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Objective To investigate the clinical efficacy of one-stage posterior percutaneous transpedicular screw fixation combined with lateral anterior approach for focus debridement bone graft fusion in the treatment of lumbar tuberculosis(TB).Methods Eighty-seven cases of lumbar tuberculosis treated by operation respectively adopted the one-stage anterior and posterior combined approach operation(group A) and simple lateral anterior approach operation(group B).The levels of CRP and ESR,Cobb angle,ODI score and Frankl score before and after surgery were statistically analyzed,and operation situation was analyzed in the two groups.Results The operation time and intraoperative bleeding volume in the group A were significantly more than those in the group B(P＜0.05),but there was no statistically significant difference in average hospitalization time between the two groups(P＞0.05).All cases were postoperatirely followed up for average (20.30-4-3.70) months.The levels of ESR and CRP,ODI score,Frankel score and Cobb angle after operation and at last follow up in the two group were significantly improved compared with before operation(P＜0.05).The bone graft healing time in the group A was significanlly shester than that in the group B.Conclusion Posterior approach fixation combined with anterior approach debridement operation has the advantages of less trauma,fixation stability and high bone healing rate for treating lumbar tuberculosis.
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Objective:To investigate the surgical outcome of one-stage combined anterior and posterior ap-proach for severe thoracolumbar and lumbar spine fracture.Method:A total of 62 cases suffered from severe thoracolumbar and lumbar spine fracture undergoing surgery from Jan 2003 to Jan 2008 were reviewed retro-spectively.Of these,there were T11 involved in 2 cases,T12 in 13 cases,L1 in 28 cases,L2 in 10 cases,L3 in 6 cases and L4 in 3 cases.There were 58 fresh fractures and 4 old fractures.Based on Dennis classifica-tion,12 were compression fracture,33 were burst fracture and 17 fracture dislocation.All cases had spine load score≥7 and TLICS score≥5.Of 19 cases with neurological deficit according to Frankel grade,there were 7 A,5 B and 7 C.Combined anterior and posterior approach was performed in all cases,anterior bony graft plus posterior pedicle instrumentation were performed either,of these,52 cases had additional anterior decompres-sion.Result:All operations were performed successfully,with the mean surgical time of 170min (range, 150-210min) ,the average blood loss was 819ml(range,400-2900ml).No iatrogenic neuroinjury,skin infection, dural matter tearing and graft displacement were noted.The preoperative Cobb's angle was 8°-40°(mean, 23.9°), while the postoperative counterpart returning to normal with 5 cases having 2°-10° kyphosis.The preoperative compression rate was 20%-95%(mean,54.5%),while the postoperative counterpart returning to normal in 47 cases,with 15 cases having 2%-30%.The preoperative canal stenosis rate was 5%-90%(mean,51.1%) while the postoperative counterpart was 0-30%(mean,4.7%),which showed significant difference with regarding to these 3 parameters (P<0.05).All cases were followed up for an average of 31 months (range,12-72 months). Bony fusion was evidenced in cases undergoing anterior bony graft.At 10-12 months, the Cobb's angle was 0°-15°(mean,0.62°) ,the vertebral compression rate was 0-30%(mean,4.6%),no significant difference were noted between them and their postoperative counterparts(P>0.05).At final foUow-up,15 of 19 cases with neu-rological deficit had neurofunction improved,while 4 remained unchanged.According to our hospital criteria,of 43 cases with no neurological deficit,there were 30 excellent,9 good,3 fair and 1 bad with the total excel-lent to good rate of 90.6%.Cage subsidence and pedicle screw breaking was noted in 1 case,who developed severe kyphosis presenting with irreducible back pain.Conclusion:One-stage combined anterior and posterior approach for severe thoracolumbar and lumbar spine fracture can ensure three column stability as well as complete decompression,which has good early outcome.
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PURPOSE: To compare the clinical and radiological results between the anterior and posterior screw fixation for the treatment of talar neck fracture. MATERIALS AND METHODS: Among 30 patients who received surgical treatment for talar neck fracture from 2001 to 2008. Twenty-seven patients with a follow-up period of more than 1 year were divided into two groups. Twelve patients were treated with anterior screw fixation and 15 patients with posterior approaches. We analyzed preoperative, postoperative and follow-up radiographs. Clinical results were evaluated by Hawkins criteria. RESULTS: The posteriorly inserted screws were placed across the more central portion of the talar neck and perpendicular to the plane of fracture (p<0.05). There were no difference in clinical results, the duration of union, and complications including avascular necrosis between two groups. However, 2 patients complained of pain around the talonavicular joint in the anterior insertion group. CONCLUSION: Although the clinical results were good irrespective of insertion methods, the posterior approach of screw fixation for talar neck fractures allows for a better mechanical advantage than anterioly placed screws. This may allow early motion with a reduced risk of failure of fixation or of displacement of the fracture.
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Humans , Displacement, Psychological , Follow-Up Studies , Imidazoles , Joints , Neck , Necrosis , Nitro Compounds , TalusABSTRACT
OBJECTIVE: The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach (discectomy and fusion) and posterior approach(open-door laminoplasty) in the treatment of cervical spondylotic myelopathy. METHODS: The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association (JOA) score and then the cervical curvature, change of spinal canal to vertebral body(SC/VB) ratio and canal widening were measured and compared to the clinical symptoms. RESULTS: The mean JOA score increased from 10.4+/-3.1 preoperatively to 14.8+/-1.2 at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios (average 0.70+/-0.08 before surgery to 1.05+/-0.12 after surgery) and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8 mm, 116.61 mm2. CONCLUSION: Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.
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Animals , Humans , Asian People , Decompression , Follow-Up Studies , Lordosis , Neck , Pathology , Postoperative Complications , Radiography , Spinal Canal , Spinal Cord , Spinal Cord DiseasesABSTRACT
Objective To evaluate the clinical results of one stage ante rior and posterior approach in the treatment of severe lower cervical injury. Me thod 8 cases of severe lower cervical injury underwent reduction, decompression and fixation through one stage anterior and posterior approach. 6 cases had fra cture and dislocation of cervical spine, and 2 cases cervical spine burst fractu re with cervical stenosis. Their clinical and radiographic records were reviewed retrospectively. Results Follow-ups of a mean period of 14 months showed that satisfactory recovery of neurological function was achieved. The Frankel Grade w as A in 7 cases and B in 1 case before operation, but D in 2 cases, C in 3 cases , and B in 1 case after operation except in 2 cases who had no improvement and r emained A. X-ray film demonstrated satisfactory stabilization of the fracture a nd dislocation, complete fusion of autograft, and preservation of the normal int ervertebral height and cervical lordosis. Conclusion One stage anterior and post erior approach operation is essential, safe and effective when radiographs demon strate that lower cervical canal is compressed from both anterior and posterior directions and clinical symptoms show severe neurological defects.
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The authors report two cases of giant cell tumor in the lumbar spine. Giant cell tumor in the spine is histologically malignant tumor and recurrence is often even after the surgical excision. Two case of spinal giant cell tumor received total excision of the tumor with wide fixation. We have been following up and observing the two cases of patients with surgically treated giant cell tumor. From the two cases of experience, we could not find any recurrence of the tumor after operation and got the good clinical result with anterior and posterior fixation.
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Humans , Giant Cell Tumors , Recurrence , SpineABSTRACT
PURPOSE: To report the results of a combined anterior and posterior approach to complex acetabular fractures and establish the guidelines for the operative treatment of complex acetabular fractures. MATERIALS AND METHODS: Thirteen fractures (8 both column, 5 T-shaped fractures) of thirteen patients (8 men, 5 women) were treated with this combined anterior and posterior approach from August 1995 to December 1999. We reviewed the clinical and radiological results for an average of 33months (range, 12-60) follow-up. RESULTS: This approach resulted in an anatomical reduction in ten (78%) patients and, two imperfect and one poor reduction. The average Harris hip score was 69.2 (range, 58-87) and the clinical results were good in eleven, very good in one and poor in one patient using the D'Aubigne/Postel clinical grading. A poor reduction occurred in one patient who had a both column fracture that extended to the ipsilateral sacroiliac joint combined with a joint subluxation. CONCLUSION: Overall clinical results for most complex acetabular fractures treated by a combined anterior and posterior approach were preferable to other approaches, but we must consider an extensile or extended ilioinguinal approach to be an alternative surgical approach in this complicated fracture that involves the sacroiliac joint.
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Humans , Male , Acetabulum , Follow-Up Studies , Hip , Joints , Sacroiliac JointABSTRACT
STUDY DESIGN: This case report presents a rare case of pre-sacral giant schwannoma which originates from the S1 nerve root. OBJECTIVES: To discuss a surgical approach for removal of pre-sacral giant schwannoma and review the pertinent literatures. SUMMARY OF LITERATURE REVIEW: Pre-sacral tumors are unusual neoplasms that cause approximately one in 40,000 hospital admissions. Schwannoma represents only a small fraction of the many types of tumors that may be present in this region. Less than 1% of all spinal schwannomas occur in the sacrum. The treatment of this lesion is complete removal, which is curative. MATERIALS AND METHODS: A 46-year-old woman developed gradual back pain and radiating pain on her left lower extremity for about a year. There was no noted improvement with the use of conservative treatment. T1-weighted sagittal MRI reveals a large homogeneous low-signal intensity mass on left pre-sacral area and intrasacral extension of the tumor forming a dumbbell shaped mass. RESULTS: The tumor was completely removed by a combined anterior and posterior approach. The excised mass was cylindrical, measuring 8x4x3cm in size, which had originated from the S1 nerve root. It was histologically diagnosed as benign schwannoma. Satisfactory result was obtained after the complete removal of the mass. CONCLUSIONS: We report a case of the successful and complete removal of a pre-sacral giant schwannoma and the affected nerve root through a combined anterior and posterior approach.