Transpedicular Fixation Research Articles

Surgical treatment of patients with primary and metastatic spinal tumor with use of the O-Arm intraoperative portable computed tomography scanner

The study objective is to demonstrate our experience of employment of O-Arm intraoperative portable сomputed tomography scanner combined with navigation system Stealth Station Treon Plus (Medtronic Navigation) during decompressive-stabilizing surgeries for patients with primary and metastatic spinal tumors.Materials and methods. We have reviewed results of surgical treatment of 44 patients (24 males and 20 females, average age is 54.3 ± 1.8), who were hospitalized and operated in the department of spinal neurosurgery in Federal Centre of Neurosurgery (Tyumen). All surgeries were performed by one surgical team in the period of April 2011 to June 2017. All patients underwent full clinical examination according to diagnostic algorithm, including assessment of general condition, degree of bone and visceral dissemination, neurological status, quality of life, pain syndrome intensity. The most common cause of vertebral lesions was plasma cell myeloma (15 patients, 34.1 %), metastatic spinal lesions (12 patients, 27.3 %). Patients were subjected to posterior decompression and stabilization with total and subtotal excision of mass lesions. Assessment of degree of decompression and transpedicular fixation were carried out visually using O-Arm combined with navigation station.Results. In 6 to 12 months after surgery 79.5 % of patients demonstrated significant improvement of neurological status, specifically a decrease of conduction and sensory disorders. Degree of pain syndrome was reduced by 3.6 times. Using O-Arm combined with navigation station we placed screws adequately in 99.6 % of the cases. The main technical problem that occurred during the surgery was the failure of navigation system caused by: defect of reflective spheres, distant installation and shift of referential frame, aging of Jamshidi needle, malfunction of navigation camera, failure of data transfer from navigation station.Conclusion. The use of O-Arm combined with navigation station for decompressive and stabilizing surgeries in patients with spine and spinal cord tumors let us perform surgeries with 3D control and navigation, conduct surgeries in areas where it is hard to determine surgical landmarks, ensure precision of transpedicular screw implantation, accomplish total resection of mass lesions with minimal blood loss and less aggressive surgical intervention and properly decompress the spinal canal which, eventually, result in positive anatomical and functional characteristics, and contribute to good general outcome of surgical intervention.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

Post-traumatic deformities of the spine: relevance, problems, and revision surgery

Objective . To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine. Material and Methods . Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods. Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The follow ing types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively. Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.

Outcome of Lumbar Trans-Pedicular Fixation in Management of Recurrent Lumber Disc Herniation

Abstract Background: Recurrent lumbar disc herniation is one of the common problems facing most of neurosurgeons and spine surgeons. Treatment options include conservative management (pharmacological and physical therapy) and finally surgical intervention. Surgical options include repeat discectomy and adhesolysis with or without instrumented spinal fusion. Fusion is usually suggested for patients with deformity, instability, or associated axial low back pain. Aim of Study: This study aims to evaluate the role of trans-pedicular fixation in the management of recurrent lumbar disc herniation. Patients and Methods: The study was carried out on 20 patients with recurrent lumber disc herniation underwent surgery for discectomy with trans-pedicular fixation with postero-lateral inter-transverse fusion at neurosurgery depart-ment at Benha university hospital, in the duration between 12/2016 to 12/2018 with minimum follow-up 6 months. All the patients were clinically examined carefully, Preoperatively and post-operatively, low back pain and radiculopathy were assessed by visual analogue score (VAS). Patients were radiologicaly investigated by MRI and dynamic X-rays. Results: All the patients were improved clinically imme-diately after surgery. The Median VAS for back pain and radiculopathy significantly decreased from 8 pre-operatively to 2 post-operatively. Post-operative radiological assessment was done for all 20 patients by CT LSS to asses accuracy of instrumentation and fusion. Conclusion: Using Trans-pedicular fixation and fusion for treatment of recurrent LDP provide adequate Clinical improvement for LBP and sciatica giving chance for better nerve root decompression and avoid mico-instability.

PROPHYLACTIC OF STRESS FRACTURES OF VERTEBRAE ADJACENT TO TRANSPEDICULAR SCREW FIXATION FOR OSTEOPOROSIS

ABSTRACT Objective: To assess the efficacy and use of vertebroplasty as a prophylactic measure to prevent stress fractures of vertebrae adjacent to transpedicular screw fixation with augmentation for osteoporosis. Methods: An experimental cadaveric study was performed to assess the overall strength of 10 cadaveric blocks of T10-L4 vertebral segments with simulation of L1 fracture and T12-L2 transpedicular 4-screw system with augmentation. T11 and L2 vertebroplasty cranial and caudal to the transpedicular system was performed in 5 blocks in the main group. Stress testing of the blocks was performed by placing them under a vertically directed load until destruction. Results: Vertically directed load on the blocks in the main group (0.84 ± 0.39831 kN) resulted in T11 vertebrae fractures. Vertebrae with augmentation were resistant to the load in the main group. T10 vertebrae fractures in the blocks of the main group occurred at a load of 1.91 ± 0.40566 kN. Conclusion: 1. The adjacent T11 vertebra is the weakest vertebra in the anatomical blocks of T10-L4 vertebral segments with simulation of L1 fracture (type A according to the AO/Magerl classification) and the T12-L2 4-screw transpedicular system with augmentation. 2. Bone cement injection into the T11 cranial vertebra adjacent to the level of fixation increases the overall strength of the blocks 3. Vertebroplasty of the overlying vertebra is an effective way to prevent its fracture and in case of osteoporosis. 4. Prophylactic vertebroplasty of the vertebra caudal to the level of fixation is unnecessary due to the insignificant risk of a fracture. Level of Evidence III; Experimental – Quasi experiments

Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study

BackgroundEach year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage.ObjectiveThe aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures.MethodsThis study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20–49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction.ResultsThe length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc.No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60.ConclusionBy comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.

A distraction technique using reduction multi-axial screws for open reduction of high-grade lumbar posterior dislocation:a case report and literature review

BackgroundL3 vertebral fractures with posterior dislocation are rare and usually secondary to high-energy trauma. To assess the outcome of a valuable distraction technique, using long-tail multiaxial pedicle screw which we have employed in reduction of L3 vertebral fracture with posterior dislocation, and emphasize the importance of preoperative blood vessel evaluation.Case presentationA 47-year-old patient fell from a height of 4 m and was paralyzed. Computed tomography scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L3 vertebral body. Computed tomography angiography showed that the third lumbar artery was ruptured without active bleeding. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Finally, Vertebral reduction and sagittal balance were achieved and patients recovered well after operation.ConclusionPreoperative blood vessel evaluation is very important to avoid massive bleeding during the surgery, and the standard technique which can achieve good reduction is easy to understand, perform, and is reproducible.

Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively; and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis; and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis); while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

Surgical treatment of progressive idiopathic scoliosis in adolescents aged 10–14 years: literature review

Objective . To perform a systematic review of publications devoted to the evaluation of the results of surgical treatment of adolescents with idiopathic scoliosis aged 10–14 years. Material and Methods . Publications on surgery for adolescent idiopathic scoliosis for the last 40 years were analyzed taking into account different treatment approaches. The long-term results of surgical correction and complications occurred at different stages of the vertebrology development were reviewed based on the data of 23 publications including data on 826 patients aged 10 to 14 years in the period of active growth. Results . The prevalence of anterior interventions such as discectomy and anterior spinal fusion at the early stages of the scoliosis surgery development was justified. This was due to the lack of instrumentation at that time to prevent postoperative progression of scoliotic deformity in growing patients. The occurrence of crankshaft phenomenon was prevented by performing intraoperative spine release and subsequent stabilization owing to the formation of interbody bone block. Conclusion . Despite the fact that the method of total transpedicular fixation occupies a leading position at the present stage of scoliosis surgery evolution, the anterior spinal release remains relevant and necessary stage of surgical treatment of patients with severe and rigid spinal deformities at any age. The need for anterior intervention is determined not by the prevention of possible postoperative progression, but by the magnitude of spinal deformity, that is, anterior surgery is performed to mobilize severe and rigid scoliotic deformity.

Direct trans-pedicular screw fixation for atypical hangman’s fracture: A minimally invasive technique using the tubular retractor system

The ideal treatment strategy of atypical hangman’s fracture (AHF) is debatable. If surgical treatment is needed, direct trans-pedicular fixation technique is advantageous in that it stabilizes the fracture site and spares adjacent motion segments. The authors describe relatively simple and minimally invasive technique using the tubular retractor system (TRS) for surgical treatment of AHF. Trans-pedicular screw fixation using the TRS was performed in seven patients with AHF. This technique was facilitated by using intraoperative fluoroscopy and a surgical microscope. Rigid cervical collar was used for 4 weeks, postoperatively. To evaluate postoperative radiological outcomes, cervical computed tomography (CT) was performed at postoperative 6 months. The clinical outcomes, including visual analog scale and neck motion, were evaluated. In surgical outcomes, no intraoperative neuro-vascular injury or postoperative complications occurred. For all patients, dynamic radiographs and CT images demonstrated a stable construct. Clinical examination also showed satisfactory pain relief and restoration of the full range of motion in the neck. Direct trans-pedicular screw fixation using the TRS for AHF appears to be safe and effective. This technique permits less skin incision and muscle dissection with good postoperative recovery. This report serves as a preliminary study and may be a surgical option for minimally invasive direct repair.

A rare clinical case of surgical treatment of a periarticular cyst of the facet joint of the lumbar spine

Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.
 Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.
 Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.

Osteometry of the human spine at the age of maturity in the Ural region

Aim. To reveal the patterns of the changes of osteometric characteristics of the adults living in the Ural region.
 Methods. 56 cadavers of human beings at the age of maturity were analyzed (28 women aged 21 to 55 years, and 28 men aged 22 to 60 years) being the residents of the Ural region. The scheme recommended by the Symposium on Age Periodization at the Institute of Age Physiology in 1969, was used for distribution by age groups. Osteometry and statistical method were used.
 Results. In the cervical spine, the greatest sagittal size was determined in the spinal process of the VII cervical vertebra (30.9±1.79 mm), in the thoracic spine — in the VII thoracic vertebra (41.5±2.4 mm), and in lumbar spine — in the III lumbar vertebra (36.4±0.95 mm). The frontal size of vertebral bodies increased from overlying vertebrae to underlying ones, however, the decrease in the frontal size of vertebral bodies was noted from the I thoracic to the VI thoracic vertebra, and starting from the VII thoracic vertebra its further increase was observed. The sagittal size of vertebral body increased only from the II cervical vertebra to the III lumbar one. The sagittal size of the bodies of the III–V vertebrae was within the range of 32–34 mm. The sizes of vertebral arch pedicle allow conducting the transpedicular fixation at the level of all vertebrae, but it should be taken into account that in V and VI thoracic vertebrae frontal size of arch pedicle is the least as compared to other levels. The frontal sizes of spinal canal were more than sagittal ones at the levels of all vertebrae, with the exception of atlas and the V thoracic vertebra.
 Conclusion. The results can serve as the basis for performing any surgical interventions on the spine and as the norm for evaluation of its pathological changes.

Optimization and Mathematical Simulation of Transpedicular Fixator

This article describes a method of optimum design of transpedicular fixator on the basis of system analysis, probabilistic approach of reliability theory, and mathematical simulation. Stress–strain model of fixator is presented by statistically indeterminate rod system. Statistic and dynamic impacts of loads are considered caused by movements during rehabilitation. Force method is used for evaluation of static indeterminability of fixator system. Dynamic impact of load is taken into account by coefficients of dynamicity based on condition of energy equality of initial and reduced systems. Fixator design is optimized for each anthropometric group of patients. Target function for rod system is arranged with consideration for efficiency criteria. External diameter of tubular rod is taken as controllable variable on the basis of preset ratio of internal to external diameters. Fixator reliability is estimated by probability of ultimate state of each three structural elements of the fixator.

Posterolateral corpectomy with pyramesh titanium cage reconstruction in dorsolumbar metastatic lesions

Background dataThe vertebral column represents the most common bony site for metastasis with an incidence ranged from 30% to 70% in patients with metastatic neoplasms. The dorsal spine carries the highest frequent site for metastasis all over the vertebral column followed by the lumber spine. These metastatic lesions are clinical entities that often necessitate a complex spinal decompression and anterior reconstruction. Posterolateral approaches alone allow for excellent decompression with transpedicular fixation and safe visualization of the neural elements for corpectomy and reconstruction so we can avoid the complications that can happen with the staged surgery.PurposeOur aim in the study is to report cases and evaluate our approach for fixation and assess the postoperative period regarding pain improvement and neurological deficit.Study designA retrospective study included 26 patients presented to the Neurosurgery Department at Sohag University Hospital within 3 years, between August 2014 and August 2017. Evaluation was made through using the Quebec Back Pain Disability Scale and muscle power grading scale.Material and methodsTwenty-six patients with metastatic dorsolumbar spine lesions underwent a single-stage surgery by midline posterior approach. Posterior decompression with transpedicular fixation above and below the affected segment was done for all patients. Unilateral facetectomies and pediculectomy followed by corpectomy were done. Insertion of pyramesh titanium cage filled with iliac bone graft with tightness of the screws bilateral. Follow-up period was 6–12 months postoperatively.ResultsThe average age was 58.36 ± 5.96 (range 33–67) years. More than two-thirds of them were males (69.2%). Majority of the lesions were dorsal (77%). Postoperative infection was observed in four patients (15.4%) who improved by IV antibiotics and frequent dressing while CSF (cerebrospinal fluid) leak occurred in three patients (11.5%) who stopped after daily dressing, and we made CSF lumbar tap in one patient. Twenty-two patients showed neurological improvement postoperatively (84.6%). The remaining four were paraplegic with no improvement. Back pain improved for all cases.ConclusionPosterolateral approach alone is efficient and safe for dorsolumbar decompression and reconstruction in the metastatic spine.Trial registrationIRB#3747 registered on August 27, 2017

Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases

Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.

Analysis of surgical treatment results in spinal metastasis

Objective: analysis of surgical treatment results in patients with spinal metastasis. Methods: 26 clinical charts were retrospectively reviewed (16 females, 10 males, aged from 27 to 87 years old) with spinal metastasis who were surgically treated. 11 patients had primary breast tumors, 7 had prostate tumor, 2 patients had thyroid cancer, 2 patients had kidney tumor and 2 had nonspecified primary location. In vast majority of cases metastasis location was Th VI –Th XII (17 patients). Fors urgical indications assessment SINS (spinal instability neoplastic score) and K. Tomita scales were used, neurological deficiency was assessed using H. Frankel scale and tumor spread and degree of epidural compression with ESCC (epidural spine cord compression scale), pain assessed using VAS. Results: open and punctional biopsy have been performed in 21 patients and 5 patients had emergent surgery because of acute neurological decline. Spinal cord decompression and transpedicular fixation underwent 16 patients, 6 patients had vertebroplasty, 5 patients had minimally invasive palliative decompression. Mean preoperative VAS score was 7.2, mean postoperative VAS score was 5.3. In Frankel B group regression to Frankel C found in 1 patient, pain relief observed in all patients. In group Frankel C neurological symptoms didn’t change in 3 patients, regression to Frankel D observed in 5 patients, decline to B class diagnosed in 1 patient. In group Frankel D shift to Frankel E observed in all patients. In 4 patients neurological symptoms temporary worsened after the surgery with gradual recovery after 2–6 weeks, 1 patient didn’t have neurological recovery. Conclusions: surgical treatment of spinal metastasis resulted in neurological recovery, postoperative pain relief, improved patient’squality of life.

Efficiency of using polyacrylic acid silver salt in decompression and stabilization surgery on the lumbar spine involving 1 to 3 segments

Objective. To determine possible effect of the preparation of an incomplete polyacrylic acid silver salt on the volume of intraoperative and postoperative blood loss in open posterior surgery on the spine involving up to three segments.Material and Methods. Study design: randomized prospective multicenter cohort analysis. Level of evidence – IIb. The study was based on 90 patients aged 27 to 65 years who underwent decompression and stabilization surgical interventions on the lumbar spine through posterior median approach using transpedicular fixation system with fixation of up to three vertebrae. A comparison of perioperative blood loss volume in patients with local application of polyacrylic acid silver salt and without it was performed.Results. The volume of inraoperative blood loss (the sample was described using the mean value and standard deviation M ± σ) in the study group was 258.1 ± 164.5 ml (min 90; max 890), in the control group – 405.5 ± 157.9 ml (min 190; max 950). The postoperative blood loss through drainage (M ± σ) was 81.500 ± 77.046 ml (min 20; max 400) in the study group, 151.560 ± 74.745 (min 20; max 600) in the control group. Comparison of both intraoperative and postoperative blood loss according to the Mann-Whitney U-test confirms the high statistical significance of differences (p < 0.01), which suggests the effectiveness of the preparation.Conclusion. The use of incomplete polyacrylic acid silver salt in decompression and stabilization interventions on the lumbar spine involving 1 to 3 segments can effectively reduce the volume of blood loss both during surgery and in the postoperative period.

CORRECTION OF IDIOPATHIC SCOLIOSIS USING TOTAL TRANSPEDICULAR FIXATION IN A PATIENT WITH INCOMPLETE GROWTH

The paper presents a completed case of the surgical treatment of a 10-year-old female patient with progressive grade IV idiopathic scoliosis who underwent surgical correction using total transpedicular fixation. The paper demonstrates long-term results of treatment of idiopathic scoliosis in the actively growing patient without the use of epiphyseodesis and staged surgical interventions.

Single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis with associated neurological deficit: a multicentre retrospective study

BackgroundA multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit.MethodsThoracolumbar junction (T12-L1) tuberculosis patients (n = 69) with neurological deficit who underwent single-stage posterior debridement, decompression and transpedicular screw fixation from January 2005 to January 2015 were included in the study. Antituberculosis therapy was performed both before and after surgery. The surgery duration and patient blood loss were evaluated, in addition to the change in pain visual analogue score (pVAS), kyphotic angle, Oswestry disability index (ODI) score and American Spinal Injury Association (ASIA) grade assessed preoperatively, immediate postoperatively and at the final follow-up visit.ResultsThe average blood loss was 354 ± 291 mL. The average kyphosis angle was corrected from 21 ± 9° preoperatively to 9 ± 4° postoperatively, with a mean decrease in pVAS and ODI scores of 3.4 and 16, respectively. The postoperative ASIA grading was grade A for five patients, grade C for 15 and grade D for 49 patients, which had improved to grade C for four patients, grade D for three patients and grade E for 62 patients at the final follow-up. The neurological deficit did not worsen in any of the patients.ConclusionsSingle-stage posterior debridement, decompression and transpedicular screw fixation is an effective treatment method in thoracolumbar junction (T12-L1) tuberculosis patients with neurological deficit, with good neurological recovery and no progression of kyphosis.

Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique

ObjectivesLumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyse the postoperative paraspinal atrophy associated with two types of intervention. Material and methodsClinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients, 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis (fixation group) and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease (non-fixation group). In which muscle atrophy was analysed quantitatively. ResultsWe found a negative correlation between age and preoperative muscle, which was higher in those who underwent lumbar fixation (rho=−0.64 p=.002). We also found a positive correlation between preoperative muscle and postoperative atrophy (rho=0.32 p=.041). In the age, sex and fixation adjusted multivariate linear regression model (R2=0.31), laminectomy with fixation is attributed to 5.3% atrophy (IC95 1.4–9.5%, p=.017); preoperative musculature>70% is attributed to atrophy of 13.8% (95% CI 5.5–22%, p=.002). Age did not correlate with postoperative atrophy. ConclusionsParaspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation. A greater previous musculature regardless of age, sex and type of surgery also predicts greater postoperative atrophy.

Operative Therapy Practices in Tubercular Patients with Bone and Joint Effects of Different Etiologies

Introduction.A decrease in the number of patients with tuberculosis of the bone system coincides with an increase in the number of indications and methods for operational treatment. The continuing development in skeletal tuberculosis surgery techniques determines the search for a material capable of replacing autologous bone. Therefore, the main purpose of this paper is to enhance the results of treatment of spinal caries to speed up treatment of tuberculous osteomyelitis by applying collagen material and to solve the issues of orthopedic alignment for TB patients.Materials and methods.Surgical treatment was carried out on 32 patients in 2016–2018. The patients were divided into several groups: 18 underwent transpedicular fixation of the spine, 2 had concomitant HIV-infection, 2 underwent necrectomy of vertebral bodies with anterior spondylodesis lift system, 1 underwent necrectomy of vertebral bodies with bone autoplasty and with plate fixation, 2 had cervical spine fixation, while 2 patients with pulmonary tuberculosis in the humerus traumatic fracture received intramedullary surgery.Results.31 patients reported a positive dynamic following surgery, while a fatal outcome not connected with the surgery was experienced in one case. Complications included allergic reaction in one case, while three patients developed postoperative wound seroma (both patients having HIV infection). One patient reported pain in the lower extremities following TPF. 3 patients with osteitis underwent necrectomy and filling of cavities with collagen material. Wounds were healed by secondary healing, while no rejection of collagen material took place.Conclusions.Introduction of collagen material in osteitis treatment can speed up fistula healing. The research work demonstrated the possibility of providing trauma care to patients under the conditions of an antitubercular centre.