scholarly journals THE USE OF NITINOL RODS IN SURGICAL TREATMENT OF DEGENERATIVE SCOLIOSIS. 2.5-YEAR FOLLOW-UP

2016 ◽  
Vol 15 (1) ◽  
pp. 22-25
Author(s):  
Natalia Sergeyevna Morozova ◽  
Dmitriy Aleksandrovich Kolbovsky ◽  
Arkadiy Ivanovich Kazmin ◽  
Sergey Vasilievich Kolesov
Keyword(s):  
Surgical Treatment ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Control Group ◽  
Rigid Fixation ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbosacral Region ◽  
Pedicle Fixation

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

scholarly journals Surgical treatment of kyphosis in children with scheuermann’s diseaseusing 3D-CT navigation

2015 ◽  
Vol 3 (1) ◽  
pp. 5-14
Author(s):  
Sergei Valentinovich Vissarionov ◽  
Dmitriy Nikolaevich Kokushin ◽  
Sergei Mikhailovich Belyanchikov ◽  
Vladislav Valerievich Murashko
Keyword(s):  
Surgical Treatment ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
3D Ct ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease ◽  
Transpedicular Fixation ◽  
Long Term Follow Up

The purpose of the study is to describe features of the surgical technique for correction of kyphotic deformity of the spine and to analyze the results of surgical treatment of juvenile kyphosis in children with the use of 3D-CT navigation.— Materials and methods. We observed 11 patientsaged 14-17 years old (2 girls and 9 boys) with kyphoticdeformity of the spine, developed on the backgroundof Scheuermann’s disease. The deformity amount aver-aged 73,9° (60 to 90°). Surgery was performed fromthe combined access, carring out discapophysectomyand corporodesis on top of kyphosis and fixing mul-tibasic corrective metal construction. For the insertionof pedicle screws we used 3D-CT navigation.— The results. After surgery kyphosis value decreasedto 32,6° (20 to 45°), the deformity correction averaged41,3° (30 to 50°). Hybrid systems were placed in 5 pa-tients, total transpedicular fixation - in 6 children.Number of fixed vertebrae with hybrid metal construc-tions averaged 14 (13 to 15), in patients with total pediclefixation - 13 (12 to 14). In all cases we observed the correct position of pedicle support elements. Postopera- tive follow-up period was from 1 year and 5 months to5 years and 4 months, on average - 3 years 5 months. The loss of the result achieved in the long-term follow- up period was observed in patients with hybrid metal constructions and averaged 7,2° (4 to 9°).— Conclusion. The use of pedicle screws for thecorrection of juvenile kyphosis in children allows forthe effective correction of the deformity, restoring thephysiological profiles of the spine, eliminating post-operative progression of curvature, and reducing thelength of metal fixation and save the result achievedin the long-term follow-up. The use of active optical3D-CT navigation allows carring out a correct inser-tion of pedicle screws in the vertebral bodies in chil-dren with juvenile kyphosis.— Keywords: Scheuermann’s disease, juvenile ky-phosis, transpedicular fixation, navigation, children,surgical treatment.

scholarly journals Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

2021 ◽  
Author(s):  
Cesare Faldini ◽  
Francesca Barile ◽  
Fabrizio Perna ◽  
Stefano Pasini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Mechanical Complication ◽  
Non Union ◽  
Implant Retention ◽  
Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

2021 ◽  
pp. 1-10
Author(s):  
Ki Young Lee ◽  
Jung-Hee Lee ◽  
Kyung-Chung Kang ◽  
Sang-Kyu Im ◽  
Hae Seong Lim ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Patient Factors ◽  
Rod Fracture ◽  
Cobalt Chrome

OBJECTIVERestoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.METHODSThe authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.RESULTSThe overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.CONCLUSIONSGreater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD surgery.

scholarly journals The treatment of chronic periodontitis by non-surgical periodontal therapy in association with diode laser compared to conventional non-surgical therapy

2020 ◽  
Author(s):  
Bellia Loredana ◽  
Ruggiero Roberta ◽  
Nicolò Michele
Keyword(s):  
Surgical Treatment ◽  
Diode Laser ◽  
Surgical Therapy ◽  
Test Group ◽  
Control Group ◽  
Probing Depth ◽  
Baseline Test ◽  
Mechanical Therapy ◽  
Non Surgical Treatment

Mechanical surface treatment and removal of the above and subgingival biofilm (Tartar ablation; SRP) are considered the most suitable tools for the treatment of periodontal inflammatory diseases, with the aim of destroying bacterial bioflim, reducing bacteria, and slowing down recolonization by pathogenic microorganisms. Often, however, the only S&RP are not enough, as there are patients who are experiencing relapses. Recently, laser therapy has been suggested as a potential tool to improve the outcome of periodontal non-surgical treatment. The objective of the following study was to evaluate the clinical healing of periodontal pockets treated with mechanical therapy, scaling and root planing, and diode laser application, compared to that obtained with non-surgical mechanical therapy alone. The study was designed as a randomized controlled clinical trial. Patients in the control group (13 patients) underwent conventional non-surgical therapy only, while patients in the test group (17 patients) were associated with conventional non-surgical treatment, a laser irradiation session. At baseline and after 6 months, the parameters of probing depth (PD), bleeding on probing (BOP), gingival recession (REC) were assessed The main variable of this study was the PD (probing depth) FMPS and FMBS at follow-up improved in both groups. The FMPS baseline test group 32.59 ± 6.74 - follow up 12.00 ± 3.16. The baseline of the control group showed 33.00 ± 9.55, the follow up 13.15 ± 4.85 The FMBS baseline test group found 24.29 ± 5.01 while at follow 9.65 ± 2.69. The baseline control group 30.31 ± 7.74, Follow up 11.08 ± 2.33. There is a statistical significance. (P.VALUE 0.0001) There were no significant differences between the groups in terms of PD, CAL and BOP at baseline and at follow-up. PD Test group 4,89±1,58 3,95±0,85 0,0001 Control group 5,02±1,57 4,01±0,86 CAL (mm)Test group 0,89±2,29 0,77±1,91 Control group 0,28±1,38 0,24±1,14 REC Test group 0,19±0,49 0,19±0,51 Control group 0,06±0,29 0,57±029 BOP Test group 51,2% 23,5% Control group 54,0% 20,9% The results showed differences in both baseline and follow-up for REC. Test group 0,19±0,49 0,19±0,51-Control group0,06±0,29 0,57±029 In intra-group analyzes, there are differences between baseline and follow-up for all values, except for REC in the control group. The diode laser can be used as an appropriate device for periodontal treatments, but it can offer additional and significant benefits if used according to appropriate protocols and parameters, and especially if associated with non-surgical, manual and ultrasound periodontal instrumentation, always site-specific , as it is a tool that does not replace traditional methods.

scholarly journals Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients

2018 ◽  
Vol 9 ◽  
pp. 215145851775051 ◽  
Author(s):  
Franz Müller ◽  
Michael Galler ◽  
Christina Roll ◽  
Bernd Füchtmeier
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Treatment ◽  
Geriatric Patients ◽  
Femoral Fractures ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Postoperative Phase ◽  
High Morbidity ◽  
Proximal Femoral Fractures

Introduction: The surgical treatment of proximal femoral fractures predominantly involves geriatric patients and is associated with high morbidity and mortality. However, analyses on postoperative infections or hematoma are rare. Methods: Patients requiring surgical revision due to infection (n = 90) or hematoma (n = 77) in the postoperative phase were identified from an electronic database of 2000 consecutive patients surgically treated for proximal femoral fractures between 2006 and 2014. Demographic and clinical data were retrieved, including information on the pathogens in patients with infection. A follow-up on morbidity and mortality was conducted via telephone for at least 2 years postsurgery. Results: The follow-up rate was 100%, and the mean age was 81.9 years. The incidence rate of infection was 4.1% (90/2000), and women were commonly affected. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly detected pathogens (35.5% and 25.5%, respectively). Mixed infections were observed in 15 patients, and Methicillin-resistant Staphylococcus aureus infections were observed in only 4 patients. A total of 77 (85.6%) infections occurred within 30 days postsurgery. The implant was preserved in 76 (84.4%) patients, and resection arthroplasty was required in 14 patients. Dementia and pertrochanteric fractures were significantly more common in the infection than in the hematoma group. Although infections were associated with high mortality rates for up to 2 years postsurgery, the rates did not significantly differ from those in the hematoma control group. Conclusion: One of every 2 patients who developed an infection following the surgical treatment of a proximal femoral fracture died within 2 years postsurgery. In addition, infections were significantly associated with dementia. Avoiding postoperative infection should be a high priority in the surgical treatment of proximal femoral fractures.

Prone Transpsoas Technique for Simultaneous Single-Position Access to the Anterior and Posterior Lumbar Spine

2020 ◽  
Vol 20 (1) ◽  
pp. E5-E12 ◽  
Author(s):  
Luiz Pimenta ◽  
William R Taylor ◽  
Lauren E Stone ◽  
Arvin Raj Wali ◽  
David R Santiago-Dieppa
Keyword(s):  
Interbody Fusion ◽  
Spinal Column ◽  
Early Experience ◽  
Anterior Column ◽  
Posterior Decompression ◽  
Severe Stenosis ◽  
Representative Case ◽  
Pedicle Fixation ◽  
Anterior Correction

Abstract BACKGROUND Effective decompression, arthrodesis, and correction of spinal conditions frequently utilize operative approaches that expose both the anterior and posterior spinal column. Until now, circumferential spinal column access often requires the surgeon to reposition and drape the patient multiple times or utilize a posterior only approach that has limited anterior correction capability or to utilize a lateral-only approach that complicates otherwise traditional posterior surgical maneuvers. OBJECTIVE To describe a technique utilizing a single surgical position that enables minimally disruptive anterior column correction with simultaneous access to the posterior spinal column. METHODS The operative technique for accessing the lateral lumbar interbody space from a prone transpsoas (PTP) approach is described. The rationale for this approach and a representative case example are reviewed. RESULTS The PTP approach was used to perform an L3-4 and L4-5 interbody fusion in a 71-yr-old female with spondylolisthesis, severe stenosis, and locked facets. The PTP approach enabled efficient completion of an anterior column correction, direct posterior decompression, multi-segment pedicle fixation, and maintenance of alignment, all while in a single prone position. There were no intraoperative or postoperative complications. CONCLUSION The authors’ early experience with the described PTP technique suggests it is not only feasible but offers some advantages, as it allows for single-position surgery maximizing both anterior and posterior column access and corrective techniques. Further follow-up studies of this technique are ongoing.

scholarly journals Threaded cortical bone dowels for lumbar interbody fusion: technique and short-term results

1999 ◽  
Vol 7 (6) ◽  
pp. E8 ◽  
Author(s):  
Bryan Barnes ◽  
Mark R. McLaughlin ◽  
Barry Birch ◽  
Gerald E. Rodts ◽  
Regis W. Haid
Keyword(s):  
Cortical Bone ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Posterior Lumbar Interbody Fusion ◽  
Low Back ◽  
Lumbar Interbody Fusion ◽  
Nerve Root Injury ◽  
Satisfactory Outcome ◽  
Bone Dowels

The authors retrospectively reviewed a series of cases involving mechanical low-back or disogenic pain; 35 patients underwent lumbar interbody fusion in which threaded cortical bone dowels (TCBDs) were placed to treat degenerative disc disease. The series was composed of 18 females, and 17 males whose mean age was 46 years (range 17-76 years). There were nine smokers in the group. All patients presented with symptoms consistent with mechanical low-back or discogenic pain, and magnetic resonance imaging–documented degenerative changes and disc collapse greater than 50%, as compared with the adjacent normal-appearing level, were confirmed. Twenty-three patients underwent a posterior lumbar interbody fusion (PLIF) procedure for placement of the TCBD, whereas 12 underwent an anterior lumbar interbody fusion (ALIF) procedure for placement of the TCBD. In all patients undergoing PLIF procedures pedicle screw and rod constructs were used without posterolateral fusion except one. In all cases of ALIF except one TCBDs were used as “stand-alone” devices without supplemental fixation. All TCBDs were packed with morselized cancellous autograft prior to implantation. The success of fusion was determined at follow-up intervals and was defined as: the absence of lucency around the TCBD; an increase in subchondral endplate sclerosis; and the presence of bridging bone incorporating the anterior bone graft as demonstrated on static lumbar radiographs and/or computerized tomography scans. Stability was also determined by an absence of movement on dynamic lumbar radiographs. The degree of lumbar lordosis at the diseased level was measured immediately postoperatively and compared with the change in lordosis at follow up. Outcomes were assessed using a modified Prolo outcome scale and rated as excellent, good, fair, or poor. Excellent and good outcomes were considered satisfactory; fair or poor outcomes were considered unsatisfactory. In 27 patients radiographic and clinical follow-up results were considered adequate (nine ALIF and 18 PLIF patients). The mean follow-up duration was 7.9 months. Overall satisfactory outcome was 70%: a 77% satisfactory outcome in PLIF patients and a 55% in ALIF patients. Osseous fusion was present in 94% of the patients in the PLIF group and in 33% of those in the ALIF group. Complications included one L-5 nerve root injury and two postoperative wound infections, all in patients who underwent PLIF; there was also a case of breakout of one implant at 8 months postoperatively. The degree of vertebral body angulation measured at last follow up compared with the measurement obtained immediately postoperative was 3.4° of kyphosis in the ALIF group and 3.1° of kyphosis in the PLIF group, which represented an 11% and 9% loss of lordosis, respectively. Preliminary results indicate that there is a dramatically higher fusion rate in PLIF compared with ALIF procedures in which TCBDs are used. There is a corresponding trend seen in patient outcomes, but no distinct difference seems apparent in terms of restoration of lordosis when performing either procedure. The results suggest that TCBDs may best be used in PLIF procedures in conjunction with pedicle screws and rod constructs. Moreover, in patients in whom TCBDs and supplemental tension band constructs are used fusion rates appear to be comparable with those reported in other series but at a faster rate (94% at 7.9 months mean follow up). Longer follow-up periods and a larger series of patients are needed to confirm these preliminary observations.

scholarly journals Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

2016 ◽  
Vol 25 (6) ◽  
pp. 697-705 ◽  
Author(s):  
Russell G. Strom ◽  
Junseok Bae ◽  
Jun Mizutani ◽  
Frank Valone ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Leg Pain ◽  
Sagittal Imbalance ◽  
Hybrid Strategy ◽  
Lateral Interbody Fusion ◽  
Lateral Interbody

OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.

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