Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. We describe a simple and reliable technique to identify the correct thoracic spine level. After induction of general anaesthesia, the patient is placed prone and the pedicle of interest is identified using fluoroscopy. A ‘K’ wire is then inserted percutaneously into this pedicle under image guidance (confirmed in the antero-posterior (AP) and lateral views). The ‘K’ wire is then cut flush and the patient is then positioned laterally and the intended procedure is performed.Introduction/Aim
Methods
Numerous lumbo-pelvic reconstruction methods based on posterior construct and anterior cages have been proposed for cases involving total sacrectomy and lumbar vertebrectomy. These constructs create long lever arms and generate high cantilever forces across the lumbo-sacral junction resulting in implant failure or breakage. Biomechanical studies have shown that placing implants anterior to lumbo-sacral pivot point provide a more effective moment arm to resist flexion force and improve the ultimate strength of the construct. As a result more emphasis is placed on screws in the pelvis. We report a new and novel technique that allows for the placement of a pelvic ring construct to augment the posterior construct in a lumbo-pelvic reconstruction. In the prone position, two contoured hard rods are passed along the inner table of the pelvis under the iliac muscle from a minor posterior approach. The rods are connected to the posterior lumbo-pelvic construct with T-junction clamps. The patient is turned supine and the anterior ends of the rods are connected to a sub-cutaneously placed hard rod along the anterior abdominal wall with T-junction clamps. This in turn is fixed to the AIIS (anterior inferior iliac spine) with two poly axial screws. The whole construct resembles an oblong ring.Introduction/Aim
Method
In rigid Sagittal and Coronal deformities of the spine Pedicle Subtraction Osteotomies (PSO) is preferred to achieve maximal correction. We describe successful Asymmetrical Pedicle Subtraction Osteotomies (APSO) performed on patients with symptomatic coronal imbalance. Case 1: 28yr old female with VATER syndrome with 25° coronal imbalance to her left with past h/o fusion from L3 – S1 for L5 hemi-vertebra. After APSO at L3 coronal imbalance was reduced to 0°. Case 2: 49yr old male with post-traumatic coronal deformity of 35° at T6 and paraplegia affecting his sitting balance and respiratory function. Following APSO at T12 imbalance was reduced to 5°.Introduction/Aim
Methods/Results
Literature review about the current management strategies for U-shape sacral fractures A thorough literature search was carried out to find out the current concepts in the management of U-shaped sacral fractures. Meta-analysis of 30 cases of U-Shaped sacral fractures Radiological assessment for bone healing, and clinical examination for neurological recovery. 7 papers were published in the English literature between 2001 and 2009 about the management of U-shaped sacral fractures. In total 30 cases were included. The most common mechanism of injury was fall or jump from height (63%), followed by road traffic accidents and industrial injuries. Pre-operative neurological deficit was noted in 73% of patients. The average follow up time ranged from 2-12 months. 18 (60%) of patients were treated with sacroiliac screws. In this group pre-operative neurological deficit was found in 12(66%) patients. All of these patients had satisfactory radiological healing at follow up but 5(27%) patients had residual neurological deficit. No immediate complication was reported in this group. Incomplete sacroiliac screw disengagement was reported in one patient without fixation failure. Other procedures performed were lumbopelvic fixation, triangular osteosynthesis and transsacral plating. The most common cause of U-shaped sacral fractures is a fall or jump from height. There is a high association of neurological damage with U-shaped sacral fractures. From the current available evidence sacroiliac screw fixation is the most commonly performed procedure, it is however not possible to deduce which procedure is better in terms of neurological recovery.
The footplate in the current available TDR is flat without any allowance for endplate concavity in the sagittal plane. To assess the morphology of the endplates of the lower lumbosacral in the sagittal plane, and to identify the frequently occurring shape patterns of the end plates at each level. Retrospective Study 200 consecutive magnetic reasonance imaging (MRI) scans of patients between the age of 30 and 60 years were analysed. In each endplate, the anteroposterior width, the height of concavity of the endplate, and the distance of the summit from the anterior vertebral body margin were noted. The shape of the endplate was noted as oblong (o) if the curve was uniform starting from the anterior margin and finishing at the posterior margin, eccentric (e) if the curve started after a flat portion at the anterior border and then curving backwards, and flat (f) if there is no curve in the sagittal plane. The shape of the end plate is mostly oblong at L3 IEP(59%), equally distributed between oblong and eccentric at L4 SEP (o=43.5%, e=46.5%), eccentric at L4 IEP (e=62.5%), eccentric at L5 SEP (e = 59.0%), eccentric at L5 IEP (e=94.0%), and flat at S1 SEP (f=82.5%). As there is a difference in the shape of the endplate at each level and they are not uniform, there is a need to focus on the sagittal shape of the footplate to avoid subsidence and mismatch of the footplate in cases of endplate concavity.
