ABSTRACT
OBJECTIVE AND IMPORTANCE: Although many patients with unstable Chance fractures can heal in an external brace, others will require internal stabilization. Short-segment minimally invasive internal bracing of a Chance fracture offers the rigidity and patient compliance of internal bracing with minimal tissue disruption. This technique has not yet been described. CLINICAL PRESENTATION: A healthy 16-year-old female and 21-year-old male sustained classic nondisplaced Chance fractures. They were both neurologically intact. TECHNIQUE: An image-guided Jamshidi needle was used to percutaneously place K-wires to direct percutaneous pedicle screws. Freehand percutaneous passing of rods to connect the pedicle screw heads on each side created a short-segment construct. CONCLUSIONS: Minimally invasive internal bracing of nondisplaced bony Chance fractures is an option for selected neurologically intact patients unable to tolerate external bracing.
Subject(s)
Bone Screws/standards , Internal Fixators/standards , Lumbar Vertebrae/surgery , Spinal Fractures/surgery , Spinal Fusion/instrumentation , Spinal Fusion/methods , Adolescent , Adult , Bone Screws/trends , Braces/adverse effects , Diagnostic Imaging/methods , Female , Humans , Internal Fixators/trends , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Male , Monitoring, Physiologic/methods , Postoperative Complications/prevention & control , Radiography , Spinal Fractures/diagnostic imaging , Spinal Fractures/pathology , Treatment OutcomeABSTRACT
OBJECT: Clinical and radiographic results were assessed to determine the clinical outcomes and fusion rate in eight consecutive patients selected for minimally invasive transforaminal lumbar interbody fusion (TLIF) in which a percutaneous pedicle screw system was used unilaterally. METHODS: Eight patients underwent one-level, minimally invasive TLIF in which a percutaneous pedicle screw system was used only on the side where facets were removed for interbody access. Clinical, economic, functional, and radiographic data were recorded preoperatively and at 6 months postoperatively. The mean 6-month change in the modified Prolo Scale score was 7, and osseous interbody bridging assessed on coronal and sagittal computerized tomography studies was seen in all patients. CONCLUSIONS: The use of unilateral percutaneous pedicle screw instrumentation for the minimally invasive TLIF procedure provides excellent clinical results and is an option in selected patients.
Subject(s)
Bone Screws , Functional Laterality , Minimally Invasive Surgical Procedures/methods , Spinal Diseases/surgery , Spinal Fusion/methods , Adult , Follow-Up Studies , Humans , Internal Fixators , Lumbosacral Region/diagnostic imaging , Lumbosacral Region/surgery , Middle Aged , Neurologic Examination , Pain Measurement , Radiography , Spinal Diseases/diagnostic imaging , Time Factors , Treatment OutcomeABSTRACT
Adult high-grade degenerative spondylolisthesis represents the extreme end of the spectrum for spondylolisthesis and is consequently rarely encountered. Surgical management of high-grade spondylolisthesis requires constructs capable of resisting the shear forces at the slipped L5-S1 interspace. The severity of the slip, sacral inclination, and slip angle may make conventional approaches to 360 degrees fusion difficult or hazardous. Transdiscal pedicle screw fixation, transvertebral fibular graft fusion, and transvertebral cage fixation are techniques that have been developed to establish anterior column load sharing and to resist shear forces at the L5-S1 interspace, given the anatomical constraints accompanying high-grade spondylolisthesis. In this technical note the authors describe the procedure for implanting an in situ anterior L5-S1 transvertebral cage and performing L4-5 anterior lumbar interbody fusion, followed by placement of posterior S1-L5 vertebral body transdiscal pedicle screws for management of high-grade spondylolisthesis.
Subject(s)
Bone Screws , Internal Fixators , Spinal Fusion/instrumentation , Spinal Fusion/methods , Spondylolisthesis/surgery , Biomechanical Phenomena/methods , Humans , Lumbar Vertebrae/surgeryABSTRACT
We report a rare case of bilateral pericallosal artery ectasia with stenosis in a 49-year-old man complaining of frontal headache. CT showed a serpiginous calcified interhemispheric fissure lesion with contrast enhancement. Imaging of this lesion was pursued with MR and MR angiography; however, conventional cerebral angiography was needed to make a definitive diagnosis.
