The study was conducted to review the outcome in cases of anterior expandable interbody cages inserted through a posterior only approach. Cases selected were the anterior cage insertion and posterior stabilization patients managed by posterior only approach. Study includes the patients of various pathologies requiring 3 column support. Twenty patients were included in study. Pathology in 9 patients was tuberculosis, trauma in 3, tumours in 3, metastasis in 3 and deformities in 2patients. Patients with or without neurological deficit were included. Cases were carefully assessed and patients with single level involvement were included as more then single level involvement required more extensive exposure and possible nerve root sacrifice. Detailed neurological status was recorded. The surgery was performed in prone position and after posterior stabilization by pedicle screws the extracavitatory approach was used to insert the expandable cage. In cases of suspicious pathologies the samples for histopathology and staining were collected. Morbidity, mortality blood loss, surgical time, complications, outcome of surgery were compared with historical controls of front and back surgery. The insertion of cages from posterior approach was feasible in all carefully planned cases. None of the patients had problem related to implant in form of cage displacement. All the patients had satisfactory outcome. Posterior stabilization of spine with expandable cage insertion from posterior approach saves the operating time, spares the additional surgical incision and blood loss without compromising the outcome. In carefully planned surgeries it gives excellent results irrespective of etiology.
The study is been conducted to compare the outcome of pedicle screw fixation in dorsolumbar fractures by long segment fixation and short segment fixation with a screw in fractured vertebra. Study includes the consecutive patients of dorsolumbar fractures treated by either long segment or short segment fixation. Twenty patients were included in each category. Patients with or without neurological deficit were included. Patients with single fractured vertebra only were included. Patients with single level dorsolumbar fracture were subjected to detailed radiological analysis preoperatively by measurement of height loss and kyphosis angle of fractured vertebra. Detailed neurological status was recorded. During the fixation the pedicle screw was inserted in less affected pedicle of fractured vertebra and decompression if needed was done by hemilaminectomy of other side. Bone graft Postoperative kyphosis correction and restoration of height was calculated in both the groups. At 3 months, 12months and 24 months the maintenance of corrected kyphosis and restored height was recorded. Neurological examination to record the effect of surgical intervention on neurological recovery was recorded at every examination. All the patients had satisfactory outcome. The loss of correction in both the groups was comparable. The treatment allows easier postoperative nursing and early mobilization of the patient. Segmental fixation with screws at the level of the fracture offers improved biomechanical stability. It allows additional fixation points that may aid in fracture reduction and kyphosis correction. It also reduces the duration of surgery, blood loss as well as cost of implant without significant compromise on outcome. Pedicle screw at the level of fracture in short segment fixations provides added stability, better postoperative maintenance of corrected kyphosis at reduced cost of implant.
We present an illustrative case using a modification of the Gaines procedure for the surgical management of patients with spondyloptosis. It involves excision of the inferior half of the body of L5 anteriorly combined with posterior reduction and fusion.
