ABSTRACT
OBJECTIVE: In a variety of thoracolumbar diseases, corpectomy followed by interbody bone graft and anterior instrumentation has allowed direct neural decompression and reconstruction of the weight-bearing column by short segments fusion. In this study, we compared spinal stability of the two different anterior thoracolumbar instruments : Z-plate and Kaneda device representing plate and two-rods type, respectively. METHODS: A retrospective review was performed for all the patients with thoracolumbar diseases or traumas treated with anterior corpectomy, autologous iliac bone graft, and fixation with instruments from 1996 to 2000. For the anterior instrumentation, Z-plate or Kaneda device was used for 24 (M:F=5:9, average age=37) and 12 (M:F=9:3, average age=41) patients, respectively. The plain AP and lateral flexion-extension films were taken immediately after surgery and at each follow-up. The sagittal and coronal Cobb's angles at the operation segments were used to observe the change of initial fixation status. The surgical time length and bleeding amount of the two groups were compared. Intra-operative and post-operative instrumentassociated complications were evaluated. Student t-test was used for statistical analysis and p-value less than 0.05 was considered to be significant. RESULTS: Mean follow-up durations for Z-plate and Kaneda device were 24 and 21 months, respectively. The fusion rate was 91% for Z-plate and 100% for Kaneda device. Two cases of Z-plate group showed instrumentation failure during the followup period, in which additional surgery was necessary. The mean differences of sagittal Cobb's angles among the AP images immediate after surgery and at follow-up were 7 and 2 degrees for Z-plate and Kaneda device, respectively (p<0.05). The mean differences of coronal Cobb's angles were 5 and 2 degrees for Z-plate and Kaneda device, respectively (p<0.05). No intra-operative complication has occurred in both groups. There was no difference in surgery time and bleeding amount between two groups. CONCLUSION: We think that Kaneda device (rod type) is stronger than Z-plate (plate type) to keep the spinal stability after anterior thoracolumbar surgery.
Subject(s)
Humans , Decompression , Follow-Up Studies , Hemorrhage , Operative Time , Retrospective Studies , Transplants , Weight-BearingABSTRACT
Among the 98 patients who underwent operations for thoracolumbar spinal lesions from May 1989 to September 1994, the authors performed clinical analysis of 72 patients who were followed-up for more than 12 months. There were 52 cases of trauma, 18 cases of tuberculous spondylitis, and 2 cases of metastatic tumor. After partial or toal vertebrectomy, interbody fusion was performed using autogenous iliac bone or autogenous ribs which were taken while approaching the thoracic spine, and stabilized using Kaneda devices. Complete neural decompression was possible under direct vision in all cases. Neurologic deficits improved to an average of 1.7 grades using a modified Frankel scale. Patients with tuberculous spondylitis did not show recurrence or any evidence of increased risk of secondary infection caused by instrumentation. Loosening or breakdown of instruments occurred in 4 patients, and spinal deformity in 7 patients, but reoperation was not needed in any of these patients. By anterior decompression, interbody fusion and stabilization using Kaneda device in thoracolumbar spinal lesions, we could obtain satisfactory neurologic improvement as well as immediate firm stability and high fusion rate involving only a minimum(usually two) number of motion segments as compared with the posterior approach.
Subject(s)
Humans , Coinfection , Congenital Abnormalities , Decompression , Neurologic Manifestations , Recurrence , Reoperation , Ribs , Spine , SpondylitisABSTRACT
The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.
Subject(s)
Humans , Conus Snail , Decompression , Early Ambulation , Lumbar Vertebrae , Spinal InjuriesABSTRACT
The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.
Subject(s)
Humans , Conus Snail , Decompression , Early Ambulation , Lumbar Vertebrae , Spinal InjuriesABSTRACT
Recently anterior spinal device(Kaneda device) for the treatment of the unstable spine has been used. We have experienced 33 patients of the unstable thoracolumbar spine, which were composed of 24 cases with burst fracture, 1 case with kyphotic angulation, and 8 patients with tuberculous spondylitis. These 33 patients were treated with and one stage anterior operation consisting of anterior decompression by vertebrectomy and diskectomies, and interbody fusion using autogenous ribs or iliac bone realigment and stabilization with Kaneda device. No patient showed neurologic deterioration after surgery. Follow-up periodes was 6 months to 2.5 years. The anterior spinal instrumentation with Kaneda deviced affored enough stability to enable early ambulation with good aligment and solid fusion.
Subject(s)
Humans , Decompression , Diskectomy , Early Ambulation , Follow-Up Studies , Ribs , Spine , SpondylitisABSTRACT
Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.