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.
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
