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Hat die Navigation in der Traumatologie noch einen Stellenwert?
No full textHintergrund
Navigationssysteme sollen die Präzision erhöhen und den Operateur bei der Durchführung bestimmter Eingriffe unterstützen. Unterschieden werden eine bildbasierte und eine bildfreie Navigation. Bildbasierte Verfahren beruhen auf 2‑D- bzw. heutzutage meist auf 3‑D-Systemen. Bei der bildfreien Navigation wird u. a. der 3‑D-Druck eingesetzt.
Indikationen
In der Literatur existieren zahlreiche Studien zu Navigationsverfahren in der Unfallchirurgie. Während sich die Navigation in der Extremitätenchirurgie nicht durchsetzen konnte, ist der Einsatz der 3‑D-Navigation in der Becken- und Wirbelsäulenchirurgie etabliert. Vor allem bei Frakturen des hinteren Beckenringes (SI-Verschraubung) und bei dorsalen Stabilisierungsoperationen der Halswirbelsäule wird die Navigation regelmäßig angewendet.
Voraussetzungen
Um die Navigation optimal einsetzen zu können, sollte die Lernkurve abgeschlossen sein und die Technik regelmäßig angewendet werden. Zudem sollte der Chirurg die Operationstechnik sicher in konventioneller Technik beherrschen, um potenzielle Fehler der Navigation zu erkennen.
Vor- und Nachteile
Vorteile sind neben der erhöhten Patientensicherheit, die reduzierte Strahlenbelastung sowie eine geringere Invasivität chirurgischer Eingriffe. Als Nachteile sind unter ökonomischen Gesichtspunkten u. a. die hohen Anschaffungskosten anzuführen.Background
Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing.
Indications
There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine.
Requirements
To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation.
Advantages and disadvantages
Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high
Long-term Quality of Life after Fusion of the Ventral Thoracic and Lumbar Spine
No full textAbstract Background Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Material and Methods Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Results Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Conclusions Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation.Abstract Background Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Material and Methods Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Results Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Conclusions Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation
Revealing the potential: radiological assessment of pedicle screw placement in the craniocervical junction and upper cervical spine
No full textAbstract Purpose Instabilities of the craniocervical junction and the upper cervical spine may necessitate dorsal spinal stabilization to prevent neurological complications, deformities and pain. Among the options available, the implantation of mass or pedicle screws is considered. This study aims to assess the feasibility of pedicle screw placement based on anatomical considerations and its clinical significance. Methods A retrospective analysis was conducted on 210 patients who underwent cervical spine CT scans at a University Medical Center. Pedicle dimensions of the first cervical vertebra and the third to fifth cervical vertebrae were measured bilaterally. The primary endpoint was a pedicle height and width greater than 4 mm, with secondary endpoints including sex-specific and age-specific differences. Results Results indicate that approximately 50% of patients had a pedicle height greater than 4 mm in the first cervical vertebra, while for the third to fifth cervical vertebrae, most patients (77.1–100%) had both pedicle height and width exceeding 4 mm. Notably, a significant gender disparity was observed in the pedicle height of the first cervical vertebra, with female patients achieving the required pedicle height in only 39.5% and 29.1% of cases, respectively. Conclusion In conclusion, while pedicle screw placement is feasible in every second patient based on the pedicle height of the first cervical vertebra, gender-specific differences must be considered during preoperative planning. In contrast to C1, pedicle screw placement is possible in 70 to 100% of patients in C3 to C5. These findings underscore the importance of individualized treatment strategies in spinal stabilization procedures
Biomechanical Effects of a Cross Connector in Sacral Fractures – A Finite Element Analysis
Full text linkBackground: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated ( p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated ( p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.Open-Access-Publikationsfonds 202
The influence of pelvic tilt on sacral insufficiency fracture occurrence: Insights into the prevalence of high pelvic tilt among patients affected
No full texthttp://dx.doi.org/10.13039/501100003385 Georg-August-Universität Göttinge
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