Posterior Access Research Articles

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Transfer of Motor Fascicle From the Ulnar Nerve to the Axillary Nerve by Posterior Access. New Approach.

We describe a new technique of transferring the motor branch ulnar nerve (UN) to the axillary nerve (AN) by posterior approach. Three patients with C5, C6, and C7 brachial plexus injury were operated. By supraclavicular approach, the spinal accessory was transferred to the suprascapular nerve. By posterior approach in the arm, the AN was identified within the quadrilateral space, and the UN was identified medially with intrafascicular dissection of a motor fascicle, which is lifted to 4 cm in length and transferred to AN. By medial approach, a motor branch from the median nerve is transferred to the biceps nerve. At a follow-up minimum of 10 months, the maximum abduction was 160 and the minimum 90 degrees. This technique, neurotization of the AN with fascicles of the UN, spinal accessory to suprascapular nerve, and median nerve branch to biceps nerve are indicated in C5-C7 avulsion when there is no radial nerve available. Level IV.

Implementation of the Fast-track Protocol for Total Hip Arthroplasty in a Public Hospital in the State of São Paulo - Brazil.

Objective Evaluate the results of the implementation of the Fast Track Protocol (FTP), a medical practice based on scientific evidence, for elective total hip arthroplasty surgery, mainly comparing the National Average Hospital Admission Rate of 7.1 days. Methods 98 patients who underwent elective total hip arthroplasty surgery via the direct anterior approach, anterolateral approach and posterior approach were included in the FTP from December 2018 to March 2020, being followed up preoperatively, intraoperatively and immediately postoperatively. Results The average length of hospital stay was 2.8 days, being 2.1 days for the direct anterior approach, 3.0 days for the anterolateral access approach and 4.1 days for the posterior access approach. The average surgery time was 90 minutes, 19 (19.39%) of the patients were referred to the ICU in the postoperative period, however, none of them underwent surgery using the direct anterior approach. We had no cases of deep vein thrombosis (DVT), pulmonary embolism (PTE) or neurological injury, 19 (19.39%) patients had postoperative bleeding requiring dressing change, 4 (4.08%) needed blood transfusion, 2 (2.04%) patients had implant instability, 1 (1.02%) patient had a fracture during surgery and 1 (1.02%) patient died of cardiac complications. Conclusion FTP may be a viable alternative to reduce the length of stay and immediate postoperative complications for elective total hip arthroplasty surgery decreasing the length of stay of patients by 2 to 3 times when compared to the national average of 7.1 days.

Platelet rich plasma (PRP) in the surgical treatment of Haglund's syndrome: the use of PRP membranes as an intra-operative local adjuvant.

Aim Haglund's syndrome may be responsible for chronic pain in the ankle and hindfoot. Although numerous therapeutic approaches have been described in the literature, to this date no consensus over a surgical treatment has been established. We report our experience in the treatment of Haglund's syndrome and pre-insertional calcifications of the Achilles tendon using an open surgical approach and platelet rich plasma (PRP) membranes as a local adjuvant. Methods The study retrospectively evaluated patients with Haglund syndrome treated with a direct posterior access, Achilles tendon split, bursectomy, resection of the heel deformity and topical administration of PRP membranes. After surgery, a standardized rehabilitation protocol was performed. The preoperative and postoperative functionalities of the foot and ankle were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score. Intraoperative and postoperative complications were recorded. Results Twenty consecutive patients were included. The mean follow-up was 23 months. No patient had major intraoperative or postoperative complications. After the surgery, the mean AOFAS score increased from 44.1 to 92.0, resulting in a statistically significant increase in patient functionality after the treatment (p=0.001). Conclusion Our results suggest that an open surgical approach consisting of a combination of bursectomy, resection of the calcaneal deformity, and topical administration of PRP membranes may be effective for the treatment of Haglund's disease.

Feasibility of extended ultrasound examination of the fetal brain between 24 and 37weeks' gestation in low-risk pregnancies.

To assess the feasibility of identifying fetal brain structures and anatomic landmarks included in the anterior complex (AC) and posterior complex (PC), as well as the proximal hemisphere (PH). This was a prospective observational multicenter study of healthy pregnant women evaluated by ultrasound screening at 24 to 36+6weeks' gestation. Six physicians performed transabdominal ultrasound, to obtain the planes required to visualize the AC, PC, and PH. Blind analysis by an expert and non-expert operator in fetal neurosonography was used to assess the structures included in each plane view. In the population studied (n=366), structure detection rates for AC were over 95 %, with an agreement of 96 % when comparing expert and non-expert examiners. Visualization of the corpus callosum crossing the midline was detected in over 97 and 96 % of cases for the AC and PC, respectively, with an agreement of over 96 %. The PH plane, particularly through the posterior access via the mastoid fontanelle, enabled visualization of the proximal anatomical structures in almost 95 % of cases. Detection of the corpus callosum through the AC and PC, both proximal/distal germinal matrix (AC) and proximal Sylvian fissure through the anterior access (PH) in the 24-25+6, 26-31+6 and 32-36+6weeks' gestation groups were successful in over 96 % of cases with high level of agreement. Inclusion of AC, PC, and PH later in pregnancy proves feasible with a high level of agreement between both expert and non-expert operators.

The experience in tuberculous spondylitis treatment taking into account the susceptibility of mycobacteria tuberculosis to antibacterial medicines

Objective — to increase the effectiveness of treatment of patients with tuberculous spondylitis (TS), to improve the etiological diagnosis and operative treatment of patients with TS. Materials and methods. The data of 60 patients with active TS of the thoracic and lumbar vertebrae, operated in the osteoartikular tuberculosis department of Kharkiv Regional Antituberculosis Dispensary No. 1 and Traumatology and Orthopedics department of Kharkiv Municipal Clinical Emergency Care Hospital named after A.I. Meshchaninov in the period 2014—2019. Patients were divided into the main and control groups (n = 30). The main group includes patients with TS operated with the use of a telescopic titanium cage for ventral interbody spondylodesis after necrosequestrectomy. The group II (control group) included patients treated with using traditional approaches to TS treatment. Results and discussion. Bacteriological confirmation of the diagnosis was obtained in 40.0 % of patients of the control group, of which 20.0 % of mycobacterium tuberculosis (MBT) were isolated only by culture, 13.3 % only by bacterioscopy, and in 6.7 % of cases positive results were obtained using two methods.In patients of the control group, the largest number of positive results was obtained from the contents of abscesses — in 30.0 % of patients, with pus on tampons and secretions from fistulas — in 6.7 % (p < 0.01), from operative material (granulations and caseous masses) — in 16.7 %. Among the patients of the control group, bacteriological confirmation was obtained in 10 (33.3 %) patients.Diagnostic puncture biopsy of vertebral bodies, used in 17 diagnostic patients, made it possible to diagnose cancer metastasis in the vertebral body in one (5.9 %) case, in three (17.6 %) — primary tumors of the spine, in 9 (52.9 %) patients — tuberculosis and 4 (23.6 %) — non-specific osteomyelitis of the spine. This study was performed by the method of diagnostic percutaneous trepanobiopsy of the vertebral bodies with the help of electronic-optical converter through the posterior access through the root of the affected vertebral arch.The long-term results of TS treatment were studied in 26 patients of the main group (86.7 %) and in 25 patients of the control group (83.3 %) in the period from 1 to 10 years. Long-term results of treatment were evaluated using a generally accepted scoring scale. Conclusions. The new method of TS treatment in the main group compared to traditional standards of surgical interventions in the control group allowed: 1) to avoid the progression of TS, the development of complications of the disease (p < 0.05) and complications related to the transplant (fractures, displacement of the autograft, cage) (p < 0.05), in the early postoperative period; 2) significantly increase the effectiveness of treatment due to an increase in excellent results (46.7 and 26.7 %, respectively) and a decrease in satisfactory (13.3 and 23.3 %) and unsatisfactory (0.0 and 10.0 %; p < 0.05) of the results in the remote terms of obser­vation; 3) significantly shorten the inpatient stage of treatment ((96 ± 12) and (190 ± 21) bed-days; p < 0.001).

Эффективность транспедикулярной репозиции интраканальных костных фрагментов при оскольчатых переломах тела LI позвонка

The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.

Lateral T-Capsulotomy with Hip Arthroscopy for Access and Excision of Posterior Intra-Articular Mass

There is a lack of literature regarding arthroscopic access to the posterior peripheral compartment of the hip. Compared with open surgery, arthroscopy offers less-invasive treatment for intra-articular mass excision. Arthroscopic hip mass excision has focused on selective resection of lesions in the central compartment and anterior peripheral compartment due to difficult and previously undescribed posterior access. We introduce a technique for arthroscopic excision of a posterior intra-articular hip mass consistent with pigmented villonodular synovitis, also known as tenosynovial giant cell tumor, using a modified T-capsulotomy based on the lateral aspect of the hip capsule. This modified capsulotomy allows for more posterior and lateral access to the central and peripheral compartments while minimizing violation of the iliofemoral ligament.

Experience in the treatment of implant-associated wound complications after spinal surgery

Objective: Improvement of the treatment results of patients with implant-associated complications in the surgical site (SSI) by developing treatment tactics depending on the type of complication.Material and methods: The analysis of the treatment results of 245 patients with implant-associated complications of SSI was carried out in patients with various pathologies of the spine who underwent inpatient treatment in the neurosurgical department no. 3 in Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 in the period from 2015 to 2020.Results: Out of the 245 wound complications identified in clinic, partial or complete resolution of the problems was achieved in 241 (98.36%) cases. In 4 patients (1.63%), a negative trend was noted, even though the removal of the metal structure and the application and change of vacuum assisted closure (VAC) dressings were carried out in a timely manner. In these 4 cases, the generalization of the infectious process led to lethal outcome.Conclusion: In a neurosurgical department with a high surgical activity, wound complications after spinal surgery using spinal implants, occur in no more than 2.36% of cases, provided that a set of preventive measures are carried out. More often, such complications develop after operations on the lumbar spine from the posterior access for infectious (16.58%) or oncological diseases (11.76%). The depth of suppuration, the period of the complication development from the moment of surgery, as well as the presence or absence of an interbody bone or fibrous block play a crucial role in the decision on the implants removal. In patients with implant-associated infections of the area of surgical intervention on the spine, the use of the proposed tactics and VAC bandages allowed to achieve positive treatment results in 98.36% of cases.

Conchal Excision Techniques in Otoplasty: A Literature Review

Background:Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons’ insights into current data on outcomes and complications of conchal excision techniques.Methods:We conducted a literature search through the MEDLINE, EMBASE, Scopus, and Cochrane databases. Prospective and retrospective studies on otoplasty, including revision surgeries and conchal excision techniques involving concha cartilage resection, were included. Articles with no outcomes data, review articles, case reports, expert opinion or comment, and nonclinical studies were excluded.Results:There were a total of four manuscripts that fulfilled our criteria. Three out of four authors preferred posterior access that separates the skin excision from the cartilage excision. Following resection, cartilage edges can be approximated by placing cartilage sutures, or they can be allowed to collapse spontaneously. Although only two authors employed a systematic classification for complications, all the articles reviewed indicated a low complication rate and excellent postoperative cosmetic outcomes.Conclusion:Although the techniques and principles stated in the literature varied to some extent, the outcomes of all studies reviewed were comparable.

Specifics of Epidural Compression Syndrome Surgery in Patients with Spinal Malignancy

Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55 patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p < 0.05) at no significant change of Frankel neurological function status (p > 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression.

Acetabular defect management and revision arthroplasty via the direct anterior approach.

Acetabular revision arthroplasty and osseous defect management through the direct anterior approach (DAA) with or without proximal extension. Aseptic or septic component loosening, periacetabular osseous defects, pelvic discontinuity, intrapelvic cup protrusion, anterior pseudotumors, iliopsoas tendonitis, polyethylene wear or iliopsoas abscess. Clinically relevant gluteal tendon lesions, active infection, morbid obesity, large abdominal pannus, ASA (American Society of Anesthesiologists) score > III, inguinal skin infection. Electrocautery dissection is recommended to dissect the Hueter interval and to debulk pericapsular scar tissue. At all times during capsular debulking, it should be made sure not to damage the iliopsoas tendon or the neurovascular bundle. Astepwise releasing sequence can facilitate dislocation of the prosthesis. Most cases can be revised via the standard DAA but certain circumstances require an intra- or extrapelvic extension. Access to the anterior gluteal surface of the ilium can be provided using a"tensor snip". More posterior access is provided by the extensile extrapelvic approach described by Smith-Petersen. The intrapelvic Levine extension offers access to the entire visceral surface of the ilium and large parts of the anterior column. Patient revised via the intra- or extrapelvic extension and patients suffering from extensive soft tissue or osseous defects should undergo postoperative weight-bearing restrictions with 20 kg for 6weeks. Based on our studies, there is no limitation on the type of acetabular implant that can be used in DAA revision arthroplasty. Moreover, virtually all types of periacetabular osseous defects can be managed through the approach and its extensions. Acetabular revision arthroplasty via the DAA and its extensions is safe and can result in good midterm results.

The direct posterior gluteal muscle splitting approach for posterior access to acetabular fractures: Surgical technique and case series

We present a minimally invasive direct posterior, gluteal muscle splitting approach (PMS) as an alternative to the traditional Kocher-Langenbeck (KL) approach for posterior access to acetabular fractures. We believe it offers significant advantages and provides improved access while maximizing the range of fracture patterns that can be addressed through a posterior approach.One hundred and eighty-four consecutive patients treated with this approach by the senior author (RMS) between 2001 and 2018 were reviewed. The most common individual fracture pattern addressed was a posterior wall (66/36%) but more complex combination fracture types were the dominant group (106/58%), and included transverse with posterior wall, posterior wall / posterior column, and T types. A radiographically congruent reduction was consistently obtained at surgery, without any operative sciatic nerve palsies and a comparable heterotopic bone formation rate to previous reports. We have reviewed all 120 patients who were followed beyond 6 months and noted the hip replacement conversion rates to be different with each fracture type. The rate was highest with Transverse/ posterior wall injuries (36%), 16% of the posterior wall injuries were converted, a history of dislocation was not specifically associated with conversion.We believe this approach improves the posterior access to the acetabulum, but this study also confirms the poor prognosis of specific groups of higher energy multi-fragmentary, posterior acetabular injuries and suggests the need for a classification system that better predicts the prognosis for the hip joint. Level of Evidence4

A case of heterotopic ossification of the elbow joint

Patients who have undergone severe elbow trauma often develop various complications. Heterotopic ossification is considered to be the most severe complication, which leads to severe impairment of upper limb function due to the formation of severe contractures and ankylosis in the elbow joint. The paper presents the results of surgical treatment of the elbow joint in a patient with «immature» ossification against the background of aged dislocation of the forearm, non-unionized fracture of the radial head, and stage II osteoarthritis. Analysis of the outpatient follow-up of the patient after injury revealed gross diagnostic and treatment errors. As a result of medical errors, inadequate treatment of injuries in the early stages after injury was prescribed, which contributed to the formation of heterotopic ossification and resulted in functional failure of the joint. During surgery, the ossification located in the ulnar fossa was removed via a small posterior access to the elbow joint, the remaining tissues of the joint were not affected, thorough hemostasis was performed, and a Volkov-Oganesian joint-distraction device was applied to provide a physiological range of motion in the elbow joint. Postoperative long-term rehabilitation ensured restoration of the elbow joint function with the patient's return to professional activities.

A Comparative Study on Outcome of Three Dissimilar Approaches for Supracondylar Humerus Fractures in Children

Aim: To compare the radiological and functional results of lateral, medial and posterior access for K-wire fixation and open reduction among children with type III supracondylar fractures of the humerus. Study Design: A retrospective cohort study. Place and Duration: In the Orthopedic department of PIMS hospital, Islamabad for three-year duration from October 2018 to September 2021. Methods: All children with type-3 supracondylar fractures of the humerus who were operated and followed for at least one year who met the criteria of inclusion were involved in the research. There were 105 total children in this study. Lateral approach, Medial approach and posterior approach was used in 35 children each. Medical records were reviewed for surgical access, and children with lateral (LA), medial (MA), and posterior (PA) access were screened. The radiological result was evaluated by measuring the Baumann angle and Shaft Condylar Angle (SCA). All children were applied with Flynn's criteria for functional results, which were classified as excellent, good, poor (unsatisfactory) and Fair (satisfactory). The results from medial, lateral and posterior approaches were compared and the P value was determined using the Kruskal-Wallis and Chi-square test (significant P value <0.05). Results: There were 105 total children in this study. Lateral approach, Medial approach and posterior approach was used in 35 children each. The mean age of children with Lateral approach was 8.60 ± 4.2 years, Medial approach 7.15 ± 4.1 years and with posterior approach 7.9 ± 5.9 years. The mean angle of the condylar axis was 41.9±7.4°, 42.5 ± 3.2 ° and 42.1±2.1 o in lateral approach, Medial approach and posterior approach respectively (p> 0.05). The mean Bauman angle was 20.1±3.9 o, 21.1±6.1 o and 22.2±3.4 o in lateral approach, Medial approach and posterior approach (P> 0.05). Excellent results were obtained in 25 (71.4%), 19 (54.3%) and 17 (48.6%) patients in lateral approach, Medial approach and posterior approach respectively. (P> 0.05) Good results were obtained in 10 (28.6%) children in LA, 16 (45.7%) children in MA and 18 (51.4%) children in PA (P> 0.05). Conclusions: The lateral approach for the supracondylar fracture gave better functional and radiological results in our patients in comparison to the medial and posterior approach. Though, the difference was not statistically significant. Keywords: Functional outcome, Flynn's criteria, Supracondylar fractures and Open reduction

Beating heart implantation of transventricular artificial cordae: How can access site selection and leaflet insertion improve mitral regurgitation correction?

NeoChord-DS1000-System (NC) and The Harpoon-Mitral-Repair-System (H-MRS) are two trans-apical chordal implantation devices developed for the treatment of degenerative mitral valve (MV) regurgitation (DMR) either if as Fibroelastic-Deficiency (FED), Forma-Frusta (FF), or Barlow (B) presentation. The aim of this study is to evaluate some of the advantages and disadvantages of these two different devices by performing numerical simulation analyses focused on different transventricular access sites in all subsets of DMR presentations. By applying a novel approach for the development of patient-specific MV domains we worked out a set of numerical simulations of the artificial chordae implantation. Different leaflet insertions and ventricle access sites were investigated, and resulting contact-area (CA), tensioning-forces (F) and leaflet's stress (LS) were calculated. The analyses showed that: i) NC-approach maintains low LS when performed with a posterior access site and optimizes the overlap between the leaflets at the systolic peak; ii) H-MRS-system presents better results in case of a more anterior ventricular entry site; however, for FED prolapse large variation of F and LS with respect to NC-approach are found; iii) an accidental contact between artificial sutures and the anterior leaflet may occur when valve function is restored through an excessive anterior access site. Present findings set light on specific technical aspects of transapical off-pump chords implantation, either performed with NC and H-MRS systems and highlight the advantages and disadvantages proper to the two devices. Our study also paves the basis for a systematic application of computational methodology, in order to plan a patient-specific mini-invasive approach thus maximizing the outcomes.

Hemivertebra Resection and Spinal Arthrodesis by Single-Stage Posterior Approach in Congenital Scoliosis and Kyphoscoliosis: Results at 9.6 Years Mean Follow-up.

Congenital kyphoscoliosis due to hemivertebra is generally treated surgically because of high risk of curve progression and high risk of nervous system complications. Modern posterior access surgical techniques, including total hemivertebra resection, can completely correct deformity without additional anterior access surgeries. The purpose of this study was to evaluate midterm results of hemivertebra resection and spinal arthrodesis; the hypothesis was that it is a safe, effective, and reproducible procedure. From 2006 to 2019, hemivertebra resection and instrumented spinal arthrodesis with pedicle screws was performed on 82 patients with congenital vertebral deformities (62 scoliosis and 20 kyphoscoliosis) by posterior approach. Mean age at surgery was 8.6 years, and 22 patients were under 10 years of age. After stabilization patients have been braced for a period from 3 to 5 months. Mean follow-up was 9.6 years (range 1.2-12.8 years); mean kyphosis curve after surgery was reduced to 20° Cobb; and mean scoliosis curve was reduced to 11° Cobb. We experienced no major complications (postsurgical infection, instrumentation failure, severe neurological impairment, severe blood loss) at latest follow-up . We strongly advocate one-time posterior hemivertebra resection and arthrodesis as the most suitable surgical procedure for congenital scoliosis due to hemivertebra. Posterior approach interventions with pedicle screws instrumentation are less invasive than combined anterior-posterior approach interventions. We think that posterior approach procedures can lead to excellent deformity correction in both frontal and sagittal views, optimal stability, and low risk of nervous injury. Congenital scoliosis treatment is one of the most challeging conditions a spine surgeon has to face. We advocate that a one-stage posterior approach for hemivertebrectomy and fusion is a reliable, safe tachnique, whom excellent results remain stable at a mid/long-term follow-up. Level 4.

IDENTIFICAÇÃO DOS FATORES DE RISCO ASSOCIADOS À READMISSÃO EM 30 DIAS DE PACIENTES SUBMETIDOS À CIRURGIA DE COLUNA CERVICAL PELAS VIAS ANTERIOR E POSTERIOR

ABSTRACT Aim: To conduct a systematic review of the literature to identify risk factors associated with 30-day readmission of patients submitted to anterior or posterior access cervical spine surgery. Methods: The databases used to select the papers were PubMed, Web of Science, and Cochrane, using the following search strategy: patient AND readmission AND (30 day OR “thirty day” OR 30-day OR thirty-day) AND (spine AND cervical). Results: Initially, 179 papers that satisfied the established search stringwere selected. After reading the titles and abstracts, 46 were excluded from the sample for not effectively discussing the theme proposed for this review. Of the 133 remaining papers, 109 were also excluded after a detailed reading of their content, leaving 24 that were included in the sample for the meta-analysis. Conclusions: The average readmission rate in the studies evaluated was 4.85%. Only the occurrence of infections, as well as the presence of patients classified by the American Society of Anesthesiology (ASA) assessment system with scores greater than III, were causal factors that influenced the readmission of patients. No significant differences were noted when comparing the anterior and posterior surgical access routes. Level of evidence II; Systematic Review of Level II or Level I Studies with discrepant results.

Acetabular Screw cup implant as a rescue procedure in case of failure to obtain sphericity allowing stable settlement of press-fit acetabular cup

Background. The lack of ideal sphericity of the hip joint acetabular bed is a problem encountered by orthopedists during the initial process of learning about hip joint replacement procedures. The aim of the study was analysis of the complications after cementless endoprosthesoplasty, when the primary sphericity was not obtained and the “Screw Cup” acetabulum (Aesculap) was used as a rescue procedure. Material and methods. The inclusion criteria were met only by 39 patients since, due to numerous complications, such implants were no longer used for patients aged 44–90 years and the average time of postoperative observation was 54 months. The patients were operated in a lateral position, from the posterolateral access or minimally invasive posterior access. In order to assess hip joint function after the procedure, the Harris and Hoos Hip Score questionnaires were used. Results. Harris Hip Score revealed 64.3%very good and good results and the obtained mean score was 96 points according to Hoos’s questionnaire. The type of surgical incision, BMI values and the types of dermal sutures had no impact on the functional result, the rate of complications and the incidence of pain in the groin. All the pa­tients who underwent surgical procedures using the minimally invasive access and whose skin sewn using a transdermal continuous suture, assessed their postoperative scars as esthetic. However, the lateral position during the procedure significantly complicated the intraoperative limb length assessment. In consequence, 30% of the opera­ted patients reported different lengths of their lower limbs, which significantly (p = 0,036) reduced the score corresponding to limb functionality, measured using HOOS and Harris Hip Score. The functional values show a significantly negative correlation with age, but not with gender, although men are more at risk of postoperative complications (p = 0,18). Despite the relatively big number of postoperative complications after surgical procedures using the “Screw Cap” acetabular implants, 75% of patients operated using this approach reported no objections to secondary procedures using the same system. Conclusions. Using the Screw Cap” acetabular implants in cases of failure to obtain an ideal sphericity entails the risk of numerous complications and only 60% of the results are good and very good, therefore, the authors of this paper do not recommend this solution.

En-bloc resection of a chordoma in L3 by a combined open posterior and less invasive retroperitoneal approach: technical description and case report.

To fulfill oncological criteria, extensive open anterior and posterior approaches are usually performed in the lumbar spine to obtain an appropriate en-bloc spondylectomy. It is commonly accepted that the price of a tumor-free margin includes such extensive incisions and soft-tissue damage, with consequent relevant blood loss and possible postoperative complications as delayed wound healing. In this article, a case of chordoma in L3 is presented, submitted to an oncologically appropriate en-bloc resection performed by an open posterior approach combined with a mini-retroperitoneal approach. The successful oncologic procedure was combined with a short and uneventful postoperative course. The authors present the surgical technique and the possible challenges of minimally invasive anterior oncologic surgery as a contribution to a limited literature. Up to date, palliative care of single metastases has been the main setting in which anterior, minimally invasive surgery has been performed in the lumbar spine. The authors explained how, in selected cases, this approach can be performed in combination with an open posterior access for an oncologically appropriate treatment of a primary malignant tumor. Anterior, minimally invasive surgery can have a role in selected patients with primary malignant tumors of the lumbar spine. The surgical team should have extensive training both in oncologic and minimally invasive surgery.