Posterior Osteotomy and Osteosynthesis for Malunited Atlas Fracture: A Surgical Technique.

Conservative treatment is commonly accepted and widely used for most atlas compression fractures. Malunion due to mismatching of the articular surfaces in C0-C1 and C1-C2 is therefore frequent even without associated instability. Such a result is considered acceptable in the elderly with low functional requests but should be avoided in young patients. Authors describe a new surgical technique to reduce and fix a nonunion and malunited fracture of the atlas through a posterior arch osteotomy followed by articular masses stabilization with polyaxial screws and precurved titanium rod. Rod prebending reduces lateral inclination of the screw heads during the reduction maneuver through compression applied between screw heads making it effective.

Management of a Lumbar Burst Fracture Occurring After a Sneeze in a Patient Affected by Systemic Mastocytosis: A Case Report.

CASE: We present a 36-year-old man with L1 burst fracture after a sneeze. He was in follow-up for indolent systemic mastocytosis (ISM), and osteoporosis was treated with bisphosphonate. Owing to neurologic impairment, posterior decompressive laminectomy and thoraco-lumbar fusion with cemented screws were performed. CONCLUSION: Vertebral fractures in young patients affected by ISM required a multidisciplinary approach and a careful preoperative planning to achieve acceptable results. These fractures are so rare that even an experienced spine surgeon may not come across them during his whole career. Nevertheless, diagnostic tool improvement makes its diagnosis more frequent, that is why every spine surgeon should know this disease.

Costotransverse screw fixation in a severe cervicothoracic deformity because of a type 1 neurofibromatosis: case report.

BACKGROUND CONTEXT: Spinal implant placement may be challenging in cases of severe cervicothoracic spinal deformities and anatomical anomalies as in Type 1 neurofibromatosis. Intralaminar screwing of the thoracic spine has been described in few cases in which pedicles were hypoplasic. The costovertebral joints have never been used before as an anchorage point for screws. PURPOSE: The purpose of the study was to describe a new thoracic fixation technique to be used in severe deformities whenever the posterior arch (laminae and pedicles) is not available because of anatomic abnormalities. STUDY DESIGN: This is a case report. METHODS: An 18-year-old woman with progressive tetraparesis caused by increasing deformity of cervicothoracic spine underwent evaluation and surgical treatment: procedure and techniques were described. The clinical features, the radiological findings, and the outcomes were assessed. Complications and local recurrences were also recorded. RESULTS: Costotransverse joint screwing was successfully used in one case of severe cervicothoracic spine deformity with major hypoplasia of the pedicles. The posterior arch of one thoracic vertebra became mobile soon after periosteal stripping probably because of iatrogenic fracture of the only existent pedicle. The four-cortical trajectory of the screws resulted in a good bone purchase allowing the surgeon to complete the procedure. No local or general complications were recorded during 2 years of follow-up. CONCLUSIONS: The procedure was used as a salvage technique during a difficult surgery where a local complication forced a change of strategy. Although the implant remained stable long enough to achieve fusion, it still consists of placing a screw through a joint that remains slightly mobile. This could possibly result in a screw loosening in the long period if fusion is not achieved. We suggest the use of this technique when all the other options have been explored and excluded for anatomical reasons.

Traumatic expulsion of T4 vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

STUDY DESIGN: A case report. OBJECTIVE: To describe an exceptional case of traumatic 2-level adjacent disk disruption with expulsion of the vertebral body into the spinal canal treated by vertebrectomy and spine shortening. SUMMARY OF BACKGROUND DATA: Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Vertebral body expulsion is mostly the result of tremendous flexion-extension shearing forces causing a double contiguous disk disruption. METHODS: A 49-year-old male was admitted to the emergency department of another hospital because of a high-speed car crash. He was conscious and collaborating and showed a complete paraplegia. Spinal computed tomographic scan showed a posterior expulsion of the T4 vertebral body and dislocation into the spinal canal. Magnetic resonance imaging of the spine confirmed the presence of a 2-level adjacent T3-T4 and T4-T5 disk disruption and severe compression of the spinal cord by the T4 vertebral body. We performed a posterior stabilization from T1 to T8 with T4 vertebrectomy and spine shortening. RESULTS: A postoperative computed tomographic scan showed a tolerable sagittal and frontal alignment and apposition of the endplates of T3 and T5. At present, 12 months after surgery, the patient is neurologically unchanged, but he can keep the sitting position without support. CONCLUSION: Total vertebrectomy and spinal shortening are safe and replicable procedures applicable in few patients with paraplegia. A surgical procedure after 3 weeks makes a complete reduction and a perfect sagittal alignment of the spine difficult to be obtained.