Bone Chips Research Articles

“One day visit”: a predictable clinical procedure.

The present clinical case aims to introduce a cluster of techniques based on a digital and biological basis, to be used at intrasurgical time, in order to achieve a predictable clinical outcome. In fact, the possibility of merging data could allow a single-step procedure, introducing concepts like ‘one day visit’ with Socket shield (SS), implant and provisional crown, same-day delivery. This procedure is well accepted by the patient as reducing surgery sessions and prosthetic time. A CBCT and a digital impression were used for initial diagnosis, obtaining data about tooth anatomy, bone quality, and bundle bone extension. Surgical planning and relative stent, allowed a careful position of implant inter-radicularly to achieve best primary stability, required for an immediate load on the mandibular molar area. It was first performed an SS on molar #46, with a seagull wing configuration (i.e., maintaining a small septum area between vestibular roots laminae. The implant was positioned in the inter-radicular area using a safe surgical stent: IT, IT curve and the implant stability quotient (ISQ (>70) were measured establishing criteria for immediate loading. An intra surgical impression scan was taken using a T-Base system allowing the planning of an immediate digital provisional crown in 40 minutes. Meanwhile, the SS shoulder was reduced, root spaces were filled with bone chips mixed with Fibrin glue and covered with platelet-rich-fibrin (PRF) A large healing cap was inserted on waiting time. The provisional crown fit was excellent requiring minor adjustment, and was immediately positioned. Seven months later a digital crown copy on disilicate was inserted. SS proved to maintain marginal gingiva and bundle bone. A novel intrasurgical action allows the implant stability measurement and immediate digital impression, picking high-quality prosthetic data.(time 0 concept. Follow-up shows crown stability and maintenance of both soft and hard tissue volume over 3 years. This is a proof of principle clinical case. Hardware & Software technologies were used to improve the predictability of outcome and stability over time of soft and hard tissue. Several activities were done at intra-surgical time and allowed to achieve unique data for prosthetic planning. The SS typically used on an anterior maxillary area was here used on posterior region and it is a fundamental step on ‘single day visit’ approach. The technique is operator sensitive and may not be applicable in any single case. More studies and clinical confirmation are therefore required.

Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes.

Total hip arthroplasty (THA) is increasingly performed in young patients and the number of revisions is estimated to rise over time. Acetabular osteolysis and bone loss are frequently encountered during revision and may be classified and treated in different ways. Impaction bone grafting (IBG) with morselized allograft offers a viable option. IBG was introduced over 40 years ago in combination with cemented cups, and is also used with uncemented cups. The impacted bone chips act as a void filler to restore bone stock; once incorporated they are substituted by host bone. Surgery entails assessment of the defect, acetabular preparation, preparation of the morselized graft, impaction of the graft, and cup implantation. Satisfactory medium- and long-term results have now been reported in most studies. With the advent of high-porosity cups, indications have been extended, enhancing the potential of IBG, in which primary stability of the cup to the host bone is essential for a successful procedure. Synthetic bone substitutes have also been used in combination with allogenic grafts and may extend the original technique for which long-term studies are warranted.

Does Grafting the Jumping Gap in Immediately Placed Anterior Implants Using Vestibular Socket Therapy Influence the Labial Bone Thickness?

There is no consensus in the literature on whether grafting the jumping gap (the distance between the inner surface of the labial bone plate and the implant surface) in immediately placed implants influences the thickness of the labial bone plate. This study aimed to compare the efficacy of particulate bone graft filling material and spontaneous bone healing following blood clot formation when placing immediate implants in the esthetic zone. A double-blind randomized controlled clinical trial was conducted in a private practice on patients scheduled for immediate implant placement using the vestibular socket therapy between November and December 2019. Participants were assigned to 2 groups. In Group 1, the jumping gap was filled with a mixture of 75% autogenous bone chips and 25% deproteinized bovine bone mineral (DBBM). In Group 2, the gap was unfilled. The regenerated facial bone thickness was evaluated using CBCT. Measurements were taken at baseline before tooth extraction and 12months postoperatively. The Mann Whitney U test was used for between group comparisons and Wilcoxon signed-rank test for within-group comparisons. Twenty-two patients (8 men and 14 women; mean age, 45.22years) were randomly assigned to Group 1 or Group 2, with 11 patients each. A statistically significant difference in bone thickness was found between groups (P=.008). The mean (SD) overall bone thickness was 2.95 (0.97) mm for the particulate bone group compared to 1.45 (0.92) mm preoperatively. While, for the unfilled group, the mean (SD) overall bone thickness was 1.98 (0.56) mm compared to 0.79 (0.49) mm preoperatively. The results suggested that grafting the jumping gap with particulate bone graft when implementing the vestibular socket therapy enhanced the thickness of the labial bone plate of immediately placed implants in the esthetic zone.

Minimally Manipulated Bone Marrow-Derived Cells Can Be Used for Tissue Engineering In Situ and Simultaneous Formation of Personalized Tissue Models

Red bone marrow and autologous bone tissue (bone fragments and bone chips) of the donor were harvested intraoperatively during autoplasty of talus bone defect. Titanium chips were obtained by grinding a fragment of a microporous titanium-coated hip arthroplasty (Zimmer). Bone marrow mononuclear cells were isolated in the operating room, and bone and titanium fragments were incubated with a suspension of mononuclear cells. The quality of revitalization was assessed by fluorescence microscopy and histological examination after culturing of adherent cells on the bone and titanium fragments. During culturing on bone chips, bone marrow mononuclear fraction cells demonstrated significantly higher metabolic activity than bone marrow cells (p=0.04). Mononuclear fraction cells were also capable of stable colonization of titanium fragments with the formation of composite tissue model.

Endonasal sinus lift as a new way of augmenting the alveolar process of the upper jaw

Aim to develop a new method of endonasal augmentation of the alveolar process of the upper jaw to reduce postoperative risks.
 Material and methods. The study involved 10 patients during the period of December, 2019, and June, 2021. The examination methods were: computed tomography of the nose and paranasal sinuses, upper and lower jaw, and video-endoscopy of the nasal cavity. The patients received the indonasal sinus inlay with the use of allogenic bone chips.
 Results. The surgical access through the lower nasal passage, under the lower nasal concha, allows to expose the maxillary sinus floor with preservation of mucous membrane integrity and to fill in the space between them with the allogenic bone material. Formation of a bone window in the lateral nasal wall using a piezotome prevents the rupture of the sinus mucous membrane. A bony fragment of the lateral nasal cavity wall transferred into the cavity of the maxillary sinus as one block with the mucosa creates additional protection for the Schneiderian membrane. Allogenic material introduced by endonasal method is substituted by the own organotypic tissue, restoring the lost volume of the maxillary sinus alveolar process.
 Conclusion. The endonasal method of alveolar augmentation may be used in clinical practice as an alternative to the classic methods.

The Results of Interfacetal Fusion Using Local Bone Combined With an Atlantoaxial Instrumentation.

Many studies have described different C1-2 fusion techniques that have evolved over time. We introduced an easy and effective C1-2 fusion technique using local bone chips combined with atlantoaxial instrumentation. To identify the efficacy of interfacetal fusion using local bone combined with atlantoaxial instrumentation by assessment of clinical outcomes and fusion rate. We retrospectively reviewed the data from 25 patients who underwent atlantoaxial stabilization surgery using C1-2 pedicle screws and interfacetal bone fusion by a single surgeon between March 2012 and December 2019. The demographics were 15 men and 10 women with a mean age of 57.6 years (range, 27-85 years) at the time of surgery. Three patients underwent surgery for myelopathy due to os odontoideum, 9 for C1-2 instability, 9 for trauma, 3 for rheumatoid arthritis, and 1 for bony spur, C1-2. At 3 months postsurgery, 3 and 21 patients showed 2-point and 1-point improvements in the Nurick grade, respectively. There was no difference in the Nurick score in 1 patient. Seven patients had a computed tomography scan at 1 year after surgery, which revealed a bridging trabecular bone. No movement was observed in the x-ray flexion/extension view at 1 year after surgery in all patients. In addition, no patients complained of postoperative occipital neuralgia. This study showed that interfacetal fusion with C1-2 pedicle screws using the free-hand technique was efficient and simple.

In Vitro Toxicity of Bone Graft Materials to Human Mineralizing Cells.

Bone graft materials from synthetic, bovine, and human sources were analyzed and tested for in vitro cytotoxicity on dental pulp stem cells (DPSCs) and osteosarcoma cells (Saos-2). Raman spectroscopy indicated significant amounts of collagen only in human bone-derived materials, where the mineral to protein ratio was 3.55 ± 0.45, consistent with bone. X-ray fluorescence revealed tungsten (W) concentrations of 463 ± 73, 400 ± 77, and 92 ± 42 ppm in synthetic, bovine, and human bone chips, respectively. When these chips were added to DPSCs on tissue culture plastic, the doubling times after two days were the same as the controls, 16.5 ± 0.5 h. Those cultured with synthetic or bovine chips were 96.5 ± 8.1 and 25.2 ± 1.4 h, respectively. Saos-2 was more sensitive. During the first two days with allogeneic or bovine graft materials, cell numbers declined. When DPSC were cultured on collagen, allogeneic and bovine bone chips did not increase doubling times. We propose cytotoxicity was associated with tungsten, where only the concentration in human bone chips was below 184 ppm, the value reported as cytotoxic in vitro. Cells on collagen were resistant to bone chips, possibly due to tungsten adsorption by collagen.

Micropathological Chip Modeling the Neurovascular Unit Response to Inflammatory Bone Condition.

Organ-on-a-chip in vitro platforms accurately mimic complex microenvironments offering the ability to recapitulate and dissect mechanisms of physiological and pathological settings, revealing their major importance to develop new therapeutic targets. Bone diseases, such as osteoarthritis, are extremely complex, comprising of the action of inflammatory mediators leading to unbalanced bone homeostasis and de-regulation of sensory innervation and angiogenesis. Although there are models to mimic bone vascularization or innervation, in vitro platforms merging the complexity of bone, vasculature, innervation, and inflammation are missing. Therefore, in this study a microfluidic-based neuro-vascularized bone chip (NVB chip) is proposed to 1) model the mechanistic interactions between innervation and angiogenesis in the inflammatory bone niche, and 2) explore, as a screening tool, novel strategies targeting inflammatory diseases, using a nano-based drug delivery system. It is possible to set the design of the platform and achieve the optimized conditions to address the neurovascular network under inflammation. Moreover, this system is validated by delivering anti-inflammatory drug-loaded nanoparticles to counteract the neuronal growth associated with pain perception. This reliable in vitro tool will allow understanding the bone neurovascular system, enlightening novel mechanisms behind the inflammatory bone diseases, bone destruction, and pain opening new avenues for new therapies discovery.

ИССЛЕДОВАНИЕ ВЫЖИВАЕМОСТИ КЛЕТОК ДВУХ ВИДОВ АУТОЛОГИЧНЫХ КОСТНО-ПЛАСТИЧЕСКИХ МАТЕРИАЛОВ ПРИ ВЫПОЛНЕНИИ СПОНДИЛОДЕЗА

Objectives. To compare the survival rate of «bone chip» cells and native transplant automixture by evaluating the architectonics of cell membranes. Material and methods. Autograft in the form of a native graft automixture obtained using a «bone dust filtering device» and «bone chips» obtained using Kerrison rongeurs in 6 patients operated for degenerative diseases of the spine. The study was carried out using a flow cytometer by assessing the architectonics of cell membranes during the first three days. Results. The study of native transplant automixture and «bone chips» determined the dispersed state of the first graft and the latter, similar in its structure to the whole bone. The spectrograms analysis showed a heterogeneous composition of grafts, and in the case of native transplant automixture, the scatter was more pronounced. The increase in the number of cells during the first three days of the native transplant automixture is probably associated with the elimination of contact inhibition of their proliferation and the release of osteoinductive factors from the bone matrix. The number of necrotic cells was higher in the native transplant automixture, which is due to the rough method of its preparation, however, this number was not statistically significant compared to the number of necrotic cells in the «bone chips». Despite the combined thermal and mechanical impact, the survival of the cell component in both cases made up more than 98.0% without any statistical significance in comparison between the two types of transplants (p>0.05). Conclusions. The high survival rate of the cellular component of both types of autografts indicates that the osteogenic potential does not depend on the method of their preparation.

Examination of the Quality of Particulate and Filtered Mandibular Bone Chips for Oral Implants: An In Vitro Study

(1) Background: Autologous bone is supposed to contain vital cells that might improve the osseointegration of dental implants. The aim of this study was to investigate particulate and filtered bone chips collected during oral surgery intervention with respect to their osteogenic potential and the extent of microbial contamination to evaluate its usefulness for jawbone reconstruction prior to implant placement. (2) Methods: Cortical and cortical-cancellous bone chip samples of 84 patients were collected. The stem cell character of outgrowing cells was characterized by expression of CD73, CD90 and CD105, followed by osteogenic differentiation. The degree of bacterial contamination was determined by Gram staining, catalase and oxidase tests and tests to evaluate the genera of the found bacteria (3) Results: Pre-surgical antibiotic treatment of the patients significantly increased viability of the collected bone chip cells. No significant difference in plasticity was observed between cells isolated from the cortical and cortical-cancellous bone chip samples. Thus, both types of bone tissue can be used for jawbone reconstruction. The osteogenic differentiation was independent of the quantity and quality of the detected microorganisms, which comprise the most common bacteria in the oral cavity. (4) Discussion: This study shows that the quality of bone chip-derived stem cells is independent of the donor site and the extent of present common microorganisms, highlighting autologous bone tissue, assessable without additional surgical intervention for the patient, as a useful material for dental implantology.

Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips.

To investigate the benefits of vancomycin-soaked femoral head allograft versus allogenic bone chips as an osteotomy gap filler in reducing infection rates and perioperative pain control after medial opening wedge high tibial osteotomy (MOW-HTO). Retrospective analysis of 114 knees that underwent MOW-HTO between 2013 and 2020. Osteotomy gaps were filled with vancomycin-soaked femoral head allograft (Study Group) or allogenic bone chips (Control Group). Both groups received systemic antibiotics. Perioperative parameters studied included pain, blood loss, length of stay, postoperative day (POD1) pain scores at rest, with activity as well as ambulatory distance. Patients in the Study Group were also followed up prospectively and clinical outcome scores, namely Knee Society Score, Oxford knee score (OKS) and Physical and Mental Component of the Short-Form 36 Questionnaire (PCS and MCS, respectively). Statistical analyses using Student's T-test were performed between the groups. Patients of the study group had significantly better POD1 visual analogue scale (VAS) at rest (0.9 ± 1.6 vs 2.9 ± 1.2, p < 0.001) as well as when active (3.0 ± 1.9 vs 5.8 ± 1.5, p < 0.001). A greater proportion of patients in the study group ambulated on POD 1, (90.6% vs 26.0%, p < 0.001). Of those who ambulated on POD1, study group patients managed to cover a greater ambulatory distance (13.9 ± 7.4m vs 8.4 ± 9.3m, p < 0.05). The proportion of study group patients requiring patient-controlled analgesia (PCA) was also significantly less compared to the control group (32.8% vs 58.0%, p < 0.05). Of those requiring PCA, the amount of morphine requirement was also significantly reduced in the group with vancomycin-soaked allograft (8.7 ± 8.1mg vs 23.9 ± 33.0mg, p < 0.05). The study group also had a reduced length of stay (3.5 ± 2.0days vs 5.5 ± 2.6days, p < 0.001). Patients in the study group demonstrated significant improvement in Knee Society Knee Score (KSKS), OKS, PCS and MCS at 12months postoperatively. The study group had a significantly reduced incidence of superficial wound infections compared to the control group (3.1% vs 18.0%, p < 0.05). Vancomycin-soaked femoral head allograft reduced superficial and deep wound infections in MOW-HTO. It was also effective in reducing postoperative pain, thereby enabling early ambulation and shorter hospital stays. Retrospective comparative study, III.

Revision hip arthroplasty

From 1990 to 2000 238 revision hip joint replacements were performed at Joint Replacement Department of CITO. Both cement and cementless implants as well as in case of need allografts in the form of bone chips and spongeous bone were used. Technique peculiarities of revision operations for Sivash and Compomed implants replacement are described. The working time for Com- pomed implants was detected to be up to 5 у ears, for Gerchev implants up to 7 years and for Sivash implants 10 years and more. In revision replacement the following complications occurred: lethal outcome 2 cases, acute myocardial infarction in early postoperative period 1 case (recovery), deep suppuration 1 case (implant was removed), thromboembolia of small branches of a. pulmonalis 3 cases (recovery), paresis of fibular portion of n. ischiadicus 5 cases (complete function restoration), dysbacteriosis during antibacterial therapy 2 cases (recovery). Results of treatment were evaluated in 140 patients in the periods from 3 months to 10 years. In 139 cases complete or almost complete restoration of operated limb function was clinically noted. In 37 out of 139 patients signs of bone resorption around the cup and stem of implant were detected roentgeno- logically.

An ultrasonic osteotomy device enhanced post-osteotomy bone healing beyond that with a conventional rotary device in a rat calvarial model

ObjectiveUltrasonic osteotomy devices (UODs) are reported to have many clinical benefits; for example, they cause little damage to adjacent tissues in oral surgery. However, the difference in the tissue repair process between rotary osteotomy devices (RODs) and UODs is still unclear. This study aimed to compare bone healing after osteotomy with UODs versus RODs in a rat calvarial defect model. MethodsCalvarial bone defects were made in male Wistar rats with a UOD on the right side and an ROD on the left side. Bone and morphological changes were quantitatively evaluated for 4 weeks by micro-CT, light microscopy and electron microscopy. Furthermore, after calvarial bone osteotomy, osteoblastic cells were collected from the bone chips and cultured for 2 weeks, and their proliferation and differentiation activities were analysed. ResultsScanning electron microscopy (SEM) showed that UOD cuts had smoother surfaces than ROD cuts. In HE-stained sections and micro-CT images, the bone wound gap was closed earlier on the UOD side than on the ROD side. Bone thickness, the quantity of newly formed bone, and the number of osteocytes were greater on the UOD side than on the ROD side. Cultured osteoblast-like cells harvested from bone chips cut by the UOD had greater proliferative activity than those harvested from ROD-cut bone chips. ConclusionsThe use of a UOD may assist bone regeneration, presumably because osteoblasts differentiated from mesenchymal cells are activated by ultrasonic microvibration and because UODs cause less damage to the bone than conventional RODs.

A novel drill bit design for reducing bone-chip morphology in orthopaedic bone drilling

Bone drilling is necessary during orthopaedic surgery for internal fixation. The drilling through the bones is the same as the mechanical drilling that uses a surgical twisted drill bit. The design and geometry of drill-bit play a paramount role in producing bone debris of various shapes and sizes. These different bone chips are responsible for chip clogging and chip accumulation at drill sites, leading to a higher temperature, torque, and thrust force. This study compared three hollow drill bits with different diamond grit sizes with a conventional surgical twisted drill bit to observe the chip morphology. It was witnessed that the influence of diamond grit size plays a significant role in producing bone debris. Different sizes of bone chips were stimulated with various drill bits. Similar chip characteristics were observed in all types of bone debris with varying drill bits. The twisted drill bit produces thick spiral-shaped bone debris compared to the hollow drill bit. The fine diamond grits in the drill bit reduce the chip morphology of bone debris during bone drilling. Thus, the diamond-impregnated surgical tool is preferable to drilling burr than a surgical twisted drill bit for surgeons during orthopaedic surgery.

Microdanos ósseos gerados na preparação do sítio de instalação de implantes: uma alternativa para análise ex vivo de diferentes protocolos de velocidade de perfuração

ABSTRACT Objective: The aim of this study was to evaluate bone microdamage in sites prepared for implant placement by using an ex vivo model with three drilling rotation speeds. Methods: Bovine bone ribs were used for the creation of 18 osteotomy sites at different rotation speeds: 1200 rpm, 800 rpm, and 400 rpm. Specimens were stained with xylenol orange and prepared for histological analysis by using fluorescence and polarized light microscopies. Bone microdamage was evaluated by number and based on total bone area, as follows: microfracture density (Fr.D = n/mm2), microcrack morphology (diffuse or linear), and density (Cr.D = n/mm2), and presence of bone chips. To complement the analysis, linear microcracks were assessed by using confocal microscopy for three-dimensional visualization. Results: Bone microdamage on the osteotomy sites included microcracks, diffuse damages, microfracture, and bone chip formation. There was an association between bone microdamage and cancellous bone (p 0.0016), as well as a positive correlation between Fr.D and Cr.D (p 0.05, r 0.54). BM occurrence was not different between the three rotation speeds. In 3D, the height of the microcrack depth was 60.81 µm. Conclusion: Bone microdamage occurs during osteotomy, and the ex vivo model used was effective for the assessment of these biomechanical parameters. In addition, microdamage was not influenced by the drilling rotation speed in this experimental condition.

Modified enzymatic collagen digestion-mediated isolation of osteocytes

This study established a method for isolating large numbers of high-purity osteocytes from high-density bone. Bone fragments derived from mice tibia and femurs were alternately digested with type I collagenase and EDTA nine times, and the digested cells and bone chips (BC) were cultured, digested, and passaged when cells were fully grown. The types of cells obtained were identified by morphology, viable cell counts, alkaline phosphatase staining, and biochemical activity analyses, and specific osteocyte and osteoblast markers were evaluated by quantitative real-time polymerase chain reaction. Our results showed that among the cells obtained from the third digestion (fractions 7–9) of wild mice tibias and femurs and the remaining BCs, 85%–90% of the cells were osteocytes. Moreover, their morphology was approximately one-tenth to one-fifth the size of osteoblasts, star-shaped or polygonal, with a dendritic structure, negative for alkaline phosphatase staining, and showed a high expression of dmp1 and sclerostin. Ninety percent of the cells in fractions 1–3 were osteoblasts, and were fusiform or polygonal shape. The activity of osteoblast-specific alkaline phosphatase and mRNA expression were high in this fraction, while the expression of osteocyte-specific dmp1 and sclerostin was not detected. In the second portion (fractions 4–6), a large number were osteoblasts, mixed with a small number of osteocytes, and had high alkaline phosphatase activity and osteocyte mRNA levels, a specific level of the osteocyte marker dmp1, and no sclerostin was detected. Osteocytes in daβcatot mice were also successfully isolated by this method, and we found that Wnt signaling increased the proliferation of these osteocytes. The proposed method can be used to culture osteocytes and osteoblasts of high purity and can be used for isolation and culture of these two kinds of cells from high-density bone, which provides an avenue for the study of osteocyte function in vitro.

Transfacetal Screw Fixation for Subaxial Cervical Spine.

In the modern era of spine surgery for subaxial cervical spine, transfacetal screw fixation has evolved enormously. Transfacetal screw fixation for subaxial cervical spine is a biomechanically effective technique. In this fixation, four cortical surfaces of the facets are purchased by the transfacetal screws. In this video, we demonstrated the surgical technique of posterior transfacetal screw fixation. Transfacetal screw fixation of subaxial cervical spine was done along with posterior decompression. The entry point of transfacetal screw was defined as 1 mm caudal to mid-point of lateral mass, and screws were directed perpendicular to facet joint in the sagittal plane and straight in the coronal plane. Bone chips were placed over decorticated lateral mass after decompression. Patient had uneventful recovery and maintained good status at follow up. In subaxial cervical spine, transfacetal screw fixation is a biomechanically effective, rigid, and an inexpensive technique to obtain immediate rigid fixation.

Bone chip versus myositis ossificans after supracondylar fracture of humerus.

A 44-year-old male presented to the department of physiotherapy with the primary concern of inability to fully straighten his right elbow. As per the history given by the patient, he had sustained a fall on an outstretched hand 10 months ago. He had sustained a fracture around the elbow, which was managed conservatively with plaster cast for six weeks by a local practitioner. He had pain and swelling around the elbow after the injury, but it had subsided two months ago. On examination, terminal 30 degrees of the range of motion (ROM) of right elbow was limited. Although, forearm supination-pronation was full. The X-ray revealed bone chip at the anterior aspect of the distal humerus, along with supracondylar fracture of the humerus that was not completely healed. Bone chip can be differentiated from myositis ossificans, which is a common complication of fractures around the elbow, by its well-defined margins. As a part of physiotherapy intervention, gentle active ROM of right elbow and functional use of right hand for light activities of daily living was emphasized. The patient was advised to avoid use of heat, massage and jerky movements of elbow as these can lead to myositis ossification. He was assured that he had functional ROM of 30 degrees to 130 degrees elbow flexion, so lack of terminal extension should not bother him in his lifestyle.

Posterior Cervical Decompression and Fusion With Exoscope: 2-Dimensional Operative Video.

Posterior cervical decompression and fusion is an effective strategy for correction of cervical spondylotic myelopathy. Here, we highlight the operative treatment of a 63-yr-old man entailing a 4-level posterior cervical laminectomy and fusion, with the use of an exoscope throughout. The patient initially presented with symptoms of gait dysfunction and loss of fine motor control in the upper extremities, without neck pain or radiculopathy. His imaging demonstrated a congenitally narrowed spinal canal with cervical stenosis at C3-C4, C5-C6, and C6-C7. The patient consented to the procedure and publication of his image, along with other participants and any identifiable individuals. The operation proceeded with the patient in a prone position with midline dissection to the posterior elements of C3-C6. Pilot holes were drilled in the lateral masses and C3-C4, C4-C5, C5-C6, and C6-C7 laminectomies performed using a high-speed drill, with removal of the laminae en bloc. Lateral mass screws were inserted and precontoured rods secured, with morselized autograft and allograft bone chips placed for arthrodesis. Postoperatively, the patient reported noted improvement in his symptoms.

The radiological outcomes of short-segment pedicle screw fixation combined with transforaminal interbody fusion for treatment of thoracolumbar burst fracture

Objective: This study aims to evaluate radiological outcomes of short-segment pedicle screw fixation with transforaminal interbody fusion (TIF) using bone chip graft for treatment of unstable thoracolumbar burst fracture, Denis type IIB. Subject and method: The data in this study were retrospectively collected from all patients with isolated unstable thoracolumbar burst fractures treated by posterior short segment pedicle screw fixation and TIF from January 2013 to January 2017. All patients were followed up for a minimum time interval of 1 year. For radiologic outcome evaluation, a loss percentage of anterior vertebral body heights (%ABC), vertebral kyphotic angle (VKA) and regional kyphotic angle (RKA) were collected preoperatively, postoperatively and at final follow-up. Result: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months (range, 17-73 months). The mean % ABC, VKA and, RKA at the time of admission were 49.9%, 24.6o and 19.7o, respectively. These values were 17.6%, 11.5o, 8.5o postoperatively, and 27.5%, 14.4° and 14.1° at final follow-up, respe­ctively. Fusion rate at final follow-up was 91.7% based on Bridwell’s criteria. There were 6 patients (16.7%) with hardware failure at final follow-up. Conclusion: Short-segment pedicle screw fixation with TIF using bone chip graft is an effective surgical management for unstable thoracolumbar burst fracture with the acceptable radiological outcomes in Vietnamese patients.