Long Segment Research Articles

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

BackgroundThis study aimed to determine if the hybrid short-segment (HSS) technique is a good alternative to the intermediate-segment (IS) and long-segment (LS) techniques in pedicle screw fixations for acute thoracolumbar burst fractures (TLBFs).MethodsIn this retrospective evaluation, we examined 43 patients who underwent surgical treatments, including one- or two-level suprajacent (U) and infrajacent (L) pedicle screw fixations, for acute single-level TLBFs with neurological deficits between the T11 and L2 levels from July 2013 to December 2019. Among these patients, 15 individuals underwent HSS (U1L1), 12 received IS (U2L1), and 16 underwent LS (U2L2) fixations. Supplemental kyphoplasty of the fractured vertebral bodies was performed exclusively in the HSS group. Our analysis focused on assessing blood loss and surgical duration. Additionally, we compared postoperative thoracolumbar kyphotic degeneration using the data on Cobb angles on lateral radiographic images acquired at three time points (preoperatively, postoperative day 1, and follow-up). The end of follow-up was defined as the most recent postoperative radiographic image or implant complication occurrence.ResultsBlood loss and surgical duration were significantly lower in the HSS group than in the IS and LS groups. Additionally, the HSS group exhibited the lowest implant complication rate (2/15, 13.33%), followed by the LS (6/16, 37.5%) and IS (8/12, 66.7%) group. Implant complications occurred at a mean follow-up of 7.5 (range: 6–9), 9 (range: 5–23), and 7 (range: 1–21) months in the HSS, IS, and LS groups. Among these implant complications, revision surgeries were performed in two patients in the HSS group, two in the IS group, and one in the LS group. One patient treated by HSS with balloon kyphoplasty underwent reoperation because of symptomatic cement leakage.ConclusionsThe HSS technique reduced intraoperative blood loss, surgical duration, and postoperative implant complications, indicating it is a good alternative to the IS and LS techniques for treating acute single-level TLBFs. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment within 1 year. Supplemental kyphoplasty with SpineJack® devices and high-viscosity bone cements for anterior reconstruction can potentially decrease the risk of cement leakage and related issues.

The efficacy of different segments fixation for treatment thoracolumbar fractures: A Bayesian network meta-analysis.

We did this network meta-analysis to comprehensively compare the efficacy of different segments [intermediate segment (IS), short segment (SS) and long segment (LS)] in the fixation of thoracolumbar fractures. We searched studies from inception until January 20, 2023 through PubMed, Embase, Web of Science, and the Cochrane Library. All studies comparing different segments in the fixation of thoracolumbar fractures were included in this meta-analysis. Outcomes were anterior vertebral height ratio (AVHR), sagittal Cobb angle (SCA), visual analogue scale score, and implant failure rate. This network meta-analysis was performed by R software with gemtc package. Finally, a total of 22 studies were finally included in this network meta-analysis. IS (WMD 2.43, 95% CrI 2.04-2.91) was more effective than SS in terms of the AVHR, and the difference was statistically significant. IS was more effective than LS in reducing SCA (WMD -2.87, 95% CrI -3.79 to -1.96) with statistically significant. Compared with SS, IS significantly reduced the SCA with statistically significant (WMD -2.52, 95% CrI -3.31 to -1.72). IS (WMD -2.87, 95% CrI -3.78 to -1.96) was more effective than LS, and the difference was statistically significant. Moreover, IS (WMD -2.52, 95% CrI -3.31 to -1.72) was more effective than SS, and the difference was statistically significant. IS was associated with a significant reduction in SCA, implant failure rate, and visual analogue scale compared to SS and LS, while having the most favorable impact on AVHR among all the treatments assessed.

Biomechanical Comparison Between Posterior Long-Segment Fixation, Short-Segment Fixation, and Short-Segment Fixation With Intermediate Screws for the Treatment of Thoracolumbar Burst Fracture: A Finite Element Analysis.

Posterior long-segment (LS) fixation, short-segment (SS) fixation, and short segment fixation with intermediate screws (SI) have shown good outcomes for the treatment of thoracolumbar burst fractures. However, limited data compared the biomechanical properties between LS fixation and SI. The purpose of this study was to compare the von Mises stresses on the pedicular screw system and bone between posterior LS fixation, SS fixation, and SI for the treatment of thoracolumbar burst fracture. The finite element model of thoracolumbar spines from T11 to L3 was created based on the computed tomography image of a patient with a burst fracture of the L1 vertebral body. The models of pedicular screws, rods, and locking nuts were constructed based on information from the manufacturer. Three models with different fixation configurations-that is, LS, SS, and SI-were established. The axial load was applied to the superior surface of the model. The inferior surface was fixed. The stress on each screw, rod, and vertebral body was analyzed. The motion of the spine in SS (0.5 mm) and SI (0.9 mm) was higher than in LS (0.2 mm). In all models, the lowest pedicle screws are the most stressed. The stress along the connecting rods was comparable between SI and LS (50 MPa). At the fracture level, stress was found at the pedicles and vertebral bodies in SI. There was relatively little stress around the fractured vertebral body in LS and SS. Posterior SI preserves more spinal motion than the LS. In addition, it provides favorable biomechanical properties than the SS. The stress that occurred around the pedicle screws in SI was the least among the 3 constructs, which might reduce complications such as implant failure. SI produces more stress in the fractured vertebral body than LS and SS, which could potentially aid in bone healing according to the Wolff law. SI has proved to be a biomechanically favorable construct and helps preserve the spinal motion segment. It could be an alternative surgical option for treating patients who present with thoracolumbar burst fractures.

Telomere lengths in Barrett's esophagus as a precancerous lesion.

We have reported that precancerous conditions and lesions invariably have shorter telomeres and associated chromosomal instability relative to normal tissue. Using the Q-FISH method and our original software, Tissue Telo, we estimated telomere lengths in cardiac- and intestinal-type mucosae in 48 cases of Barrett's esophagus (short-segment (SS) n = 18; long-segment (LS) n = 30). There were no significant differences in telomere length between the cardiac and intestinal types in any of the 48 cases, suggesting that the presence or absence of goblet cells in the columnar segments is unrelated to telomere-dependent chromosomal instability in Barrett's esophagus. In LS Barrett's esophagus, telomeres were shorter in cardiac-type than in intestinal-type mucosa, suggesting that the former may play a more important role than the latter as a precancerous lesion in LS. Telomeres in cardiac-type mucosa were longer in SS than in LS, supporting the possibility that cardiac-type LS may pose a higher risk as a precancerous lesion than cardiac-type SS. Although it has been considered that Barrett's carcinoma arises only from intestinal-type mucosa, our present findings support previous histogenetic studies suggesting that cardiac-type mucosa is more important as a precancerous condition in Barrett's esophagus than anticipated.

What you learn & when you learn it: Impact of early bilingual & music experience on the structural characteristics of auditory-motor pathways

Music and language engage the dorsal auditory pathway, linked by the arcuate fasciculus (AF). Sustained practice in these activities can modify brain structure, depending on length of experience but also age of onset (AoO). To study the impact of early experience on brain structure we manually dissected the AF in bilinguals with and without music training (MT) who differed in the AoO of their second language (L2), or MT. We found the usual left-greater-than-right asymmetry in the volume of the long segment (LS) of the AF across all groups. However, simultaneous exposure to two languages from birth enhanced this leftward asymmetry, while early start of MT (≤7) enhanced the right LS macrostructure, reducing the normative asymmetry. Thus, immersive exposure to an L2 in the first year of life can produce long-term plastic effects on the left LS, which is considered to be largely under genetic control, while deliberate music training in early childhood alters the right LS, whose structure appears more open to experience. These findings show that AoO of specific experience plays a key role in a complex gene-environment interaction model where normative brain maturation is differentially impacted by diverse intensive auditory-motor experiences at different points during development.

Does Multifocal Dysplasia in Barrett’s Esophagus Increase the Risk of Progression to Esophageal Adenocarcinoma?: Presidential Poster Award

Introduction: Barrett’s Esophagus (BE), is thought to be secondary to gastroesophageal reflux disease and progresses to esophageal adenocarcinoma (EAC) in a stepwise manner. Current guidelines utilize dysplasia to guide management, but there is conflicting evidence on the extent of dysplasia for risk stratification. Here, we evaluated the effect of multifocal dysplasia on the risk for EAC and hypothesized that multifocality in low-grade dysplasia (LGD) and high-grade dysplasia (HGD) are risk factors for progression to EAC. Methods: This was a retrospective study of BE patients with, or with suspected, dysplasia presenting to an academic medical center for evaluation from 2006 to 2016. Information collected include: patient demographics; BE length; histology, including grade and presence of multifocal dysplasia; disease progression; PPI use; need for esophagectomy; and length of follow-up. All pathology specimens were read by expert GI pathologists as: no dysplasia (ND), indefinite for dysplasia (IND), LGD, or HGD. LGD or HGD was further categorized as unifocal or multifocal. Results: Of 305 BE patients with, or with suspected, dysplasia, 51 were excluded (33 ND, 18 IND). 254 BE patients were included in the final analysis: 112 LGD (unifocal=90, multifocal=22) and 142 HGD (unifocal=108, multifocal=34). In total, twenty-five patients with dysplastic BE (13 unifocal, 12 multifocal) developed EAC; all were diagnosed with intramucosal adenocarcinoma with either T1a or T1b lesions. Multifocality significantly increased the risk for progression to EAC (Table 2: RR 3.26, p=0.004), with the effect most pronounced in the subgroup with multifocal LGD as compared to those with unifocal LGD (RR 8.18, p=0.013). In patients with HGD, multifocality did not increase the risk for subsequent EAC (RR 2.31, p=0.079). Lastly, multifocal dysplasia associated with long segment BE (LSBE) significantly increased the risk for EAC (Table 3: RR 3.09, p=0.011), and HGD patients with LSBE were more at-risk for progression to EAC than that of LGD patients (RR 4.33, p=0.007). Conclusion: Multifocal dysplasia significantly increases the risk of progressing from BE to EAC and is especially important in BE patients with LGD. Identification of the extent of dysplasia is also essential in patients with LSBE, particularly those diagnosed with HGD. If confirmed, incorporating dysplasia multifocality into the BE management algorithm should be considered.335_A Figure 1 No Caption available.335_B Figure 2 No Caption available.335_C Figure 3. Short Segment (SS) BE is defined as <3 cm in length, while Long Segment (LS) BE is defined as > or = to 3 cm in length

Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

To investigate the effect of fusion on short segment including fractured level (SSIFL) and long segment (LS) transpedicular fixation after acute thoracolumbar junction burst fractures. The 2-year clinical and radiologic follow-up results of the 2 groups also were compared. Seventy-four patients were randomized into one of 2 groups: SSIFL (n= 39) or LS (n= 35). The SSIFL group included one level above and one level below, including the fracture level, whereas the LS group included 2 levels above and 2 levels below, excluding the fracture level, for the transpedicular fixation. Fusion was assessed by technetium 99m-methylendiphosphonate, bone scintigraphy, and single-photon emission computed tomography. The 2-year follow-up results were compared clinically (Oswestry Disability Index and visual analog scale) and radiologically (kyphosis angle, sagittal index, anterior vertebral body height loss) at regular intervals. The clinical scores and radiologic parameters of patients with and without fusion also were compared. The number of patients with fusion was significantly greater in the SSIFL group compared with the LS group. There was a significant reduction of the clinical scores of patients who had fusion compared with the fusion-free group; however, there was no radiologically significant difference. Furthermore, there was no significant difference between the SSIFL and LS groups in terms of the 2-year radiologic and clinical follow-up results. Fusion occurred sooner and patients experienced earlier clinical recovery in the SSIFL group compared with the LS group.

PD14-10 A MULTIINSTITUTIONAL EVALUATION OF THE MANAGEMENT AND OUTCOMES OF LONG SEGMENT AND PANURETHRAL STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) II1 Apr 2015PD14-10 A MULTIINSTITUTIONAL EVALUATION OF THE MANAGEMENT AND OUTCOMES OF LONG SEGMENT AND PANURETHRAL STRICTURES Jonathan Warner, Ibraheem Malkawi, Panjak Joshi, Sanjay Kulkarni, Guido Barbagli, Massimo Lazzeri, Ryan Mori, Kenneth Angermeier, Justin Han, Christopher Gonzalez, Fransisco Martins, Reynaldo Gomez, and Richard Santucci Jonathan WarnerJonathan Warner More articles by this author , Ibraheem MalkawiIbraheem Malkawi More articles by this author , Panjak JoshiPanjak Joshi More articles by this author , Sanjay KulkarniSanjay Kulkarni More articles by this author , Guido BarbagliGuido Barbagli More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Ryan MoriRyan Mori More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , Justin HanJustin Han More articles by this author , Christopher GonzalezChristopher Gonzalez More articles by this author , Fransisco MartinsFransisco Martins More articles by this author , Reynaldo GomezReynaldo Gomez More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1339AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study presents the results of an international multi-institutional collaborative review of the largest available series of long segment and panurethral stricture repairs. The authors seek to better understand the management of long segment and panurethral strictures. METHODS A retrospective review was performed of patients treated with strictures longer than 8 cm at 8 different international tertiary referral centers. Data collected included demographics, cause of stricture, prior dilation or DVIU, prior urethroplasty, length of stricture, and surgical approach. Endpoints analyzed included surgical complications and recurrence. RESULTS 466 patients were identified. Treatment intervals ranged from 12/27/1984 to 11/9/2013 and included the experience of 8 experts in the field. Dorsal onlay buccal mucosa graft was the most common procedure utilized (223, 47.9%) while other techniques included first stage Johanson (including perineal urethrostomy) (162, 34.8%), second stage Johanson (56, 12%), fasciocutaneous flaps (8, 1.7%) and a combination flap and graft (17, 3.6%). Overall success was achieved in 361 patients (77.5%) with a mean follow up of 20 months. Recurrences of the various surgical types were similar; however, second stage Johanson urethroplasty was found to have a higher recurrence rate compared to one-stage buccal mucosal graft urethroplasty (35.7% versus 17.5%, respectively, p <0.01). In cases of lichen sclerosis, the recurrence rate was higher after second stage Johanson versus after a one-stage buccal graft procedure (14.0% versus 47.8% respectively, p <0.01). Those urethroplasties performed with a fasciocutaneous flap had a higher complication rate compared to those performed without (32% versus 14%, respectively, p =0.02). Prior dilation or urethrotomy, higher number of prior dilations or urethrotomies, abnormal postoperative voiding cystourethrogram, and skin grafts all portend a higher recurrence rate. Stricture length and location of buccal mucosal graft appear to have no impact on recurrence. On logistic regression analysis, only second stage Johanson had an increased odds ratio of recurrence compared to BMG, at 2.82 (1.41-5.86). CONCLUSIONS Panurethral and long segment strictures can be treated with high success rates. Considering all techniques, a 77.5% success rate was noted. Buccal grafts were particularly more successful than second stage Johanson urethroplasty. Fasciocutaneous flaps, while successful, had high complication rates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e322 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Warner More articles by this author Ibraheem Malkawi More articles by this author Panjak Joshi More articles by this author Sanjay Kulkarni More articles by this author Guido Barbagli More articles by this author Massimo Lazzeri More articles by this author Ryan Mori More articles by this author Kenneth Angermeier More articles by this author Justin Han More articles by this author Christopher Gonzalez More articles by this author Fransisco Martins More articles by this author Reynaldo Gomez More articles by this author Richard Santucci More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Vertebroplasty plus short segment pedicle screw fixation in a burst fracture model in cadaveric spines

The current project investigates the role of vertebroplasty in supplementing short segment (SS) posterior instrumentation, only one level above and below a fracture. In the treatment of thoracolumbar burst fractures, long segment (LS) posterior instrumentation two levels above and below the fracture level has been used. In our study, burst fractures were produced at L1 in eight fresh frozen human cadaveric spines. The spines were then tested in three conditions: 1) intact, 2) after LS (T11–L3), 3) SS (T12–L2) instrumentation with pedicle screws and rods, and 4) short segment instrumentation plus cement augmentation of the fracture level (SSC). LS instrumentation was found to significantly reduce the motion at the instrumented level (T12–L2) as well as the levels immediately adjacent in flexion, extension and lateral bending. Similarly, SSC augmentation was found to significantly reduce the motion compared to intact at T12–L2 but still maintained the adjacent level motion. However, SS instrumentation alone did not significantly reduce the motion at T12–L2 except for left lateral bending. While LS instrumentation remains the most stable construct, SS instrumentation augmented with vertebroplasty at the fracture level increases rigidity in flexion, extension and right lateral bending beyond SS instrumentation alone.

MP3-05 URETHROPLASTY FOR HIGH-RISK, LONG SEGMENT URETHRAL STRICTURES WITH VENTRAL BUCCAL MUCOSA GRAFT AND GRACILIS MUSCLE FLAP

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-05 URETHROPLASTY FOR HIGH-RISK, LONG SEGMENT URETHRAL STRICTURES WITH VENTRAL BUCCAL MUCOSA GRAFT AND GRACILIS MUSCLE FLAP Drew A. Palmer, Alex J. Vanni, Jill C. Buckley, and Leonard N. Zinman Drew A. PalmerDrew A. Palmer More articles by this author , Alex J. VanniAlex J. Vanni More articles by this author , Jill C. BuckleyJill C. Buckley More articles by this author , and Leonard N. ZinmanLeonard N. Zinman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES End-stage urethral stricture disease presents a reconstructive challenge that frequently results in urinary diversion. Our objective was to assess the success of urethral reconstruction for high-risk, long segment urethral strictures with a ventral buccal mucosa graft and gracilis muscle flap in patients who were unfit for standard repair because of a poor graft bed. METHODS A retrospective review of 1039 patients who underwent urethroplasty from a tertiary care facility between 1999 and 2013 was performed. We identified 18 patients who underwent urethroplasty with ventral buccal mucosa graft and gracilis muscle flap buttress as a graft bed. Patient demographics, stricture etiology, length, location, prior surgical procedures and surgical approach were identified. Stricture recurrence was defined as the inability to pass a 17 Fr cystoscope. RESULTS The mean age was 60.2 years (23-81) with a mean follow-up of 39.3 months (6-92). The mean stricture length was 8.2 cm (3.5-15). Stricture etiology was radiation therapy in 50% (due to prostate cancer in 33%, urethral cancer in 11.1%, and Ewing’s sarcoma in 5.6%), followed by trauma (16.7%), prostatectomy (11.1%), endoscopic instrumentation (11.1%), hypospadias (5.6%), and sacral agenesis (5.6%). 7 patients (38.9%) had previous urethroplasty and 3 (16.7%) had previous UroLume® Urethral Stents placed. The strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 55.6%, followed by the bulbomembranous urethra (33.3%), bulbar urethra (5.6%), and penile urethra (5.6%). All patients had a ventral buccal mucosa graft urethroplasty with gracilis muscle flap. Urethral reconstruction success was 83.3% (15/18). Of the three failures, one had an ileal loop while the other two were managed with a suprapubic tube. Mean time to stricture recurrence was 6 months (2-13). 5 patients (27.8%) had postoperative incontinence requiring an artificial urinary sphincter. CONCLUSIONS Urethroplasty for high-risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and gracilis muscle flap avoiding urinary diversion in the majority of patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e35 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Drew A. Palmer More articles by this author Alex J. Vanni More articles by this author Jill C. Buckley More articles by this author Leonard N. Zinman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Posterior fixation of thoracolumbar burst fractures: Is it possible to protect one segment in the lumbar region?

BackgroundThe treatment for thoracolumbar burst fractures is controversial. The aim of this retrospective study was to compare intermediate-segment (IS) and long-segment (LS) instrumentation in the treatment for these fractures.MethodsIS instrumentation was considered as pedicle fixation two levels above and one level below the fractured vertebra (infra-laminar hooks attached to lower vertebra with pedicle screws). LS instrumentation was done two levels above and two levels below the fractured vertebra. Among a total of 25 consecutive patients, Group 1 included ten patients treated by IS pedicle fixation, whereas Group 2 included fifteen patients treated by LS instrumentation.ResultsThe measurements of local kyphosis (p = 0.955), sagittal index (p = 0.128), anterior vertebral height compression (p = 0.230) and canal diameter expansion (p = 0.839) demonstrated similar improvement at the final follow-up between the two groups. However, there was a significant difference (p < 0.05) between Group 1 and Group 2 regarding clinical outcome [Hannover scoring system, Oswestry disability questionnaire and the range of motion of the lumbar region compared to neutral (0°)].ConclusionsThe radiographic parameters were the same between the two groups. However, the clinical parameters demonstrated that IS instrumentation is a more effective management of thoracolumbar burst fractures.

1094 OUTCOME OF DORSAL ONLAY FOR LONG SEGMENT URETHRAL STRICTURE

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 20101094 OUTCOME OF DORSAL ONLAY FOR LONG SEGMENT URETHRAL STRICTURE Patrick J. Bastian, Margit Mayer, Alexander Buchner, Stefan Tritschler, Christian G. Stief, and Christian Gozzi Patrick J. BastianPatrick J. Bastian More articles by this author , Margit MayerMargit Mayer More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian G. StiefChristian G. Stief More articles by this author , and Christian GozziChristian Gozzi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the study was to evaluate the interim outcome of long segment (> 2cm) urethral strictures managed by dorsal onlay/inlay following previous, endourological or open urethroplastic surgery. Reconstruction of the urethra included a perineal incision in lithotomy position and dissection of the musculus bulbospongiosus followed by complete scar excision and construction of a dorsal onlay next to the corpra cavernosa which represent a well vascularized recipient bed ensuring appropriate graft healing. METHODS Between August 2007 and April 2009 a total of 46 patients (mean age 57,2 years, 14 - 83 years) with complex urtethral strictures >2 cm were enrolled into the study. All patients underwent one stage urethral reconstruction using penile skin/foreskin in 42 cases and thigh (harvested by electrodermatom) in 4 cases, respectively. Etiology of strictures was either iatrogenic (n = 22), idiopatic (n=19), due to inflammation/balanitis xerotica (n = 3) or as a consequence of trauma (n =2). Outcome analysis included urinary flow, urethral calibration > 18ch, voiding cystometry and patient's satisfaction. RESULTS In fourty-four patients (95%) no recurrent urethral stenosis was observed resulting in a postoperative flow of average 31,7 ml/s (12-54) and an decrease of PVR from average 70,9 ml to 17,5 ml. Late complications (>30days) included stricture recurrence in 2 patients which were treated with glanduloplasty and dorsal onlay, respectively. One patient suffered from fistula which resolved spontaneously 5 weeks after operation. Cosmetic results were satisfactory in all patients. Postoperative voiding parameters were significantly improved (p<0.001). CONCLUSIONS One stage dorsal onlay/inlay for reconstruction of long segment urethral stenosis represents a reliable method with minimum complication rate even if the urethral plate is severely scarred or has been excised during previous surgery. Meticulous scar excision is necessary to provide a well vascularized grafting bed thus ensuring excellent graft imbibition. Munich, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e426 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick J. Bastian More articles by this author Margit Mayer More articles by this author Alexander Buchner More articles by this author Stefan Tritschler More articles by this author Christian G. Stief More articles by this author Christian Gozzi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Posterior Fixation of Thoracolumbar Burst Fracture

The treatment of thoracolumbar burst fracture is a controversial issue. Short-segment (SS) pedicle fixation has become a popular treatment option. However, there are several studies regarding the high rate of failure. The aim of this prospective study was to compare SS versus long-segment (LS) instrumentation. For this purpose, 18 consecutive patients were assigned to two groups. Group 1 included nine patients treated by SS pedicle fixation, whereas group 2 included nine patients treated by LS instrumentation. SS instrumentation was pedicle fixation one level above and below the fractured vertebra. LS instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. As a result, measurements of local kyphosis, sagittal index, and anterior vertebral height compression showed that the LS group had a better outcome at final follow-up (P < 0.05). Also, the SS group had a 55% failure rate, whereas the LS group had prolonged operative time and increased blood loss. However, there was no difference between the two groups according to Low Back Outcome Score. In conclusion, radiographic parameters demonstrated that LS instrumentation is a more effective management of thoracolumbar burst fractures. Nevertheless, clinical outcome was the same between the two groups. However, our conclusions were based on posterior-only surgery. Anterior column support would negate the need for LS fixation. Also, SS would have been more successful if two above and two below pedicle screws were used.