330?Outcome of Percutaneous Versus Open Posterior Spinal Fixation in Thoracolumbar Fractures.

By Kamruz Zaman

330 Outcome of Percutaneous Versus Open Posterior Spinal Fixation in Thoracolumbar Fractures.

Neurosurgery. 2016 Aug;63 Suppl 1, CLINICAL NEUROSURGERY:196

Authors: Elsawaf AM

Abstract
INTRODUCTION: Unstable thoracolumbar fractures are usually managed by posterior instrumentation. The standard open pedicle screw fixation or the newly introduced percutaneous technique can be used. The purpose of this study is to provide safety and feasibility of both techniques and getting a more obvious plan for choosing either of them in such cases.
METHODS: In a prospective study of a total of 166 patients with unstable thoracolumbar fractures with a mean follow-up of 14 months (range 10-21), the patients were classified randomly into 2 groups: Group I: patients who underwent percutaneous spinal fixation and minimally invasive decompression if needed (72 patients). Group II: patients who underwent standard open pedicle screw fixation with open decompression (94 patients). All patients had complete clinical assessments with the use of the Frankle grading scale and the visual analog scale (VAS) for assessment of fracture site pain. We had also neuroradiographic assessment (anteroposterior x-ray, thin cuts CT scan, and MRI imaging) at the first presentation and at 3, 6, and 12 months later.
RESULTS: Immediately after surgery, the percutaneous approach had significantly better results than open procedures in respect to operative time, hospital stay, and postoperative pain. At the final follow-up; 87.5% of the percutaneous group showed either completely normal or neurological improvement according to Frankle grade. However, 89.5% in group II showed similar results. Regarding screw position, the open group had only 75% satisfactory position; however, 83% of screws inserted showed satisfactory position in the percutaneous technique, the Cobb angle, and degree of canal encroachment also assessed, respectively.
CONCLUSION: Percutaneous technique in stabilizing the thoracolumbar fractures could be done regularly in all cases with percutaneous minimally invasive decompression if needed. Open spinal fixation can be reserved for those with significant canal compromise, especially if multilevel decompression is required.

PMID: 27399528 [PubMed – as supplied by publisher]

Classification of odontoid destruction in patients with rheumatoid arthritis using reconstructed computed tomography: reference to vertical migration.

By London Spine

Classification of odontoid destruction in patients with rheumatoid arthritis using reconstructed computed tomography: reference to vertical migration.

J Rheumatol. 2011 May;38(5):863-7

Authors: Shimada H, Abematsu M, Ishido Y, Kawamura I, Tominaga H, Zenmyo M, Yamamoto T, Taketomi E, Komiya S, Ijiri K

To reveal the factors that determine the natural course of subluxation of occipital-cervical lesions in rheumatoid arthritis (RA). The atlanto-axial region is one of the most common locations for lesions in RA. Some cases progress from reducible atlanto-axial subluxation (AAS) to irreducible vertical migration, while others continue to exhibit reducible AAS. No study has revealed the factors that determine the natural course of subluxation. We focus on the odontoid as a key structure of the progression of occipito-cervical lesions and investigated this region in patients with RA using reconstructive computed tomography (CT) images, and analyzed factors in association with CT findings.

PMID: 21362768 [PubMed – in process]

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate.

By London Spine
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Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate.

J Orthop Res. 2012 Apr;30(4):587-92

Authors: Ordway NR, Rim BC, Tan R, Hickman R, Fayyazi AH

Abstract
Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles.

PMID: 22002745 [PubMed – indexed for MEDLINE]

Identification of Apical Vertebra for Grading of Idiopathic Scoliosis using Image Processing.

By London Spine

Identification of Apical Vertebra for Grading of Idiopathic Scoliosis using Image Processing.

J Digit Imaging. 2011 Jul 2;

Authors: Anitha H, Prabhu GK

Scoliosis is a 3-D deformity of spinal column, characterized by both lateral curvature and vertebral rotation. The disease can be caused by congenital, developmental, or degenerative problems; but most cases of scoliosis actually have no known cause, and this is known as idiopathic scoliosis. Vertebral rotation has become increasingly prominent in the study of scoliosis and the most deformed vertebra is named as apical vertebra. Apical vertebral deformity demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. Precise measurement of apical vertebral rotation in terms of grading is most valuable for the determination of reference value in normal and pathological conditions for better understanding of scoliosis. Routine quantitative evaluation of vertebral rotation is difficult and error prone due to limitations of observer characteristic and specific imaging property. This paper proposes automatic identification of the apical vertebra and its parameter that depends on the objective criteria of measurement using active contour models. The proposed technique is more accurate and is a reliable measurement compared to manual and computer-assisted system.

PMID: 21725622 [PubMed – as supplied by publisher]