RESUMO
AIM: To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure. MATERIAL AND METHODS: Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of > 1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria. RESULTS: The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injury; 2 and 10 patients with stage 3 had grades D and E injuries, respectively; two patients with stage 4 had grade D injury and two had grade E injury at the last follow-up. Moreover, 100%, 84.6%, and 50% of the patients with stages 1 and 2, 3, and 4 spondylodiscitis achieved good or excellent results, respectively. CONCLUSION: The choice of the surgical technique depends on the destruction severity at the adjacent vertebral corpus. Surgical staging system for spondylodiscitis is useful and reliable in choosing appropriate surgical techniques.
Assuntos
Discite , Fusão Vertebral , Algoritmos , Desbridamento , Discite/diagnóstico por imagem , Discite/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
RATIONALE: Facioscapulohumeral muscular dystrophy (FSHD) is the third most common muscular dystrophy, which is associated with facial, shoulder girdle, and paraspinal muscle atrophy. Most of the patients develop hypokyphosis and hyperlordosis in the course of the disease, to preserve standing posture. Corrective fusion is contraindicated in these patients as the surgery results with loss of compensatory hyperlordosis and leads to loss of trunk balance while standing. Although spinal fusion in neuromuscular scoliosis is a known treatment option, there are no studies in the literature on the spinal fusion of this specific patient group. PATIENT CONCERNS: In this case report we have presented a 66-year-old woman, who was admitted with back and abdominal pain, inability to sit straight, abdominal discomfort, and numbness in the lower extremities after prolonged sitting. DIAGNOSES: The patient developed severe hyperlordosis causing intra-abdominal disorders, radicular symptoms, and sitting discomfort due to FSHD. INTERVENTIONS: The patient underwent T2-S1 fusion and successful fusion was achieved. OUTCOMES: Individualized Neuromuscular Quality of Life Questionnaire (INQoL) was used to assess preoperative and 3 years postoperative functional outcomes. All domains and total score improved at the end of the follow-up period and successful fusion was verified radiologically. LESSONS: This case suggests that spinal fusion may provide functional improvement in carefully selected patient groups. Patient stratification considering spinal disability is required for further studies in this specific indication.
Assuntos
Lordose/cirurgia , Distrofia Muscular Facioescapuloumeral/fisiopatologia , Fusão Vertebral/métodos , Idoso , Feminino , Humanos , Lordose/etiologia , Atrofia Muscular/etiologia , Distrofia Muscular Facioescapuloumeral/complicações , Postura , Qualidade de Vida , Postura Sentada , Resultado do TratamentoRESUMO
STUDY DESIGN: Nonrandomized, retrospective, comparative, and single-center trial. OBJECTIVE: The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar burst fractures in neurologically intact patients, treated surgically or nonsurgically with the aim to optimize their management. SUMMARY OF BACKGROUND DATA: There is an ongoing controversy regarding the treatment of thoracolumbar burst fractures (TLBF) (A3, A4) in neurologically intact patients. Surgical treatment as well as conservative treatment methods are advised to this specific group of patients, while contrasting results exist in the literature. METHODS: Forty-five neurologically intact patients with TLBF (A3 or A4) (2010-2016) were included. Twenty-one patients with a mean age of 34.3 and a mean follow-up period of 63.1 months were treated surgically with short segment posterior fixation (group 1), while 24 patients with a mean age of 45.7 and a mean follow-up period of 67.1 months were treated conservatively (group 2) with thoracolumbosacral orthesis. RESULTS: At the final follow-up groups 1 and 2 had an average segmental kyphosis of 4.09°/11.65° (Pâ=â0.027), an average loss of kyphosis of 2.04°/4.03° (Pâ=â0.038), an average loss of anterior/posterior vertebral body height of %12.89/%2.84/%17.94/%7.62 (Pâ=â0.027/ Pâ=â0.03), a median JOA score of (16.6/16.75) (Pâ=â0.198), a median ODI score of (11.7/12.1) (Pâ=â0.25), a median VAS score of (1.9/2.3) (Pâ=â0.3), SF-36 PCS of (56.74/56.67) (Pâ=â0.25), SF-36 MCS of (55.47/55.5) (Pâ=â0.3), mean durations of hospital stay of 9-11 days (Pâ=â0.3), respectively. CONCLUSION: While there is an ongoing controversy regarding the management of stable thoracolumbar burst fractures in neurologically intact patients in the literature, this study concluded that surgical management of stable thoracolumbar burst fractures in neurologically intact patients provided better radiolographic outcomes, despite the result, that the difference between surgically and nonsurgically treated patients in terms of clinical outcome parameters and quality of life was not statistically significant. LEVEL OF EVIDENCE: 3.
Assuntos
Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Vértebras Lombares/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/diagnóstico por imagem , Adulto , Tratamento Conservador/tendências , Feminino , Seguimentos , Fixação Interna de Fraturas/tendências , Humanos , Tempo de Internação/tendências , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
STUDY DESIGN: Case report. OBJECTIVE: We present a 18-year-old male patient with gunshot injury through right scapular region with the bullet ending up and causing a fracture in the odontoid process. SUMMARY OF BACKGROUND DATA: Odontoid fracture owing to gunshot wound is an extremely rare injury. METHODS: An 18-year-old male patient was brought to the emergency department with gunshot injury. x-Ray imaging showed retained bullet in the odontoid process. Computed tomography scan showed fracture of the odontoid and body of scapula consistent with the trajectory of the bullet. Owing to a normal neurological examination, conservative follow-up was decided and given a Philadelphia collar. RESULTS: At 2 years' follow-up, patient demonstrated limited axial rotation and flexion/extension. However, no pain and neurologic problem were observed. CONCLUSION: Odontoid fracture owing to gunshot wound can be treated conservatively; emergency or elective surgical intervention was not necessary. In the follow-up, patient did not demonstrate any signs of neurological impairment or infection. LEVEL OF EVIDENCE: 5.
Assuntos
Processo Odontoide , Traumatismos da Coluna Vertebral , Ferimentos por Arma de Fogo , Adolescente , Tratamento Conservador , Humanos , Masculino , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/terapiaRESUMO
AIM: To compare posterior surgery alone versus combined anterior and posterior surgery for the management of spinal tuberculosis. MATERIAL AND METHODS: Data from 31 consecutive patients who underwent surgery for spinal tuberculosis were analyzed retrospectively. Patients were divided into two groups as group A (posterior surgery alone) or group B (combined anterior and posterior surgery), and groups were compared in terms of invasiveness of the procedure, spinal deformity, fusion, neurological status, and postoperative complications. RESULTS: Group A included 16 patients (mean age: 56 years, range: 29-75) with a mean follow-up period of 29 months (range 12-60) while group B included 15 patients (mean age: 60 years, range: 35-73) with a mean follow-up period of 28 months (range 12-60). Procedurally, average operation time and mean length of hospitalization were shorter, and mean blood loss was lower in group A (p < 0.05) compared to group B. Postoperative bone fusion took significantly (p < 0.05) longer time in group A (10.5 ± 2.1 months)than in group B (9.3 ± 3.1 months), and all patients with a neurological deficit recovered completely during the postoperative period. No significant differences were observed between two groups with respect to postoperative complications (p > 0.05). CONCLUSION: Combined anterior-posterior surgery may not be required for treating vertebral tuberculosis as posterior surgery alone appears to be sufficient.
Assuntos
Procedimentos Neurocirúrgicos/métodos , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Resultado do TratamentoRESUMO
STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.
RESUMO
BACKGROUND AND PURPOSE: Impaired shoulder function is the most disabling problem for daily life of Fascioscapulohumeral muscular dystrophy (FSHD) patients. Scapulothoracic arthrodesis can give a high impact to the functionality of patients. Here we report our experience with scapulothoracic arthrodesis and spinal stenosis surgery in FSHD patients. METHODS: 32 FSHD patients were collected between 2015-2016. Demographical and clinical features were documented. All the patients were neurologically examined. The Medical Research Council (MRC) and the FSHD evaluation scale was used to assess muscle involvement1. Scapulothoracic arthrodesis and spinal stenosis surgeries were performed in eligible patients. RESULTS: There were 16 male and 16 female (mean age 34.4 years; range 12-73) patients. 6 shoulders of 4 patients aged between 2132 years underwent scapulothoracic arthrodesis (two bilateral, one left and one right sided). Only one 63 years old female patient with severe hyperlordosis had spinal fusion surgery. All of the patients undergoing these corrective surgeries have better functionality in daily life, as well as superior shoulder elevation. CONCLUSION: Until the emergence and clinical use of novel therapeutics, surgical interventions are indicated in carefully selected patients with FSHD to improve arm movements, the posture and the quality of life of patients in general. Scapulothorosic arthrodesis is a management with good clinical results and patient satisfaction. In selected cases other corrective orthopedic surgeries like spinal fusion may also be considered.
Assuntos
Artrodese/métodos , Distrofia Muscular Facioescapuloumeral/cirurgia , Costelas/cirurgia , Escápula/cirurgia , Adulto , Feminino , Humanos , Masculino , Distrofia Muscular Facioescapuloumeral/fisiopatologia , Qualidade de Vida , Amplitude de Movimento Articular , Escápula/fisiopatologia , Parede Torácica/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to investigate the effect of distal fusion level selection on the distal junctional kyphosis (DJK) in Scheuermann kyphosis (SK) patients who underwent posterior fusion. METHODS: Thirty-nine SK patients who underwent posterior fusion with a minimum follow-up of 3 years were retrospectively evaluated. According to the distal fusion level, patients were divided into 3 groups. Group S; lowest instrumented vertebra (LIV) was the sagittal stable vertebra (SSV), Group F; LIV was the first lordotic vertebra (FLV) and, Group L; LIV was the lower end vertebra (LEV). DJK was evaluated according to distal level selection. RESULTS: Thoracic kyphosis (TK) decreased from 73.3° (SD ± 7.9°) to 39° (SD ± 8.7°) postoperatively, with a mean correction rate of 46% (SD ± 13) (p < 0.0001). In 11 patients, FLV and SSV was the same vertebra. In remaining 28 patients, 10 patients were in Group S, 15 patients were in Group F and 3 patients were in Group L. In Group S, none of them developed DJK, however, DJK was observed 9 of 15 patients in Group F. DJK was developed in all cases in Group L. There is a statistically higher risk for developing DJK when FLV or LEV was selected as LIV (p < 0.05). CONCLUSION: Selecting SSV for the distal fusion level has been found to be effective for preventing DJK. Selecting distal fusion level proximal to SSV will increase the risk of DJK which may become symptomatic and require revision surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Assuntos
Cifose/cirurgia , Lordose/cirurgia , Complicações Pós-Operatórias , Doença de Scheuermann , Fusão Vertebral , Adolescente , Feminino , Humanos , Cifose/diagnóstico , Cifose/etiologia , Lordose/diagnóstico , Lordose/etiologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Padrões de Prática Médica , Reoperação/métodos , Estudos Retrospectivos , Doença de Scheuermann/diagnóstico , Doença de Scheuermann/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adulto JovemRESUMO
Growing rod is a commonly used surgery for early-onset scoliosis (EOS). However, the effect of growing-rod lengthening on the spinopelvic alignment is unclear. In this study, 21 EOS patients treated by growing rod were evaluated retrospectively and thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI) , sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA) were measured. Preoperatively, the mean TK, LL, PI, PT, SS, and SVA were 27.4°, 35.2°, 43.8°, 7.5°, 33.8°, and 47.7 mm respectively. After the last lengthening, TK, LL, PI, PT, SS, and SVA were 28.3°, 28.06°, 41.4°, 7°, 5.2°, and 42.6 mm, respectively. The sagittal plane parameters in our EOS patients were not significantly altered during the lengthening period.
Assuntos
Fixadores Internos , Ossos Pélvicos/crescimento & desenvolvimento , Ossos Pélvicos/cirurgia , Sacro/crescimento & desenvolvimento , Sacro/cirurgia , Escoliose/cirurgia , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Masculino , Ossos Pélvicos/diagnóstico por imagem , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECTIVE: Ankylosing spondylitis is a systemic disease which affects the axial skeleton and may cause rigid spinal deformities in advanced cases. Clinical and radiological results of patients with ankylosing spondylitis who underwent pedicle subtraction osteotomy (PSO) were evaluated. METHODS: Twelve (3 female, 9 male) patients who were treated for rigid spinal deformities due to ankylosing spondylitis were evaluated. All patients were treated with the same surgical technique, which included PSO and pedicle screw-rod combination. For radiological results, thoracic kyphosis, lumbar lordosis, pelvic parameters (pelvic incidence, sacral inclination, pelvic tilt), and the distance between the central sagittal line (CSVL) and the sacrum were measured from pre- and postoperative radiograms. For functional results, SF-36 and Oswestry Disability Index (ODI) were used. RESULTS: Mean age of the patients was 39.8±8.4 years, and mean follow-up was 85.6±39.1 months. Mean angle of lordosis was improved from 6.6°±13.7° preoperatively to 43.8°±8.4° postoperatively (p<0.0001). Mean CSVL was improved from 19.7±9.7 cm preoperatively to 7.45±3.8 cm postoperatively (p=0.0005). Mean local angular change around the osteotomy site was 30.2°±6.2°. The pelvic parameters were not significantly changed after the surgeries. Mean ODI, SF-36 mental, and SF-36 physical scores were 30.16±9.7, 41.2±9.9 and 35.3±7.1, respectively. CONCLUSION: In patients with rigid sagittal spinal deformities due to ankylosing spondylitis, lumbar lordosis and sagittal balance can be obtained using PSO.
Assuntos
Osteotomia , Equilíbrio Postural , Transtornos de Sensação , Espondilite Anquilosante/complicações , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Osteotomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Período Perioperatório/métodos , Transtornos de Sensação/diagnóstico , Transtornos de Sensação/etiologia , Transtornos de Sensação/terapia , Curvaturas da Coluna Vertebral/diagnóstico , Curvaturas da Coluna Vertebral/etiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Curvaturas da Coluna Vertebral/cirurgia , TurquiaRESUMO
OBJECTIVE: The aim of the study was to evaluate the efficacy of the intraoperative blood salvage cell saver method for allogeneic blood transfusion in the surgical treatment of adolescent idiopathic scoliosis with pedicle screw and rod combination. METHODS: The study included 33 patients (5 males and 28 females) who underwent surgery due to adolescent idiopathic scoliosis. Patients were divided into 2 groups; 16 patients (mean age: 17.1±3.9 years) in Group A were operated using the cell saver (Medtronic Autolog; autologous cell saver machine) method and the 17 patients (mean age 18.7±6.8 years) in Group B (control group) were treated without cell saver. The Cobb angle, levels of pedicle fixation, operation time, postoperative bleeding, hemoglobin change, allogeneic blood replacement and the amount of autologous erythrocytes were recorded. RESULTS: Mean level of pedicle fixation was 12.9±1.54 vertebra using a mean of 21.1±3.21 screws in Group A and 12.8±1.47 vertebra using 18.7±3.59 screws in Group B (p>005). The mean operation time was 224 (Group A: 228±58; Group B: 221±60) minutes. There were no statistically significant differences in the demographic characteristics of both groups (p>0.05). The preoperative mean hemoglobin levels were 12.2±1.47 mg/dl in Group A and 13.1±1.56 mg/dl in Group B. Postoperative mean hemoglobin level was 11.3±1.62 mg/dl in Group A and 9.86±0.93 mg/dl in Group B (p=0.004). The mean amount of autologous erythrocyte replacement was 284±139 ml. The mean postoperative bleeding was 834±253 ml in Group A and 759±380 ml in Group B (p>0.05). The mean allogeneic blood replacement was 1.88±0.88 units in Group A and 1.94±1.34 in Group B (p>0.05). CONCLUSION: Autologous erythrocyte replacement was possible using the cell saver method. However, there was no decrement in allogeneic blood replacement using cell saver in the surgical treatment of adolescent idiopathic scoliosis.
Assuntos
Transfusão de Sangue Autóloga/métodos , Recuperação de Sangue Operatório , Escoliose/cirurgia , Fusão Vertebral , Adolescente , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Estudos de Casos e Controles , Feminino , Hematócrito , Hemoglobinas/análise , Humanos , Masculino , Recuperação de Sangue Operatório/estatística & dados numéricos , Duração da Cirurgia , Parafusos Pediculares , Reprodutibilidade dos Testes , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
The goal of the treatment of early onset scoliosis (EOS) is correction of the deformity while still allowing for spinal growth. The aim of this study was to determine the safety and effectiveness of the single and dual growing rod techniques and which technique was the most effective in the management of EOS respectively. From 2003 to 2009, 23 patients underwent single (15) or dual (8) growing rod procedures using a pedicle screw construct and tandem connectors. The etiology of the patients' spinal deformities were as follows; infantile, juvenile idiopathic, congenital and neuromuscular. Clinical evaluation included age, sex, diagnosis, follow-up, number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in Cobb angle, kyphosis, lordosis, frontal and sagittal balance. Overall 46 lengthening procedures were performed, the average number of lengthening procedures being 2.1 +/- 1.14 per patient. The average time between two lengthening procedures was 13 (2-28) months. Average follow-up time was 40.8 +/- 20.6 months.The mean coronal Cobb angle was improved from 64.8° +/- 16.6° to 39.7°+/- 16.4°.Statistically, at the final follow-up, early postoperative measurements in the coronal plane were better in the dual growing rod group than in the single rod group. Nine patients underwent fusion surgery. Their mean age was 11 (10-14) years, with a follow-up of 34.6 (14-54) months. The mean Cobb angle before fusion was 58.7° (40°-75°). There were 0.9 complications per patient in all groups, 0.38 in the dual rod and 1.2 in the single rod group, respectively. Dual growing rods result in better deformity correction and stability of correction with an acceptable complication rate.
Assuntos
Parafusos Pediculares , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fusão Vertebral/instrumentaçãoAssuntos
Hemangioma/complicações , Paraplegia/etiologia , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas , Criança , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
OBJECTIVE: A new technique for posterior sacroiliac fixation is described and compared with conventional techniques. PATIENTS/MATERIAL AND METHODS: A patient with sacral alar fracture (zone 1) and another one with sacroiliac joint instability due to tuberculous infection underwent fixation using screws placed in the S1 pedicle and the iliac bone. Vertical stability of the new technique also was investigated using polyurethane pelvic bone analogs and compared with anterior double plating (group P) and iliosacral screw fixation (group ISS) techniques. RESULTS: Healing was obtained and reduction was maintained in both patients on the final follow-up examination at 2 years postoperatively. Vertical loading tests revealed that failure loads within the first 10 mm of displacement of the new pediculoiliac screw fixation technique (group PIS) was higher than plating (P = 0.03) and lower than ISS techniques (P = 0.002). Ultimate failure load of the PIS technique was slightly higher than plating (P = 0.277) and lower than ISS techniques (P = 0.003). With the addition of an iliosacral screw to the pediculoiliac screw construction (PIS+ISS), the PIS technique became more stable in early (P = 0.110) and ultimate failure loads (P = 0.003). CONCLUSIONS: Pediculoiliac screw fixation for sacroiliac joint disruptions and zone I sacrum fractures using iliac and S1 pedicle screws is a new and effective alternative for obtaining and maintaining anatomic reduction.
Assuntos
Fenômenos Biomecânicos , Parafusos Ósseos , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Ílio/cirurgia , Instabilidade Articular/cirurgia , Ossos Pélvicos/cirurgia , Articulação Sacroilíaca/lesões , Articulação Sacroilíaca/cirurgia , Adulto , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Humanos , Ílio/diagnóstico por imagem , Ílio/fisiopatologia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Radiografia , Articulação Sacroilíaca/fisiopatologiaRESUMO
There are conflicting data regarding the management of rigid kyphosis. None of the currently known techniques can completely correct severe kyphosis without resulting in residual deformity. Seven patients with local kyphosis exceeding 60 degrees were operated on to achieve complete correction of the deformity. The surgery consisted of total spondylectomy of the deformed vertebra and simultaneous application of compression-distraction forces to this area. The operation included three stages: The initial stage includes resection of posterior spinal elements and temporary fixation. In the second stage, an anterior corpectomy is performed to conclude the resection, and simultaneous antero-posterior correction is obtained. The final stage includes another posterior procedure to achieve a precise correction and to correct any compensatory curves. All patients were operated on using this technique in a single session. The mean preoperative and postoperative kyphosis angles were 76.1 degrees (range, 65 degrees -92 degrees) and 6 degrees (range, 0 degrees -13 degrees), respectively. Complete bony fusion was achieved after a mean follow-up period of 38 months (range, 26-52 months) without any neurological sequelae or significant loss of correction.
Assuntos
Cifose/cirurgia , Procedimentos Ortopédicos , Adolescente , Adulto , Humanos , Cifose/diagnóstico , Cifose/diagnóstico por imagem , Imageamento por Ressonância Magnética , Dispositivos de Fixação Ortopédica , Procedimentos Ortopédicos/efeitos adversos , Radiografia , Fusão Vertebral , Resultado do TratamentoRESUMO
Twenty-two patients with primary tumors of the sacrum were surgically treated between 1983 and 1997. Seventeen male and 5 female patients were followed up for a mean of 53.6 months (range 12-203 months). The histopathologic diagnoses were giant cell tumor (GCT) in 7 patients, chordoma in 4 patients, aneurysmal bone tumor in 3 patients, chondrosarcoma in 2 patients, osteoblastoma in 2 patients, synovial sarcoma in 2 patients, Ewing's sarcoma in 1 patient, and simple bone cyst in 1 patient. Currettage and thermo- or chemocauterization was applied to 8 patients, a subtotal sacrectomy was done in 11 patients, and total sacrectomy and lumbopelvic stabilization was done in 3 patients. The surgical margins were wide in all patients with GCT. The surgical margins were wide in 3 patients and wide contaminated in 1 patient with chordoma. The 2 patients with chondrosarcoma had high sacral lesions and were managed with total sacrectomy and lumbopelvic fixation. The surgical margin was wide in 1 patient and wide contaminated in the other, who relapsed locally and systemically in the 30th postoperative month. Three patients with aggressive aneurysmal bone cyst and 1 patient with simple bone cyst were managed by curettage and thorough debridement. One patient with low sacral Ewing sarcoma was managed by subtotal sacrectomy with wide margins. The two osteoblastomas were localized to the posterior elements of the sacrum. None of the patients relapsed. Most of the tumors of the sacrum are benign aggressive lesions or low grade malignancies. Intralesional resections in the form of curettage, with the addition of chemo- or thermocauterization, provide a complete cure for benign lesions. In contrast, wide resections are necessary for complete disease control in radio- and chemoresistant malignancies. Nerve root dissection should be performed in order to achieve wide margins.
Assuntos
Neoplasias Ósseas/cirurgia , Sacro , Adolescente , Adulto , Condrossarcoma/cirurgia , Cordoma/cirurgia , Desbridamento , Feminino , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoblastoma/cirurgia , Sarcoma Sinovial/cirurgiaRESUMO
Surgery was performed on 25 patients with combination injuries (flexion-distraction injury plus vertebral body fracture): 8 patients with anterior-column failure (compression) and 17 patients with anterior-column plus middle-column failure (burst). Patients with compression received posterior instrumentation and underwent fusion; patients with burst received posterior instrumentation and later underwent anterior decompression and fusion. Eleven patients in the burst group had a neurologic deficit. Single dural tears were discovered in 7 patients during the posterior-instrumentation procedure. By the end of the follow-up period (mean, 34.4 months; range, 18-76 months), neither implant failure nor loss of correction had occurred. Combined mechanisms may go unrecognized and thereby result in increased morbidity and inappropriate treatment. Proper evaluation of the posterior elements is of utmost importance for the diagnosis of flexion-distraction injuries with vertebral body fractures. After diagnosis, treatment should be started with a posterior procedure.
Assuntos
Fraturas da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/complicações , Adolescente , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Luxações Articulares , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Traumatismos da Coluna Vertebral/fisiopatologia , Traumatismos da Coluna Vertebral/cirurgiaRESUMO
Neurofibrosarcomas are rare tumors usually arising in somatic soft tissues or peripheral nerves. Four cases of metastatic neurofibrosarcoma to the spine have been reported before. The current case is unusual because of the presence of two distinct, metachronous spinal metastasis and lung metastasis. A 30-year-old woman with neurofibromatosis and a history of previous neurofibrosarcoma resection presented with back pain. Radiologic evaluation revealed a lytic lesion of the eleventh thoracic vertebra. A transthoracal corpectomy, reconstruction by Harms' cage and posterior instrumentation, and fusion were carried out. After the completion of adjuvant chemotherapy, a solitary pulmonary nodule was detected. Shortly after resection of the metastatic pulmonary nodule, the patient complained of acute onset low-back pain. Radiologic assessment revealed another lytic lesion in the L5 vertebra after 6 months. Again, a corpectomy, anterior and posterior instrumentation, and fusion were carried out. Eight months after the second spinal resection, another solitary pulmonary metastasis was diagnosed and resected. The patient's health status suddenly deteriorated 26 months after the initial spinal metastatectomy, and she died. Though local control can be achieved in more than 80% of the patients with neurofibrosarcoma by wide surgical resection followed by adjuvant chemo- and radiotherapy, most patients die of systemic metastasis. The current patient survived 50 months after the initial resection of a forearm neurofibrosarcoma. Despite achieving local control, she died due to systemic recurrence. Prolonged survival with the help of chemo- and radiotherapy justifies our aggressive surgical strategy for the treatment of spinal metastasis in order to achieve neurologic cure and spinal stability.