Lateral Extracavitatory Approach With Circumspinal Decompression In Tuberculous Spondylitis: A 5 Year Follow–Up Study

Introduction:Spinal tuberculosis has been managed with various modalities of treatment ranging from only antituberculous drugs to radical surgical extirpation. Opinion is divided on management of Potts Paraplegia with respect to surgical approach to the lesion. Results are conflicting on anterior verses posterior approaches as well combined approach. There is also confusion on to when to do anterior first or to operate from posterior first, in combined approaches. In the present study we present 10 year follow-up of our results, clinical and radiological outcomes, of Single stage Circumspinal decompression and pedicle screw fixation through lateral extracavitatory approach with anterior and posterior spinal fusion in cases of Pott's paraplegia.Methods:The study was a retrospective and prospective follow up of 30 patients with active tuberculosis of thoracolumbar spine with neurological deficit, who underwent posterior spinal instrumentation with lateral extra cavitatory approach with circumspinal decompression and pedicle screw instrumentation. Diagnosis of spinal tuberculosis was made by laboratory findings such as anaemia, elevated ESR, radiological features with typical MR imaging findings. 8 patients had multilevel involvement. Kyphosis of 250 to 550 was present. Circumspinal decompression, correction of kyphosis, anterior and posterior spinal fusion was performed in a single stage. The average follow up was 7.67 years (92 months).Results:The mean kyphosis angle improved from 320 preoperatively to 80 in early follow up, followed by a minor loss of correction of 30. Neurological recovery occurred in 28 patients out of 30 patients. 15 patients recovered from Asia Ato AIS E. 13 patients recovered to ASIAD. The visual analog scale and ASIA grade improved in all the cases. Implant failure in the form of rod breakage was seen in 1 patient but with no neurological complications.Conclusion: Drainage of abscess, debridement by extracavitatory route constitutes a less demanding, relatively safe, minimally traumatic operative technique with adequate circumspinal decompression of spinal cord, correction and maintenance of sagittal balance with relatively less morbidity is the added advantage.

Single-Staged Transoral Intra-Lesional Excision of Aneurysmal Bone Cyst of Axis (C2) Vertebra and Temporary Stabilization of Upper Cervical Spine in an Adolescent: A Case Report

@#Aneurysmal bone cyst (ABC) infrequently occurs within the upper cervical vertebrae. Various therapeutic options have been reported in the literature. We would like to share our experience in managing a case of a 16-year-old girl diagnosed with ABC at the body of axis (C2) vertebra. Serious attention had to be given on the stability of the cervical spine following tumour resection, which can be affected by the mode of treatment chosen. Instability can have a detrimental effect on the cervical spine, in which case may necessitate further surgery. We performed a single-staged intra-lesional curettage via a transoral approach and temporary non-fusion posterior stabilization of C1 lateral mass screw and C2 pedicle screw. The implants were removed after six months once ossification of C2 has taken place to regain full motion of the neck. There was no evidence of recurrence or instability of the cervical spine three years following surgery.

Posterior instrumentation and fusion for treating ankylosing spondylitis combined with lower cervical fractures / 中华创伤杂志

Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures.Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013.There were 51 male and 2 female patients.The mean age of patients was 55 years old (range,34-69 years old).All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction.A total of 20 patients had neurological dysfunction at different extents.According to the American spinal injury association (ASIA) classification,neurological status was scored as Grade A in 4 cases,Grade B in 5,Grade C in 4 and Grade D in 7.The operation time,total bleeding and decompression status were recorded during the surgery.Reduction,decompression condition and complications were evaluated.The neurological status and bone fusion were recorded at the follow-up.Results All surgeries were well accomplished.Mean surgical time was 3.7 h (range,2.9-5.3 h).Mean total bleeding was 690 ml (range,470-1 600 ml).Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively).The mean follow-up time of other patients was 25 months (range,18-48 months).The CT scan manifested all patients achieved satisfactory fusion,and the mean time span of the fusion was 3.5 months (range,3-6 months) postoperatively.Among the 20 patients with various levels of neurological deficits before operation,the postoperative ASIA score was Grade A in 4 cases,Grade C in 2,Grade D in 4,and Grade E in 10.No instrumentation failure occurred during follow-up.Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results,spinal stabilization and clinical results,and hence an effective clinical problem-solving algorithm for such kind of patients.

Posterior instrumentation and fusion for treating ankylosing spondylitis combined with lower cervical fractures / 中华创伤杂志

Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures.Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013.There were 51 male and 2 female patients.The mean age of patients was 55 years old (range,34-69 years old).All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction.A total of 20 patients had neurological dysfunction at different extents.According to the American spinal injury association (ASIA) classification,neurological status was scored as Grade A in 4 cases,Grade B in 5,Grade C in 4 and Grade D in 7.The operation time,total bleeding and decompression status were recorded during the surgery.Reduction,decompression condition and complications were evaluated.The neurological status and bone fusion were recorded at the follow-up.Results All surgeries were well accomplished.Mean surgical time was 3.7 h (range,2.9-5.3 h).Mean total bleeding was 690 ml (range,470-1 600 ml).Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively).The mean follow-up time of other patients was 25 months (range,18-48 months).The CT scan manifested all patients achieved satisfactory fusion,and the mean time span of the fusion was 3.5 months (range,3-6 months) postoperatively.Among the 20 patients with various levels of neurological deficits before operation,the postoperative ASIA score was Grade A in 4 cases,Grade C in 2,Grade D in 4,and Grade E in 10.No instrumentation failure occurred during follow-up.Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results,spinal stabilization and clinical results,and hence an effective clinical problem-solving algorithm for such kind of patients.

Effects of different pelvic incidence minus lumbar lordosis mismatch after long posterior instrumentation and fusion for adult degenerative scoliosis / 中华外科杂志

Objective@#To evaluate the influence of PI-LL (pelvic incidence minus lumbar lordosis mismatch) on scoliosis correction, living quality and internal fixation related complications for adult degenerative scoliosis (ASD) after long posterior instrumentation and fusion.@*Methods@#A total of 79 patients with ADS underwent long posterior instrumentation and fusion in the Department of Orthopedics at Beijing Chao Yang Hospital from January 2010 to January 2014 were retrospectively reviewed.There were 21 males and 58 females aging from 55 to 72 years with the mean age (63.4±4.8)years. The patients were divided into three groups according to immediately postoperative PI-LL: PI-LL<10°, 10°≤PI-LL≤20°, PI-LL>20°.Compare the Cobb′s angles, PI-LL, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Lumbar Stiffness Disability Index (LSDI). Measurement data were compared via t test and ANOVA, enumeration data were compared via Kruskal-Wallis test, noncontiguous data was performed by χ2 test. Univariate linear regression equation was performed to investigate the relative influences of postoperative PI-LL on postoperative radiographic parameters and clinical outcome.@*Results@#All the operations were successful without intraoperative complications. The operation time was 145-310 minutes (235.3±42.0) minutes, the intraoperative blood loss was 300-5 300 ml (1 021±787) ml, the duration of hospital was 12-18 d (14.5±1.3) d. A total of 4 to 10 (7.0±1.1) vertebra levels were fused. Compared to preoperative, the Cobb′s angle of scoliosis ((4.2±1.8)° vs. (20.1±2.7)°), PI-LL ((16.1±8.6)° vs. (36.0±4.3)°), JOA (3.0±1.3 vs. 5.5±1.2), ODI (24.4±8.1 vs. 62.9±2.7), VAS (3.0±1.0 vs. 6.8±1.3) were significantly decreased postoperative (t=18.539~53.826, P<0.01). Compared to preoperative, postoperative Cobb′s angle of scoliosis ((4.1±2.7)° vs. (19.5±2.7)°, (4.0±1.4)° vs. (20.2±2.4)°, (4.7±0.9)° vs. (20.6±3.0)°) (t=21.148-45.355, P<0.01) and PI-LL ((5.2±2.8)° vs. (35.8±4.9)°, (17.9±2.9)° vs. (37.2±3.9)°, (25.8±2.7)° vs. (34.5±4.0)°) (t=7.227-38.250, P<0.01) were significantly reduced postoperative in PI-LL<10° group, 10°≤PI-LL≤20° group and PI-LL>20° group. Compared to preoperative, ODI (27.7±4.9 vs. 63.3±2.6, 17.7±5.9 vs. 63.1±2.8, 30.6±6.5 vs. 62.3±2.5) (t=21.218~50.858, P<0.01), JOA (2.8±1.2 vs. 5.2±1.2, 3.3±1.1 vs. 5.7±1.1, 2.8±1.7 vs. 5.7±1.2) (t=9.042-16.025, P<0.01) and VAS (2.9±1.2 vs.7.0±1.3, 3.3±0.9 vs.7.0±1.4, 2.9±0.8 vs. 6.3±1.2) (t=16.073-22.214, P<0.01) were all significantly reduced at last follow-up. There were statistic differences in ODI and LSDI (F=38.477, P<0.01; F=37.063, P<0.01) at the last follow-up among the three groups. There was a negative correlation in PI-LL and LSDI according to linear regression (B=-5.838, P<0.01) in the last follow-up. All the patients were followed up, the follow-up duration were 2 to 5 years with the mean (3.1±0.7) years. The internal fixation failure related complications in 3 years included proximal junctional kyphosis (PJK) in 19 cases, internal fixation loosening in 6 cases. Eight patients received reoperation for severe local pain and low extremity symptoms. PJK occurrences were significantly different among PI-LL<10° group, 10°≤PI-LL≤20° group and PI-LL>20° group.@*Conclusions@#The PI-LL between 10° and 20° may be the best choice in ADS patients after long posterior instrumentation and fusion for its better clinical outcome and less proximal junctional kyphosis (PJK). The overcorrection of LL may lead to more serious postoperative lumbar stiffness.

Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis: Preliminary Report

STUDY DESIGN: Retrospective clinical study. OBJECTIVES: To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. SUMMARY OF LITERATURE REVIEW: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders. MATERIALS AND METHODS: Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups. RESULTS: Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases. CONCLUSIONS: The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.

Management of Tuberculous Infection of the Spine

Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. It is primarily a medical disease and treatment consists of a multidrug regimen for 9-12 months. Surgery is reserved for select cases of progressive deformity or where neurological deficit is not improved by anti-tubercular treatment. Technology refinements and improved surgical expertise have improved the operative treatment of spinal tuberculosis. The infected spine can be approached anteriorly or posteriorly, in a minimally invasive way. We review the various surgical techniques used in the management of spinal tuberculosis with focus on their indications and contraindications.

Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

STUDY DESIGN: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. PURPOSE: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. OVERVIEW OF LITERATURE: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. METHODS: A total of 34 patients (13 men, 21 women), with a mean age of 56.65+/-9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. RESULTS: The average follow-up time was 35.05+/-8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. CONCLUSIONS: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.

Resultados del tratamiento de la escoliosis idiopática del adolescente mediante instrumentación posterior / Results of treatment of idiopathic scoliosis by posterior instrumentation

OBJETIVO: Analizar los resultados clínicos y radiológicos obtenidos tras el tratamiento quirúrgico de la escoliosis idiopática del adolescente mediante artrodesis posterior con diversos sistemas. MATERIAL Y MÉTODOS: Estudio retrospectivo de 25 pacientes intervenidos entre Enero de 2005 y Julio de 2012; con una edad promedio de 15 años. Las curvas se clasificaron según los 6 tipos de Lenke. Se intervino a los sujetos mediante una artrodesis instrumentada posterior. Se realizó una evaluación clínica mediante el cuestionario SRS-22 (Scoliosis Research Society). Así mismo, se realizó una evaluación radiológica prequirúrgica, posquirúrgica inmediata y al final del seguimiento. (Mínimo 1 año, máximo 8 años) RESULTADOS: Mediante el cuestionario SRS-22 se obtuvieron las siguientes puntuaciones medias: 4,84 en dolor; 4,68 en actividad; 4,68 en autoimagen; 4,60 en salud mental, y 4,92 en satisfacción. La corrección radiológica media posquirúrgica en las curvas torácicas fue del 56,4% y en las curvas lumbares fue del 54,4%, con una pérdida media de 7% al 15% al final del seguimiento. CONCLUSIÓN: La instrumentación y fusión posterior es una técnica eficaz y segura, con bajo índice de pseudoartrosis. Los resultados fueron excelentes en cuanto a todos los dominios del cuestionario SRS-22, se encontró asociación estadísticamente significativa entre el género y el dolor, no se evidenció significancia estadística entre el tipo de curva, el grado de corrección, la puntuación del cuestionario SRS-22 y el tipo de implante utilizado(AU)

OBJECTIVE: To analyze the clinical and radiological results obtained after surgical treatment of adolescent idiopathic scoliosis by posterior fusion with various systems. MATERIAL AND METHODS: Retrospective study of 25 subjects who underwent surgery between January 2005 and July 2012, The curves were classified according to the 6 types of Lenke. Subjects were operated by posterior instrumented arthrodesis. Clinical evaluation was performed using the SRS-22 questionnaire (Scoliosis Research Society). Likewise, preoperative radiological evaluation, immediate postoperative and final follow-up. RESULTS: Using the SRS-22 questionnaire obtained the following average scores: 4.84 for pain, 4.68 for activity, 4.68 in self-image, mental health 4.60, and 4.92 in satisfaction. The average postoperative radiological correction in thoracic curves was 56.4% and lumbar curves was 54.4%, with an average loss of 7% to 15% at follow-up. CONCLUSION: The posterior instrumentation and fusion is a safe and effective technique with low rate of nonunion. The results were excellent in all domains of the SRS-22 questionnaire, statistically significant association was found between gender and pain, showed no statistical significance between the type of curve, the degree of correction, SRS questionnaire score-22 and the type of implant used(AU)

Prevalence Rate of Osteoporosis in the Patients Who Underwent Posterior Instrumentation of Degenerative Lumbar Spine / 대한골다공증학회지

OBJECTIVES: To identify the prevalence rate of osteoporosis in the patients who underwent posterior instrumentation of degenerative lumbar spine and to identity the prescription rate of osteoporosis medication after operation, and to identify the importance of preoperative BMD. MATERIALS AND METHODS: This study was done with 354 patients who underwent posterior instrumentation of lumbar spine from January of 2006 to July of 2011. The patients were divided into 4 groups according to their pre-operative BMD, normal, osteopenia, osteoporosis (-2.5>T> or =-3.0) and severe osteoporosis (3.0>T). We evaluated the prevalence rate of osteopenia and osteoporosis and analyzed the prescription rate and treatment options of osteoporosis medication on the patients who underwent posterior instrumentation surgery within one year after surgery. RESULTS: BMD was performed on 85.5% of all patients. By group those with osteopenia were 85 patients, the osteoporosis group was 47 patients and the severe osteoporosis group included 30 patients. Among the osteopenia group, 7.0% were under osteoporosis treatment. Among the osteoporosis group, 74.5% were under osteoporosis treatment. Among the severe osteoporosis group, 83.3% were under osteoporosis treatment within 1 year, postoperatively. CONCLUSIONS: The prevalence rate of osteoporosis was 25.4% in the patients who underwent posterior instrumentation of degenerative lumbar spine. The correlation between the patient's preoperative bone mineral density and the stability of the instrumentation was significant. Therefore, determining the patient's BMD via preoperative DEXA is very important because it can decide the treatment methods for osteoporosis before the surgery and help advance the timing of the initiation of treatment.

Diastematomyelia in Adult: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report an adult patient with diastematomyelia. SUMMARY OF LITERATURE REVIEW: Diastematomyelia is an uncommon congenital malformation of the vertebral axis, characterized by a separation of the spinal cord with an interposed bony, cartilaginous or fibrous septum. Most of the patients present this condition in childhood. The cases in adulthood are extremely rare. MATERIALS AND METHODS: The authors experienced a 46-year old female patient with diastematomyelia presenting a gradual onset of neurologic claudication. We treated with decompressive laminectomy, septum removal and posterior instrumentation. RESULTS: We had satisfactory surgical results. CONCLUSIONS: We report an extremely rare case of diastematomyelia in adulthood.

Comparison of Surgical Outcomes in Thoracolumbar Fractures Operated with Posterior Constructs Having Varying Fixation Length with Selective Anterior Fusion

PURPOSE: Surgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used, however, but the number of levels to be instrumented still remains a matter of debate. MATERIALS AND METHODS: A total of 94 patients who had a single burst fracture between T11 and L2 were selected and were managed using posterior instrumentation with anterior fusion when necessary. They were divided into three groups as follows; Group I (n = 28) included patients who were operated by intermediate segment fixation, Group II (n = 32) included patients operated by long segment fixation, and Group III (n = 34) included those operated by intermediate segment fixation with a pair of additional screws in the fractured vertebra. The mean follow-up period was twenty one months. The outcomes were analyzed in terms of kyphosis angle (KA), regional kyphosis angle (RA), sagittal index (SI), anterior height compression rate, Frankel classification, and Oswestry Disability Index questionnaire. RESULTS: In Groups II and III, the correction values of KA, RA, and SI were much better than in Group I. At the final follow up, the correction values of KA (6.3 and 12.1, respectively) and SI (6.2 and 12.0, respectively) were in Groups II and III found to be better in the latter. CONCLUSION: The intermediate segment fixation with an additional pair of screws at the fracture level vertebra gives results that are comparable or even better than long segment fixation and gives an advantage of preserving an extra mobile segment.

Anterior Debridement and Strut Graft with Pedicle Screw Fixation for Pyogenic Spondylitis

STUDY DESIGN: A retrospective study. PURPOSE: We evaluated the results of the use of anterior debridement and interbody fusion followed by posterior spinal instrumentation. OVERVIEW OF LITERATURE: An early diagnosis of pyogenic spondylitis is difficult to obtain. The disease can be treated with various surgical methods (such as anterior debridement and bone graft, anterior instrumentation, and posterior instrumentation). METHODS: This study included 20 patients who received anterior debridement and interbody fusion with strut bone graft followed by posterior spinal fusion for pyogenic spondylitis between 1996 and 2005. We analyzed the culture studies, the correction of the kyphotic angle, blood chemistry, the bony union period, and the amount of symptom relief. RESULTS: In terms of clinical symptoms relief, eight patients were grouped as "excellent", eleven patients as "good", and one patient as "fair". The vertebral body cultures were positive in 14 patients showing coagulase (-) streptococcus and S. aureus. The average times for normalization of the erythrocyte sedimentation rate and C-reactive protein level were 3.3 and 1.9 months, respectively. Four months was required for bony union. For complications, meralgia paresthetica was found in two cases. CONCLUSIONS: Due to early ambulation and the correction of the kyphotic angle, anterior interbody fusion with strut bone graft and posterior instrumentation could be another favorable method for the treatment of pyogenic spondyulitis.

The Efficacy of the Treatment of Thoracolumbar Spine Fractures with Short-segment Posterior Instrumentation and Fusion

PURPOSE: To evaluate the safety and usefulness of the short-segment posterior instrumentation and fusion in the treatment of thoracolumbar spine fractures. MATERIALS AND METHODS: Forty-two patients were treated by short-segment pedicle screw instrumentation and fusion between Oct. 1998. and Jan. 2004 by single surgeon. All patients were treated posteriorly and all the pedicle screws are monoaxial. Intraoperative rod bending and fixation technique was used to reduce the collapsed vertebral body and correct the kyphotic angle. The follow up duration is mean 2.1 year (1~6 year). The mean age is 40.2 year (18~60 year) old. The fractures were classified by Denis' classification and Load-Sharing Classification. Preoperative and postoperative changes of kyphotic angle and vertebral body height were measured. Denis' Pain Score and Work scales, Frankel neurologic grade were obtained during follow-up evaluation for patients. RESULTS: All the cases got solid bony union. Mean Load-Sharing Score was 7.3. Clinical results were good. The mean kyphotic angle was preoperatively 14.5 degree, immediate postoperatively 7.5 degree, and last follow up 9.2 degree. The mean anterior vertebral heights s were 60.8% preoperatively, 83.4% immediate postoperatively, and 79.5% last follow up. There was only one case of screw breakage but no revision operation due to loss of reduction. All the cases showed satisfactory clinical results. CONCLUSION: This study suggest that short-segment instrumentation and fusion using pedicle screw system for thoracolumbar spine fractures could lead to good results, if comminution of vertebral body is considered in the selection of approach.

Posterior Short Segment Fixation and Fusion in a Displaced Hangman's Fracture

Although most cases of C2 traumatic spondylolisthesis, a so called Hangman's fracture, can be managed by a closed reduction and immobilization, surgery should be considered in the cases of non-reducible fractures or a recurrent subluxation. This report details our recent experience with the surgical treatment of a Type II Hangman's fracture after an unsuccessful closed reduction. Advantage and the technique of the posterior short segment fixation are discussed.

Comparison of Two Surgeries in Active Thoracolumbar Tuberculous Spondylitis: One Stage Anterior Debridement with Anterior Instrumentation and Two Stage Operation of Anterior Debridement and Posterior Instrumentation / 대한척추외과학회지

STUDY DESIGN: Thirty-eight patients with thoracolumbar spinal tuberculosis were evaluated according to the surgical treatment method, either a one or two stage anterior debridement, with anterior or posterior instrumentation, respectively. PURPOSE: The aim of this study was to compare the effects of the one stage anterior debridement, with anterior instrumentation, to the two stage anterior debridement, with posterior instrumentation MATERIALS AND METHODS: Thirty-eight patients, with tuberculous spine, were divided into two groups depending on the surgical method. One group consisted of 21 patients treated with anterior debridement combined with anterior instrumentation, and the other group consisted of 17 patients treated by a two stage operation of anterior debridement combined with posterior instrumentation. The clinical outcomes were evaluated from the hematological laboratory findings, bone union in radiographs, change of kyphotic angle, duration of hospital stay and the medical cost during hospitalization. RESULTS: There were no recurrences of infection in either group and bone union was obtained within 6 months of the operation for all cases in both groups. The preoperative, postoperative and final follow-up kyphotic angle in the two groups were 18/20, 7/9 and 10/11 degrees, respectively. There was no significant difference in the decrease of the kyphotic angle between the two groups (p>0.05). However, group I was superior to group II in relation to the duration of hospital stay and the medical cost. CONCLUSION: We concluded that the one stage operation was the better of the operative methods for the treatment of active tuberculous spondylitis in a thoracolumbar spine.

Posterior Instrumentation of Thoracolumbar Fracture / 대한척추외과학회지

The thoracolumbar spine remains the most common site of vertebral column injuries. Surgical stabilization using posterior instrumentation for thoracolumbar injuries offers several advantages such as nearly anatomical reduction of fractures, protection of neurologic function and most important early ambulation of the patient, and so major benefits of early fixation are decreased hospital stay, early rehabilitation, and prevention of deformity and pain. The treatment of fracture-dislocation of the thoracolumbar spine has been progressively improved over the past decades and recently a lot of posterior instrumentation has been introduced to improve fixation of the involved vertebrae three dimensionally and short segmental fixation as possible.

The Significance of Postural Reduction for Kyphotic Deformity in the Posterior Instrumentation of Unstable Burst Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the significance of the intraoperative postural reduction for kyphotic deformity in unstable burst fracture and confirm the relations of postural reduction and the final correction after loss of correction by posterior instrumentation. SUMMARY OF LITERATURE REVIEW: The loss of kyphotic correction after instrumentation in unstable burst fracture is found. Some methods have been developed to reduce the loss of correction. MATERIALS AND METHODS: 24 short-segment pedicle screw instrumentations in the patients with a unstable burst fracture were performed. We measured sagittal index, wedge angle of vertebral body and anterior vertebral height preoperatively, intraoperatively, postoperatively and at final follow-up. RESULTS: Sagittal index was 20.2 degrees preoperatively, 7.5 degrees intraoperatively, 0.9 degrees postoperatively and 7.2 degrees at final follow-up, so the loss of correction was 32.6%. Wedge angle of vertebral body was 20.3 degrees preoperatively, 10.1 degrees intraoperatively, 6.8 degrees postopera-tively and 9.4 degrees at final follow-up, so the loss of correction was 19.3%. Anterior vertebral height was 57.0%, 79.3%, 85.0%, and 78.8% respectively, so the loss of correction was 22.1%. The loss of correction occurred more in the disc space and less in the vertebral body itself. Postural reduction corrected 63% of sagittal index, 50% of wedge angle of vertebral body and 52% of anterior vertebral height. CONCLUSIONS: Postural reduction corrected kyphotic deformity appropriately. The correction by posterior instrumentation in unstable burst fracture was lost in some amount. The final correction was similar to the one by postural reduction. It is important to obtain the maximum postural reduction intraoperatively to prevent kyphotic deformity caused by loss of correction after surgery.

Comparison of Apical Z-axis Derotation between Rod Derotation(RD) and Vertebrae to Rod(VTR) Methods in Idiopathic Thoracic Scoliosis / 대한척추외과학회지

STUDY DESIGN: A prospective study. OBJECTIVE: To compare the derotational effect of the two methods and to determine the effect of the position of axis of the rotation on derotation of the apical vertebrae. SUMMARY OF BACKGROUND DATA: Vertebral derotation about z-axis following a posterior instrumentation and its relation to the position of the rotational axis is still controversial. Rod derotation(RD) method rotates the vertebrae about the axis of the rod curvature located relatively anterior position whereas the vertebrae to rod(VTR) method, reducing the vertebrae to the contoured rod, rotates the vertebrae about the posteriorly located axis. MATERIALS AND METHODS: Eleven consecutive thoracic idiopathic scoliosis subjected to segmental pedicle screw instrumentation were analysed. Six were treated by RD and five by VTR. Average preoperative curve was 46.6 delta in RD and 51 delta in VTR with flexibility of 69% and 71% respectively (p>0.05). Mean preoperative relative apical vertebral rotation(RAVR) measured by computerized tomography were 11.2 delta in RD and 13.8 delta in VTR(p>0.05). RESULTS: Average postoperative curve magnitudes were 11.5 delta in RD and 12 delta in VTR with correction rates of 77% and 74% respectively (p>0.05). Postoperative relative apical vertebral rotation(RAVR) were 3.6 delta in RD and 6.1delta in VTR with correction rates of 68% and 56% respectively (p>0.05). The mean instrumentation time per vertebral segment instrumented was 4.7 minutes in RD and 8.5 minutes in VTR (p<0.05). Screw pullout during operative procedure in 8/51 screws(15%) in VTR and none(0/60) in RD. CONCLUSION: RD and VTR methods were not significantly different, both enabling a significant apical z-axis derotation and frontal curve correction. However, RD was more efficient than VTR with less operative time and intraoperative screw loosening. The position of the axis of rotation did not significantly influence the apical derotation effect of segmental pedicle screw instrumentation.

The Results of the Surgical Treatment using Posterior Spinal instrumentation for Tuberculous Spondylitis / 대한척추외과학회지

STUDY DESIGN: Twenty-nine patients with spinal tuberculousis were evaluated according to the surgical treatment methods using posterior spinal instrumentation and conventional anterior excision and interbody fusion methods without posterior spinal instrumentation. OBJECTIVE: To confirm the effectiveness of the surgical treatment methods using posterior spinal instrumentation (combined with anterior radical excision and anterior interbody fusion ) in tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: Relatively good results(maintaining corrected kyphotic angle , short fusion time, rapid rehabilitation etc.)were obtained in posterior spinal instrumetnation group, especially at thoracic and thoracolumbar spine, but no specific benefits of posterior instrumentation at low lumbar spine during follow-up period. METHODS: Twenty-nine patients with tuberculous spondylitis were divided into two groups depending on their use of posterior spinal instrument in surgical treatment methods ; one group consisted of 18 cases which were treated by anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation(Group I), and the other groups consisted of 11 cases which were treated by anterior radical excision of involved body and anterior interbody fusion(Group II). Change of corrected kyphotic angle according to the level of lesion, number of involved body and complications were measured using pre-, post-operative, and follow-up radiographs and chart review. RESULTS: Comparing the two groups, relatively short fusion time, less kyphotic angle loss, and low complication rates were obtained in posterior spinal instrumentation group(Group I) during the follow up period, especilally, at thoracic and thoracolumbar spine. However, there were no significant postoperative and follow-up results in both groups at low lumbar spine. CONCLUSIONS: Tuberculous spondylitis can be treated, and correction can be maintained with anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation during follow up period.