Posterior Approach For Surgical Treatment Research Articles

Clinical Observation of Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spinal Disorders

To evaluate the surgical effectiveness of posterior procedure with long segment stabilization for treating thoracolumbar pseudarthrosis associated with ankylosing spinal disorders (ASD) without anterior fusion or osteotomy. Twelve patients with thoracolumbar pseudarthrosis in ASD were enrolled. All patients underwent posterior long-segment stabilization procedures. In some patients, the percutaneous technique or the aid of a robot or O-arm navigation was utilized for pedicle screw implantation. The clinical results were evaluated by means of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes were evaluated for bone fusion, anterior column defect, local kyphotic correction (LK) and position of the pedicle screws. All patients experienced effective bone fusion at the sites of pseudarthrosis. The mean operative time was 161.7±57.1 min, and the average amount of blood loss was 305.8 ± 293.2 ml. For six patients who underwent surgery with the assistance of a robot or O-arm navigation, there was no statistically significant difference observed in terms of operative time and mean blood loss compared to those who used the freehand technique (P>0.05). The VAS score, ODI value, and mean LK angle showed significant improvements at the final follow-up (P<0.05). The accuracy of pedicle screw placement was 96%. Posterior surgery with long-segment fixation, without anterior fusion or osteotomy, can achieve satisfactory outcomes in ASD patients with thoracolumbar pseudarthrosis. The application of percutaneous techniques, as well as the assistance of robots or navigation technique may be a good choice for the treatment of pseudarthrosis in ASD patients.

Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine

Background Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases, thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common, spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia. Aim of the Work The aim of this study is review the literature comparing the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. Patients and Methods In this meta-analysis, we combined 25 studies that compared the clinical outcomes of the anterior and posterior approaches in treating 1797 patients with thoracic and lumber spinal TB. This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). Based on patient safety and the efficacy of the procedures, we raised three clinically crucial questions to determine the optimal surgical procedure in treating thoracic and lumbar tuberculosis. The primary data used as evidence to answer these questions were obtained from the treatment results, such as the radiologic data and patient-related outcomes. Results The results showed that there is no statically significant different in the operative time for the anterior approach (220.8-51.5 minutes) versus posterior approach (213.9-69.3 minutes), and no statistically significant difference was detected. Blood loss was significantly greater in the anterior approach (1125.0-275.5 mL) than in the posterior approach (710.4-192.4 mL). Conclusion The posterior approach showed a higher potential for maintaining the correction of deformity and a lower overall surgical complication rate; however, both groups showed no statistically significant differences in operative time, blood loss, radiological and clinical outcome; therefore posterior approach could be used as an alternative procedure to treat thoracic and lumbar tuberculosis patients in terms of pain control, Cobb’s angle, and reduction of complications, however; posterior-only approach alone cannot be used in cases of anterior abscess formation or multilevel involvement where an anterior debridement is mandatory, so; when deciding among the two procedures for treatment of thoracic and lumbar spinal tuberculosis, surgeons must thoroughly consider the patient’s specific features of spinal tuberculosis, the surgeon’s own surgical experience, the risks of surgical complications ranging from neurological to structural, and the different possible outcomes.

Extended lateral approach for surgical treatment in tuberculosis of spine

The selection of anterior versus posterior approach for surgical treatment of thoracic or lumbar tuberculosis is still a matter of debate. The extra pleural anterolateral approach which has less morbidity compared with two stage approach provides simultaneous exposure of both anterior and posterior parts of the spine and allows anterior decompression of the spinal cord along with posterior stabilisation and anterior and posterior fusion in one stage through a single approach. Materials and Methods: The study included45 patients with TB spine who have undergone modified extended lateral decompression and posterior instrumentation between Jan 2016 to Jan 2020. Qualitative evaluation was done with help of ODI scoring for the entire patient. Radiologically all patients were evaluated for the fusion and correction of kyphosis post operatively and progression of kyphosis over period of 2 years. Results: The average preoperative ODI score was 21.47 (range 12 to 34 and standard deviation of 6.868) and 4.44 post operatively (range 0 to 14 and standard deviation of 3.042). The average value of preoperative angle of kyphosis was 25.73o (range 11-51o). The average values of angles at immediate postoperative, at 6 months postoperative, one year post-operative and at the end of two years post operative were 9.76o (range 2o to 26o), 11.58o (range3o to 28o), 12.51 (range 4 to 31)and 12.58o(range 4o to 30o) respectively. Conclusion: Decompression of spine tuberculosis through extended Lateral approach using bone graft for fusion along with posterior instrumentation as a single stage procedure is an ideal procedure to treat spinal tuberculosis which requires surgical management. Keywords: Decomoression of spine, Tuberculosis spine, Extended lateral approach spine, Extra pleural approach of spine, Anterior and posterior spinal fusion.

Research progress of surgical treatment of thoracolumbar spinal tuberculosis

To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis. The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress. Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone. The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.

Evaluating a Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spondylitis.

Retrospective study of a posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spondylitis (AS). The aim of the current study was to report the surgical results of symptomatic thoracolumbar pseudarthrosis in AS through a posterior approach. Spinal pseudarthrosis is a well-known complication in AS. The condition may complicate with mechanical back pain, spinal deformity, and sometimes neurological deficits. Conservative treatment often fails in this situation and surgical treatment is required. However, the optimal surgical procedure for this condition is still controversial. From January 2006 to December 2011, 12 AS patients with spinal pseudarthrosis at the thoracolumbar segment were treated surgically after failure of >3 months conservative treatment. The indications for surgery were persisting back pain in all patients, combined with neurological deficits in 4 patients and spinal deformities in 3 patients. Transforaminal or transpedicular debridement of the pseudarthrosis at the anterior column was performed from a posterior approach. After complete debridement, bone graft at the anterior open wedge defect of the pseudarthrosis was performed from a posterior approach. Posterior pedicle screws were placed for fixation. Clinical and radiographic outcomes were assessed with an average follow-up of 28 months (range, 24-36 mo). The persistent back pain obtained significant relief in all cases after surgery. Four patients with neurological deficits showed complete recovery of neurological function at follow-up. The spinal deformities in 3 cases obtained correction. Solid bony fusion was achieved in all cases, and there was no correction loss at follow-up. In AS with symptomatic thoracolumbar pseudarthrosis, a posterior transforaminal or transpedicular approach can provide circumferential stability, anterior bone graft, and neurological decompression simultaneously. A supplemental anterior approach may be avoided by this method.

Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine

Purpose The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

How to Reduce Bilateral Cervical Facet Joint Dislocation in Anterior Approach: A Trick to Avoid Anterior-Posterior-Anterior Surgical Procedures

Introduction Cervical facet joint dislocation is a common injury of the lower cervical spine. These flexion distraction lesions in cervical spine occur as a subluxation or unilateral/bilateral dislocation of the facet joints, which often be accompanied by direct spinal cord and nerve root injury. The presence of herniated intervertebral disc requires an anterior approach to decompress the spinal cord. Because often it is not possible to reduce facet joint dislocation while performing anterior surgery an additional posterior approach and then the fixation trough an anterior approach again is necessary. This method (supine-prone-supine) creates difficulties for surgeons because of the prolonged operation time; the need for frequent changes in patient position; and a subsequent high incidence of complications. Materials and Methods On the basis of a case, we present a maneuver to use pins such as joysticks in vertebral body during anterior approach to reduce dislocated facet joints in cervical spine fractures. After cervical discectomy/corpectomy, we use the pins to put the vertebral body in kyphotic position following rotational motion to reduce the facet joints. Results and Conclusion: Since we implemented this procedure, we had no more to perform posterior approach in surgical treatment in the last 15 cases of bilateral facet joint dislocation with herniated intervertebral disc in cervical trauma.

Posterior approach for surgical treatment of neglected elbow dislocation

Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach. This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21days. We treated 22patients (17men, five women) with an average age of 22.8±8.2years (range 14 to 46years). The dislocations were 8.5±4.2months old on average (range 2 to 17months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required. The average follow-up was 21months (range 12 to 30months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection. Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used. IV.

Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity.

Extremely severe Pott's kyphotic deformity cannot be completely corrected by conventional techniques, including vertebral body resection, Smith-Peterson, pedicle subtraction osteotomy or even vertebral column resection (VCR). The authors developed a new technique combining transpedicular eggshell osteotomies and VCR as multilevel modified vertebral column resection (MVCR) through a single posterior approach for surgical treatment of Pott's kyphosis with Konstam's angle beyond 90 degrees. A total of 9 patients (6 males, 3 females) in our institution with severe Pott's kyphosis who underwent single-stage posterior-only multilevel MVCR were retrospectively reviewed. The candidates for multilevel MVCR were those with a sharp, angular kyphosis in the lower thoracic or upper lumbar spine with a Konstam's angle beyond 90 degrees. The follow-up averaged 30.6 months (ranging from 21 to 50 months). Fusion status was evaluated at each follow-up by CT three-dimensional reconstruction images. An average of 2.5 vertebrae was removed in each case (ranging from 2 to 4 vertebrae). A mean of 7 vertebrae were fused (ranging from 6 to 11 vertebrae). The mean duration of surgery was 285 min (ranging from 246 to 400 min), the average intraoperative blood loss was 2,933 ml (ranging from 2,000 to 6,000 ml). The mean preoperative kyphus was 100.3 degrees (ranging from 90 degrees to 132 degrees ). The mean kyphosis in the immediate postoperative period was 15.9 degrees (ranging from 4 degrees to 30 degrees) with an average postoperative kyphos correction of 84.4 degrees (ranging from 63 degrees to 126 degrees). Fusion of the resection site was confirmed on radiographs in all patients at the minimum 12 months follow-up. No pseudoarthrosis was found. No loosening or breakage of pedicle screws occurred. A single-stage posterior-only multilevel MVCR is an effective way to correct extremely severe Pott's kyphosis with Konstam's angle beyond 90 degrees.