Internal fixation systems in the surgical treatment of spondylolisthesis.

The authors of this article describe the surgical procedure for fixation of spondylolisthesis using transpedicular fixation, and offer a comparative evaluation of the DERO, CD, C-CD, SOCON, and STRYKER systems.
The evaluation involved 36 patients operated in the Rehabilitation Clinic at the Lublin Academy of Medicine during the period 1994-2000. In 11 cases the DERO fixation system was used; in 5 cases, fixation with CD or C-CD instrumentation; in 15 cases, using the SOCON system; and in 5 cases with the STRYKER instrumentation.
Indications for surgery included pain and symptoms of nerve root irritation with sciatic neuralgia. The concomitant neurological symptoms resulted from the displacement into the vertebral canal of fragments of the nucleus pulposus, or from bone-related stenosis of the vertebral canal and intervertebral foramina.
Surgical treatment involved decompression of the nerve elements and internal fixation. In all the cases reported here posterior and postero-lateral spondylodesis was performed, while in 20 cases interbody spondylodesis was additionally performed, in 14 cases using interbody plugs.
The authors analyze the reasons for complications, such implants working loose and fatigue fractures.

Internal fixation of the spine in the surgical treatment of scoliosis.

Progressive idiopathic scoliosis, despite the good effects of treatment by kinesitherapy and corrective corsets, continues to pose a complicated problem in planning surgical procedure. On the one hand, the steady growth and improvement of systems for three-plane correction and fixation of scoliosis improves the radiological and clinical outcome; on the other hand, three arises the necessity to choose the surgical procedure and system of implants appropriate for the given type, localization, and angular dimensions of the curvature. The problems faced by the operating surgeon include not only making the right choice of implants, but also arranging the transpedicular screws and hooks at the proper strategic points along the curvature of the spine.
On the basis of clinical material from 200 patients surgically treated for idiopathic scoliosis, the authors present surgical solutions and analyze various implant systems (CD-HORIZON, DERO, STRYKER), made of steel or titanium, for three-plane correction and fixation of the spine. Attention is called to the application in the lumbar spine of transpedicular screws, which improve the correction and fixation of the spine and reduce the amount of instrumentation needed, while assuring the essential horizontal arrangement of the lower lumbar vertebrae.
The authors' own experience shows that modern systems for three-plane correction and fixation of the spine in scoliosis exceeding 750, despite spondylodesis, do not assure the proper correction and biomechanical value, in comparison to the Wisconsin method, which combines BW distraction with Luque intersegmentary fixation.

[Surgical approach to the atlas and axis]. / Dojscie chirurgiczne do kregu szczytowego i obrotowego.

On the basis of three operated patients a posterior, lateral and antero-lateral approaches to the atlas and axis are presented. The type of approach depends on location and extent of a lesion in the vertebra.