The goal of the present study is to investigate if one of the two dorsal operative procedures (rod-rotation versus translation technique) leads to a better radiographic correction of idiopathic adolescent thoracic scoliosis after operative treatment. The operative technique in scoliosis surgery introduced by Cotrel and Dubousset attempts to achieve an improvement of the sagittal profile and a derotation of the vertebrae, in addition to a correction of the main curvature of the scoliotic spine by rotation of the convex-side rod (rod-rotation). The technique of segmental correction was described by Luque. Correction of the scoliosis is performed after fixation of each vertebral body with wire cerclages, followed by segmental correction of the deformed spine. The Universal Spinal System was introduced and an operating technique was developed to take advantage of the principle of segmental correction of scoliosis (translation technique). The radiographic outcomes in two groups comprising a total of 69 adolescent patients treated for idiopathic thoracic scoliosis with
In recent years internal fixation of the spine by using posterior approach with minimally invasive and percutaneous technique were increasingly used in trauma. The percutaneous surgery lose information and navigation is supposed to provide better data because the lost information is found again. We hypothesise that a percutaneous minimal invasive dorsal procedure by using 3D intra-operative imaging for vertebral fractures allows short operating times with correct screw positioning and does not increase radiation exposure. 59 patients were included in this prospective, monocentric and randomised study. 29 patients (108 implants) were operated on by using conventional surgical procedure (CP) and 30 patients (72 implants) were operated on by using a 3D fluoroscopy-based navigation system (3D fluo). In the two groups, a percutaneous approach was performed for transpedicular vertebroplasty or percutaneous pedicle screws insertion. In the two groups surgery was done from T4 level to L5 levels. Patients (54 years old on average) suffered trauma fractures, fragility fractures or degenerative instabilities. Evaluation of screw placement was done by using post-operative CT with two independent radiologists that used Youkilis criteria. Operative and radiation running time were also evaluated. With percutaneous surgery, the 3D fluo technique was less accurate with 13.88% of misplaced pedicle screws (10/72) compared with 11.11% (12/108) observed with CP. The radiation running time for each vertebra level (two screws) reached on average 0.56 mSv with 3D fluo group compared to 1.57 mSv with the CP group. The time required for instrumentation (one vertebra, two screws) with 3D fluo was 19.75 minutes compared with CP group 9.19 minutes. The results were statistically significant in terms of radiation dose and operative running time (p < 0.05), but not in terms of accuracy (p= 0.24). With percutaneous procedures, 3D fluoroscopy-based navigation (3D fluo) system has no superiority in terms of operative running time and to a lesser degree in terms of accuracy, as compared to 2D conventional procedure (CP), but the benefit in terms of radiation dose is important. Other advantages of the 3D fluo system are twofold: up-to-date image data of patient anatomy and immediate availability to assess the anatomical position of the implanted screws.
Aims: Aim of this prospective clinical study was to prove whether there are clinical differences between ms VTS with interposition of an autogenic tricortical bone graft alone and a consecutive dorso-ventral procedure for A 1.2 and A 3.1 fractures of the thoracic and lumbar spine. Materials und Methods: From 01/2002 to 12/2003 298 pat. with traumatic fractures of the thoracic and lumbar spine were treated and had a prospective clinical and radiological follow-up according to the mc-study of the DGU. For 29 pat. (14 m, 15 f; mean age 33 y) ms VTS was performed either isolated (10) or consecutive after
Aim of Study: (A) To study what causes Anterior Column Deficiency in Burst Fracture of Dorso Lumbar Spine in the acute and later phase. (B) To analyse radiologically, the significance of adjacent disc injuries in burst fracture of dorso lumbar spine. (C) To look into the effectiveness of posterior short segment stabilisation by pedicle screw fixation and fusion in these injuries, in relation to deformity and anterior column deficiency. Methods and Materials: Twenty consecutive cases of Superior Burst-split fracture of Dorsolumbar spine were studied prospectively. All cases underwent reduction, posterior short segment stabilisation by Steffee type pedicle screw fixation and two level posterolateral fusion. The average follow-up duration was 30.2 months. Standardised AP and lateral radiograph were taken pre-operatively and post-operatively at regular intervals (every three months). Radiological assessment using seven parameters (Vertebral body angle, Upper disc angle, Lower disc angle, Kyphotic angle, etc) were done from these radiographs. Result and Significance: The total average correction of kyphosis (in degree) at surgery was 21.5°, and the proportion of correction during surgery was – Upper disc 29% (6.3°), Vertebral body 68% (14.6°) and Lower disc 3% (0.6°). So 68% of the correction was at the vertebral body level and 32% at the adjacent discs levels. At follow-up, the total average loss of correction was 16.5°, and the proportion of loss at follow-up was – Upper disc 44% (7.2°), Vertebral body 14% (2.3°) and Lower disc 42% (7.0°). There was loss of 14.2° at the disc levels compared to 2.3° only at the vertebral body level. So 86% of the loss was at the adjacent disc levels. Conclusion: Distraction at the adjacent disc levels occurred at surgery while contouring the vertebral body using
Revision surgery and surgery in previously operated areas are associated with an increased infection risk. In such situations, aggressive surgical debridement may be necessary to control and eradicate the infection. Full thickness defects resulting from such debridement present as a challenge. In most cases, an association of various methods, both surgical and non-surgical, is necessary. Our goal is to describe the use of vaccum dressings as an effective way to deal with extensive and infected dorsolumbar surgical defects, while avoiding the use of myocutaneous flaps. This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of complementary exams. We present the case of a 57-years-old obese woman with prior history of double approach with posterior instrumentation and spine arthrodesis (D3 to L4) due to severe dorsolumbar adolescent idiopathic scoliosis. She presented to our consult 42 years after surgery, complaining of lower back pain. Clinical observation and imaging exams demonstrated degenerative disc disease in L5-S1 and L5 anterolisthesis. There was also distal instrumentation breakage (right L4 pedicular screw and contralateral rod) with pseudarthrosis suspicion. Distal instrumentation was removed and no pseudarthrosis was found. Therefore, posterior instrumentation and arthrodesis was performed, from L4 to S1. Surgery went without complications. One week after surgery, patient developed fever and inflammatory signs at the surgical incision, with purulent oozing. Escherichia coli and Proteus mirabilis were identified as the causative agents. Decision was made to remove both lumbar and distal
Introduction: The role of transpedicular bone graft for the stability after
Introduction and purpose: The purpose of our study is to make a critical review of our experience and find a method of systematised, objective therapeutic strategy in the treatment of vertebral metastases. Materials and methods: We reviewed 38 cases of vertebral metastasis (1995–2004) from primary tumours: lung 21%, breast 21%, prostate 12%, renal 12%, ovary 8%, tongue 4%, cavum 4%, melanoma 4%, unknown primary tumour 17%. 24 cases were treated surgically in terms of the clinical criterion agreed between oncologist and traumatologist. We reviewed the follow-up of the cases (treatment, complications, mortality) and the subsequent application of the Tokuhashi prognostic index and the Tomita therapy protocol with two objectives: to evaluate our results and assess these two methods as working tools. Results: 74% of the patients had preoperative radiotherapy. The surgical treatment was corporectomy and dorsal decompression (17%), partial corporectomy and dorsal decompression (29%), decompression and
Background: To assess the accuracy of pedicle instrumentation placement using an image guidance system ( Medi Vision) in a pig cadaveric model. Methods: A 4mm diameter (10cm long) screw was inserted transversely into the spinous process of a pig cadaver percutaneously using fluoroscopic guidance. The dynamic reference base (DRB) of the image guidance system was then attached to the screw. Using the navigation system both pedicles at each level were identified and 3.2mm guide wires inserted percutaneously. This process was performed for each level from D7 to L4. Actual wire placement was recorded using standard anteroposterior and lateral fluoroscopic images. Virtual trajectories generated by the image guidance system were recorded on the guidance system database. Accuracy of wire placement was then evaluated in an automated way by linear correlation between corresponding images. Results: 20 pedicles were instrumented at 10 levels from D7 to L4. Mean estimate of accuracy for dorsal levels AP and lateral (mm). Mean = 1.452mm, standard deviation 1.57mm. Mean for lumber levels= 1.047mm, standard deviation 1.187mm. Conclusion: Lumbar pedicle instrumentation showed more accuracy when compared to
