EXPANDABLE INTRAVERTEBRAL IMPLANTS IN POST-TRAUMATIC VERTEBRAL NECROSIS - NEW CLASSIFICATION SUGGESTION.

The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.

A evolução progressiva da necrose vertebral pós-traumática e consequente perda da integridade estrutural do corpo vertebral, juntamente com o risco neurológico, a torna uma das patologias mais temidas e imprevisíveis na traumatologia da coluna. Vários estudos têm abordado o papel da vertebroplastia, cifoplastia e corpectomia no tratamento da necrose vertebral, no entanto, o tratamento ainda é controverso sem um algoritmo terapêutico definido. O recente surgimento dos implantes intravertebrais expansíveis, que permitem através duma aplicaçao transpedicular percutânea a capacidade de preenchimento intrassomático e de manutenção da altura do corpo vertebral, torna-os uma opção viável não só no tratamento das fraturas vertebrais agudas, mas também em situações de não consolidação óssea. Neste estudo, apresentamos uma revisão das evidências atuais sobre a aplicação de implantes intravertebrais expansíveis em casos de necrose vertebral pós-traumática. Com base na literatura científica disponível, incluindo classificações prévias de necrose vertebral pós-traumática, e nas características mecânicas dos principais implantes intravertebrais expansíveis disponíveis, propomos uma classificação simplificada desta patologia, considerando parâmetros que influenciam a orientação terapêutica cirúrgica, a morfologia e a dinâmica da mobilidade da vértebra. De acordo com seus estágios e com base na experiência dos autores e na escassa literatura, propomos um algoritmo terapêutico inicial e sugerimos estratégias preventivas para esta doença, considerando seus principais fatores de risco, ou seja, cominução da fratura e lesão da vascularização vertebral. Portanto, os implantes intravertebrais expansíveis têm um papel promissor nessa condição; no entanto, estudos prospectivos de grande dimensão são necessários para confirmar sua eficácia, esclarecer as indicações de cada um desses dispositivos e validar a presente proposta do algoritmo de tratamento e prevenção da necrose vertebral pós-traumática. Nível de Evidência III, Revisão Sistemática/Atualização.

Expandable intravertebral implants in post-traumatic vertebral necrosis - new classification suggestion / Implantes intravertebrais expansíveis no tratamento de necrose vertebral pós-traumática - proposta de nova classificação

ABSTRACT The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.

RESUMO A evolução progressiva da necrose vertebral pós-traumática e consequente perda da integridade estrutural do corpo vertebral, juntamente com o risco neurológico, a torna uma das patologias mais temidas e imprevisíveis na traumatologia da coluna. Vários estudos têm abordado o papel da vertebroplastia, cifoplastia e corpectomia no tratamento da necrose vertebral, no entanto, o tratamento ainda é controverso sem um algoritmo terapêutico definido. O recente surgimento dos implantes intravertebrais expansíveis, que permitem através duma aplicaçao transpedicular percutânea a capacidade de preenchimento intrassomático e de manutenção da altura do corpo vertebral, torna-os uma opção viável não só no tratamento das fraturas vertebrais agudas, mas também em situações de não consolidação óssea. Neste estudo, apresentamos uma revisão das evidências atuais sobre a aplicação de implantes intravertebrais expansíveis em casos de necrose vertebral pós-traumática. Com base na literatura científica disponível, incluindo classificações prévias de necrose vertebral pós-traumática, e nas características mecânicas dos principais implantes intravertebrais expansíveis disponíveis, propomos uma classificação simplificada desta patologia, considerando parâmetros que influenciam a orientação terapêutica cirúrgica, a morfologia e a dinâmica da mobilidade da vértebra. De acordo com seus estágios e com base na experiência dos autores e na escassa literatura, propomos um algoritmo terapêutico inicial e sugerimos estratégias preventivas para esta doença, considerando seus principais fatores de risco, ou seja, cominução da fratura e lesão da vascularização vertebral. Portanto, os implantes intravertebrais expansíveis têm um papel promissor nessa condição; no entanto, estudos prospectivos de grande dimensão são necessários para confirmar sua eficácia, esclarecer as indicações de cada um desses dispositivos e validar a presente proposta do algoritmo de tratamento e prevenção da necrose vertebral pós-traumática. Nível de Evidência III, Revisão Sistemática/Atualização.

INTRAVERTEBRAL EXPANDABLE IMPLANTS IN THORACOLUMBAR VERTEBRAL COMPRESSION FRACTURES.

Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.

A evidência científica atual aponta para a importância de obter restauração anatómica dos corpos vertebrais com fraturas em compressão, tal como acontece em outras articulações do corpo humano, de modo a garantir uma coluna biomecânica e funcionalmente mais próxima da prévia à fratura. Consideramos que a redução anatómica destas fraturas apenas se consegue na totalidade com a aplicação de implantes intravertebrais expansíveis, restaurando a morfologia das plataformas vertebrais e assim proporcionando uma cicatrização do disco intervertebral mais adequada. Isto permite minimizar a progressão para alterações disco e osteodegenerativas desse segmento vertebral e dos níveis adjacentes, bem como em idosos evitar a sobrecarga anterior dos corpos adjacentes consequente ao achatamento pós--traumático e assim minimizar o risco de fraturas vertebrais adjacentes. A capacidade de redução da fratura e de manutenção da altura do corpo vertebral ao longo do tempo, bem com a sua aplicação percutânea transpedicular, torna os implantes intravertebrais expansíveis uma opção muito atrativa no tratamento destas fraturas. Os autores apresentam os conceitos de redução direta e indireta de fraturas vertebrais, revêm a biomecânica, características e indicações dos implantes intravertebrais expansíveis, finalizando com uma proposta de atualização do algoritmo de tratamento cirúrgico das fraturas vertebrais em compressão que inclui a aplicação de implantes intravertebrais expansivos. Nível de Evidência V, Opinião do Especialista.

Intravertebral expandable implants in thoracolumbar vertebral compression fractures / Implantes intravertebrais expansíveis nas fraturas vertebrais dorsolombares em compressão

ABSTRACT Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.

RESUMO A evidência científica atual aponta para a importância de obter restauração anatómica dos corpos vertebrais com fraturas em compressão, tal como acontece em outras articulações do corpo humano, de modo a garantir uma coluna biomecânica e funcionalmente mais próxima da prévia à fratura. Consideramos que a redução anatómica destas fraturas apenas se consegue na totalidade com a aplicação de implantes intravertebrais expansíveis, restaurando a morfologia das plataformas vertebrais e assim proporcionando uma cicatrização do disco intervertebral mais adequada. Isto permite minimizar a progressão para alterações disco e osteodegenerativas desse segmento vertebral e dos níveis adjacentes, bem como em idosos evitar a sobrecarga anterior dos corpos adjacentes consequente ao achatamento pós- -traumático e assim minimizar o risco de fraturas vertebrais adjacentes. A capacidade de redução da fratura e de manutenção da altura do corpo vertebral ao longo do tempo, bem com a sua aplicação percutânea transpedicular, torna os implantes intravertebrais expansíveis uma opção muito atrativa no tratamento destas fraturas. Os autores apresentam os conceitos de redução direta e indireta de fraturas vertebrais, revêm a biomecânica, características e indicações dos implantes intravertebrais expansíveis, finalizando com uma proposta de atualização do algoritmo de tratamento cirúrgico das fraturas vertebrais em compressão que inclui a aplicação de implantes intravertebrais expansivos. Nível de Evidência V, Opinião do Especialista.

Expandable Intravertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology.

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed kyphoplasty", "Vertebral Body Stenting" or "stentoplasty" and "SpineJack". The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.

Evolution of vertebral posttraumatic necrosis to bone healing after self-stabilizing osteophytosis development-case report.

Post-traumatic vertebral necrosis and pseudarthrosis at the thoracolumbar transition level usually progresses to bone resorption, leading to vertebral collapse, sometimes with retropulsion of the posterior wall and neurological deficit. As such, the therapeutic goal is the interruption of this evolution, seeking to stabilize the vertebral body, preventing collapse progression and the risk of neurological deficits. We present a clinical case regarding the evolution of a vertebral pseudarthrosis that self-stabilized with the development of an exuberant anterior osteophyte mass, joining the anterolateral surfaces of the adjacent vertebrae bodies. Vertebrae stabilization would have made it possible to minimize the pathological hypermobility that perpetuated pseudarthrosis and would have ensured sufficient stabilization to obtain clinically and imagiologically proven vertebrae bone healing. However, despite the unusually favorable evolution of this clinical case, in order to avoid highly disabling symptoms for several months, as occurred with the patient for 4 to 6 months, we consider that early percutaneous surgical stabilization of symptomatic vertebral pseudarthrosis is indicated, allowing for almost immediate pain relief and functional improvement, which is beneficial in terms of health and quality of life. This is a clinical case of unusual evolution of vertebral pseudarthrosis, which, however, is useful to confirm the prolonged duration and intensity of symptoms in the face of a conservative treatment for this disease.

Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease-Prospective Analysis of Clinical and Functional Outcomes.

Objective This was a prospective controlled study with lumbar degenerative disc disease patients submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior stabilization. Methods A sample with 64 consecutive patients was operated by the same surgeons over 4 years. Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody cages with integrated screws, filled with bone matrix and bone morphogenetic protein 2, were used. Results Half of the patients had undergone previous lumbar spine surgeries, 75% presented with associated degenerative listhesis, and 62.5% had posterior lumbar compression disease. Approximately 56% of the sample had at least 1 risk factor for nonunion. The Oswestry index changed from 71.81 ± 7.22 at the preoperative assessment to 24.75 ± 7.82 at the final follow-up evaluation, while the visual analogue pain scale changed from 7.88 ± 0.70 to 2.44 ± 0.87 ( p < 0.001). Clinical and functional improvements increased with the number of operated levels, proving the efficacy of multilevel ALIF, performed in 93.75% of the sample. The global complication rate was of 7.82%, with no major complications. No cases of nonunion were observed. Conclusion Instrumented ALIF combined with posterior stabilization is a successful option for uni- and multilevel degenerative disc disease of the L3 to S1 segments, even in the significant presence of risk factors for nonunion and of previous lumbar surgeries, assuring very satisfactory clinical-functional and radiographic outcomes with a low medium-term complication rate.

Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease- Prospective Analysis of Clinical and Functional Outcomes / Artrodese lombar intersomática anterior multinível combinada com estabilização posterior em discopatia-Análise clínico-funcional prospectiva

Abstract Objective This was a prospective controlled study with lumbar degenerative disc disease patients submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior stabilization. Methods A sample with 64 consecutive patients was operated by the same surgeons over 4 years. Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody cages with integrated screws, filled with bone matrix and bone morphogenetic protein 2, were used. Results Half of the patients had undergone previous lumbar spine surgeries, 75% presented with associated degenerative listhesis, and 62.5% had posterior lumbar compression disease. Approximately 56% of the sample had at least 1 risk factor for nonunion. The Oswestry index changed from 71.81 ± 7.22 at the preoperative assessment to 24.75 ± 7.82 at the final follow-up evaluation, while the visual analogue pain scale changed from 7.88 ± 0.70 to 2.44 ± 0.87 (p < 0.001). Clinical and functional improvements increased with the number of operated levels, proving the efficacy of multilevel ALIF, performed in 93.75% of the sample. The global complication rate was of 7.82%, with no major complications. No cases of nonunion were observed. Conclusion Instrumented ALIF combined with posterior stabilization is a successful option for uni- and multilevel degenerative disc disease of the L3 to S1 segments, even in the significant presence of risk factors for nonunion and of previous lumbar surgeries, assuring very satisfactory clinical-functional and radiographic outcomes with a low medium-term complication rate.

Resumo Objetivo Estudo prospectivo controlado em pacientes com discopatia degenerativa submetidos a artrodese intersomática lombar anterior instrumentada combinada com estabilização posterior. Métodos Amostra com64 pacientes consecutivos operados pelos mesmos cirurgiões ao longo de quatro anos. Metade das artrodeses intersomática lombar anterior foi efetuada emdois níveis, 43,8% emtrês níveis e 6,25% emumnível. Foramusadas caixas intersomáticas com parafusos integrados preenchidas com matriz óssea e proteína morfogenética óssea 2. Resultados Metade da amostra apresentava cirurgias prévias à coluna lombar, 75% listeses degenerativas associadas e 62,5% patologia compressiva posterior da coluna lombar. Aproximadamente 56% da amostra apresentavam pelo menos um fator de risco de não união da artrodese. O índice Oswestry passou de 71,81 ± 7,22 no pré-operatório para 24,75 ± 7,82 na avaliação no fimdo tempo de seguimento, enquanto a escala visual analógica da dor passou de 7,88 ± 0,70 para 2,44 ± 0,87 (p < 0,001). Amelhoria clínicofuncional foi crescente de acordo com a intervenção num número superior de níveis, o que comprova a eficácia da artrodese intersomática lombar anterior multinível, aplicada em 93,75% da amostra. Ataxa global de complicações foi de 7,82% e de complicaçõesmajor de 0%. Não se identificou qualquer caso de não união. Conclusão A artrodese intersomática lombar anterior instrumentada combinada com estabilização posterior é uma opção de sucesso na discopatia degenerativa uni ou multinível dos segmentos de L3 a S1, mesmo empresença significativa de fatores de

Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy: Technical note.

BACKGROUND: Authors aim to report on the outcomes of combining selective anterior cervical decompression and fusion (ACDF) with laminectomy in patients with cervical spondylotic radiculomyelopathy (CSR). METHODS: 10 patients with ACDF and posterior laminectomy reviewed. RESULTS: 60% female population, mean age 61 ±â€¯3 years, mean BMI 24.7 ±â€¯3.4 kg/m2. VAS and NDI showed significant improvement, p < 0.001, p = 0.02 respectively. Mean PCS 31.9 ±â€¯2.7, MCS 38.9 ±â€¯3.4 improved to mean PCS 42.2 ±â€¯5.1, MCS 51.0 ±â€¯4.7, p = 0.09 and 0.06 respectively. At final follow up fusion rate was 90% and all patients had Nurick Grade 0. CONCLUSION: In this pilot study, procedure shown to be safe with improved symptoms.

Tratamiento de fracturas mandibulares bicondilar y parasinfisiariacon reducción abierta y cerrada: Reporte de Caso / Bicondile and parasinfissiary mandibular fractures treatment with open closed reduction: A case report

La mandíbula es el hueso más frecuentemente fracturado en la región facial. Dentro de estas, las fracturas condilares presentan una incidencia considerable pero su tratamiento sigue siendo tema de discusión, autores apoyan la reducción cerrada como tratamiento conservador, mientras que otros se inclinan por tratamientos quirúrgicos como reducción abierta. El presente reporte de caso describe las características clínicas y radiográficas de la fractura bicondilar y parasinfisiaria izquierda, y su tratamiento, en un paciente masculino de 18 años de edad, que presentó trauma maxilofacial generado por accidente en moto. (AU)

Biomechanics of posterior instrumentation in L1-L3 lateral interbody fusion: Pedicle screw rod construct vs. transfacet pedicle screws.

BACKGROUND: The use of pedicle screws is the gold standard for supplemental posterior fixation in lateral interbody fusion. Information about the performance of transfacet pedicle screws compared to standard pedicle screws and rods in the upper lumbar spine with or without a lateral interbody fusion device in place is limited. METHODS: Fifteen fresh frozen human cadaveric lumbar spine segments (T12-L4) were studied using standard pure moment flexibility tests. Specimens were divided into two groups to receive either bilateral transfacet pedicle screws (n=8) or bilateral pedicle screws (n=14). Stability of each motion segment (L1-L2 and L2-L3) was evaluated intact, with posterior instrumentation with an intact disc, with posterior instrumentation and a lateral interbody fusion device in place, and following cyclic loading with the interbody device and posterior instrumentation still in place. Both raw values of motion (range of motion, lax zone and stiff zone) and normalized mobility (ratios to intact) were analyzed for each case. FINDINGS: In terms of immediate stability, transfacet pedicle screws performed equivalent to similarly sized pedicle screws, both with intact disc and with lateral interbody fusion device in all directions of loading. Stability following cyclic loading decreased significantly during lateral bending and axial rotation. INTERPRETATION: Posterior fixation with transfacet pedicle screws provides equivalent immediate stability to similarly sized pedicle screws. However, in the presence of a lateral interbody fusion device, pedicle screws seem to resist loosening more and may be a better option for fusion in the upper lumbar spine.

Stability of transforaminal lumbar interbody fusion in the setting of retained facets and posterior fixation using transfacet or standard pedicle screws.

BACKGROUND CONTEXT: The transforaminal lumbar interbody fusion (TLIF) technique supplements posterior instrumented lumbar spine fusion and has been tested with different types of screw fixation for stabilization. Transforaminal lumbar interbody fusion is usually placed through a unilateral foraminal approach after unilateral facetectomy, although extraforaminal entry allows the facet to be spared. PURPOSE: To characterize the biomechanics of L4-L5 lumbar motion segments instrumented with bilateral transfacet pedicle screw (TFPS) fixation versus bilateral pedicle screw-rod (PSR) fixation in the setting of intact facets and native disc or after discectomy and extraforaminal placement of a TLIF technology graft. STUDY DESIGN: Human cadaveric lumbar spine segments were biomechanically tested in vitro to provide a nonpaired comparison of four configurations of posterior and interbody instrumentation. METHODS: Fourteen human cadaveric spine specimens (T12-S1) underwent standard pure moment flexibility tests with intact L4-L5 disc and facets. Seven were studied with intact discs, after TFPS fixation, and then with TLIF and TFPS fixation. The others were studied with intact discs, after PSR fixation, and then combined with extraforaminally placed TLIF. Loads were applied about anatomic axes to induce flexion-extension, lateral bending, and axial rotation. Three-dimensional specimen motion in response to applied loads during flexibility tests was determined. A nonpaired comparison of the four configurations of posterior and interbody instrumentation was made. RESULTS: Transfacet pedicle screw and PSR, with or without TLIF, significantly reduced range of motion during all directions of loading. Transfacet pedicle screw provided greater stability than PSR in all directions of motion except lateral bending. In flexion, TFPS was more stable than PSR (p=.042). A TLIF device provided less stability than the intact disc in constructs with TFPS and PSR. CONCLUSIONS: These results suggest that fixation at L4-L5 with TFPS is a promising alternative to PSR, with or without TLIF. A TLIF device was less stable than the native disc with both methods of instrumentation presumably because of a fulcrum effect from a relatively small footplate. Additional interbody support may be considered for improved biomechanics with TLIF.

Optimismo Disposicional, Adherencia al Tratamiento, y Calidad de Vida en Pacientes Venezolanos con VIH/SIDA

Este estudio tuvo como objetivo determinar la relación entre optimismo disposicional, la adherencia del tratamiento antirretroviral y la calidad de vida relacionada a la salud en pacientes venezolanos con VIH-SIDA. Se desarrolló un estudio no experimental de corte transversal, empleando una muestra de 136 personas, de entre 15 y 64 años de edad de Barquisimeto, Venezuela. Los resultados demuestran que los participantes presentan altos niveles de Adherencia al Tratamiento (93%) Calidad de Vida (83%) y Optimismo (67%); se observa una correlación positiva moderada entre Calidad de Vida y Adherencia al tratamiento (rho=,337; p=0.01) así como entre optimismo y calidad de vida (rho=,454; p=0.01) y positiva baja entre optimismo y adherencia al tratamiento (rho=,199; p=0.01). Se concluye que existe una correlación directa y significativa entre las variables estudiadas, donde aquellas personas con altos niveles de optimismo presentan mayor probabilidad de tener elevada calidad de vida y en menor medida, adherencia al tratamiento.

This study aimed to determine the relationship between dispositional optimism, adherence to antiretroviral treatment and life quality related to health in Venezuela patients with HIV - AIDS. A non-experimental cross-sectional investigation was developed using a sample of 136 people, 100 men, and 36 women, aged between 15 and 64 years-old, residents of Barquisimeto, Lara State, Venezuela. The results show that individuals present high levels of adherence to the treatment (93 %) life quality (83 %) and optimism (67 %) also a positive correlation is observed between moderated optimism and life quality (rho = 454; p = 0.01) and low positive correlation between optimism and adherence to treatment (rho = , 199; p = 0.01). We conclude that there is a direct and significant correlation between the studied variables, where those with high levels of optimism are most likely to have a high life quality and adherence to treatment.

Estrategias de afrontamiento en mujeres víctimas de violencia de género que denuncian: un estudio exploratorio / Coping strategies in women victims of gender violence who report: an exploratory study

El presente estudio tiene como objetivo comparar las estrategias de afrontamientos en mujeres víctimas de violencia que denuncian y no denuncian dicho abuso. Participaron 39 mujeres que asistieron a tres centros de atención a mujeres víctimas de maltratos de dos estados venezolanos, en edades comprendida entre 19 y 57 años. Los resultados indican que la estrategia de afrontamiento que predomina en ambos grupos es el pensamiento desiderativo, además existe diferencia significativa solo en la estrategia de resolución de problema. Se discuten los resultados y sus implicaciones en el ámbito social.

The objective of this study is to compare coping strategies in women victims of violence who report and do not report such abuse. Forty-nine women participated in three care centers for women victims of mistreatment in two Venezuelan states, aged between 19 and 57 years. The results indicate that the coping strategy that predominates in both groups is desiderative thinking, in addition there is significant difference only in the problem solving strategy. The results and their implications in the social sphere are discussed.

Preoperative direct percutaneous embolization of spinal metastasis from renal cell carcinoma.

Preoperative direct percutaneous embolization has been very rarely used in hypervascular metastatic spinal tumors to decrease blood loss during the surgery. A patient is presented with solitary spinal metastasis due to renal cell carcinoma who underwent a two-stage spondylectomy. Transarterial tumor embolization with polyvinyl alcohol (PVA) particles and liquid coil placement, and percutaneous tumor embolization with PVA particles were used before the first and the second stage, respectively.

A novel crossed rod configuration incorporating translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study.

BACKGROUND CONTEXT: Occipitocervical (OC) spinal instrumentation involving the axis (C2) entails the use of transarticular screws through C1-C2 or lateral mass screws at C1 and pedicle screws at C2 to achieve fusion. Because of the anatomical complexity, interpatient anomalous variation, and danger to the vertebral artery injury, there has been an increased interest in alternate sites for fixation. Recent studies have involved the placement of screws bilaterally into the C2 lamina. Several biomechanical studies have been carried out to evaluate the performance of C2 translaminar screws (TLSs). PURPOSE: The aim of the study was to compare the biomechanics of an OC2 rigid construct using C2 pedicle screws and C2 TLSs. Also, this study included a new construct in which the OC2 fixation was carried out by connecting rods to the contralateral TLS. STUDY DESIGN: Human cadaveric cervical spines were tested in an in vitro biomechanical flexibility experiment to investigate the biomechanical stability provided by a novel crossed rod (CR) configuration incorporating TLSs for OC2 internal fixation. METHODS: Seven fresh human cadaver occipitocervical spines (occiput-C3) were tested by applying pure moments of ±1.5 Nm. After intact specimen testing, an occipital plate was implanted. Each specimen was then tested in the following modes: bilateral pedicle screws (BPSs) and rods at C2; TLSs at C2 with rods in parallel configuration (TLS+parallel rod); and TLSs at C2 with rods in crossed configuration (TLS+CR). OC2 range of motion (ROM) for each construct was obtained by applying pure moments in flexion-extension, lateral bending, and axial rotation. RESULTS: All three instrumented constructs significantly reduced ROM in all physiological planes when compared with the intact spine. The BPS construct similarly reduced ROM when compared with both the translaminar constructs. There was no significant difference in ROM between the translaminar constructs in all loading modes. CONCLUSIONS: A cadaveric model was used to investigate the stability offered by a novel CR construct by using TLS fixation in an OC2 fusion construct. The results were compared with BPS fixation. All three constructs significantly decreased motion as compared with the intact state. There was no statistically significant difference in flexibility among any of the constructs. The novel CR construct provides as much stability as traditional constructs and may be a viable alternative for clinical use.

Degenerative spondylolisthesis of the cervical spine: analysis of 58 patients treated with anterior cervical decompression and fusion.

BACKGROUND CONTEXT: Degenerative spondylolisthesis has been well described as a disorder of the lumbar spine. Few authors have suggested that a similar disorder occurs in the cervical spine. To our knowledge, the present study represents the largest series of patients with long-term follow-up who were managed surgically for the treatment of degenerative spondylolisthesis of the cervical spine. PURPOSE: To describe the clinical presentation and radiographic findings associated with degenerative cervical spondylolisthesis, and to report the long-term results of surgically managed patients. STUDY DESIGN: Analysis of 58 patients treated with anterior cervical decompression and fusion for degenerative spondylolisthesis of the cervical spine. PATIENT SAMPLE: From 1974 to 2003, 58 patients were identified as having degenerative spondylolisthesis of the cervical spine occurring in the absence of trauma, systemic inflammatory arthropathy, or congenital abnormality. These patients were identified from a database of approximately 500 patients with degenerative cervical spine disorders treated by the senior one of us. OUTCOME MEASURES: Patient outcomes were evaluated with regard to neurologic improvement (Nurick grade myelopathy) and osseous fusion. METHODS: The records of 58 patients were reviewed. The average follow-up period was 6.9 years (range, 2-24 years). Seventy-two cervical levels demonstrated spondylolisthesis. In all cases, there was radiographic evidence of facet degeneration and subluxation. All patients were treated with anterior cervical decompression and arthrodesis with iliac crest structural graft. This most commonly involved corpectomy of the caudal vertebrae. Three patients required additional posterior facet fusion. RESULTS: Fifty-eight patients demonstrated 72 levels of involvement. The C4-C5 level was most frequently involved (43%). Two radiographically distinct types of listhesis were observed based on the amount of disc degeneration and the degree of spondylosis at adjacent levels. The average neurologic improvement was 1.5 Nurick grades. The overall fusion rate was 92%. Three patients were treated with combined anterior-posterior arthrodesis. The prevalence of myelopathy and instability pattern was greater in the listheses occurring adjacent to spondylotic levels. CONCLUSIONS: Degenerative spondylolisthesis is relatively common in the cervical spine. Common to all cases is facet arthropathy and neurologic compression. Anterior cervical decompression and arthrodesis appears to yield excellent union rates and neurological improvement in those patients having cervical degenerative spondylolisthesis and significant neurological sequelae who have failed nonoperative treatments.

The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3-year consecutive series.

STUDY DESIGN: The treatment of unstable thoracic spine fractures remains controversial. Theoretical biomechanical advantages of transpedicular screw fixation include three-column control of vertebral segments and fixation of a vertebral segment in the absence of intact posterior elements. Additionally, pedicle screw constructs may obviate the need for neural canal dissection and potential neural element impingement by intracanal instrumentation. A 3-year consecutive series was performed to evaluate the use of transpedicular screw fixation in the treatment of unstable thoracic spine injuries. OBJECTIVE: This study was performed to evaluate the efficacy of transpedicular screw fixation in the upper, middle, and lower thoracic spine. SUMMARY OF BACKGROUND DATA: The use of rod/hook and rod/wiring techniques has been evaluated in the treatment of thoracic spine injuries. To date, a study evaluating the safety and efficacy of pedicle screw instrumentation in the upper, middle, and lower thoracic spine has not been reported. METHODS: Thirty-two patients with 79 individual vertebral injury levels (T2-L1) treated with transpedicular spinal stabilization and bone fusion were evaluated during a 3-year consecutive series from 1998 to 2001. Patient charts, operative reports, preoperative and postoperative radiographs, computed tomography scans, and postoperative follow-up examinations and radiographs were reviewed from the time of surgery to final follow-up assessment. Radiographic measurements included: sagittal index, Gardner segmental kyphotic deformity, and compression percentage. RESULTS: A total of 252 pedicle screws were placed, of which 222 were placed in segments T2-L1. Clinical examination and plain radiographs were used to determine the presence of a solid fusion. Fracture healing and radiographic stabilization occurred at an average of 4.8 months after the initial operation. There were no reported cases of hardware failure, loss of reduction, or painful hardware removal. Two hundred fifty-two transpedicular screws were successfully placed without intraoperative complications. The mean preoperative sagittal index was 13.9 degrees, whereas the mean follow-up was 5.25 degrees (P < 0.001). The mean final correction of sagittal index achieved was 8.65 degrees, or a 62.2% improvement. The mean Gardner segmental kyphotic angle was 15.9 degrees, whereas the mean follow-up angle was 10.6 degrees (P < 0.0005). The mean compression percentage was 35.4, and at follow-up was 27.4 (P < 0.07). CONCLUSIONS: In carefully selected instances, pedicle screw fixation of upper, middle, and lower thoracic and upper thoracolumbar spinal injuries is a reliable and safe method of posterior spinal stabilization. Transpedicular screw fixation may offer superior three-column control in the absence of posterior element integrity and obviates the need for intracanal placement of hardware. Transpedicular instrumentation provides rigid fixation for upper, middle, and lower unstable thoracic spine injuries and produces early pain-free fusion results. These results provide evidence that with appropriate preoperative radiographic evaluation of pedicular size and orientation using computed tomography as well as radiograph assessment, transpedicular instrumentation is a safe and effective alternative in the treatment of unstable thoracic (T2-L1) spinal injuries.