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Zeng Y, Huang Z, Huang Z, Cheng Y, Zhu Q, Ji W, Jiang H. Ipsilateral Fixation and Reconstruction of the Cervical Spine after Resection of a Dumbbell Tumor Via a Unilateral Posterior Approach: A Case Report and Biomechanical Study. Orthop Surg 2023; 15:2435-2444. [PMID: 37431728 PMCID: PMC10475664 DOI: 10.1111/os.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE There is lack of an internal fixation following resection of a dumbbell tumor by hemi-laminectomy and facetectomy that achieves adequate stability with less trauma. Unilateral fixation and reconstruction (unilateral pedicle screw and contralateral lamina screw fixation combined with lateral mass reconstruction, UPS + CLS + LM) may be an ideal technique to address this problem. A biomechanical comparison and a case report were designed to evaluate its spinal stability and clinical effect. METHODS Seven fresh-frozen human subcervical specimens were used for the biomechanical testing. The conditions tested were: (1) intact; (2) injured (single-level hemi-laminectomy and facetectomy); (3) unilateral pedicle screw (UPS) fixation; (4) UPS fixation combined with lateral mass (LM) reconstruction (UPS + LM); (5) UPS fixation and contralateral lamina screw fixation (UPS + CLS); (6) UPS + CLS + LM; (7) UPS fixation and contralateral transarticular screw fixation (UPS + CTAS); (8) bilateral pedicle screw (BPS) fixation. Range of motion (ROM) and neutral zone (NZ) were obtained at C5-C7 segment under eight conditions. In addition, we report the case of a patient with a C7-T1 dumbbell tumor that was treated by UPS + CLS + LM technique. RESULTS Except left/right lateral bending and right axial rotation (all, p < 0.05), ROM of UPS + CLS + LM condition in other directions was similar to that of BPS condition (all, p > 0.05). There was no significant difference between UPS + CLS + LM and the UPS + CTAS condition in other directions of ROM (all, p > 0.05), except in left/right axial rotation (both, p < 0.05). Compared to UPS + CLS condition, left/right lateral bending ROM of UPS + CLS + LM condition were significantly reduced (both, p < 0.05). UPS + CLS + LM condition significantly reduced ROM in all directions compared to UPS and UPS + LM condition (all, p < 0.05). Similarly, except lateral bending (p < 0.05), there was no difference in NZ in other directions between UPS + CLS + LM and BPS condition (both, p > 0.05). There was no significant difference between UPS + CLS + LM and UPS + CTAS condition in NZ in all directions (all, p > 0.05). Axial rotation NZ of UPS + CLS + LM condition was significantly reduced compared to UPS + CLS condition (p < 0.05). Compared to UPS and UPS + LM condition, NZ of UPS + CLS + LM condition was significantly reduced in all directions (all, p < 0.05). The patient's imaging examination at 3 months postoperatively indicated that the internal fixation did not move and the graft bone was seen with fusion. CONCLUSION After resection of a dumbbell tumor in the cervical spine, UPS + CLS + LM technique is a reliable internal fixation method to provide sufficient immediate stability and promote postoperative bone fusion.
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Affiliation(s)
- Yongqiang Zeng
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Zhiping Huang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Zucheng Huang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Yongquan Cheng
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Qing'an Zhu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Wei Ji
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
| | - Hui Jiang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople's Republic of China
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Girão MMV, Miyahara LK, Dwan VSY, Baptista E, Taneja AK, Gotfryd A, do Amaral E Castro A. Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures. Insights Imaging 2023; 14:103. [PMID: 37278946 DOI: 10.1186/s13244-023-01447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. KEY POINTS: Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. CRITICAL RELEVANCE STATEMENT: This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context.
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Affiliation(s)
| | - Lucas Kenzo Miyahara
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil.
| | | | | | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil
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Shen FH, Hayward GM, Harris JA, Gonzalez J, Thai E, Raso J, Van Horn MR, Bucklen BS. Impaction grafting of lumbar pedicle defects: a biomechanical study of a novel technique for pedicle screw revision. J Neurosurg Spine 2023; 38:313-318. [PMID: 36683188 DOI: 10.3171/2022.10.spine22351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/07/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The two most common revision options available for the management of loose pedicle screws are larger-diameter screws and cement augmentation into the vertebral body for secondary fixation. An alternative revision method is impaction grafting (pedicoplasty) of the failed pedicle screw track. This technique uses the impaction of corticocancellous bone into the pedicle and vertebral body through a series of custom funnels to reconstitute a new pedicle wall and a neomedullary canal. The goal of this study was to compare the biomechanics of screws inserted after pedicoplasty (impaction grafting) of a pedicle defect to those of an upsized screw and a cement-augmented screw. METHODS For this biomechanical cadaveric study the investigators used 10 vertebral bodies (L1-5) that were free of metastatic disease or primary bone disease. Following initial screw insertion, each screw was subjected to a pullout force that was applied axially along the screw trajectory at 5 mm per minute until failure. Each specimen was instrumented with a pedicoplasty revision using the original screw diameter, and on the contralateral side either a fenestrated screw with cement augmentation or a screw upsized by 1 mm was inserted in a randomized fashion. These revisions were then pulled out using the previously mentioned methods. RESULTS Initial screw pullout values for the paired upsized screw and pedicoplasty were 717 ± 511 N and 774 ± 414 N, respectively (p = 0.747) (n = 14). Revised pullout values for the paired upsized screw and pedicoplasty were 775 ± 461 N and 762 ± 320 N, respectively (p = 0.932). Initial pullout values for the paired cement augmentation and pedicoplasty were 792 ± 434 N and 880 ± 558 N, respectively (p = 0.649). Revised pullout values for the paired cement augmentation and pedicoplasty were 1159 ± 300 N and 687 ± 213 N, respectively (p < 0.001). CONCLUSIONS Pedicle defects are difficult to manage. Reconstitution of the pedicle and creation of a neomedullary canal appears to be possible through the use of pedicoplasty. Biomechanically, screws that have been used in pedicoplasty have equivalent pullout strength to an upsized screw, and have greater insertional torques than those with the same diameter that have not been used in pedicoplasty, yet they are not superior to cement augmentation. This study suggests that although cement augmentation appears to have superior pullout force, the novel pedicoplasty technique offers promise as a viable biological revision option for the management of failed pedicle screws compared with the option of standard upsized screws in a cadaveric model. These findings will ultimately need to be further assessed in a clinical setting.
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Affiliation(s)
- Francis H Shen
- 1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Gerald M Hayward
- 2Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania; and
| | - Jonathan A Harris
- 2Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania; and
| | - Jorge Gonzalez
- 3School of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Evan Thai
- 3School of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Jon Raso
- 1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Margaret R Van Horn
- 2Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania; and
| | - Brandon S Bucklen
- 2Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania; and
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Zhou LP, Shang J, Zhang ZG, Jiang ZF, Zhang HQ, Jia CY, Zhang RJ, Shen CL. Characteristics and Comparisons of Morphometric Measurements and Computed Tomography Hounsfield Unit Values of C2 Laminae for Translaminar Screw Placement Between Patients With and Without Basilar Invagination. Neurospine 2022; 19:899-911. [PMID: 36597627 PMCID: PMC9816593 DOI: 10.14245/ns.2244730.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Patients with basilar invagination (BI) had high incidences of vertebral variations and high-riding vertebral artery (HRVA) that might restrict the use of pedicle or pars screw and increase the use of translaminar screw on axis. Here, we conducted a radiographic study to investigate the feasibility of translaminar screws and the bone quality of C2 laminae in patients with BI, which were compared with those without BI as control to provide guidelines for safe placement. METHODS In this study, a total of 410 patients (205 consecutive patients with BI and 205 matched patients without BI) and 820 unilateral laminae of the axis were included at a 1:1 ratio. Comparisons with regard to insertion parameters (laminar length, thickness, angle, and height) for C2 translaminar screw placement and Hounsfield unit (HU) values for the assessment of the appropriate bone mineral density of C2 laminae between BI and control groups were performed. Besides, the subgroup analyses based on the Goel A and B classification of BI, HRVA, atlas occipitalization, and C2/3 assimilation were also carried out. Furthermore, the factors that might affect the insertion parameters and HU values were explored through multiple linear regression analyses. RESULTS The BI group showed a significantly smaller laminar length, thickness, height, and HU value than the control group, whereas no significant difference was observed regarding the laminar angle. By contrast, the control group showed significantly higher rates of acceptability for unilateral and bilateral translaminar screw fixations than the BI group. Subgroup analyses showed that the classification of Goel A and B, HRVA, atlas occipitalization, and C2/3 assimilation affected the insertion parameters except the HU values. Multiple linear regression indicated that the laminar length was significantly associated with the male gender (B = 0.190, p < 0.001), diagnoses of HRVA (B = -0.109, p < 0.001), Goel A (B = -0.167, p < 0.001), and C2/3 assimilation (B = -0.079, p = 0.029); the laminar thickness was significantly associated with the male gender (B = 0.353, p < 0.001), diagnoses of HRVA (B = -0.430, p < 0.001), Goel B (B = -0.249, p = 0.026), and distance from the top of odontoid to the Chamberlain line (B = -0.025, p = 0.003); laminar HU values were significantly associated with age (B = -2.517, p < 0.001), Goel A (B = -44.205, p < 0.001), Goel B (B = -25.704, p = 0.014), and laminar thickness (B = -11.706, p = 0.001). CONCLUSION Patients with BI had narrower and smaller laminae with lower HU values and lower unilateral and bilateral acceptability for translaminar screws than patients without BI. Preoperative 3-dimensional computed tomography (CT) and CT angiography were needed for BI patients.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin Shang
- Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Zhi-Gang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Hua-Qing Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chong-Yu Jia
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Co-corresponding Author Ren-Jie Zhang Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Cai-Liang Shen
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Corresponding Author Cai-Liang Shen Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
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Lee S, Hur JW, Lee JB, Park JH, Park D, Park SJ, Kim KT, Cho DC. Radiological evaluation of atlantoaxial fusion using C2 translaminar screws and C2 pedicle screws: Does the screw halo sign imply fusion failure? Medicine (Baltimore) 2022; 101:e31496. [PMID: 36397438 PMCID: PMC9666149 DOI: 10.1097/md.0000000000031496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to identify the criteria for atlantoaxial (AA) fusion by comparing follow-up lateral radiographs and computed tomography (CT) images. We retrospectively analyzed data from 161 consecutive patients undergoing AA fusion. Patients with a minimum of 1 year of CT follow-up after AA fusion surgery using C2 pedicle screws or translaminar screws (C2TLS) were included. Patients were followed up radiographically at 3, 6, and 12 months after surgery, and dynamic lateral radiographs were also evaluated. A total of 49 patients were analyzed, with a mean CT image follow-up of 41.6 ± 37.6 months. Thirty eight patients had C2 pedicle screw placement, and 11 patients underwent planned C2TLS. AA fusion with bridging bone mass formation was achieved in 45/49 (91.8%) patients. Screw halos were observed in 14/49 (28.6%) patients. Among them, final fusion failure occurred in 2 (14.3%) patients. The last follow-up CT showed no difference in the fusion failure rate according to the presence or absence of a screw halo (no halo, 5.7%; halo, 14.3%; P = .33). The differences in C1-2 segmental angles (SA) in flexion-extension dynamic lateral radiographs were 1.99 ± 1.62° in the fusion group and 4.37 ± 2.13° in the non-fusion group (P = .01). The likelihood of fusion failure increased when the SA gap was greater than 2.62° (P = .05). C2TLS placement had a significantly higher incidence of screw halos. However, the halo sign was not significantly related to final bone fusion. Bone fusion could be predicted when the SA gap of C1-2 was less than 2.62° on the dynamic radiograph.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine Korea University, Seoul, Republic of Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine Korea University, Seoul, Republic of Korea
| | - Jang-Bo Lee
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine Korea University, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Daewon Park
- Spine Center, Good Moonhwa Hospital, Busan, Republic of Korea
| | - Sang-Jin Park
- Department of Neurosurgery, Charmjoeun Spine and Joint Hospital, Daegu, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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Singh DK, Shankar D, Singh N, Singh RK, Chand VK. C2 Screw fixation techniques in atlantoaxial instability: A technical review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:368-377. [PMID: 36777907 PMCID: PMC9910137 DOI: 10.4103/jcvjs.jcvjs_128_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Atlantoaxial instability (AAI) is surgically a complex entity due to its proximity to vital neurovascular structures. C1-C2 fusion has been an established standard in its treatment for a considerable time now. Here, we have outlined the most common techniques for C2 screw fixation in practice at present such as C2 pedicle, C2 pars, C2 translaminar, C2 subfacetal, C2-C3 transfacetal, and C2 inferior facet screw. We have discussed in detail the technical as well as biomechanical aspects of each technique of C2 screw fixation in AAI and explored the intricacies of each technique.
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Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Diwakar Shankar
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Kumar Chand
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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7
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Yu Y, Zeng H, Guo E, Tang B, Fang Y, Wu L, Xu C, Peng Y, Zhang B, Liu Z. Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221107509. [PMID: 35721367 PMCID: PMC9203950 DOI: 10.1177/21514593221107509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/14/2022] [Accepted: 05/25/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Posterior short-segment fixation (SSF) and long-segment fixation (LSF) are two methods for the treatment of Kummell disease, but the safety and effectiveness of these two surgical methods still lack adequate medical evidence. This study aimed to evaluate the two methods. Methods Database searches for randomized controlled trials, case-control studies, and cohort studies of posterior SSF and posterior LSF in the treatment of Kummell disease were performed. After the document quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale, a meta-analysis was carried out. Results Meta-analysis revealed that the operation time and intraoperative blood loss in the LSF group were higher than those in the SSF group [MD = −18.17, 95% CI (−30.31, −6.03), z = 2.93, P = .003; MD = −82.07, 95% CI (−106.91, −57.24], z = 6.48, P < .00001). The postoperative last follow-up local kyphosis angle in the SSF group was greater than that in the LSF group (MD = 3.18, 95% CI [.56, 5.81], z = 2.38, P = .02), and there were no significant differences in perioperative complications, bone cement leakage rate, incidence of adverse events during follow-up, postoperative follow-up visual analog scale, postoperative Oswestry dysfunction index, and postoperative immediate local kyphosis angle between the two groups (P > .05). Conclusion SSF and LSF are effective and safe for the treatment of Kummell disease. SSF can reduce the operation time and intraoperative bleeding; LSF can better maintain the long-term stability of kyphosis. The methods should be evaluated by clinicians according to the individual situation of the patients.
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Affiliation(s)
- Yikang Yu
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopedics and Traumatology, Xinchang Hospital of traditional Chinese Medicine, Shaoxing, China.,School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hanbing Zeng
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopedics and Traumatology, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Enpin Guo
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China.,Binhai town health center, Taizhou, China
| | - Binbin Tang
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopedics and Traumatology, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Yuan Fang
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopedics and Traumatology, Dongyang Hospital of traditional Chinese Medicine, Jinhua, China
| | - Lianguo Wu
- Department of Orthopedics and Traumatology, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Chao Xu
- Department of Orthopedics and Traumatology, Xinhua Hospital of Zhejiang Province, Hangzhou, China
| | - Yi Peng
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Zhang
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhen Liu
- Second Clinical Medical School,Zhejiang Chinese Medical University, Hangzhou, China
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Cho W, Le JT, Shimer AL, Werner BC, Glaser JA, Shen FH. The Feasibility of Translaminar Screws in the Subaxial Cervical Spine: Computed Tomography and Cadaveric Validation. Clin Orthop Surg 2022; 14:105-111. [PMID: 35251547 PMCID: PMC8858891 DOI: 10.4055/cios21059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/28/2021] [Accepted: 10/14/2021] [Indexed: 11/11/2022] Open
Abstract
Background The use of translaminar screws may serve as a viable salvage method for complicated cases. To our understanding, the study of the feasibility of translaminar screw insertion in the actual entire subaxial cervical spine has not been carried out yet. The purpose of this study was to report the feasibility of translaminar screw insertion in the entire subaxial cervical spine. Methods Eighteen cadaveric spines were harvested from C3 to C7 and 1-mm computed tomography (CT) scans and three-dimensional reconstructions were created to exclude any bony anomaly. Thirty anatomically intact segments were collected (C3, 2; C4, 3; C5, 3; C6, 8; and C7, 14), and randomly arranged. Twenty-one segments were physically separated at each vertebral level (group S), while 9 segments were not separated from the vertebral column and left in situ (group N–S). CT measurement of lamina thickness was done for both group S and group N–S, and manual measurement of various length and angle was done for group S only. Using the trajectory proposed by the previous studies, translaminar screws were placed at each level. Screw diameter was the same or 0.5 mm larger than the proposed diameter based on CT measurement. Post-insertion CT was performed. Cortical breakage was checked either visually or by CT. Results When 1° and 2° screws of the same size were used, medial cortex breakage was found 13% and 33% of the time, respectively. C7 was relatively safer than the other levels. With larger-sized screws, medial cortex breakage was found in 47% and 46% of 1° and 2° screws, respectively. There were no facet injuries due to the screws in group N–S. Conclusions Translaminar screw insertion in the subaxial cervical spine is feasible only when the lamina is thick enough to avoid any breakage that could lead to further complications. The authors do not recommend inserting translaminar screws in the subaxial cervical spine except in some salvage cases in the presence of a thick lamina.
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Affiliation(s)
- Woojin Cho
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Jason T. Le
- Department of Orthopaedic Surgery, Banner Estrella Medical Center, Phoenix, AZ, USA
| | - Adam L. Shimer
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John A. Glaser
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Francis H. Shen
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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9
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Cabrera J, Carelli L, Girão A. Translaminar screw of C1 for the reinforcement of subaxial cervical spine reconstruction. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:201-203. [PMID: 35837433 PMCID: PMC9274678 DOI: 10.4103/jcvjs.jcvjs_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/02/2022] [Indexed: 11/06/2022] Open
Abstract
Translaminar screws in the cervical spine have been mostly employed at C2 level when conventional trajectories are challenging. However, reports in the literature of translaminar screw of C1 are remarkably anecdotal. We aimed to report a case using C1 translaminar in addition to C1 lateral mass screws for the reinforcement of subaxial cervical spine reconstruction. We present a 22-year-old female patient, who developed persistent cervical pain, and computed tomography scan demonstrated lytic lesions of the vertebral bodies and lateral masses from C3 to C6. Magnetic resonance imaging showed spinal cord compression without myelopathy. Surgical biopsy was inconclusive, and an oncological vertebral instability led to surgical stabilization. Laminectomy and bilateral facetectomy of levels involved was achieved, instrumentation from C1 to T3 and reconstruction with posterolateral fibula bilaterally, and without occipital fixation. A third satellite rod was placed using C1-2–7 translaminar screws. Translaminar screw of C1 is a feasible alternative for increasing the strength of the construct.
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10
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Hendow CJ, Beschloss A, Cazzulino A, Lombardi JM, Louie PK, Milby AH, Pugely AJ, Ozturk AK, Ludwig SC, Saifi C. Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993-2015). J Neurosurg Spine 2020; 32:900-906. [PMID: 31978892 DOI: 10.3171/2019.11.spine19551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to investigate revision burden and associated demographic and economic data for atlantoaxial (AA) fusion procedures in the US. METHODS Patient data from the National Inpatient Sample (NIS) database for primary AA fusion were obtained from 1993 to 2015, and for revision AA fusion from 2006 to 2014 using ICD-9 procedure codes. Data from 2006 to 2014 were used in comparisons between primary and revision surgeries. National procedure rates, hospital costs/charges, length of stay (LOS), routine discharge, and mortality rates were investigated. RESULTS Between 1993 and 2014, 52,011 patients underwent primary AA fusion. Over this period, there was a 111% increase in annual number of primary surgeries performed. An estimated 1372 patients underwent revision AA fusion between 2006 and 2014, and over this time period there was a 6% decrease in the number of revisions performed annually. The 65-84 year-old age group increased as a proportion of primary AA fusions in the US from 35.9% of all AA fusions in 1997 to 44.2% in 2015, an increase of 23%. The mean hospital cost for primary AA surgery increased 32% between 2006 and 2015, while the mean cost for revision AA surgery increased by 35% between 2006 and 2014. Between 2006 and 2014, the mean hospital charge for primary AA surgery increased by 67%; the mean charge for revision surgery over that same period increased by 57%. Between 2006 and 2014, the mean age for primary AA fusions was 60 years, while the mean age for revision AA fusions was 52 years. The mean LOS for both procedures decreased over the study period, with primary AA fusion decreasing by 31% and revision AA fusion decreasing by 24%. Revision burden decreased by 21% between 2006 and 2014 (mean 4.9%, range 3.2%-6.4%). The inpatient mortality rate for primary AA surgery decreased from 5.3% in 1993 to 2.2% in 2014. CONCLUSIONS The number of primary AA fusions between 2006 and 2014 increased 22%, while the number of revision procedures has decreased 6% over the same period. The revision burden decreased by 21%. The inpatient mortality rate decreased 62% (1993-2014) to 2.2%. The increased primary fusion rate, decreased revision burden, and decreased inpatient mortality determined in this study may suggest an improvement in the safety and success of primary AA fusion.
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Affiliation(s)
| | | | | | - Joseph M Lombardi
- 2Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Philip K Louie
- 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Andrew H Milby
- 4Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew J Pugely
- 5Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, Iowa; and
| | - Ali K Ozturk
- 6Neurosurgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, Philadelphia, Pennsylvania
| | - Steven C Ludwig
- 7Department of Orthopedic Surgery, University of Maryland Medical System, Baltimore, Maryland
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