Oblique Lateral Interbody Fusion with Anterolateral Screw Fixation Is as Effective as with Posterior Percutaneous Pedicle Screw Fixation in Treating Single-Segment Mild Degenerative Lumbar Diseases.

BACKGROUND Oblique lateral interbody fusion (OLIF) is a new and minimally invasive surgery. This study aimed to compare the clinical efficacy and safety of oblique lateral interbody fusion with anterolateral screw fixation and with posterior percutaneous screw fixation in treating single-segment mild degenerative lumbar diseases. MATERIAL AND METHODS A retrospective analysis was performed on 51 patients with single-segment mild degenerative lumbar diseases who received OLIF from April 2017 to January 2020 in Hong Hui Hospital, Xi'an Jiao Tong University; 24 and 27 patients received OLIF with anterolateral screw fixation (OLIF+AF) and OLIF with posterior percutaneous screw fixation (OLIF+PF), respectively. Anesthesia time, operation time, intraoperative blood loss, intraoperative fluoroscopy number, hospital stay, postoperative complications, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, anterior and posterior disc heights, foraminal height, and fusion rate of the 2 groups were compared to assess clinical and radiological outcomes. RESULTS Anesthesia time, operation time, intraoperative blood loss, number of intraoperative fluoroscopy, and VAS score in the OLIF+AF group were significantly better than those in the OLIF+PF group (P<0.05). There were no significant differences in ODI score, anterior and posterior disc heights, foraminal height, fusion rate, and incidence of complications between the 2 groups (P<0.05). CONCLUSIONS OLIF+AF in treating single-segment mild degenerative lumbar diseases produces a satisfactory clinical effect. Moreover, OLIF+AF does not invade the paraspinal muscle group, thereby reducing trauma, postoperative residual low back pain, operation time, bleeding, and frequency of fluoroscopy. Thus, OLIF+AF is a feasible treatment method for single-segment mild degenerative lumbar diseases.

Rationale and Options for Choosing an Optimal Closure Technique for Primary Midsagittal Osteochondrotomy of the Sternum, Part 2: A Theoretical and Critical Review of Techniques and Fixation Devices.

The intact one-piece sternum is indispensible to the thorax for its normal physiological biomechanics. To overcome tri-planar forces acting on the sternum following midsagittal osteochondrotomy, it must be reconstructed using an optimal technique to withstand distraction loads of normal respiration and violent cough. It should be fixed rigidly to reconstitute the anterior coronal column of the axial skeleton to maintain erect posture and prevent kyphosis. Sterile or infective non-union of the sternum compromises the physical endurance of patients and has an immense psychological effect. From an engineering perspective, there is no substantially proven gold standard technique to fix a divided sternum. Stainless steel wire applied in various configurations to a variety of shapes and sizes has become an acceptable standard of care due to its long-standing history and cost-effectiveness. Recently there has been a proliferation of innovative techniques to deal with primary and failed union of the sternum in an effort to prevent mechanical failure and serious deep surgical wound infection progressing to mediastinitis. Among the newer implant designs, the ones currently in use are shaped like clamps and clasps to compress the sternal halves together as well as alphabet-shaped mini-plating systems. In this section of the review series, mechanisms, pros and cons of currently available implants to reconstruct the bisected sternum, and external support systems considered necessary in high-risk clients are discussed.

Craniostenosis: a neurosurgeon's perspective.

In pediatric neurosurgery departments in India, craniosynostosis is being increasingly identified and dealt with during the past several years. The management of this problem is well established in units that have a strong pediatric bias, whereas it is still in infancy in certain departments. Some misconceptions exist regarding this condition with reference to clinical, genetic aspects and management-in particular, the surgical indications. The experience gained for more than 2 decades of treating this condition as well as the problems faced in the management of this condition will be discussed. Although the terms craniostenosis and craniosynostosis do not mean quite the same thing, the terms are used interchangeably and will be done so in this communication.

Comparison of the biomechanical effects of posterior and anterior spine-stabilizing implants.

Posteriorly and anteriorly fixed implants for stabilizing unstable spines are available on the market. Differences in the biomechanical behavior of these implant types are not yet fully clear. They were investigated using three-dimensional nonlinear finite element models of the lumbar spine in an intact state, with an anteriorly fixed MACS-TL implant and with posteriorly fixed internal fixators. The bisegmental implants spanned the L3 vertebra, and bone grafts were used with both implant types to replace parts of the two bridged discs. The computer models were loaded with partial body weight and muscle forces simulating standing, flexion, extension and axial rotation. Both implant types have reduced intersegmental rotation for flexion, extension, and axial rotation in the bridged region. The reduction is more pronounced for the MACS-TL implant. The implant type has only a minor effect on intradiscal pressure. Maximum von Mises stresses in the vertebrae are lower for flexion and extension with the MACS-TL implant than with the internal fixator. Very high stresses are predicted for flexion after insertion of internal fixators. For standing and torsion, maximum stresses differ only negligibly between the two implant types. In the period immediately after surgery, patients with osteoporotic vertebrae and who are treated with an internal spinal fixation device should therefore avoid excessive flexion. This study adds new information about the mechanical behavior of the lumbar spine after insertion of posterior and anterior spine-stabilizing implants. This information improves our biomechanical understanding of the spine.

Orthopedic devices; classification for the resorbable calcium salt bone void filler device. Final rule.

The Food and Drug Administration (FDA) is classifying the resorbable calcium salt bone void filler device intended to fill bony voids or gaps of the extremities, spine, and pelvis that are caused by trauma or surgery and are not intrinsic to the stability of the bony structure into class II (special controls). Elsewhere in this issue of the Federal Register, FDA is announcing the availability of a class II special controls guidance entitled "Class II Special Controls Guidance Document: Resorbable Calcium Salt Bone Void Filler Device; Guidance for Industry and FDA." This action is being undertaken based on new information submitted in a classification proposal from Wright Medical Technology under the Federal Food, Drug, and Cosmetic Act as amended by the Medical Device Amendments of 1976, the Safe Medical Devices Act of 1990, and the Food and Drug Administration Modernization Act of 1997.

[The value and limits of intervertebral cages in lumbar arthrodesis]. / Intérêt et limites des cages intervertébrales dans les arthrodèses lombaires.

Cages are not disk prosthesis, they not preserve intervertebral mobility. In selected cases they are useful to improve immediate intervertebral stability when lumbar interbody fusion is performed, they also avoid the risk of bone graft crushing before fusion is obtained thanks to their rigidity. In most cases, additional instrumentation is mandatory. A perfect surgical procedure is required to avoid specific complication and failure. The use of cages does not preclude the use of more classical spinal fusion procedures, they have specific indications and do not replace former techniques.

Tratamiento quirúrgico de escoliosis torácica por vía anterior con toracoscopía. Liberación y fijación por la misma vía. Reporte preliminar / Surgical treatment for thoracic scoliosis through an anaterior approach by thoracoscopy. Release and fixation by the same approach. Preliminary report

Desde la publicación del uso de toracoscopía para el tratamiento de problemas de columna no hay reportes de series de pacientes con fijación anterior realizada por toracoscopía. El presente estudio presenta un reporte preliminar de liberación, discectomía y fijación por toracoscopía con sistema de fijación de diseño propio. Se incluyeron nueve pacientes, cinco hombres, cuatro mujeres, con promedio de edad de 17.2 años para los hombres y 12.2 años para las mujeres con diagnóstico de escoliosis idiopática en seis casos, dos con hemivértebras y uno con escoliosis asociada a neurofibromatosis. Presentaron curvas de 28.4º. en promedio se liberaron cuatro niveles. En promedio se colocaron cuatro tornillos por paciente. Se trabajó entre los niveles de T6 a T11. Dos pacientes se sometieron a un segundo procedimiento de fijación posterior. En un paciente se presentó complicación por aflojamiento de tornillo. Todos se manejaron con corsé posoperatorio por cuatro meses. El presente estudio demuestra la posibilidad de realizar liberaciones anteriores, discectomías y fijaciones anteriores por toracoscopía de manera segura con buenos resultados hasta el momento y con limitaciones asociadas a la pequeña muestra y el corto periodo de seguimiento, así como a la selección adecuada de los pacientes para hacer el procedimiento

Orthopedic devices: classification and reclassification of pedicle screw spinal systems--FDA. Final rule.

The Food and Drug Administration (FDA) is classifying certain previously unclassified preamendments pedicle screw spinal systems into class II (special controls) and reclassifying certain postamendments pedicle screw spinal systems from class III (premarket approval) to class II. FDA is taking this action because it believes that special controls would provide reasonable assurance of safety and effectiveness. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA).

Fracturas multifragmentadas de cabeza humeral. Resultados del tratamiento con substitución protésica tipo Neer II / Multifragmentary fractures of humeral head. Results of the treatment with type Neer II prosthetic replacement

Las fracturas de la cabeza del húmero son comunes en el paciente senil y difíciles de tratar por la diversidad de sus desplazamientos y la osteoporosis dejando secuelas que limitan la actividad del paciente. El presente estudio trata de establecer un algoritmo de tratamiento que facilite, mejore y unifique el manejo de estas fracturas donde la recomendación será la colocación de una prótesis que brindará resultados más funcionales evitando la limitación del movimiento de la articulación del hombro. Durante el periodo de marzo de 1987 a julio de 1993 se estudiaron 16 pacientes con este tipo de fracturas, tratados mediante artroplastía y prótesis, se evaluaron los resultados que fueron satisfactorios y permitieron la pronta reintegración de los pacientes a sus actividades de la vida diaria

Utilización de plantilla antiequino en pacientes manejados co fijadores externos en tibia / The use of anti-equinus splint in patients who are under treatment with external fixators of the tibia

En un periodo de seis meses se captaron 18 pacientes; 11 femeninos y 7 masculinos, siendo el miembro afetado más frecuente el izquierdo (11-7), cinco con lesiones congénitas y 13 de origen adquirido, destacando el origen traumático (61.5 por ciento), infeccioso (30.9 por ciento), y un paciente con deformidad de Blount (7.6 por ciento). Se elongaron 10 miembros con un promedio de 5.8 cm, 12 requirieron de aparato modelo Ilizaro y seis fijadores modelo AO. Se mantuvieron con los fijadores y la plantilla antiequino un promedio de 4.7 meses y ningún paciente presentó complicaciones por la utilización de la plantilla antiequino ni dolor de tobillo pasterior al tratamiento. Presentaron una recuperación de los arcos de movilidad del tobillo una mínima de 80.35 por ciento y una máxima de 96.5 por ciento, mostrándose todos los pacientes satisfechos con los logros obtenidos. Ningún paciente presentó complicaciones o alteraciones en los arcos de movilidad del tobillo. La plantilla ayundó a prevenir la deformidad residual en quino en pacientes manejados con fijadores externos en tibia disminuyendo el número de reintervenciones y reingresos hospitalarios ofreciendo un método sencillo, para manejo domiciliario, proporcionando una medida económica que no interfirió con el funcionamiento de los fijadores ayudando a solucionar el problema de equino residual

A primer of fixator devices and configurations.

This paper gives a general introduction to the terminology, concepts, and classifications of external fixators. A clear distinction is made between characteristics typical of the three types of external fixators, simple, clamp, and ring, and those typical of the four standard frames that can be built with each of the devices. These four frames, the one-plane unilateral, two-plane unilateral, one-plane bilateral, and two-plane bilateral configurations, differ in the ease of wound access they allow and their mechanical balance, particularly toward bending moments. Hybrids of different devices and frames may prove beneficial for stabilizing complex injuries.