Single-stage Posterior Approach Research Articles

An improved total en bloc spondylectomy for L5 vertebral giant cell tumor through a single-stage posterior approach.

Although total en bloc spondylectomy (TES) is strongly recommended for spinal giant cell tumor (GCT), it is extremely difficult to excise a L5 neoplasm intactly through the single-stage posterior approach. Given the risk of neurological and vascular injury, intralesional curettage (IC) is usually recommended for the treatment of L5 GCT. In this study, we presented our experience with the use of an improved TES to treat L5 GCT through the single-stage posterior approach. This study included 20 patients with L5 GCT who received surgical treatment in our department between September 2010 and April 2021. Of them, seven patients received improved TES without iliac osteotomy, and the other 13 patients received IC (n = 8), sagittal en bloc resection (n = 1), TES with iliac osteotomy (n = 3), and TES with radicotomy (n = 1) as control. The mean operative time was 331.43 ± 92.95min for improved TES group and 365.77 ± 85.17min for the control group (p = 0.415), with the mean blood loss of 1142.86 ± 340.87ml vs. 1969.23 ± 563.30ml (p = 0.002). Postoperative treatment included bisphosphonates in nine patients and denosumab in 12 patients including one patient who changed from bisphosphonates to denosumab. Three patients who received IC experienced local recurrence, and no relapse was observed in improved TES group. Single-stage posterior TES for L5 GCT was previously considered impossible. In this study, we presented our experience with the use of an improved surgical technique for L5 TES through the single-stage posterior approach, which has proved to be superior to the conventional procedures in terms of blood loss control and complication and recurrence rates. IV.

Surgical results and quality of life after single-stage posterior transpedicular approach for circumferential epidural decompression in patients with thoracolumbar spine metastasis.

Objective: The primary aim of this study was to evaluate the effect of palliative surgery using posterior transpedicular approach (PTA) with posterior instrumentation on pain response and quality of life (QoL) in patients with metastatic thoracic and lumbar tumors. Methods: From 2018 to 2019, 39 patients with metastatic thoracic and/or lumbar tumors were prospectively enrolled to measure the reduction in pain and the changes in QoL after surgical decompression with posterior instrumentation via PTA. The patient group was composed of 27 men and 12 women with a mean age of 60 years (range, 28 to 92 years). Pain response was measured using the visual analog scale (VAS) and neurologic status was evaluated using Frankel grades. QoL was assessed with use of the EORCT QLQ-BM22 questionnaire before surgery (baseline) and at 1-, 3-, 6-, and 12-month after surgery. The survival times of all the patients were also collected. Results: All patients showed either an improvement or a similar pain level after surgery, which the VAS score decreased from 7.10 ± 2.22 preoperatively to 3.10 ± 2.15 one month postoperatively (P<0.05). 19 patients (48.7%, 19/39) showed neurological function improvement postoperatively. Among the 19 patients, 7 cases improved from Frankel grade C to D, 5 cases from grade C to E, and 7 cases from grade D to E. Another 20 patients still have the same Frankel grade postoperatively, however, most of them improved clinically. The QoL improvement of the patients was also evident after treatment. Paired-samples T-test examination of the postoperative scores showed a significant improvement in terms of pain location, pain severity and performance status (P<0.01). Compared with the preoperative score, the 1-month postoperative score of functional interference was significantly improved (63.6 vs. 34.5, P<0.01). There were no significant changes in social or psychological functioning. Three patients experienced cerebrospinal fluid leakage postoperatively, and they were all successfully managed by lying flat without a pillow. One patient experienced rod breakage, at 10 months after surgery. All the patients were alive at 3 months; however, 7 patients died within 3 to 6 months, and another 9 patients died from the disease within 6 to 12 months. Conclusions: The present feasibility study found that the application of the PTA for decompression and fusion in patients with spinal metastases is beneficial for achieving prompt and sustained pain relief, reducing neurologic deficits and improving functional outcomes, health utilities, and HRQoL.

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

Single-Stage Posterior Approach for the En Bloc Resection and Spinal Reconstruction of T4 Pancoast Tumors Invading the Spine.

Retrospective cohort study. This study aimed to evaluate the outcomes of patients who had T4 Pancoast tumors invading the spine and underwent en bloc resection and spinal stabilization through a single-stage posterior approach. Surgical resection for Pancoast tumors affecting the spine has been successfully performed in two stages involving spinal reconstruction and tumor resection. However, reports have rarely presented the results of en bloc resection combined with spinal stabilization for T4 Pancoast tumors invading the spine through a single-stage posterior approach. Patients who had T4N0M0 Pancoast tumors invading the spine and underwent a single-stage posterior approach were retrospectively recruited. The following data were obtained and examined: demographics, tumor histology, preoperative and postoperative therapy, complications, spinal reconstruction technique, tumor resection extent, survival time, and disease recurrence. Eighteen patients were included. The mean population age was 61±17 years, and the most common pathological type was adenocarcinoma (61.1%). Complete resection (R0) was obtained in 15 patients (83.3%), positive surgical margins (R1) were found in three patients (16.7%), and the 90-day mortality rate was 0%. Postoperative major complications were detected in 12 patients (66.7%), who required reoperation. The mean survival time was 67±24 months, but the median survival time was not reached. Among the patients, 10 (55.6%) are still alive at the end of the study. The 2- and 5-year actual survival rates were 59% (95% confidence interval [CI], 35.7%-82.3%) and 52.5% (95% CI, 28.4%-76.6%), respectively. En bloc resection and spinal stabilization through a single-stage posterior approach might be effective for T4 Pancoast tumors invading the spine.

Surgical treatment approach of cervicothoracic junction spinal tuberculosis in pediatric: A case report.

Introduction and importanceThe cervicothoracic junction is prone to infection by tuberculosis bacteria, which leads to spinal instability. Meanwhile, cervicothoracic junction spinal tuberculosis is a disease that affects the C7 to T3 vertebral, and it accounts for 5% of all spinal tuberculosis cases. Surgical procedures of treating this disease vary, and the most commonly used method is the combined anterior and posterior approach. This case report presents the disease with uncommon location in pediatric, which is rarely reported, and performed with the single-stage posterior approach to treat the patient, which showed a good clinical and radiological result.Case presentationA 15-years old girl with one-month history of progressive inferior paraplegia (within a month, her muscle strength went from score 5 to 0) initially complained of neck pain, gradual weakness of the lower extremities, and hypoesthesia below T4. The spine's MRI also showed a tuberculous spondylitis in the T1 to T3 vertebral and a huge paravertebral abscess at the C5 to T3 level. Subsequently, an adequate decompression, debridement, maintenance and reinforcement of stability as well as deformity correction were carried out using the single-stage posterior approach.ConclusionsThe cervicothoracic junction spinal tuberculosis with huge paravertebral abscess makes surgical procedures difficult, specifically in pediatric patients. However, the single stage posterior approach produced a better clinical and radiological result with a short operation time. The selection of appropriate surgical approach management with good perioperative planning as well as effective medical management improved the patient's condition.

The Single Posterior Approach for Resection of Sacral Chordoma: A Case Report

Chordoma is a relatively rare primary malignant neoplasm that originates from ectopic notochordal cells, and most chordomas arise in the sacrococcygeal and clivus regions. Due to the poor response to adjuvant therapy, complete tumor resection is the treatment of choice. This case report describes a 57-year-old male patient who presented with a very large sacral chordoma involving the S2-S5 bodies, extending to the right piriformis and gluteal muscles. He was successfully treated with a single-stage posterior approach and was free of local recurrence at a 5-year follow-up examination, without neurological deficits. A single posterior approach is a feasible option for the treatment of sacral chordomas.

Three-column osteotomy by single-stage posterior approach in congenital and post-tubercular kyphosis: a comparison of outcomes.

To compare the clinical, radiological and functional outcomes of three-column osteotomy (3CO) by a single-stage posterior approach in patients with isolated congenital angular kyphosis (CK) and healed post-tubercular kyphosis (PTK). The hospital records of 30 patients with isolated congenital kyphosis (Group CK) and 51 patients with healed post-tubercular kyphosis (Group PTK), operated at a single centre utilizing a 3CO by a single-stage posterior-only approach, were retrospectively analysed. The two groups were compared with respect to selected demographic variables with clinical, radiological and functional outcome measures at a minimum follow-up of 24months. Patients in Group CK (median: 13years, range: 4-30years) presented earlier than those in Group PTK (median: 16years, range: 6-45years). The apex of the deformity was most often located in the thoracic spine in Group PTK, and in the thoracolumbar or lumbar spine in Group CK. The mean operative time (198.2 ± 31.5min v/s 174.4 ± 34.5; p = 0.01) and estimated blood loss (859.6 ± 312.2ml v/s 720.8 ± 187.3; p = 0.04) were significantly higher in Group PTK. While the local kyphosis angle was significantly corrected with surgery in both groups, the correction was significantly better in Group CK-this group also had significantly better overall functional (SRS-22r) scores at a follow-up of 24months (p < 0.05). The overall complication rate (29.4% v/s 23.3%) and neurological complication rate (9.8% v/s 6.6%) were higher in Group PTK. Permanent neurological deterioration occurred in one patient in each group. Patients with PTK have significantly higher age of presentation, higher operative time and higher complication rate as compared to CK. However, good functional outcomes and kyphosis angle correction can be achieved in both the groups with posterior-only three-column osteotomies.

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.

Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study

Introduction: The study has been designed with all perseverance’s, to observe and evaluate the results of single stage transpedicular decompression and posterior fixation in Dorso Lumbar Spinal Tuberculosis. Material and Methods: The present study “Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study” was conducted on clinicopathologically diagnosed cases of spinal tuberculosis of dorsal and lumbar region during a period of two years from “October 2018 to October 2020” in the Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha. Method of Collection of Data: This is a clinical and prospective study conducted on patients admitted to S.C.B. Medical College, Cuttack after obtaining ethical clearance from the institutional ethical committee. A total of 25 cases of tuberculosis of spine in thoracic and lumbar region were selected for this procedure after obtaining proper informed and written consent.Patients were admitted based on clinical presentation such as prolonged back pain usually with tender gibbus, with/ without neurologic deficit. Objective of the Study: The objective of the study is to evaluate the efficacy of single stage posterolateral decompression and posterior fixation in spinal tuberculosis. The patients are to be evaluated postoperatively regarding following parameters: – • Postoperative neurological status and its improvement • Degree of pain relief • Radiological fusion of vertebra • Correction of angle of kyphosis Discussion: This piece of work conducted in Department of Orthopaedics, SCB Medical College, Cuttack, is meant for an analytical study of transpedicular decompression and debridement of spinal cord and fixation of the unstable spine by means of screws &amp; rod system in a single stage posterior approach surgery. In our study we followed Tuli’s Middle Path Regimen in the management. Hence, all clinicoradiological diagnosed TB spine cases were administered ATT drugs under govt. sponsored DOTS Therapy Schedule. The pts who didn’t show signs of improvement, or deteriorating neural deficit, or progressive and gross kyphosis, or patients with severe pain were taken up for surgery and then followed up regularly at 3 months interval for a minimum average follow up period of 1 year. In our study, out of 25, 11 patients recovered completely from neurological deficit and was found to have Frenkel grade E. Another 12 patients had recovered to Frenkel grade D. Hence almost 92 percent of patients had satisfactory neurological recovery. In our study fusion was seen in 64 percent of cases which was significant and comparable with the studies of Gueven et al, Lee et al, and Chacko et al. Pain reduced in all cases. Conclusion: There was neurological recovery in all cases except one, indicating debridement by transpedicular approach is still effective though not radical. Pain was significantly reduced in all cases. Another vital observation was a correction in kyphotic deformity which was significant and also quite stable. There was fusion in more than half of the cases Keywords: Single Stage Posterolateral Decompression, Posterior Fixation in Dorsolumbar Spinal Tuberculosis, Potts Paraplegia

Single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation for the treatment of lumbar tuberculosis and psoas major abscess.

To investigate the feasibility and clinical efficacy of the treatment for lumbar tuberculosis with psoas major abscess with single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation. Thisretrospectivestudy evaluated the clinical data of 24 patients (14 males and 10 females) with lumbar tuberculosis and psoas major abscess admitted to the Comprehensive Surgery from June 2016 to June 2019.All patients were treated with the single-stage posterior approach to remove the transverse process combined with the intervertebral foramina approach for debridement, interbody fusion, internal fixation. The quadruple anti-tuberculosis drug therapy was given both pre-operatively and post-operatively. Clinical symptoms and complications were investigated and recorded. The visual analogue scale (VAS), American Spinal Injury Association (ASIA), degree of lesion fusion C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were evaluated. The average follow-up period was 16. 5months (from 12 to 36months). The average VAS score at threemonths post-operation was significantly declined than the pre-operative VAS score [(2.17 ± 0.87) points vs (5.46 ± 1.22) points, t = - 11.534, P < 0.01)]. At the last follow-up, the neurological function of 20 patients recovered to grade E, whereas four patients were still in grade D. The ESR and CRP returned to normal levels in all patients. Bone fusion was achieved in nine cases at sixmonths, 11 cases at ninemonths, and four cases at 12months. The incisions of 23 patients had healed nicely without chronic sinus. Poor incision healing only happened in one case at the day 12 post-operation. The bone grafts among the lesions obtained bony fusion. Besides, there was no recurrence of tuberculosis, loosening or fracture of internal fixation during the follow-up. Single-stage posterior resection of the transversal process combined with an intervertebral foramina approach for debridement, interbody fusion, internal fixation is probably an effective and safe approach of the treatment for lumbar tuberculosis combined with psoas major abscess, producing few complications. This technique provides an alternative method for the surgical treatment of lumbar tuberculosis combined with psoas major abscess.

Atlantoaxial Dislocation with Bony Fusion of C1/2 Facet Joints Treated with Posterior Joint Release, Distraction and Reduction.

Introduction Atlantoaxial dislocation (AAD) is a complicated and challenging deformity with severe morbidities. Irreducible AAD with C1/2 bony fusion requires anterior (transoral or transnasal) odontoidectomy to decompress spinal cord or medulla, which is highly demanding technique that is risky for comorbidities. Here, we report our application of modified Goel's technique to reduce AAD with bony fusion through single-stage posterior approach surgery. Technical Note Our technique that can reduce AAD with bony fusion through single-stage posterior approach surgery is reported. Joint release, distraction, cage implantation, and atlantoaxial or occipitocervical fixation can successfully manage AAD with C1/2 bony fusion. Key points for the technique include pinpointing original joint space, thorough release of bony fusion, stepwise distraction, and cage implantation with autograft. Conclusions Joint release, distraction, cage implantation, and atlantoaxial or occipitocervical fixation can successfully manage bony irreducible AAD. This technique provided an option for bony fused AAD and improved safety and efficacy of its management.

Surgical outcomes following hemivertebrectomy in congenital scoliosis: a systematic review and observational meta-analysis.

Hemivertebrectomy is widely used definitive correction surgery in congenital scoliosis due to hemivertebrae. It may be done either as combined anterior and posterior approach or a single-stage posterior approach only. The purpose of this meta-analysis was to compare two techniques with regards to blood loss, operative time, deformity correction and complications. The systematic review andmeta-analysis were conducted according to PRISMA guidelines among peer-reviewed journals published in English between June 2000 and June 2020. Quality appraisal of all selected articles was done and data extracted. After thorough literature search and excluding, 37 studieswere included for review.The commonest location of the hemivertebrae was thoracolumbar spine (51.3%), thoracic (26.2%), lumbar/lumbosacral (21.6%) followed by cervical (0.7%). Pooled data showed a significant difference (p < 0.05) in mean operative time with posterior only approach (227min, 95% CI 205-250) as compared to Combined Anterior Posterior Approach (CAPA) (316min95% CI 291-341). Significant difference (p < 0.05) in mean blood loss was observed in posterior only approach (522ml, 95% CI 434-611) as compared to CAPA (888ml, 95% CI 663-1113). No significant difference was noted in mean correction in either of the approaches and overall pooled mean correction rate was 66%, 95% CI 61-72. This review and meta-analysis of two surgical techniques of hemivertebrectomy, shows that operative time and blood loss is significantly lower in posterior only approach with no difference in correction rate as compared to CAPA. There was significant correlation between age at surgery and need for revision surgeries. IV.

Single-Stage Posterior Approach for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament With K-line (-) Using Thick Cervical Pedicle Screw System: A Technical Note and Preliminary Results.

Technical note, retrospective case series. The optimal surgical strategy for multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with a negative kyphosis line (K-line (-)) remains controversial. We present a novel single-stage posterior approach that converts the K-line from negative to positive in patients with multilevel cervical OPLL, using a posterior thick cervical pedicle screw (CPS) system and report the procedure's outcomes and feasibility. Twelve consecutive patients with multilevel cervical OPLL and K-line (-) underwent single-stage posterior thick CPS fixation, with laminectomy and foraminal decompression. A pre-bent rod was installed to convert the K-line from negative to positive. Radiographic parameters, including the extent and occupying ratio of OPLL and the C2-C7 angle, were examined. CPS accuracy was assessed using computed tomography. The Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores were analyzed. Quality of life was assessed using the Neck Disability Index (NDI). The mean OPLL extent was 5 vertebral body levels, and posterior decompression was performed on 4.2 segments. The average C2-C7 angle and the occupying ratio of OPLL improved from -9.0° to 14.3° and from 63% to 33%, respectively. The preoperative JOA, VAS, and NDI scores significantly improved from 8.4 to 13.3, from 7.1 to 2.2, and from 21.9 to 9.3, respectively. The K-line was converted from negative to positive in all cases. No severe complications were identified. Single-stage posterior surgery with a thick CPS system may be a reliable and effective treatment for multilevel cervical OPLL and K-line (-).

Thoracolumbar Vertebral Column Resection With Rectangular Endplate Cages Through a Posterior Approach: Surgical Techniques and Early Postoperative Outcomes.

Thoracolumbar pathology can result in compression of neural elements, instability, and deformity. Circumferential decompression with anterior column reconstruction is often required to restore biomechanical stability and minimize the risk of implant failure. To assess the safety and viability of wide-footprint rectangular cages for vertebral column resection (VCR). We performed VCR with wide-footprint rectangular endplate cages, which were designed for transthoracic or retroperitoneal approaches. We present our technique using a single-stage posterior approach. A total of 45 patients underwent VCR with rectangular endplate cages. Mean age was 58 yr. Diagnoses included 23 tumors (51%), 14 infections (31%), and 8 deformities (18%). VCRs were performed in 10 upper thoracic, 17 middle thoracic, 14 lower thoracic, and 4 lumbar levels. Twenty-four cases involved a single level VCR (53%) with 18 two-level (40%) and 3 three-level (7%) VCRs. Average procedure duration was 264 min with mean estimated blood loss of 1900 ml. Neurological outcomes were stable in 27 cases (60%), improved in 16 (36%), and worse in 2 (4%). There were 7 medical and 7 surgical complications in 11 patients. There were significant decreases in postoperative thoracic kyphosis (47° vs 35°, P=.022) and regional kyphosis (34° vs 10°, P<.001). There were 2 cases of cage subsidence due to intraoperative endplate violation, neither of which progressed on CT scan at 14 and 35 mo. Posterior VCR with rectangular footprint cages is safe and feasible. This provides improved biomechanical stability without the morbidity of a lateral transthoracic or retroperitoneal approach.

Surgical outcome of high grade spondylolisthesis following reduction, instrumentation, fusion through single stage posterior approach

Introduction: Literature evidence of outcome of reduction, spinal fusion through single stage posterior approach in patients of high-grade spondylolisthesis is lacking. Aim of the study, is to study the surgical outcome of High-grade spondylolisthesis patients, managed through single stage posterior approach. Materials and Methods: We have retrospectively analysed high -grade spondylolisthesis adolescents and young adults of patients of age less than 30 years, who have undergone reduction and spinal fusion in our institute for the past 5 years with a follow-up of two years. 27 patients, who have undergone surgery in the time period between 2011 to 2016, were evaluated with preop standing lumbosacral radiograph for slip angle, L5 incidence angle, lumbar lordosis, slip percentage. Oswestry disability index [ODI] score for low back pain, neurological examination, sf-36 health survey questionnaire are the clinical parameters analysed. The patients who had undergone the surgery were followed up for 2 years and evaluated with standing radiographs for all the above radiological parameters, clinical parameters and assessment of spinal fusion by Bridwell criteria. Parameters were analysed statistically with SPSS software version 25.0. p less than 0.05 was considered statistically significant. Results: The aim of the surgery is to reduce the L5-S1slip angle to less than 30 degrees, and not about the complete restoration of displacement of L5 over S1. Mean slip angle, L5 incidence angle, Lumbar lordosis, slip percentage changed from 41.57 to12.10 [p

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite

Objective: To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Methods: Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test. Results: The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(t=6.2,P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. Conclusions: The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

P107. Releasing anterior soft tissue and reduction of the irreducible atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach

BACKGROUND CONTEXT The management of AAD combined with BI is challenging. Traditional posterior approaches lack the ability to release the anterior soft tissue and result in unsatisfactory reduction; posterior fixation followed by the anterior release approach has higher morbidity and lead to higher costs and a longer length of stay. PURPOSE This study aims to analyze outcomes of the release of anterior soft tissue through posterior route in order to reduce irreducible atlantoaxial dislocation (AAD) and basilar invagination (BI) through a single-stage operation. This study aims to analyze outcomes of the release of anterior soft tissue through posterior route in order to reduce irreducible atlantoaxial dislocation (AAD) and basilar invagination (BI) through a single-stage operation. STUDY DESIGN/SETTING This is a retrospective study. PATIENT SAMPLE Thirty-one patients with irreducible AAD and concomitant BI with congenital osseous abnormalities were analyzed. OUTCOME MEASURES The clinical results were evaluated using the Japanese Orthopedic Association (JOA) scale, and the radiological measurements included anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle (CCA) and the length of the syrinx. METHODS The anterior soft tissue was released posteriorly, and cages were placed into the facet joint followed by occipital-cervical fixation with cantilever correction. We used paired t-test to compare preoperative and postoperative measurements. RESULTS The mean JOA score increased from 11.65 to 14.48 at 1-year follow-up. Complete reduction of AAD and BI was achieved in 23 patients (74.2%). The mean clivus-canal angle improved from 113.0 degrees preoperatively to 148.4 degrees postoperatively. Shrinkage of the syrinx was observed in 6 patients in one week after surgery. Nine patients had 18-month follow-up and achieved bone fusion. Twenty-two patients have a 12-month follow-up, and 19 (86.3%) achieved bony fusion. Unilateral vertebral artery occlusion was diagnosed in 2 cases without clinical symptoms. CONCLUSIONS It appears effective and safe to treat irreducible AAD associated with BI by releasing the anterior soft tissue from a posterior approach. Cage implantation within the facet and fixation using cantilever can achieve complete reduction in most cases. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comprehensive treatment algorithm for management of thoracic and lumbar tubercular spondylodiscitis by single-stage posterior transforaminal approach.

Surgery in tubercular spondylodiscitis involves radical debridement and fusion by combined anterior and posterior or all posterior approaches with a posterolateral window with its associated morbidities. This study evaluates the outcome of a comprehensive treatment algorithm for thoracic and lumbar tubercular spondylodiscitis by a single-stage posterior transforaminal approach. One hundred and twenty-six patients with tubercular spondylodiscitis between T1 and S1 who underwent posterior surgery with/without fusion by transforaminal approach with a minimum follow-up of 2years were analyzed. Radiological outcome was assessed by documenting healing with magnetic resonance imaging/computed tomography and radiographical fusion, while clinical outcome was assessed by visual analog score (VAS) for pain and Frankel grading for neurological recovery. Of the 114 patients available for follow-up with a mean age of 53years, complete radiological healing was observed in all patients (100%) with radiographical fusion in 97.4% and neurology recovered to Frankel E in all 37 patients with deficit. The preoperative VAS score of 9.2 improved significantly to 1.7 postoperatively, and all patients returned to their preoperative occupational activities at the final follow-up. This comprehensive treatment algorithm of single-stage posterior surgery by transforaminal approach in thoracic and lumbar tubercularspondylodiscitis provided good clinical and radiological outcomes. It aids in achieving the same surgical goals, obviating the need for extensive posterior or combined surgical approaches.

Single-stage anterior debridement, posterior instrumentation and global fusion in thoracic and thoracolumbar tubercular spondylodiscitis.

The present study evaluated the clinical and radiological outcomes in patients with tuberculosis of the thoracic and thoracolumbar spine, treated by an operative technique in which anterior debridement with posterior instrumentation and global fusion was performed through a single-stage posterior approach. Ninty-seven patients with spinal tuberculosis, between T1 and L1, in whom anterior debridement, bone grafting, with posterior instrumentation and fusion was performed through a single-stage posterior approach, with a minimum follow-up of 2years, formed the basis of this study. During each follow-up, neurological recovery was assessed using modified American Spinal Injury Association grading, healing of the disease was assessed by appearance of sclerosis and interbody fusion and the degree of kyphotic deformity was analysed using the modified Konstam's angle. Two hundred and twenty-six lesions were found in the radiographs of 97 patients with 28.9% of them having multiple lesions. The mean ± SD preoperative, post-operative, and 2-year follow-up kyphotic angle were 49.5 ± 18.4°, 22.6 ± 7.1° and 24.5 ± 7.6°, respectively, and showed significant kyphosis correction (P < 0.01). Sclerosis was seen as early as 3months in 82(84.5%) patients whereas interbody fusion started appearing at the end of 6months in 38.14% of patients and peaked at 1year. All patients recovered neurologically, with no significant loss of kyphosis correction, at final follow-up. The surgical technique described in this study had favourable clinical and radiological outcomes. Early surgery helps in having a definitive diagnosis and detects the presence of drug-resistant strains.

Correction in a severe post-tuberculosis kyphosis using modified posterior vertebral column resection

Introduction: Kyphotic Deformity is one of the complications that affect the quality of life in patients post-tuberculosis. Patients with significant kyphosis typically present cosmetic and functional problems related to the biomechanical changes. There are many types of kyphotic deformity corrections, the posterior approach allows bigger degree of correction, but its main problem is neurological deficit during or post-surgery. Therefore, we correct the deformity by performing gradual cantilever bending after vertebral resection. Methods: We present a case: a 31 year-old female diagnosed with severe kyphosis in healed spondylitis tuberculosis. The patient was diagnosed with lung and spine tuberculosis 20 years ago and she was treated with anti-TB drugs for 12 months. Physical examination showed severe kyphotic deformity of 91 degrees. Although the patient did not have any neurological deficit or pain, the patient had difficulty when lying on bed and she also complained about getting easily fatigue, hence she agreed on the correction procedure. The procedure took place at Cipto Mangunkusumo Hospital dated January 24th 2017. The Surgery was performed by an attending spine surgeon, one spine fellow surgeon and two orthopedic residents. The technique used was a modification of posterior approach of vertebral column resection with gradual bending. The length of surgery was 7 hours, with 2100 ml blood loss during the surgery. Results: Pre- and post-operative X-rays was compared with Cobb method, pre-operative X-ray was 91.47o compared to post-operative X ray which was 51.35o. There was no major event observed. The patient was discharged 7 days postoperative without any neurological deficit. Discussion: A single stage posterior approach with posterior column resection could be one choice of treatment in patients with post-tuberculosis kyphosis. The advantages of this single stage approach is reduced possibility of what could occur in a two-stage surgery: extensive blood loss and longer duration of surgery. Conclusion: We conclude that this procedure is an effective and a save method in correcting severe post-tuberculosis kyphosys.