and functional results. The used method of surgical treatment of patients of this category should be considered pathogenetically justified, as it is aimed at repair of spondylolytic defects as the main cause of segmental instability and forward displacement of vertebrae. The possibility to avoid fixation of intact segments of spine allows to categorize this operation as organ-preserving.

Healing Pattern of Thoracolumbar Burst Fracture after Posterior Short-segmental Fixation

Background: Vertebral cavity sometimes occurs after posterior short-segmental fixation for thoracolumbar burst fractures, but the risk factor of its formation is unclear. We aim to investigate their vertebral healing pattern and explore the risk factor of vertebral cavities.Methods: The thoracolumbar burst fractured patient treated with posterior short segmental fixation were followed up for minimal 3 years. Healing patterns were observed and divided into 4 healing types according to the integrity status of the endplates and the morphology of the cavities. The demographic characteristics and clinical outcomes were compared between patients with and without vertebra cavities at the last follow-up.Results: The incidence of vertebral cavities in our cohort was 59.6%. Accordingly, the healing pattern of the vertebra were classified as Complete Healing type or Endplate Cavity type, Spherical Cavity type or Burst Cavity type. The proportion of men, history of smoking, severity of neurological impairment and presence of A4 type fracture were significantly higher in the Vertebral Cavity group than the Intact Vertebra group. Clinical outcomes, including ASIA scales,VAS and ODI scores, were similar between the Intact Vertebra group and the Vertebral Cavity group. Conclusions: Vertebral cavities are commonly seen after posterior short-segmental fixation for thoracolumbar burst fractures. The healing pattern can be divided into four types. The presence of vertebral cavity may be related to gender, smoking history and the severity of the fracture. Most of the vertebral cavities are asymptomatic, but the clinical significance needs further study.

Analysis of percutaneous kyphoplasty or short-segmental fixation combined with vertebroplasty in the treatment of Kummell disease

Background In recent years, short segment internal fixation combined with vertebroplasty (SSF + VP) has provided a new option for the treatment of Kummell disease (KD). The purpose of this study is to evaluate the efficacy of percutaneous kyphoplasty (PKP) and SSF + VP, to provide evidence-based medical support for the decision-making process when treating KD patients without neurological deficits. Methods Databases including MEDLINE (PubMed) and EMBASE (Ovid) (1947 to April 6, 2019) were searched for PKP and short-segmental fixation combined with vertebroplasty (SSF + VP) to treat Kummell disease in randomized controlled trials (RCTs) or cohort studies. Two investigators independently evaluated the eligibility of the studies retrieved from the databases based on the predetermined selection criteria. The postoperative evaluation indexes included operation time, bleeding volume, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, local vertebral Cobb angle, and cement leakage. When the data were significant, a random-effects model was used for analysis. In contrast, when the results showed no statistical heterogeneity, a fixed-effects model was used to estimate the overall effect sizes. Results Three retrospective case-control studies were included in the final analysis. The differences in the bleeding volume and operation time were statistically significant, and the combined weighted mean differences (WMDs) (95% CI) were − 0.204.46 (− 210.97, − 197.93) and − 98.98 (− 141.63, 56.32), respectively. The combined data showed that the differences in VAS score, ODI score, local vertebral Cobb angle, and cement leakage were not statistically significant. Conclusions This analysis demonstrates that the PKP and SSF + VP methods are safe and effective in treating Kummell disease patients without neurological symptoms. However, PKP can shorten the operation time and reduce the volume of blood loss.

Odontoid Fracture Type II

Type II odontoid fracture is one of the most common cervical spine injuries, associated with significant morbidity. A thorough history and evaluation of diagnostic imaging is crucial to identify specific patient and injury factors that will assist with the treatment algorithm. The initial decision between operative and nonoperative management is made on the basis of careful consideration of the patient’s age, comorbidities, concomitant injuries, prior functional status, neurological status, and fracture morphology. This chapter describes various operative surgical treatments for odontoid fractures, including segmental fixation consisting of C1 lateral mass with either C2 pedicle or pars screws, anterior odontoid osteosynthesis, and C1–C2 transarticular screw fixation. A posterior approach with segmental fixation using C1–C2 lateral mass with C2 pars screw is reviewed with special attention to help avoid neurovascular complications. Postoperatively, patients should be monitor for signs of retropharyngeal hematoma, dysphagia, aspiration, vocal cord paralysis, and surgical site infections.