[Treatment of osteoporotic vertebral compression fractures with PMMA-augmented pedicle screw fixation]. / Osteoporoticus kompressziós csigolyatörések kezelése PMMA-augmentált csavaros transpedicularis rögzítéssel.

BACKGROUND: Over the last few decades many innovative operation technique were developed due to the increase of porotic vertebral fractures. These new techniques aim to reach the required stability of the vertebral column. In case of significant instability, spinal canal stenosis or neural compression, decompressive intervention may be necessary, which results in further weakening of the column of the spine, the minimal invasive percutan vertebroplasty is not an adequate method to reach the required stability, that is why insertion of complementary pedicular screws is needed. Considering the limited screw-fixing ability of the porotic bone structure, with this new technique we are able to reach the appropriate stability of cement-augmented pedicle screws by dosing cement carefully through the screws into the vertebral body. We used this technique in our Institute in case of 12 patients and followed up the required stability and the severity of complications. METHODS: Fifteen vertebral compression fractures of 12 patients were treated in our Institute. Using the classification proposed by Genant et al. we found that the severity of the vertebral compression was grade 3 in case of 13, while grade 2 in case of two fractures. The average follow up time of the patients was 22 months (12-39), during this period X-ray, CT and clinical control examinations were taken. During the surgery the involved segments were localised by using X-ray and after the exploration the canulated screws were put through the pedicles of the spine and the vertebral body was filled through the transpedicular screws with bone cement. Depending on the grade of the spinal canal stenosis, we made the decompression, vertebroplasty or corpectomy of the fractured vertebral body, and the replacement of the body. Finally the concerned segments were fixed by titanium rods. RESULTS: In all cases the stenosis of spinal canal was resolved and the bone cement injected into the corpus resulted in adequated stability of the spine. In case of six patients we observed cement extravasation without any clinical signs, and by one patient--as a serious complication--pulmonary embolism. Neurological progression or screw loosening were not detected during the follow up period. Part of the patients had residual disability after the surgery due to their older ages and the problem of their rehabilitation process. CONCLUSION: After the right consideration of indications, age, general health condition and the chance of successful rehabilitation, the technique appears to be safe for the patients. With the use of this surgical method, the stability of the spine can be improved compared to the preoperative condition, the spinal canal stenosis can be solved and the neural structures can be decompressed. The severity of complications can be reduced by a precise surgical technique and the careful use of the injected cement. The indication of the surgical method needs to be considered in the light of the expected outcome and the rehabilitation.

[New surgical technique for atlanto-axial instability: C1-2 dorsal fixation with the screw-rod system]. / Az atlantoaxialis instabilitás mutéti kezelésének újabb módszere: CI-II. Dorsalis rögzítés csavaros-rudas rendszerrel.

OBJECTIVE: It is still challenging to perform the operation for the instability of the C1-C2 junction because of the limited cases, unique anatomical landmarks, the potential or real injury of the neurological elements, the serious clinical state and the special technical and human background is demanding. With the aim of minimalize the risk the following method provide sufficient stability, successful and simple. METHOD: The authors used the dorsally implanted screw-rod systems for operating 34 patient with C1-2 instability resulting clinically signs and symptoms. Depending the anatomical landmarks and the technical possibilities, the screw insertion method and the reinforced wire cable use was selected. Meaning the indication of the surgical treatment, the neurological signs, compromise of the spinal canal and pain resisting the conservative treatment was presented. RESULT: The C1-2 dorsally fixation was performed to 34 patients. Both sided lateral mass screw was inserted in 30 cases (88.3%). Because of the anatomical landmarks in four cases (11.7%) the one sided screwing was made by the Magerl technique. Pure bone quality detecting intraoperatively demand reinforcement with titanium cables for three cases (8.8%). Pain resulted of instability was recovered. The clinical and neurorariological follow-up present perfect result for 26 patients (76%), good result for six patients, there was respectable result for two patients. Most of the patients, 31 cases (91%) were satisfied, and three patients (9%) consider their condition acceptable. CONCLUSION: Performing the represened techique, the risk and the time of the operation was decreased reducing the rate of the complications. The method providing full stability resulted immediate axial painless, no outer support and early mobilization is possibile. Summarizing this technique is safe, reliable and cost effective.

[Bilateral "over the top" decompression through unilateral laminotomy for lumbar and thoracic spinal canal stenosis]. / A gerinccsatorna kétoldali "over the top" rekalibrációja féloldali feltáráson keresztül degeneratív háti es agyéki gerinccsatorna- szukület esetén.

OBJECTIVE: The standard surgical procedures used in degenerative thoracic and lumbar spinal canal stenosis allows decompression of the neural structures by unroofing the spinal canal, often resulted in destruction or insufficiency of facet joints, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles altering an already pathologic biomechanical milieu causing segmental instability. Various less invasive techniques exists to save the integrity and prevent the instability of the spine and allow decompression of neural structures located in the spinal canal. The authors discusses the experiences with technique of unilateral laminotomy for bilateral decompression. METHODS: The unilateral laminotomy for bilateral decompression technique was performed at 60 levels in 51 patients to decompress the symptomatic degenerative stenosis of the thoracic and lumbar spinal canal. The inclusion criteria were used as follows: symptoms of neurogenic claudication and/or radiculopathy, myelopathy, neuroimaging evidence of degenerative stenosis and absence of instability. Symptoms were considered refractory to nonsurgical conservative management or myelopathy was detected. RESULTS: The distribution of mostly affected segments were the L 4-5 (45%) and L3-4 (28.4%). Neurogenic claudication and walking distance improved during the follow up period in all patients. Seven patients (13.73%) reported excellent, 32 (62.74%) good, 12 (23.53%) fair outcome and no patient a poor overall outcome. The low back pain was the major residual postoperative complaint. 25 (49%) patients were very satisfied with their outcome, 23 (45.1%) were fairly satisfied, 2 (3.9%) were not very satisfied and 1 (2%) patients was dissatisfied. CONCLUSION: The unilateral laminotomy for bilateral microdecompression technique minimizes resection of and injury to tissues not directly involved in the pathologic process, while affording a safe and through decompression of neural structures located in a degeneratively stenotic spinal canal.

[Combined anterior and posterior approach in surgical treatment of tumors at the cervicothoracic junction: our experience]. / A cervicothoracalis átmenetben elhelyezkedó daganatok mútéti megoldása ventralis és kombinált ventrodorsalis megközelítésból: saját tapasztalatok.

INTRODUCTION: In the past, surgery of the pathologies of cervicothoracic junction carried high risk. Better knowledge of the anatomical situation and the increasing experience with anterior approach, corpectomy and spinal stabilization instruments have all made possible to remove the tumours of the cervicothoracic junction in a combined way. CASE REPORTS: The authors present six cases of spinal tumours where removal was done via anterior approach with partial clavicle and sternal resection. In two cases the anterior approach were combined with posterior tumour removal and fixation. Two of the cases were metastatic tumours, one lymphoma, one osteochondroma, one giant cell osteoid tumour and one malignant neurogenic tumour. The ventral approach gave a relatively wide window to explore the tumours and with the help of the operative microscope the tumour removal went fairly well. After total removal of the tumours the cervical spine were stabilized with own clavicle or iliac bone graft, titanium plate and screws. In patients with three-column involvement posterior fixation was made. The immediate recovery of the patients was well and there were no postoperative complications. Postoperative CT and MRI scans have great value in the early control after surgery as well as for the follow up of the patients. CONCLUSION: The anterior approach with partial clavicle and sternal resection combined with posterior approach and fixation seems to be feasible and safe method to explore and remove cervicothoracic junction pathologies.

Surgery of ventral intradural midline cervical spinal pathologies via anterior cervical approach: our experience.

INTRODUCTION: The surgical removal of the cervical intradural pathologies located ventrally carries a high risk. According to the anatomical situation and the increasing experience with anterior cervical approach and corpectomy revealed the reality to remove the ventral midline pathologies this way. The anterior approach which require corpectomy preferable to cervical intradural lesions located ventrally at the midline. In the literature have described anterior approach for intradural cervical lesions in very limited cases. CASE: The authors present five cases of intradural ventral cervical spinal pathologies, where removal was done via anterior cervical approach with corpectomy. Two of the cases were intradural meningeomas, one intramedullary cavernoma, one ventral arachnoid cyst and one malignant neurogenic tumour. The approach was described elsewhere. The corpectomy gave a relatively wide window to explore the pathologies and under operative microscope the local control of removal was fairly well. After the total removal of tumours and cavernoma, and fenestration of arachnoid cyst to the subarachnoid space watertight dural closure was made and the cervical spine was stabilized with autolog iliac bone graft, plate and screws. The recovery of the patients was well and there were no postoperative complications. CONCLUSIONS: The anterior cervical approach with corpectomy seems to be a real and safe way to explore and remove the cervical ventral midline pathologies. Postoperative MRI has a great value in early control after the surgery and for follow up the patients.