Lumbar Fusion Surgery – Spinal Surgeries

By Jaimig Aljorna

What is lumbar fusion surgery? Lumbar fusion surgery avoids the movement at a painful, unstable spinal joint. When the specialist links together (fuse) two or more vertebrae, he is trying to achieve this in that portion of the spine. Patients experience pain relief when surgeons accomplish the stabilization of a segment of the spine. The…

[PMMA augmentation of pedicle screws: results of a survey in Germany].

By London Spine
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[PMMA augmentation of pedicle screws: results of a survey in Germany].

Z Orthop Unfall. 2012 Jun;150(3):318-23

Authors: Goost H, Kabir K, Wirtz DC, Deborre C, Karius T, Pflugmacher R, Koch EM, Burger C, Fölsch C

Abstract
BACKGROUND: The anchorage of pedicle screws can be challenging in the osteoporotic spine. A promising technique are cement augumented pedicle screws. The goal of this study was to gain more information regarding application of pedicle screw augmentation in Germany.
MATERIALS AND METHODS: Participants of the National German Spine Congress 2009 were invited to participate in an internet-based anonymous survey regarding application of pedicle screw augmentation. The questionnaire was related to different aspects of materials and procedures for pedicle screw augmentation. The frequency of answers was divided according to the specialty state of the surgeons: orthopaedic and trauma surgeons vs. neurosurgeons. The Mantel-Haenszel test was applied to evaluate the differences between the groups.
RESULTS AND CONCLUSION: 69 (64 %) orthopaedic and trauma surgeons and 39 (36 %) neurosurgeons participated (n = 108). Nearly 80 % of the participants use cement-augmented pedicle screws in their daily practice. Almost 2/3 of the specialists apply cannulated screws or other special screws. The Expedium (Company) screws are particularly preferred. The insertion of screws is combined with kyphoplasty or vertebroplasty in 20 % of the cases. The balloon kyphoplasty was applied most commonly. There was no statistical difference between the surgeon groups regarding the different techniques. The main indications for pedicle screw augmentation were osteoporosis, intraoperative findings as well as loosening of screws, and revision. The most frequently observed complication is cement extravasation into the spinal canal (28 %). The cost issue is considered as being important but unknown to most of the participants. It can be assumed that the use of pedicle screws in Germany is well established in spine surgery, without as yet a standard technique being established.

PMID: 22723073 [PubMed – indexed for MEDLINE]

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial.

By London Spine
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Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial.

Eur Spine J. 2013 Mar;22(3):495-502

Authors: Heintel TM, Berglehner A, Meffert R

Abstract
PURPOSE: The percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional fluoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional fluoroscopy.
METHODS: A prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional fluoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234-240, 2004; Eur J Trauma 30:241-247, 2004].
RESULTS: 427/502 pedicle screws (85 %) were classified as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological deficit.
CONCLUSIONS: This study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional fluoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures.

PMID: 22903200 [PubMed – in process]

Percutaneous iliac screws for minimally invasive spinal deformity surgery.

By London Spine
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Percutaneous iliac screws for minimally invasive spinal deformity surgery.

Minim Invasive Surg. 2012;2012:173685

Authors: Wang MY

Abstract
Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

PMID: 22900162 [PubMed]

Augmentation of transpedicular screws by intraoperative vertebroplasty.

By London Spine
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Augmentation of transpedicular screws by intraoperative vertebroplasty.

Neurol Neurochir Pol. 2012 Nov-Dec;46(6):560-8

Authors: Zapałowicz K, Godlewski B, Jekimov R, Grochal M

Abstract
BACKGROUND AND PURPOSE: The aim of the study was to determine the efficacy of posterior spinal stabilization, combined with intraoperative vertebroplasty defined as intraoperative filling of instrumented vertebral bodies (VB) with polymethylmethacrylate (PMMA).
MATERIAL AND METHODS: Seventeen patients with osteoporosis or osteopenia underwent posterior spinal fusions. The surgical procedures included laminectomy, spondylodesis, insertion of pedicular screws, intraoperative vertebroplasty and correction of spinal deformity.
RESULTS: Postoperative assessment showed improvement of pain in all cases. Motor deficit regressed in 2 of 3 afflicted patients. In 12 vertebrae (27.3%), the mass of PMMA ex-tended from one endplate to another, filling 100% of VB height, in 7 (15.9%) it filled 90-99%, in 14 (31.8%) 80-89%, in 9 (20.4%) 70-79%, and in 2 (4.5%) it filled 50-60% of VB height. In the horizontal plane, PMMA filled central parts of 72.7% of vertebral bodies. PMMA completely surrounded 68.9% of screws, and partially surrounded 18.4% of screws, whereas 12.6% of screws had no contact with cement mass. Spinal stabilization reduced kyphotic deformity in 15 patients (range of reduction: 6°-25°; mean: 13.6°). During follow-up (3-32 months; mean: 16) implants of 11 patients were stable, 1 implant instability was diagnosed 7 months after surgery, 5 patients were lost to follow-up. Asymptomatic cement leaks occurred in 45% of vertebrae.
CONCLUSIONS: Intraoperative vertebroplasty performed after insertion of pedicular screws may be considered as a technical variation useful to stabilize osteoporotic spines. After PMMA hardening, intraoperative manoeuvres to correct spinal deformity were possible without any damage of instrumented vertebrae.

PMID: 23319224 [PubMed – in process]