1,720,996 research outputs found
Atlantoaxial anterior transarticular screw fixation. a case series and reappraisal of the technique
No full textBACKGROUND CONTEXT:
Atlantoaxial instability is commonly treated with C1-C2 fixation performed via posterior approaches. Although anterior transarticular screw (ATS) fixation, performed with a classic retropharyngeal approach, was described more than 10 years ago, the published literature still lacks a comprehensive analysis of the procedure and a real case series.
PURPOSE:
We report a series of patients treated with atlantoaxial ATS, describing the surgical procedure in detail and discussing advantages and disadvantages of the technique.
STUDY DESIGN:
The study design includes case series and technical report.
METHODS:
We prospectively enrolled 15 patients affected by atlantoaxial instability secondary to trauma, degenerative diseases, or inflammatory diseases. Anterior transarticular screw fixation was performed with anteroposterior open-mouth and lateral intraoperative radiographs. All patients were evaluated radiologically at follow-up to identify bone fusion.
RESULTS:
Anterior transarticular screw was performed successfully in 14 patients without complications. The procedure was aborted in a case of vertebral invagination, and one case required revision surgery owing to C2 articular bone fracture. Solid C1-C2 fusion was achieved in all cases (at 10- to 21-week follow-up) except in an elderly patient affected by severe osteoporosis. No complications occurred.
CONCLUSIONS:
Although the procedure is still not widely known, ATS allows the effective and safe treatment of C1-C2 instability even in patients with systemic comorbidities. It offers several advantages over posterior approaches.
Copyright © 2015 Elsevier Inc. All rights reserved
Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up
No full textTo evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine). Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb's angle and the Sagittal Index. In the LSG, the correction values of MSI, Cobb's angle and SI were statistically significantly higher than in nLSG. When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing screw.PURPOSE:
To evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine).
METHOD:
Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb's angle and the Sagittal Index.
RESULTS:
In the LSG, the correction values of MSI, Cobb's angle and SI were statistically significantly higher than in nLSG.
CONCLUSION:
When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing sc
Double dural patch in decompressive craniectomy to preserve the temporal muscle: technical note
No full textBackground: In frontotemporal decompressive craniectomy and subsequent cranioplasty, temporal muscle damage is frequently observed as a result of surgical manipulation, lack of bone attachment, and prolonged muscle inactivity. We investigated the use of a double dural patch in decompressive craniectomy to favor the safe surgical dissection of the temporal muscle in the subsequent cranioplasty and reduce temporal muscle damage. Methods: In 11 patients submitted to a decompressive craniectomy and duraplasty, a second (external) dural sheet was positioned to separate the inner dural patch from the temporal muscle. Results: When bone repositioning was performed, the detachment of the deep temporal muscle surface, covered by the external dural sheet, was easy and fast, with reduced blood loss. All the muscle fibers were preserved. Conclusion: The technique described in this article reduces the damage to the temporal muscle and can improve the functional and cosmetic results after decompressive craniectomy and cranioplasty. © 2008 Elsevier Inc. All rights reserved
Total en-bloc Spondylectomy of the second Thoracic Vertebra by a Modified Fessler's Approach: an Anatomical Study on Cadaver
No full text
Symptomatic ganglion cyst of ligamentum flavum as a late complication of lumbar fixation
No full textWe report the case of a 72-year-old man who underwent surgery for a mobile spondylolisthesis L4-L5. Six months later, magnetic resonance imaging revealed an extradural cyst of the ligamentum flavum at L5-S1, which was then removed. Histological examination revealed a ganglion cyst of the ligamentum flavum. Cyst formation could be explained primarily according to the natural history of chronic degenerative disease of spine elements. Nevertheless, we could also consider the cyst formation as demonstrative of an adjacent segment syndrome: hypermobility of the L5-S1 segment just below three fixed vertebral segments would have triggered the mechanical stress necessary for L5-S1 ligamentum flavum degeneration
Surgical approaches to the cervico-thoracic junction
No full textThe cervico-thoracic junction (CTJ) extends between the 7 th cervical and the 4 th thoracic vertebrae and comprehends the inferior portion of the brachial plexus and the parenchymatous, vascular and nervous structures of the upper mediastinum. The posterior surgical approaches, as the laminectomy or the arthro-pediclectomy, fail to expose the anterior spinal elements. Thus, further surgical approaches have been proposed: posterolateral, antero-lateral (thoracotomies) and purely anterior. The aim of this study was to discuss indications, key anatomical landmarks and risks of the main surgical approaches to the CTJ. Ten fresh cadavers from the Anatomical Laboratory of the University of Nantes (France) were used for the surgical dissection of the CTJ. The postero-lateral and the antero-lateral approaches were performed in 4 cadavers each and the anterior approaches were studied in 2. The postero-lateral extrapleural approach (PLEA) permits an excellent antero-lateral exposure of the T2-T4 segment, preserving the parascapular musculature integrity. The thoracotomies allow the exposure of the antero-lateral portion of the junctional vertebrae, with the limits of the intrapleural approaches. The anterior approaches, including the presternocleidomastoid cervicotomy eventually associated to the sterno-claviculotomy, expose the anterior portion of the cervical and the upper thoracic vertebrae up to T4. We believe that the PLEA performs the greater surgical exposure with minimal risk of vasculonervous damage. Among the anterior approaches, the simple cervicotomy is the most indicated procedure in case of patients with certain anatomical conditions
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