ABSTRACT
In present need to fuse bony elements of the spine. Autologous bone from the iliac crest or rib is often used for these purposes but harvesting this bone necessitates the removal of the graft from another site. Moreover, grafts of autogenic bone may be resorbed to a significant degree with time. These shortcomings have provided the impetus for the use of bone substitutes in spinal surgery. We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with postero-lateral fusion with synthetic bone substitute in thoraco-lumbar burst fracture.We enrolled 48 patients with thoraco-lumbar burst fractures for treatment with short-segment pedicle screw fixation. Group A [n = 23] were reinforced with postero-lateral fusion with synthetic bone substitute during surgery. Group B [n = 25] underwent pedicle screw fixation and postero-lateral fusion with cancellous iliac bone graft. The radiographic and clinical results were compared between the two groups. In both groups, no significant difference in terms of solid bony fusion or clinical symptoms or radiological evidences of spinal instability. Patients in group A had short duration of surgery, less blood loss and short hospital stay as compared to patients in group B. The Frankel performance scale scores increased by nearly one in both groups. Group A had more patients with no pain, minimal or occasional pain [grade P1 or P2] than group B [86% [n = 20] vs. 44% [n = 11]]. One patient [4.3%] of group A and 6 patients [24%] of group B had severe and constant pain [grade P4, P5] [P < 0.001, two tailed Fischer's exact test]. The synthetic bone substitutes are effective graft materials in postero-lateral thoraco-lumbar spine fusion. They are available in unlimited quantities and associated with no donor site morbidity
ABSTRACT
Variations in the morphometry of the vertebral artery groove which presents on the superior surface of surgery. This necessitates preoperative information about the vertebral artery groove. The present study aimed at assessment of the quantitative and qualitative anatomy of the vertebral artery groove of the atlas on 76 dry specimens with comprehensive analysis. This included the study of different linear parameters of the vertebral artery groove such as the distance from the midline, the thickness, the depth of the lateral and medial entrances, the depth of the transverse foramen and the width of the transverse foramen. In addition, the different forms of posterior and lateral bridging over the groove and their percentages were assessed. It was found that the minimum distance from the midline to the medial most edge of the vertebral artery groove in the inner and outer cortex of the posterior arch were 5 and 15 mm respectively. These data suggested that dissection of the posterior aspect of the posterior arch should remain 5 and 15 mm on the inner and outer cortex from the midline. It was also found that 44 [57.96%] of the examined specimens presented with a bridge formation which projects over the vertebral artery groove. From these 44 atlas presented with a bridge formation, 42 [55.26%] presented with partial bridges and 2 [2.63%] presented with complete posterior bridges. These bridges may interfere with the normal function of vertebral artery. It was concluded that before any craniovertebral intervention is performed, collection of the morphometric data of the vertebral artery groove must be carried out