Short Fixation Research Articles

Efficacy of Short and Mono segment Spinal Fixations in Traumatic Incomplete Thoracolumbar Burst Fractures

Background: Controversies still mount over the long segment, short segment and mono segment screw fixation for traumatic thoracolumbar spine burst fractures. This article aims to provide our initial experience of the effectiveness of these management modalities with additive focus on their potential benefits upon preventing the loss of correction over time.
 Methods: We included all operated cases of thoracolumbar fractures presenting with the ASIA grade of above ‘C’ between December 2014to December 2017 in a retrospective manner in terms of operative time, estimated intra-operative blood loss, any post-operative surgical wound complications, implant cost, average time lapse for the patients to return to physiotherapy and the follow up radiological imaging at 6 months.
 Results: Long segment fixation is comparatively more time consuming with considerable blood loss and high incidence of postoperative wound complications. We observed that both short as well as mono segment crew fixations had similar incidences with regards to the common complications pertaining to the spinal implant placement procedures.
 Conclusions: Both short and mono-segment fixation procedures resulted in comparable short and long term results. Though long segment fixation is comparatively more stable, it is, however, expensive with a higher incidence of other postoperative complications.

Outcome of Pedicular Fixation of Unstable Dorsolumbar Fractures

Background: The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist as well as protecting the spinal cord from injury. Objective: The aim of this study was to evaluate the post-operative clinical outcome of transpedicular screw and rod fixation in unstable thoracolumbar fractures by using Mc Nab’s criteria in patients collected from Sohag General Hospital and Sohag University Hospital. Patients and methods: A prospective study included patients admitted to Orthopedic and Traumatology Department of Sohag General Hospital suffering from unstable fracture of thoracolumbar area. The study was conducted on twenty patients suffering from thoracolumbar fractures attending to Department of Orthopedics and Traumatology, Sohag University Hospitals, Sohag General Hospital and Al-Azhar University Hospitals from June 2018 till December 2018. Results: In comparison between cases, which conserved and those operated as regard vertebral height loss, angle of kyphosis, oswestry disability index and visual analogue score, we found that p value was not significant in these parameters and its value was 0.15, 0.46, 0.15, and 0.88 respectively. Which means that decision making correlated to patient score. As regards type of operative fixation done, there were non-significant comparison between type of fixation done and the mentioned parameters. All changes in the parameters explain that these parameters correlate with TLICS and prove the validity of this classification. Conclusion: Posterior short segment pedicle screw fixation is good and enough for treatment of thoracolumber fractures (burst fracture) when neurological condition of the patients is intact.

Analysis of percutaneous kyphoplasty or short-segmental fixation combined with vertebroplasty in the treatment of Kummell disease

BackgroundIn recent years, short segment internal fixation combined with vertebroplasty (SSF + VP) has provided a new option for the treatment of Kummell disease (KD). The purpose of this study is to evaluate the efficacy of percutaneous kyphoplasty (PKP) and SSF + VP, to provide evidence-based medical support for the decision-making process when treating KD patients without neurological deficits.MethodsDatabases including MEDLINE (PubMed) and EMBASE (Ovid) (1947 to April 6, 2019) were searched for PKP and short-segmental fixation combined with vertebroplasty (SSF + VP) to treat Kummell disease in randomized controlled trials (RCTs) or cohort studies. Two investigators independently evaluated the eligibility of the studies retrieved from the databases based on the predetermined selection criteria. The postoperative evaluation indexes included operation time, bleeding volume, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, local vertebral Cobb angle, and cement leakage. When the data were significant, a random-effects model was used for analysis. In contrast, when the results showed no statistical heterogeneity, a fixed-effects model was used to estimate the overall effect sizes.ResultsThree retrospective case-control studies were included in the final analysis. The differences in the bleeding volume and operation time were statistically significant, and the combined weighted mean differences (WMDs) (95% CI) were − 0.204.46 (− 210.97, − 197.93) and − 98.98 (− 141.63, 56.32), respectively.The combined data showed that the differences in VAS score, ODI score, local vertebral Cobb angle, and cement leakage were not statistically significant.ConclusionsThis analysis demonstrates that the PKP and SSF + VP methods are safe and effective in treating Kummell disease patients without neurological symptoms. However, PKP can shorten the operation time and reduce the volume of blood loss.

Physeal-preserving endoprosthetic replacement with short segment fixation in children with bone sarcomas.

The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.

Technical variation of trans-articular sacroiliac joint (SIJ) fusion using three screws considering the effects of sacral dysplasia in patients with non-traumatic SIJ pain

BackgroundThis study evaluated the technical adequacy of trans-articular sacroiliac joint (SIJ) fusion using three screws for non-traumatic SIJ pain, considering different grades of sacral dysplasia.MethodsCadaveric CT data of unilateral sacropelvic complexes for 72 individuals (53.4 ± 8.4 years) were selected. A 3D model was reformatted into the plain lateral radiograph to mark the articular surface of the SIJ. Subjects were classified into dysplastic (DYS) and non-dysplastic sacrum (NDS) groups. Proximal (PS), middle (MS), and distal screws (DS) with 10-mm diameter were virtually introduced to the iliac bone and the SIJ on the lateral image with a 5-mm safety margin. On a corresponding axial image, each screw was advanced vertically to the sagittal plane with the same safety margin. The entry points for each screw to the endplate of S1 (S2) and to the corresponding anterior sacral margin on the lateral image were measured, along with the maximal screw lengths on the axial image. Whether each screw passed through the SIJ was determined. Different types of sacral dysplasia and screws were compared statistically.ResultsThirty-eight (26.4%) cases were DYS, and 106 (73.6%) were NDS. The entry points of all screws were significantly more distal in DYS than in NDS groups. The PS and MS screw lengths differed significantly between the 2 groups. Incidences of short sacral fixation (< 10 mm) were significantly higher for the DS in both NDS (38.7%) and DYS (39.5%) groups. Incidences of screw pass were lowest for the MS in both NDS (43.4%) and DYS (47.4%) groups.ConclusionsSacral dysplasia locates the SIJ more distally and therefore affects the entry point locations and screw lengths for all screws in trans-articular SIJ fusion, compared with a non-dysplastic sacrum. Moreover, three-screw fixation risks the development of unstable DS fixation and a high extra-articular fixation rate in MS.

P90. The surgical strategy of treatment lumbosacral hemivertebra: comparative analysis of under 10 years old and older than 10 years old groups with five years follow up

BACKGROUND CONTEXT The lumbosacral hemivertebra usually leads to the early rapid progress of spinal deformity, shift and large compensatory curve. Compensatory curve of lumbosacral deformities in the early stage of less than 10 years old is often more flexible, while the compensatory curve in children older than 10 usually turns into a structural curve and surgical treatment of deformity in different age is not entirely the same. However, the timing and strategy of lumbosacral hemivertebral surgery in different ages are still controversial. PURPOSE To analyze and compare the surgical strategies and long-term outcomes of lumbosacral hemivertebra deformities in different age groups. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE Eighteen patients with lumbosacral hemivertebra deformity were retrospectively reviewed between 2004 and 2013. OUTCOME MEASURES Clinical and imaging data were collected for statistical analysis. METHODS Patients received a minimum 5-year follow-up and assigned into two groups: Group A (N=8, mean age 6.6 years old) patients who were under 10 years old and underwent hemivertebral resection and short segment fixation, Group B (N=10, mean age 14.3 years old) patients who were older than 10 years old and underwent hemivertebral resection, long segment fixation including compensatory curve. RESULTS Mean follow-up was 6.2 years. In group B all patients were treated with long segment and iliac screw fixation while no iliac screw fixation in group A. The Cobb angle of coronal main curve in group A improved from 31.3° to 9.3° post-op, and to 9.5° at final follow-up. The Cobb angle of coronal main curve in group B improved from 51.5° to 15.5°post-op, and to 16.3°at final follow-up.The Cobb angle of compensatory cranial curve in group A was 23.5° before operation, 13.7°after operation, 16.2° at final follow-up, while in group B 40.5° before operation, 13.3° after operation, 13.8° at final follow-up. CSVL in group A improved from 1.5cm before operation to 0.7 cm at final follow-up and in group B improved from 2.1 cm to 0.9 cm. Fixed fusion segments were 2.1 in group A and 5.6 in group B. The mean operative time and blood loss in Group A was 189 minutes and 380 ml, respectively, and in group B 265 minutes and 750 ml, respectively. The mean operative time and blood loss in group B were statistically significant more than group A. CONCLUSIONS Lumbosacral hemivertebra deformity under 10 years old with flexible compensatory curve undergo short-segment fixation can achieve satisfactory correction, long term maintenance. While older than 10 years old with structural compensatory curve requires long segmental and iliac bone fixation in order to achieve trunk balance and deformity correction and more operative time, blood loss and complications. Early surgical treatment is recommended for lumbosacral hemivertebral deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P91. The surgical outcome of hemivertebra excision and short segment fusion treatment for under five years-old congenital scoliosis: 10 years follow-up

BACKGROUND CONTEXT Full segmented hemivertebra with large growth potential can lead to the early rapid progress of spinal deformity. Hemivertebral resection and fixation is an effective method for the treatment of congenital spinal deformity. But there were few studies focusing on the long-term follow-up of the surgical outcome and impact on spinal growth of undergoing hemivertebra resection and short-segment fusion for congenital hemivertebrae under 5 years old. PURPOSE To evaluate the effect of hemivertebra excision and short segment fixation and fusion for congenital spinal deformity under 5 years-old and its impact on spinal growth. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A consecutive series of 20 patients under 5 years old with hemivertebra deformity undergo hemivertebra resection and short-segment fusion between 2004 and 2008. OUTCOME MEASURES Surgical characteristics, including fusion levels, estimated blood loss, operation duration, main curvature scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA). METHODS All cases were 1-level full segmented hemivertebra and coronal main curve >35° and received a minimum 10-year follow-up. Clinical and imaging data were collected for statistical analysis and evaluation of surgical outcome and impact on spinal growth. RESULTS They were retrospectively studied with a mean follow-up of 11.8 years. There were 12 cases of thoracic hemivertebra and 8 cases of lumbar hemivertebra, mean aged 3.8 years (range, 2.4-5 years). The mean fused segment were 2.1. The mean operative time was 161 min (range: 120 to 320 min). The mean estimated blood loss was 175mL (range: 100 to 400 mL). The Cobb angle of coronal main curve was 39.7° (35-54°) before surgery, 5.4° (0-13°) after surgery, and 6.3° (2-16°) at final follow-up. At final follow-up, the TK angle of thoracic hemivertebra group and lumbar hemivertebra group were 22.4° (6-35°) and 25.6° (8-38°), respectively; the LL angle of lumbar hemivertebra group with 72.1° (58-80°) was significantly larger than thoracic hemivertebra group with 35.5°(24-46°). The SVA of thoracic hemivertebra group and lumbar hemivertebra group were 1.32 cm and 2.1 cm. The height of fixed segmental vertebral body, transverse and longitudinal diameter of fixed segment spinal canal is 92%, 93%, 87% of adjacent segment, respectively. CONCLUSIONS Hemivertebra excision and short-segment fusion for congenital scoliosis under 5 years old can achieve reliable fixation, satisfactory deformity correction and maintained for a long term. It has no significant impact on vertebra growth in fixed segment, but there is more likely to lead to increased lumbar lordosis in lumbar hemivertebra patient which may be related to tethered effect on spine during spinal growth. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comparison of curative effect of elastic locking intramedullary nail and anatomic locking plate in the treatment of mid-shaft clavicular fracture

Objective To compare the curative effect between Elastic Locking Intramedullary Nail (ELIN) and Anatomic Locking Plate (ALP) for the treatment of fracture in the mid-shaft of clavicle (Classification AO/OTA:2A/2B). Methods Data of 47 cases of 2A/2B clavicular fractures who were treated with operation from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into ELIN group and ALP group according to different fixation methods. There were 23 cases in ELIN group, 14 male and 9 female, aged from 19 to 85 years (average, 55.26 years). 14 cases on the left side and 9 cases on the right side. There were 6 cases of type 2A and 17 cases of type 2B. There were 24 cases in the ALP group, 18 male and 6 female, aged from 15 to 71 years (average, 51.25 years). 16 cases on the left side and 8 cases on the right side. There were 9 cases of type 2A and 15 cases of type 2B. The operation time, intraoperative blood loss, length of skin incision, fracture healing time, extraction time of internal fixation, Constant-Murley score of shoulder joint, disabilities of the arm, shoulder, and hand (DASH) score, and complication incidence were compared between the two groups. Results All the operations were successfully performed. The mean follow-up for the patients in the ELIN group was 19.35 weeks (range, 14-23 weeks). The mean follow-up for the patients in the ALP group was 53.13 weeks (range, 28-76 weeks). In the ELIN group, the operative time was 20.78 ± 7.71 min, the intraoperative blood loss was 13.26±9.72 ml, the length of incision was 1.57±1.24 cm, the fracture healing time was 10.39±2.39 weeks, the extraction time of internal fixation was 13.17±2.37 weeks, the Constant-Murley score of shoulder joint was 99.09±1.86, and the DASH score was 1.20±2.47. In the ALP group, the operative time was 57.79±11.56 min, the intraoperative blood loss was 69.17±46.24 ml, the length of incision was 9.67±2.90 cm, the fracture healing time was 14.21±4.05 weeks, the extraction time of internal fixation was 47.38±10.46 weeks, the Constant-Murley score of shoulder joint was 98.00±2.17, and the DASH score was 0.89±1.65. The operation time (t=12.856, P=0.000), intraoperative blood loss (t=5.791, P=0.000) in the ELIN group were less than that of ALP group. The length of incision was significantly smaller in ELIN group than that of ALP group (t=12.549, P=0.000). The fracture healing time was earlier in ELIN group than that of ALP group (t=3.566, P=0.002). The extraction time of internal fixation was obviously earlier in ELIN group than that of ALP group (t=15.603, P=0.000). Constant-Murley score of shoulder joint and DASH score showed no significant difference. No delayed healing, no infection was found in the ELIN group, however skin irritation and tail bursitis were found in 6 cases, 3-6 weeks after the operation. The dressing was changed, kept clean. Skin irritation and tail bursitis disappeared, after the extraction of the internal fixation. There were 2 cases of delayed healing in the ALP group. After prolonged observation, the 2 cases healed. The healing time was extended to 24 and 27 weeks, respectively. There was 1 case of infection, 1 case of poor skin healing in the ALP group. The infected patient was treated with debridement and sensitive antibiotics, and the patient with poor skin healing was treated with dressing change. All the patients had wound healing about 4 weeks after surgery. 2 cases of skin irritation in the ALP group disappeared, after the extraction of the internal fixation. Conclusion Both ALP and ELIN are effective methods for the treatment of mid-shaft clavicular fracture. ELIN group has the advantages of more minimally invasive, faster union, shorter internal fixation time, better appearance, and lower medical cost. However, the ELIN group also had skin irritation and temporary bursitis. Key words: Clavicle; Fractures, bone; Fracture fixation, intramedullary

Eye Movements During Mathematical Word Problem Solving—Global Measures and Individual Differences

In mathematical word problem solving, reading and mathematics interact. Previous research used the method of eye tracking to analyze reading processes but focused on specific elements in prototype word problems. This makes it difficult to compare the role of reading in longer, more complex word problems and between individuals. We used global measures of eye movements that refer to the word problem as a whole, similar to methods used in research on eye movements during reading. Global measures allow comparisons of reading processes of word problems of different structure. To test if these global measures are related to cognitive processes during word problem solving, we analyzed the relation between eye movements and the perceived difficulty of a task and its solution rate. We conducted two experiments with adults and undergraduate students (N = 17 and N = 42), solving challenging mathematical word problems from PISA. Experiment 1 showed that more difficult items were read with shorter fixations, more saccades, more regressions, and slower, with correlations ranging from r = 0.70 to r = 0.86. Multilevel modelling in experiment 2 revealed that for the number of saccades and the proportion of regressions, the relationship was stronger for low-performing students, with performance explaining up to 37% of the variance between students. These two measures are primarily associated with building a problem model. We discuss how this approach enables the use of eye tracking in complex mathematical word problem solving and contributes to our understanding of the role of reading in mathematics.

Comparison of three methods of bone grafting in the treatment of thoracolumbar burst fracture

Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture. Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One, Foshan Hospital of Traditional Chinese Medicine. Of them, 87 were treated with transpedicular bone grafting (group A), 87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C). The 3 groups were compared in terms of cobb angle, loss of correction, bony fusion, internal fixation failure, and Oswestry disability index (ODI). Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The cobb angles in the 3 groups at one week after operation (4.9°±1.0°, 4.8°±0.6° and 4.8°±0.6°) and at the final follow-up (6.1°±1.5°, 14.5°±3.7° and 15.3°±4.1°) were significantly smaller than those before operation (27.5°±4.9°, 27.6°±4.6° and 27.6°±4.2°) (P<0.05). The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P<0.05). At the final follow-up, both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P<0.05). The fusion rate in group A (100%) was significantly larger than in group B (80.5%) and C (76.2%). There were no significant differences between the 3 groups in the rate of internal fixation failure (0, 1.1% and 2.4%) (χ2=2.108, P=0.348). The ODI for the 3 groups at 6 months after operation (28.5±4.1, 28.7±3.9 and 28.8±3.7) and at the final follow-up (10.7±2.6, 11.0±2.7 and 11.4±3.1) were all significantly lower than the preoperative values (94.3±0.7, 94.4±0.9 and 94.4±0.8) (P<0.001). In all the patients, the ODI at the final follow-up was significantly lower than that at 6 months after operation(P<0.001). Conclusions In the treatment of thoracolumbar burst fractures, all the posterior approach plus transpedicular bone grafting, posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion. Although the latter 2 methods of bone grafting are effective, they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures, bone; Bone graft

Effects of short and long-term alcohol-based fixation on Sprague-Dawley rat tissue morphology, protein and nucleic acid preservation

Safety concerns on the toxic and carcinogenic effects of formalin exposure have drawn increasing attention to the search for alternative low risk fixatives for processing tissue specimens in laboratories worldwide. Alcohol-based fixatives are considered some of the most promising alternatives. We evaluated the performance of alcohol-fixed paraffin-embedded (AFPE) samples from Sprague-Dawley (SD) rats analyzing tissue morphology, protein and nucleic acid preservation after short and extremely long fixation times (up to 7 years), using formalin-fixed paraffin-embedded (FFPE) samples as a comparator fixative. Following short and long-term alcohol fixation, tissue morphology and cellular details in tissues, evaluated by scoring stained sections (Hematoxylin-Eosin and Mallory’s trichrome), were optimally preserved if compared to formalin fixation. Immunoreactivity of proteins (Ki67, CD3, PAX5, CD68), evaluated by immunohistochemistry, showed satisfactory results when the fixation period did not exceed 1 year. Finally, we confirm the superiority of alcohol fixation compared to formalin, in terms of quantity of nucleic acid extracted from paraffin blocks, even after an extremely long time of alcohol fixation.Our results confirm that alcohol fixation is a suitable and safe alternative to formalin for pathological evaluations. There is a need for standardization of formalin-free methods and harmonization of diagnosis in pathology department worldwide.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Percutaneous Balloon Kyphoplasty and Short Instrumentation Compared with Traditional Long Instrumentation for Thoracolumbar Metastatic Spinal Cord Compression

A considerable propotion of patients with cancer got thoracolumbar vertebral metastatic epidural spinal cord compression, which affected their quality of life. Traditional surgical management involves early decompression with concomitant spine stabilization with long instrumentation. However, complications are caused by massive blood loss and long operation time. This study aimed to compare the safety and efficacy of short posterior instrumentation with kyphoplasty and the traditional method for thoracolumbar metastatic epidural spinal cord compression. Between January 2004 and December 2015, a retrospective study was conducted on 120 patients with metastatic epidural spinal cord compression from T6 to L5 and divided into 2 groups: short posterior instrumentation with the balloon kyphoplasty group (group I, n= 50) and the long posterior instrumentation group (group II, n= 70). The clinical and radiographic parameters of patients in the 2 groups were compared with a nonrandomized cohort method. Patients were followed up from 3 to 40 months after surgery according to survival time. In group I, the surgery had a mean blood loss of 650 mL and a survival time of 19.1 months. In group II, the surgery had a mean blood loss of 2100 mL and a survival time of 14.14 months. A significant difference in blood loss amount (P= 0.002) was observed. Complications, including deep wound infection, durotomy, and uncontrolled bleeding, were observed in both groups. No postoperative cement-induced neurologic deterioration, implant failure occurred. Kyphoplasty with short posterior instrumentation is a novel technique that can be performed safely and effectively for the treatment of thoracolumbar metastatic epidural spinal cord compression. Rigid stability, reduced blood loss, and short fixation decrease surgical morbidity of spinal metastasis.

Visual processing patterns of adults with traumatic brain injury when viewing image-based grids and visual scenes

Many individuals with traumatic brain injury (TBI) rely on augmentative and alternative communication (AAC) supports to meet functional communication needs. The use of images to display message content may be advantageous for this population, given deficits in literacy, visual processing, and cognition. Grid and visual scene displays are two options for presenting images within AAC systems. Eye-tracking technology was utilized to evaluate the visual processing patterns of 13 adults with a history of TBI and 13 adults without TBI when interpreting themes depicted in grid and visual scene displays. Results indicated that differential processing and effort was required when interpreting the two display types. Both groups of participants required significantly more visual fixation time and exhibited patterns consistent with greater cognitive effort when identifying themes depicted in grids compared to visual scenes (i.e., greater numbers of short fixations). The participants with TBI were overall less efficient than those without TBI when identifying themes presented in both AAC display types. These results add to the growing body of evidence indicating that visual scenes may more effectively represent complex concepts than decontextualized, grid-based images for individuals with TBI. Additional clinical implications are discussed.

Outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spine fractures are common in today’s world due to high frequency of motor vehicle accidents and work place injuries. These are major cause of disability in adult population. The mortality rate following spinal injuries is 7%. The aim of the study was to study the functional and radiological outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Dorso-lumbar fractures with intact pedicle on the fractured segment, Load sharing classification score of equal or less than 6, Neurologic involvement caused by the fracture, loss of vertebral body height by more than 50% and kyphosis angle more than 20° are included. Patients with multiple level fractures and pathological fractures were excluded from the study. Denis classification and AO classification were used. Load sharing score is used to decision making for intermediate screw fixation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; L1 is more frequently fractured followed by D12. Distraction type (AO) and burst (Denis) are most common types. 4 of our patients had complete neurological deficit. 15 had incomplete deficit and 11 patients doesn’t have any neurological involvement. Frankel A grade cases remained in the same grade. Mean Kyphotic correction is 6.7°. Mean AVBCP in the postoperative cases 26. None of the cases developed kyphosis or loss of correction in the follow up. Outcome using Roland Morris disability questionnaire is excellent in 64.3%, good in 21.6% and poor in 14.3% cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To conclude that short segment posterior stabilisation with intermediate screws provides better biomechanical stability when compared with conventional short segment fixation.&lt;/p&gt;

Targeting Alpha Synuclein Aggregates in Cutaneous Peripheral Nerve Fibers by Free-floating Immunofluorescence Assay.

To date, for most neurodegenerative diseases only a post-mortem histopathological definitive diagnosis is available. For Parkinson's disease (PD), the diagnosis still relies only on clinical signs of motor involvement that appear later on in the disease course, when most of the dopaminergic neurons are already lost. Hence, there is a strong need for a biomarker that can identify patients at the beginning of disease or at the risk of developing it. Over the last few years, skin biopsy has proved to be an excellent research and diagnostic tool for peripheral nerve diseases such as small fiber neuropathy. Interestingly, a small fiber neuropathy and alpha synuclein (αSyn) neural deposits have been shown by skin biopsy in PD patients. Indeed, skin biopsy has the great advantage of being an easily accessible, minimally invasive and painless procedure that allows the analysis of peripheral nervous tissue prone to the pathology. Moreover, the possibility of repeating the skin biopsy in the course of the follow-up of the same patient allows studying the longitudinal correlation with the disease progression. We set up a standardized reliable protocol to investigate the presence of αSyn aggregates in skin nerve fibers of the PD patient. This protocol involves few short fixation steps, a cryotome sectioning and then a free-floating immunofluorescence double-staining with two specific antibodies: anti Protein Gene Product 9.5 (PGP9.5) to mark the cutaneous nerve fibers and anti 5G4 for detecting αSyn aggregates. It is a versatile, sensitive and easy to perform protocol that can also be applied for targeting other proteins of interest in skin nerves. The ability to mark αSyn aggregates is another step forward to the use of skin biopsy as a tool for establishing a pre-mortem histopathological diagnosis of PD.

Comparing the Biomechanical Stability of Cortical Screw Trajectory Versus Standard Pedicle Screw Trajectory for Short- and Long-Segment Posterior Fixation in 3-Column Thoracic Spinal Injury.

Information on the performance of posterior fixation with cortical screw (CS) versus pedicle screw (PS) trajectories for stabilizing thoracolumbar burst fractures is limited. Therefore, we sought to analyze stability with CS versus PS in short- and long-segment fixations using a 3-column spinal injury model. Nondestructive flexibility tests: (1) intact, (2) intact + short fixation, (3) intact + long fixation, (4) after burst fracture, (5) short fixation + burst fracture, and (6) long fixation + burst fracture using thoracic spine segments (7 CS, 7 PS). With CS, the range of motion (ROM) was significantly greater with short-segment than with long-segment fixation in all directions, with and without burst fracture (P ≤ .008). With PS and burst fracture, ROM was significantly greater with short fixation during lateral bending and axial rotation (P < .006), but not during flexion-extension (P = .10). Groups with CS versus PS were not significantly different after burst fracture during flexion-extension and axial rotation, with short (P ≥ .58) or long fixation (P ≥ .17). During lateral bending, ROM was significantly greater with CS versus PS, without burst fracture (long fixation, P = .02) and with burst fracture (short and long fixation, P ≤ .001). CS trajectory is a valid alternative to PS trajectory for thoracic spine fixation in 3-column spinal injuries, and long-segment fixation is superior to short-segment fixation with either.

NUMERICAL ANALYSIS OF SHORT AND LONG INSTRUMENTATION IN THE TREATMENT OF THORACOLUMBAR FRACTURES CONSIDERING THE LIGAMENTOUS PORTION

ABSTRACT Objective: This study aims to numerically evaluate the surgical treatment of thoracolumbar fractures, comparing the strengths between the long and short fixations using the pedicle of the fractured vertebra, taking into account the supraspinous, intertransverse, and anterior longitudinal ligaments. Methods: A numerical analysis of the techniques of long and short fixation of a thoracolumbar spine fracture was performed using computed tomography images that were converted into three-dimensional models and analyzed through the ANSYS program. The two types of treatments were analyzed considering the tensions generated in the immediate postoperative period, when the fracture has not yet been consolidated. The anterior, posterior, supraspinal and intertransverse longitudinal ligaments were added, in addition to considering different vertebral geometries. Results: Taking into account that the maximum tensile stress of the material used in the metal implant, in the case of titanium, was 960 MPa, the highest tension found in the analysis of the short instrumentation was 346.83 MPa, reaching only 36.13% of the load the material supports, being, therefore, within a safety limit. The analysis performed in the spine with long instrumentation showed the highest tension value of 229.22 MPa. Conclusions: Considering the values found and the resistance of the synthesis material used, the short and long fixation can be considered in the treatment of thoracolumbar fractures with similarity and a good safety coefficient. Level of Evidence III; Case-Control.

Acute burst fracture in Kummell\u2019s disease with acute onset neurological deficit: a case report on role of spinal stability and technical notes on \u201cpivot ligamentotaxis\u201d

BackgroundKummell’s Disease has insidious progression. Neurological deficit is usually slow in onset and progression and only few cases of acute neurological deficit have been reported. We came across a case of Kummell’s disease which progressed to burst fracture, developed neurological deficit within two weeks. We managed patient with “pivot ligamentotaxis” and Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation.Case presentationEighty-three years old woman following fall was on conservative management at another hospital. She had no neurological deficit. A week later her back pain aggravated and two weeks later developed bilateral buttock pain, bilateral lower limb weakness and diminished sensation in the sacral area.Radiological investigations (X-rays, Magnetic resonance imaging and Computed tomography) showed L1 vertebral body fracture with vacuum cleft and fracture fragment retropulsed into the spinal canal.A diagnosis of Kummell’s disease with burst fracture of L1 vertebra & neurological deficit was made.Patient was managed with Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. The reduction of the retropulsed fragment was achieved by virtue of “Pivot ligamentotaxis”. The patient got relieved of the symptoms (Preoperative VAS 8 and postoperative VAS 3) and was allowed brace assisted ambulation on first postoperative day.ConclusionThis study reports acute occurrence of the burst fracture in unstable vertebra inflicted by Kummell’s disease and role of spinal stability in recovery. We achieved closed reduction of the fracture fragments and relief of the cord compression by posterior compression with “pivot ligamentotaxis”.

Stent Screw−Assisted Internal Fixation (SAIF) of Severe Lytic Spinal Metastases: A Comparative Finite Element Analysis of the SAIF Technique

A new stent-screw-assisted internal fixation (SAIF) minimally invasive cement-augmentation technique has been introduced to treat patients with extreme osteolytic lesions of the vertebral body. The aim of the current finite element study, employing a spine model with an extreme osteolytic defect, was to assess the effect of the SAIF technique in reducing strains in the vertebral body in comparison with a standard surgical short posterior fixation. Different finite element models of a L1-S1 spine were developed, representing an intact condition (reference configuration), an extreme osteolysis condition, and its treatment, respectively with stand-alone SAIF, SAIF and posterior fixation, and with stand-alone posterior fixation. Each model was loaded to reproduce standing and upper body bending. Principal strains were calculated on the superior endplate, anterior and posterior cortical walls. A paired Wilcoxon test with a 0.05 significance level was performed to statistically analyze the results. Median strains on the bony structures increased in the osteolysis model compared with the intact model, and the SAIF technique was effective in reducing such strains under both standing and flexion conditions. Additional posterior fixation, combined with the SAIF technique, produced minimal further reduction of the median strains on the bony structures. Stand-alone posterior fixation only shielded the osteolytic vertebra avoiding excessive displacements but failed in restoring the axial stiffness to values typical of the intact vertebra. The new SAIF technique resulted effective in restoring the load-bearing capacity of the extensively osteolytic vertebra; additional posterior fixation provided only further minor advantages.