Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures.

BACKGROUND: The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation without fusion for treating type A3 and A4 thoracolumbar fractures. Traumatic thoracolumbar burst fracture is a common pathology without a consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) systems have been recently introduced in the treatment of spinal fractures to reduce the adverse effects associated with the conventional open approaches, such as iatrogenic muscle denervation and pain. METHODS: A prospective analysis was made to evaluate consecutive 46 patients with type A3 and A4 thoracolumbar fractures. Patients were divided into a percutaneous pedicle screw fixation group (PPSF) and an open pedicle screw fixation group (OPSF). The mean age of patients in PPSF group (12 men, 11 woman) was 49.9 years and in OPSF group (10 men, 13 women) 52.2 years. For the purpose of evaluation, the radiological assessment of the bisegmental Cobb angle, the loss of correction, the volume of blood loss, operation time, cumulative radiation time and dose were recorded and compared. RESULTS: All patients were followed up for 12 months. There were no significant differences between OPSF and PPSF in the Cobb angle preoperative and postoperative angle and the loss of bisegmental correction. In PPSF group, the mean preoperative Cobb angle was 10.9° and improved by 4.5° postoperatively, and in OPSF group the preoperative angle was 12.1° and postoperatively improved by 3.8°. Significant differences between OPSF and PPSF were found in the mean cumulative radiation time, radiation dose and operation time. PPSF group also had a significantly lower perioperative blood loss. CONCLUSIONS: Both open and percutaneous short-segment pedicle fixation were safe and effective methods to treat thoracolumbar burst fractures. Percutaneous fixation without fusion seems to be suitable for type A3 and A4 fractures.

Minimally invasive thoracoscopic approach to thoracolumbar junction fractures.

AIMS: A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. METHODS: Between 2002 and 2014, a total of 176 patients were treated by this technique. The patients received either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. RESULTS: In the anterior procedure, the average operative time was 90 min. (50 to 130 min). Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at two years follow-up. CONCLUSION: The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.

Biomechanical Testing of Spinal Segment Fixed by Arcofix System on the Swine Spine.

STUDY DESIGN: An in vitro biomechanical study. PURPOSE: To evaluate the mechanical properties of the spinal segment in the intact, injured, and stabilized state after fixation by an Arcofix implant. OVERVIEW OF LITERATURE: Several types of thoracolumbar spine injury necessitates anterior instrumentation. The Arcofix plate represents the latest generation of angular stablity systems. The biomechanical properties of these implants have not been sufficiently studied yet. METHODS: A total of ten porcine specimens (levels Th12-L3) were prepared. The tests were performed for intact, injured, and implanted specimens. In each state, the specimen was subjected to a tension load of a prescribed force, and subsequently, twisted by a given angle. The force load was 200 N. The torsion load had a deformation character, i.e., the control variable was the twisting angle and the measured variable was the moment of a couple. The amplitude of the load alternating cycle was 3°. Another parameter that was evaluated was the area of the hysteresis loop. The area corresponds to the deformation energy which is dissipated during the cycle. RESULTS: A statistically significant difference was found between the intact and injured states as well as between the injured and implanted specimens. The statistical evaluation also showed a statistically different value of the hysteresis loop area. In the case of instability, the area decreased to 33% of the physiological value. For the implanted sample, the area increased to 170% of the physiological value. CONCLUSIONS: The Arcofix implant with its parameters appears to be suitable and sufficiently stable for the treatment of the anterior column of the spine.

Genotypic versus phenotypic methods in the detection of Listeria monocytogenes prosthetic joint infection.

A rare case of a severe prosthetic joint infection in a 71-year-old immunocompetent woman is presented. Listeria monocytogenes was identified in two consecutive samples using broad-range PCR and sequencing, whereas cultivation remained negative for the first sample and streptococci of a non-group A streptococci, non-group B streptococci type were detected for the second one. This report demonstrates that the phenotypic approach may lead to misidentification of L. monocytogenes in a routine clinical setting. Molecular methods of pathogen detection might be useful when a rare and/or unexpected micro-organism is present or the sample is collected during antibiotic treatment.