82 research outputs found
The biomechanical effects of thoracic spine stapling
No full textThe use of anterior vertebral staples in the fusionless correction of scoliosis has received increased attention in recent literature. Several animal studies have shown stapling to be effective in modulating vertebral growth. In 2005 Betz (1) published the only clinical series to date.\ud
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Despite the increasing volume of literature suggesting the efficacy of this treatment, little is known about it's biomechanical consequences. In 2007 Puttlitz (2) measured the change in spinal range of motion after staple insertion in a bovine model. They found a small but statistically significant decrease in range of motion in axial rotation and lateral bending. The clinical significance of this is questionable as the differences were only a few degrees over three vertebral levels. A well designed biomechanical evaluation of the effects of staple insertion on spinal stability is needed. The aim of this study was to evaluate the effect of insertion of a laterally placed anterior vertebral staple on the stiffness characteristics of a single motion segment.\ud
These results suggest that staple insertion consistently decreased stiffness in all directions of motion. This is contrary to the results of Puttlitz (2), which reported a reduced range of motion (i.e. increased stiffness) for some motions using moment-controlled testing. This decrease in stiffness could not be explained by changes in anatomy or tissue properties between specimens, as each stapled motion segment was compared with its own intact state. Addition of the staple would intuitively be expected to increase motion segment stiffness, however we suggest that the staple prongs may cause sufficient disruption to the vertebral bodies and endplates to slightly reduce overall stiffness. Hence, growth modulation may be achieved through physical disruption of the endplate, rather than static mechanical stress. Further research is planned to investigate the proportion of load carried by the staple during spinal movement and the anatomical effect of the staple on the physis. In conclusion, anterior vertebral stapling causes a slight but significant decrease in the stiffness of treated motion segments
Resolution of the lumbosacral fractional curve and evaluation of the risk for adding on in 101 patients with posterior correction of Lenke 3, 4, and 6 curves
No full textOBJECTIVE In double and triple major adolescent idiopathic scoliosis curves it is still controversial whether the lowest instrumented vertebra (LIV) should be L3 or L4. Too short a fusion can impede postoperative distal curve compensation and promote adding on (AON). Longer fusions lower the chance of compensation by alignment changes of the lumbosacral curve (LSC). This study sought to improve prediction accuracy for AON and surgical outcomes in Lenke type 3, 4, and 6 curves.METHODS This was a retrospective multicenter analysis of patients with adolescent idiopathic scoliosis who had Lenke 3, 4, and 6 curves and >= 1 year of follow-up after posterior correction. Resolution of the LSC was studied by changes of LIV tilt, L3 tilt, and L4 tilt, with the variables resembling surrogate measures for the LSC. AON was defined as a disc angle below LIV > 5 degrees at follow-up. A matched-pairs analysis was done of differences between LIV at L3 and at L4. A multivariate prediction analysis evaluated the AON risk in patients with LIV at L3. Clinical outcomes were assessed by the Scoliosis Research Society 22-item questionnaire (SRS-22).RESULTS The sample comprised 101 patients (average age 16 years). The LIV was L3 in 54%, and it was L4 in 39%. At follow-up, 87% of patients showed shoulder balance, 86% had trunk balance, and 64% had a lumbar curve (LC) 5 20 degrees. With an LC 5 20 degrees (p = 0.01), SRS-22 scores were better and AON was less common (26% vs 59%, p = 0.001). Distal extension of the fusion (e.g., LIV at L4) did not have a significant influence on achieving an LSC < 20 degrees; however, higher screw density allowed better LC correction and resulted in better spontaneous LSC correction. AON occurred in 34% of patients, or 40% if the LIV was L3. Patients with AON had a larger residual LSC, worse LC correction, and worse thoracic curve (TC) correction. A total of 44 patients could be included in the matched-pairs analysis. LC correction and TC correction were comparable, but AON was 50% for LIV at L3 and 18% for LIV at L4. Patients without AON had a significantly better LC correction and TC correction (p < 0.01). For patients with LIV at L3, a significant prediction model for AON was established including variables addressed by surgeons: postoperative LC and TC (negative predictive value 78%, positive predictive value 79%, sensitivity 79%, specificity 81%).CONCLUSIONS An analysis of 101 patients with Lenke 3, 4, and 6 curves showed that TC and LC correction had significant influence on LSC resolution and the risk for AON. Improving LC correction and achieving an LC < 20 degrees offers the potential to lower the risk for AON, particularly in patients with LIV at L3
Open reduction and internal fixation of the pelvic fractures
No full textAbstract
For a long time, conservative methods was the mainstay of treatment in pelvic fractures. However, long-term results showed a high complication rate such as pain, shortening, and pelvic deformity especially in disruptions of the sacroiliac region. External fixation proved to be insufficient in the retention of reduction especially in vertical instabilities. In these cases, open reduction and internal fixation will provide anatomic reposition especially in the weight-bearing region and lower the risk of complications. We present the results of 1 Type B case and 8 Type C cases who had open reduction and internal fixation for pelvic fractures. Our results showed that anatomical reduction and integrity of the pelvic ring can be reconstituted with open reduction and internal fixation. We observed that these patients could be mobilized earlier and the hospital stay is significantly shorter than those treated conservatively.\nKeywords: Fractures of the pelvis, surgical treatment, open reduction and internal fixation
Özet
Pelvis kırıklarının tedavisinde uzun yıllar konservatif tedavi yöntemleri uygulanmıştır. Ancak bu tedavi yöntemlerinin uzun süreli sonuçları incelendiğinde özellikle sakroiliak eklem bölgesindeki ayrışmalarda ağrı, kısalık, pelvik çarpıklık gibi iskelet sistemine ait geç komplikasyonların oranının yüksek olduğu görülmüştür. Geliştirilen eksternal fiksatörlerin de özellikle vertikal instabilitelerde reduksiyonu korumada yeterli olamadıkları anlaşılmıştır. Bu olgularda uygulanacak açık reduksiyon ve internal fiksasyon ise özellikle yük taşıma bölgesinde anatomik repozisyon sağlayacak, geç komplikasyon riskini azaltacaktır. Burada açık reduksiyon ve internal fiksasyon uygulanan 1 Tip B olgusu ile 8 Tip C olgusunun sonuçları bildirilmiştir. Olgulardan aldığımız sonuçlar açık reduksiyon ve internal fiksasyon ile anatomik reduksiyon sağlandığını, pelvis halkasının bütünlüğünün yeniden oluşturulabildiğini göstermiştir. Bu yöntem ile hastaların konservatif tedavi süresindekinden daha önce mobilize olabildikleri ve hastanede kalış sürelerinin anlamlı olarak azaldığı görülmüştür
An anterior approach to the cervicothoracic junction of the spine Modified osteotomy of manubrium sterni and clavicle
No full textAbstract
Standard anterior approaches to the cervicothoracic junction of the spine provide inadequate exposure. For this reason, various techniques of exposure are developed. One of these is Sundaresan s technique in which a part of manubrium sterni and medial clavicle are resected. It provides good vision and working area at the lesion level but causes a significant bony defect. We modified Sundaresan s technique and did not damage the sternoclavicular joint. After decompression and fusion was completed, the osteotomised segment was replanted. We performed this technique in two cases of Pott s disease and had no problem of union at the osteotomy sites.
Özet
Tümör, infeksiyon, kırık gibi çeşitli patolojiler nedeniyle servikotorakal geçiş bölgesine yapılacak anterior girişimler teknik olarak önemli güçlükler içermektedir. Bu nedenle çeşitli giriş yolları önerilmiştir. Bunlardan biri Sundaresan tarafından önerilmiş olan manubrium sterni ve klavikula medial uç rezeksiyonudur. Lezyon bölgesinde oldukça iyi bir görüş ve çalışma alanı yaratan Sundaresan ın bu yöntemindeki tek sakınca rezeke edilen kemikler nedeniyle bu bölgede önemli bir defekt oluşturmasıdır. Biz, Sundaresan ın bu tekniğini rezeksiyonu sternoklavikuler eklemi bozmadan tek parça halinde yapmak ve dekompresyon ile füzyonu tamamladıktan sonra çıkarılan kemiği tekrar replante etmek suretiyle modifiye ettik. Bu yöntemi uyguladığımız iki Pott hastalığı olgusunda replante edilen kemiklerin kaynamasında herhangi bir problemle karşılaşmadık
Does Pedicule Screw Fixation Under Age Five Disrupt Vertebral Growth? A Computerized Tomography Study
No full textWhich Factors Influence Spontaneous Lumbar Curve Correction After Selective Thoracic Fusion In Lenke Type IB And C Curves?
No full textPatient with Severe Scoliosis Treated with Intraoperative Traction and Posterior Instrumentation: A Case Presentation
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