Posterior Fixation Group Research Articles

Comparison of the Effects of Posterior Cervical Fixation or Posterior Cervical Fixation Extending to the Upper Thoracic Region on Cervical Sagittal Alignment.

For degenerative diseases accompanied by cervical malalignment, the starting and ending points of fixation for better cervical sagittal alignment and clinical results are not as clear as the thoracolumbar region. In this study we aimed to compare the effects of posterior subaxial cervical fixation (PSCF), posterior cervical fixation extending to the upper thoracic region and posterior upper cervical fixation extending to the upper thoracic region on cervical sagittal alignment. Sixty-three patients who underwent posterior cervical and cervical-up thoracic fixation were retrospectively analyzed in a comparative study. The procedures that we performed from May 2019 to March 2022 on these 63 patients were: (1) C3-C6 group-posterior subaxial cervical fixation; (2) Subaxial-T2 group-posterior subaxial cervicothoracic fixation (PSCTF); (3) C2-T2 upper thoracic posterior fixation group. The C3-C6 group had 27 patients, Subaxial-T2 group had 24, and C2-T2 group had 12. We determined the minimum follow-up period as 12 months. C0-2, C2-7 lordosis angle, sagittal vertical axis (SVA), C2 slope, C7 slope, T1 slope, cervical slope, neck slope, and thoracic inlet angle (TIA) measurements were made in three patient groups. Comparatively, cervical sagittal alignment was evaluated. In the C2-T2 group, a significant increase in C2-C7 lordosis, decrease in C2 slope, and increase in TS-CL were observed. Significant C2-C7 lordosis decrease, C2 slope increase, and TS-CL decrease were observed in the C3-C6 group. A significant increase in C2-C7 lordosis and a decrease in C2 slope were observed in the subaxial-T2 group. No significant change was observed in the TS-CL angle. In cervical degenerative disorders accompanied by cervical malalignment, we recommend the C2-T2 fixation method, which provides the desired C2-C7 lordosis, SVA within the normal range, and the best Neck Disability Index results.

Unilateral versus bilateral pedicle screw fixation with anterior lumbar interbody fusion: a comparison of postoperative outcomes.

To determine of the impact of ALIF with minimally invasive unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) on perioperative outcomes, radiographic outcomes, and the rates of fusion, subsidence, and adjacent segment stenosis. All adult patients who underwent one-level ALIF with UPSF or BPSF at an academic institution between 2015 and 2022 were retrospectively identified. Postoperative outcomes including length of hospital stay (LOS), wound complications, readmissions, and revisions were determined. The rates of fusion, screw loosening, adjacent segment stenosis, and subsidence were assessed on one-year postoperative CT. Lumbar alignment including lumbar lordosis, L4-S1 lordosis, regional lordosis, pelvic tilt, pelvic incidence, and sacral slope were assessed on standing x-rays at preoperative, immediate postoperative, and final postoperative follow-up. Univariate and multivariate analysis compared outcomes across posterior fixation groups. A total of 60 patients were included (27 UPSF, 33 BPSF). Patients with UPSF were significantly younger (p = 0.011). Operative time was significantly greater in the BPSF group in univariate (p < 0.001) and multivariate analysis (ß=104.1, p < 0.001). Intraoperative blood loss, LOS, lordosis, pelvic parameters, fusion rate, subsidence, screw loosening, adjacent segment stenosis, and revision rate did not differ significantly between fixation groups. Though sacral slope (p = 0.037) was significantly greater in the BPSF group, fixation type was not a significant predictor on regression. ALIF with UPSF relative to BPSF predicted decreased operative time but was not a significant predictor of postoperative outcomes. ALIF with UPSF can be considered to increase operative efficiency without compromising construct stability.

Posterior fixation of gastric tube with fibrin sealant in laparoscopic sleeve gastrectomy: a promising method to prevent revision surgeries

BackgroundWe aim to assess the effects of gastric posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy in aspects of 12th-month body mass index and gastric volume.MethodsThe patients who underwent laparoscopic sleeve gastrectomy between January 2019 and February 2021 were divided into two groups preoperatively. The first 75 patients were appointed to the posterior fixation group, and the second 75 were to the control group. Changes in gastric volume and body mass index were assessed in the postoperative 12th month.ResultsThere were 110 patients in the final analysis. Fifty-four patients had posterior fixation, and 56 had only laparoscopic sleeve gastrectomy. The posterior fixation group was superior in terms of total weight loss rate (39.1% vs. 34.5%, p<0.001) and less gastric volume increase rate (39.8% vs. 164.7%, p<0.001) in the postoperative 12th month.ConclusionOur study suggests that posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy is a promising method for preventing weight regain and creating a need for revision surgery.

Comparison of Hybrid Posterior Fixation and Conventional Open Posterior Fixation Combined with Multilevel Lateral Lumbar Interbody Fusion for Adult Spinal Deformity.

We compared radiological and clinical outcomes between multilevel lateral lumbar interbody fusion (LLIF) + hybrid posterior fixation (PF) and multilevel LLIF + conventional open PF in patients with adult spinal deformity (ASD). Patients who underwent minimally invasive surgery for ASD in a single institution between 2014 and 2018 were retrospectively reviewed. Fifty-six patients (hybrid PF, 30; open PF, 26) who underwent ASD correction surgery were enrolled between 2014 and 2018. We evaluated patients’ demographics, clinical outcomes, and radiographical parameters in each group. There was significantly less estimated blood loss in the hybrid PF group (662.8 mL vs. 1088.8 mL; p = 0.012). The CRP level 7 days after surgery was significantly lower in the hybrid PF group (2.9 mg/dL vs. 4.3 mg/dL; p = 0.035). There was no significant difference between the two groups in other demographic variables, visual analog scores for back pain and leg pain, Oswestry Disability Index, coronal Cobb angle, lumbar lordosis, pelvic tilt, pelvic incidence–lumbar lordosis mismatch, and sagittal vertical axis. There was a significantly higher percentage of major complications in the open PF group (42.3% vs. 13.3%; p = 0.039). Thus, LLIF + hybrid PF for ASD corrective surgery may be comparable to LLIF + open PF in terms of clinical and radiographic outcomes.

Analysis of the Effect of Posterior Lateral Malleolus Plate Fixation on the Curative Effect and Mechanical Stability of Complex Ankle Fractures.

This paper investigates the effect of lateral and posterior 1/3 tubular plate bone plate fixation on the curative effect, wound healing, and mechanical stability of complex ankle fracture. 80 patients with complex ankle fractures treated in our hospital from January 2018 to July 2020 are selected for the study, and 80 patients are randomly divided into posterior fixation group and lateral fixation group according to the number table method, with 40 patients in each group. Patients in the posterior malleolus fixation group are treated with posterior lateral malleolus plate fixation, and patients in the lateral malleolus fixation group are treated with lateral malleolus plate fixation. The differences in efficacy, mechanical stability, wound healing, visual analog scale (VAS) pain score, and American Association of Foot and Ankle Surgery (AOFAS) ankle function are compared. The subjects are followed up for 6 months until January 2022. In patients with complex ankle fracture, 1/3 tubular plate osteoplate fixation in the posterior lateral malleolus can improve clinical efficacy and mechanical stability, which is helpful to promote incision healing and reduce the risk of complications. The 1/3 tubular plate osteoplate fixation in the posterior lateral malleolus is worthy of clinical promotion and application.

New Technique of Posterior Fixation of Tube With Fibrin Sealant Prevents Dysphagia in Patients Undergoing Sleeve Gastrectomy.

This study compared the effects of posterior fixation (PF) of the remnant tube with fibrin tissue glue to prevent sharp angulation and gastric twist and traditional techniques on postoperative dysphagia and vomiting. In total, 200 patients scheduled to undergo laparoscopic sleeve gastrectomy (LSG) as a bariatric surgical intervention were randomly classified into 2 groups (LSG + PF and LSG alone). We compared postoperative dysphagia symptoms among patients who underwent PF and those who did not. The Dysphagia Handicap Index (DHI) results were compared statistically among these groups. The study included a total of 191 patients (85.9% (n = 164) women and 14.1% (n = 27) men) who underwent LSG for obesity. The groups were similar in terms of the patient demographics. The DHI scores of the LSG + PF group were statistically significantly lower than those of the LSG alone group. Adoption of a standardized method of PF with a standardized surgical procedure after LSG considerably reduced the rate of surgical complications.

Augmented medial rectus muscle recession versus medial rectus recession with posterior scleral fixation in partially accommodative esotropia: a randomized clinical trial

To compare the postoperative alignment after medial rectus muscle posterior scleral fixation versus augmented recession in children with partially accommodative esotropia (PAET) without convergence excess. In this prospective study, 60 children with PAET without convergence excess were randomly assigned to either augmented medial rectus recession, based on the average of distance angle with correction and near angle without correction, or medial rectus recession, based on distance angle with correction, combined with posterior scleral fixation. The ductions, versions, angles of deviation, and difference between angles were analyzed before and 6months after surgery. Complete success was defined as orthotropia to within 8Δ of esophoria/tropia for both distance and near, with spectacle correction, at 6months. Patients who developed any exophoria/tropia with their original spectacles and needed reduction of their hyperopic correction to achieve successful outcome were defined as qualified successes. Of the 60 children, 25 in the augmented group and 28 in the posterior fixation group completed follow-up. The mean age at surgery was 4.90±2.34years. The complete success rate was 48% and 64% in the augmented and posterior fixation groups, respectively (P=0.15); the qualified success rate was 80% and 92.9%, respectively (P=0.17). Success rate was significantly higher (P=0.04) in the posterior fixation group (56%) than in the augmented group (18%) when the preoperative angle disparity was ≥20Δ. Medial rectus posterior scleral fixation can improve the success rate in PAET with large angle disparity.

Progression of Cervical Ossification of Posterior Longitudinal Ligament After Laminoplasty or Laminectomy With Posterior Fixation.

Retrospective case analysis. This study was conducted to investigate the course of ossification of the posterior longitudinal ligament (OPLL) progression after laminoplasty (LP) or laminectomy with posterior fixation (PF). LP is now recognized as a standard technique for the treatment of cervical multisegment OPLL; however, PF is beneficial for patients with severe stenosis. In recent years, there has been increasing interest in mechanical stress in OPLL, which is assumed to significantly impact progression. The progression of OPLL was assessed using midline sagittal computed tomography images of the cervical spine at various follow-up points. Radiographic parameters including the C2-C7 Cobb angle, C2-C7 range of motion (ROM), and adjacent cranial and caudal segmental ROMs were measured. Postoperative changes and differences between the LP and PF groups in the radiographic parameters were calculated to assess biomechanical stress. Logistic regression analysis was used to analyze the risk factors affecting the progression rate. The authors included 14 PF and 36 LP patients, with a mean follow-up period of 28.9±20.8 and 37.6±16.8 months, respectively (P=0.069). After surgical treatment, both groups showed loss of cervical lordosis (9.2±6.9 vs. 5.3±8.2 degrees, P=0.220) and C2-C7 ROM (14.6± 13.5 vs. 13.1±12.2 degrees, P=0.861). The decrease of ROM in the cranial adjacent segment was larger in the LP group than in the PF group (0.7±4.1 vs. 1.4±5.5 degrees, P=0.453). The ROM in the caudal adjacent segment decreased in the LP group but increased in the PF group (-1.4±6.2 vs. 2.6±5.1 degrees, P=0.041). The progression rate was 2.15±1.31 mm/mo in the PF group and 1.53±1.04 mm/mo in the LP group (P=0.041). PF showed an odds ratio of 12.917 for a higher progression rate (95% confidence interval, 1.397-119.443; P=0.024). The rate of progression of cervical OPLL was significantly higher after PF than after LP.Level III-a retrospective analysis.

Initial stability of one-stage anterior debridement and cage implantation combined with anterior-lateral fixation by a dual screw-rod construct in the treatment of lumbosacral tuberculosis: a cadaveric biomechanical study

BackgroundAlthough various surgical methods are used to treat lumbosacral tuberculosis, no unified surgical approach exists. Thus, exploring an optimal operation method has substantial clinical importance. Evaluate the initial stability of a new surgical method, a one-stage anterior debridement and cage implantation combined with anterior-lateral fixation by a dual screw-rod construct, in the treatment of lumbosacral tuberculosis and provide biomechanical support for its further promotion in clinical applications.MethodsFifteen fresh human lumbosacral spine specimens without fractures, deformities or osteoporosis were randomly divided into intact (I), anterior fixation (AF) and posterior fixation (PF) groups. All AF and PF group specimens had subtotal resections of the L5 vertebra and adjacent discs, while the I group specimens were kept intact. Then, titanium cages were implanted in the surgical site and a dual screw-rod construct was fixed anterior-laterally in the AF group, while the PF group specimens were fixed posteriorly with only the dual screw-rod construct. Mechanical tests were conducted for initial stability evaluations.ResultsThe load at the maximum displacement (5 mm) or rotation angle (5 °) was less for the I group specimens than for the AF and PF group specimens in all directions (P < 0.05). The load at the maximum displacement (5 mm) was greater for the AF group specimens than for the PF group specimens in flexion, lateral bending and axial compression (P < 0.05) and lower than in the PF group specimens in extension (P < 0.05). In torsion, there was no difference between the loads in the AF and PF groups at the maximum rotation angle (5 °) (P > 0.05).Conclusions: The proposed surgical approach can provide better immediate stability than anterior debridement with posterior dual screw-rod fixation in the treatment of lumbosacral tuberculosis in flexion, lateral bending and axial compression.

More than 5-Year Follow-up Results of Two-Level and Three-Level Posterior Fixations of Thoracolumbar Burst Fractures with Load-Sharing Scores of Seven and Eight Points.

BackgroundThe development of pedicle screw-based posterior spinal instrumentation is recognized as one of the major surgical treatment methods for thoracolumbar burst fractures. However, the appropriate level in posterior segment instrumentation is still a point of debate. To assesses the long-term results of two-level and three-level posterior fixations of thoracolumbar burst fractures that have load-sharing scores of 7 and 8 points.MethodsFrom January 1998 to May 2009, we retrospectively analyzed clinical and radiologic outcomes of 45 patients with thoracolumbar burst fractures of 7 and 8 points in load-sharing classification who were operated on using two-level posterior fixation (one segment above and one segment below: 28 patients, group I) or three-level posterior fixation (two segments above and one segment below: 17 patients, group II). Clinical results included the grade of the fracture using the Frankel classification, and the visual analog score was used to evaluate pain before surgery, immediately after surgery, and during follow-up period. We also evaluated pain and work status at the final follow-up using the Denis pain scale.ResultsIn all cases, non-union or loosening of implants was not observed. There were two screw breakages in two-level posterior fixation group, but bony union was obtained at the final follow-up. There were no significant differences in loss of anterior vertebral body height, correction loss, or change in adjacent discs. Also, in clinical evaluation, there was no significant difference in the neurological deficit of any patient during the follow-up period.ConclusionsIn our study, two-level posterior fixation could be used successfully in selected cases of thoracolumbar burst fractures of 7 and 8 points in the load-sharing classification.

Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures.

Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures. In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery. The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group. Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.

Anterior Versus Posterior Fixation for the Treatment of Lumbar Pyogenic Vertebral Osteomyelitis

This study was designed to observe the clinical outcome of anterior versus posterior instrumentation in the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine. Twenty-three patients underwent either anterior (anterior fixation group) or posterior fixation (posterior fixation group) combined with a single-stage anterior radical debridement and had an average follow-up of 38 months. Clinical evaluation was performed using the Oswestry Disability Index and visual analog scale. Serial tests of the erythrocyte sedimentation rate and C-reactive protein levels were used to monitor for infection recurrence. Radiography was performed pre- and postoperatively to assess the deformity correction and for bony fusion. Serial erythrocyte sedimentation rate and C-reactive protein levels reflect the active state of infection and can guide postoperative treatment. Patients in the anterior fixation group showed significantly better results on the Oswestry Disability Index than those in the posterior fixation group 2 years postoperatively. The visual analog scale values demonstrated a significant difference between the 2 groups at 1 and 2 years postoperatively, with pain significantly improved in the anterior fixation group. Radiological results showed no significant difference in fusion time, deformity correction, and cage subsidence. Both anterior and posterior fixation had satisfactory outcomes and were reliable and safe for the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine. Patients with anterior fixation may achieve better postoperative results, such as better well being and less pain.

Proximal to Middle One-Third Humerus Shaft Fractures may Lead to Poorer Shoulder Function Compared to Middle to Distal One-Third Humerus Shaft Fractures following Internal Fixation

Background The radiographic and functional outcomes following an anterior approach for plate fixation of humeral shaft fractures were evaluated and compared with those of a group having undergone plate fixation from a posterior approach. The hypothesis was that there would be no significant difference between these two groups in shoulder, elbow and overall upper extremity function. Methods We retrospectively reviewed radiographs and data for 78 humerus shaft fractures. Twenty-six patients returned to complete the Constant–Murley Score (CMS), Simple Shoulder Test (SST), Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results The overall median CMS [76.5 (A) versus 83.5 (P)] approached a significant difference between anterior and posterior fixation groups ( p = 0.07). Active shoulder elevation was significantly better ( p = 0.03) in the posterior group. There was no significant difference in median DASH score ( p = 0.51), MEPS score ( p = 0.69), nor in 10 of 12 individual responses on the SST. Fracture union rate was 97%. Discussion Anterior fixation of humeral shaft fractures yields satisfactory upper extremity functional outcomes that are comparable to those of extremities that have undergone posterior fixation. However, shoulder function tends to be better following posterior fixation, possibly as a result of anterior approaches being more commonly performed for more proximal shaft fractures.

Stand-Alone Interbody Fusion Versus Instrumented Interbody Fusion

There is controversy regarding the use of interbody fusion cages as stand-alone devices in patients with degenerative disk disease. A clinical comparison was made between a stand-alone cage procedure and a cage with pedicle screw procedure. This retrospective review compared 2 data sets, including consecutive patients who were diagnosed with degenerative disk disease and were fused from 1 to 4 levels of the lumbar spine using a posterior approach. Surgical and hospital details, patient demographics, and pain and function scores were collected. The stand-alone group included 72 patients (35 male and 37 female, 30 smokers). The posterior fixation group included 65 patients (39 male and 26 female, 26 smokers). Length of hospitalization for the posterior fixation group was significantly greater at 6.2 days compared with 4.7 days in the stand-alone group. Both groups showed significant improvement in back and leg pain after surgery. There were no statistically significant differences in back or leg pain or postoperative function. Group 1 had a fusion rate of 94%, whereas group 2 had a fusion rate of 89%. Multilevel cases showed a significant interaction between the procedure and time point, suggesting that multilevel pedicle screw patients show more rapid improvement after surgery. Intraoperative complication rates were 23.6% in group 1 and 21.2% in group 2. Postoperative complications and revisions were 7.6% and 9.1% in the pedicle screw group compared with 9.7% and 4.2% in the stand-alone group. Comparison of these 2 data sets reveals few differences. A faster improvement may be traded for higher revision rates and longer hospitalization.

Preliminary Report of Temporary Posterior Instrumentation in Stable Thoracolumbar Burst Fractures

‐ Abstract ‐ Study Design : A prospective study of posterior instrumentation without fusion for the stable thoracolumbar fracture. Objectives : To confirm vertebral body collapse by roentgenograp hy and computerized tomography after removing posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures. Summary of literature review : Many authors have reported that vertebral body collapse occurs after instrumentation removal. Materials & Method : Sixty patients admitted between March 1999 and March 2001 with thoracolumbar junction fractures were included. Patients were divided into 3 groups: Group I - the Conservative management group (20 patients), Group II Reduction and posterior fixation with fusion group (20 patients), Group III - Reduction and temporary posterior fixation group (20 patients). The patients were aged between 21 and 49 years (mean 38), and the follow-up period exceeded 1 year (mean 13.3 months). We studied vertebral height, kyphotic angle, disc height and facet hypertrophy by roentgenography, and the continuity of the anterior cortical connection, cavity formation, sclerotic bone formation and new bone formation by CT. Results : The loss of vertebral height was 7.9% (from 21.5 to 29.4%) in Group I, 3.7% in Group II (preop 35%, postop 12.7%, postop 1Yr. 16.4%), and 3.5% in Group III (preop. 35.2%, postop 5.6%, postop 1Yr. 9.1%). Loss of angulation was 4.2。(from 9.6。to 13.8。 ) in Group I, 3.0。in Group II (preop 15.3。 , postop 7.2。 , postop. 1Yr. 10.2。 ), and 3.0。in Group III (preop 14.6。 , postop. 5.9。 , postop 1Yr. 8.9。 ). Loss of disc height was not statistically different for the 3 groups. Degenerative changes of the posterior facet were seen 3 patients of Group I, 11 patients of Group II, and in 5 patients of group III. On CT scan of Group III, all cases showed cavity formation and sclerosis ,and continuity of the anterior cortical connection and of new bone formation into the cavity were seen in 18 cases. Conclusions : Vertebral body collapse were not observed by roentgenography by computerized tomography after removing the posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures.