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Sadeghi-Naini M, Jazayeri SB, Kankam SB, Ghodsi Z, Baigi V, Zeinaddini Meymand A, Pourrashidi A, Azadmanjir Z, Dashtkoohi M, Zendehdel K, Pirnejad H, Fakharian E, O'Reilly GM, Vaccaro AR, Shakeri A, Yousefzadeh-Chabok S, Babaei M, Kouchakinejad-Eramsadati L, Haji Ghadery A, Aryannejad A, Piri SM, Azarhomayoun A, Sadeghi-Bazargani H, Daliri S, Lotfi MS, Pourandish Y, Bagheri L, Rahimi-Movaghar V. Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1585-1596. [PMID: 37999768 DOI: 10.1007/s00586-023-08010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/10/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI). METHODS The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews. RESULTS We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%. CONCLUSION Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.
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Affiliation(s)
- Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- International Neurosurgery Group (ING), Universal Scientific Education and Research Network (Usern), Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
| | | | | | - Zahra Azadmanjir
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Dashtkoohi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR, Iran
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Australia
- National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Alex R Vaccaro
- Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aidin Shakeri
- Neurosurgical Surgery Department, Arak University of Medical Sciences, Arak, Iran
| | | | - Mohammadreza Babaei
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdolkarim Haji Ghadery
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran, Iran
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Yasaman Pourandish
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
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Sousa A, Rodrigues C, Barros L, Serrano P, Rodrigues-Pinto R. Early Versus Late Spine Surgery in Severely Injured Patients-Which Is the Appropriate Timing for Surgery? Global Spine J 2022; 12:1781-1785. [PMID: 33472431 PMCID: PMC9609529 DOI: 10.1177/2192568221989292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study conducted at tertiary spinal trauma referral center. OBJECTIVE We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. METHODS The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as "early surgeries." Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. RESULTS Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. CONCLUSIONS Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. LEVEL OF EVIDENCE OF THE STUDY Level III.
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Affiliation(s)
- Arnaldo Sousa
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Cláudia Rodrigues
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Luís Barros
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Pedro Serrano
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit/Unidade Vertebro-Medular
(UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto,
Portugal,Instituto de Ciências Biomédicas Abel
Salazar, Universidade do Porto, Portugal,Ricardo Rodrigues-Pinto, Spinal Unit/Unidade
Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar
Universitário do Porto, Largo Prof. Abel Salazar 4099-001, Porto, Portugal.
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Perna A, Smakaj A, Vitiello R, Velluto C, Proietti L, Tamburrelli FC, Maccauro G. Posterior Percutaneous Pedicle Screws Fixation Versus Open Surgical Instrumented Fusion for Thoraco-Lumbar Spinal Metastases Palliative Management: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:884928. [PMID: 35444954 PMCID: PMC9013833 DOI: 10.3389/fonc.2022.884928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
Background Surgical palliative treatment of spinal metastases (SM) could influence the quality of life (QoL) in cancer patients, since the spine represents the most common site of secondary bony localization. Traditional open posterior instrumented fusion (OPIF) and Percutaneous pedicle screw fixation (PPSF) became the main surgical treatment alternatives for SM, but in Literature there is no evidence that describes the absolute superiority of one treatment over the other. Materials and Methods This is a systematic review and meta-analysis of comparative studies on PPSF versus OPIF in patients with SM, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The outcomes of interest were: complications, blood loss, infections, mortality, pain and also the Quality of Life (QoL). Results There were a total of 8 studies with 448 patients included in the meta-analyses. Postoperative complications were more frequent in OPIF (odds ratio of 0.48. 95% CI, 0.27 to 0.83; p= 0.01), PPFS was associated with blood loss (odds ratio -585.70. 95% IC, -848.28 to -323.13.69; p< 0.0001) and a mean hospital stay (odds ratio -3.77. 95% IC, -5.92 to -1.61; p= 0.0006) decrease. The rate of infections was minor in PPFS (odds ratio of 0.31. 95% CI, 0.12 to 0.81; p= 0.02) whereas the occurrence of reinterventions (0.76. 95% CI, 0.25 to 2.27; p= 0.62) and the mortality rate was similar in both groups (odds ratio of 0.79. 95% CI, 0.40 to 1.58; p= 0.51). Finally, we also evaluated pre and post-operative VAS and the meta-analysis suggested that both techniques have a similar effect on pain. Discussion and Conclusion The PPSF treatment is related with less complications, a lower rate of infections, a reduction in intraoperative blood loss and a shorter hospital stay compared to the OPIF treatment. However, further randomized clinical trials could confirm the results of this meta-analysis and provide a superior quality of scientific evidence.
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Affiliation(s)
- Andrea Perna
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Andrea Perna,
| | - Amarildo Smakaj
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Raffaele Vitiello
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Calogero Velluto
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luca Proietti
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giulio Maccauro
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Perna A, Proietti L, Smakaj A, Velluto C, Meluzio MC, Rovere G, Florio D, Zirio G, Tamburrelli FC. The role of femoral obliquity angle and T1 pelvic angle in predicting quality of life after spinal surgery in adult spinal deformities. BMC Musculoskelet Disord 2021; 22:999. [PMID: 34847906 PMCID: PMC8630841 DOI: 10.1186/s12891-021-04823-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) represent a growing clinical condition related to chronic pain, disability and reduction in quality of life (QoL). A strong correlation among spinal alignment, spinopelvic parameters and QoL after spinal fusion surgery in ASD patients was thoroughly investigated over the last decade, However, only few studies focused on the relationship between lumbo-pelvic-femoral parameters - such as Femoral Obliquity Angle (FOA), T1 Pelvic Angle (TPA) and QoL. METHODS Radiological and clinical data from 43 patients surgically treated with thoracolumbar posterior spinal fusion for ASD between 2015 and 2018 were retrospectively analyzed. The primary outcomes were the correlation between preoperative spino-pelvic-femoral parameters and postoperative clinical, functional outcomes and QoL. Secondary outcomes were: changes in sagittal radiographic parameters spino-pelvic-femoral, clinical and functional outcomes and the rate of complications after surgery. RESULTS Using Spearman's rank correlation coefficients, spinopelvic femoral parameters (FOA, TPA, pre and post-operative) are directly statistically correlated to the quality of life (ODI, SRS-22, pre and post-operative; > 0,6 strong correlation, p < 0.05). Stratifying the patients according pre preoperative FOA value (High FOA ≥ 10 and Normal/Low FOA < 10), those belonging to the first group showed worse clinical (VAS: 5.2 +/- 1.4 vs 2.9 +/- 0.8) and functional outcomes (ODI: 35.6+/- 6.8 vs 23.2 +/- 6.5) after 2 years of follow-up and a greater number of mechanical complications (57.9% vs 8.3% p < 0.0021). CONCLUSION Based on our results, preoperative FOA and TPA could be important prognostic parameters for predicting disability and quality of life after spinal surgery in ASD patients and early indicators of possible spinal sagittal malalignment. FOA and TPA, like other and better known spinopelvic parameters, should always be considered when planning corrective surgery in ASD patients.
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Affiliation(s)
- Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Calogero Velluto
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Florio
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Zirio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2687-2697. [PMID: 34378143 PMCID: PMC8514382 DOI: 10.1007/s00264-021-05153-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.
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Mugesh Kanna R, Prasad Shetty A, Rajasekaran S. Timing of intervention for spinal injury in patients with polytrauma. J Clin Orthop Trauma 2021; 12:96-100. [PMID: 33716434 PMCID: PMC7920207 DOI: 10.1016/j.jcot.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The optimal timing of surgical intervention of spinal fractures in patients with polytrauma is still controversial. In the setting of trauma to multiple organ systems, an inappropriately timed definitive spine surgery can lead to increased incidence of pulmonary complications, hemodynamic instability and potentially death, while delayed surgical stabilisation has its attendant problems of prolonged recumbency including deep vein thrombosis, organ-sp ecific infection and pressure sores. METHODS A narrative review focussed at the epidemiology, demographics and principles of surgery for spinal trauma in poly-traumatised patients was performed. Pubmed search (1995-2020) based on the keywords - polytrauma OR multiple trauma AND spine fracture AND timing, present in "All the fields" of the search tab, was performed. Among 48 articles retrieved, 23 articles specific to the management of spinal fracture in polytrauma patients were reviewed. RESULTS Spine trauma is noted in up to 30% of polytrauma patients. Unstable spinal fractures with or without spinal cord injury in polytrauma require surgical intervention and are treated based on the following principles - stabilizing the injured spine during resuscitation, acute management of life-and limb-threatening organ injuries, "damage control" internal stabilisation of unstable spinal injuries during the early acute phase and, definitive surgery at an appropriate window of opportunity. Early spine fracture fixation, especially in the setting of chest injury, reduces morbidity of pulmonary complications and duration of hospital stay. CONCLUSION Recognition and stabilisation of spinal fractures during resuscitation of polytrauma is important. Early posterior spinal fixation of unstable fractures, described as damage control spine surgery, is preferred while a delayed definitive 360° decompression is performed once the systemic milieu is optimal, if mandated for biomechanical and neurological indications.
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Affiliation(s)
- Rishi Mugesh Kanna
- Corresponding author. Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
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Sasagawa T, Takeuchi Y, Aita I. Postoperative Blood Loss Including Hidden Blood Loss in Early and Late Surgery Using Percutaneous Pedicle Screws for Traumatic Thoracolumbar Fracture. Spine Surg Relat Res 2020; 5:171-175. [PMID: 34179554 PMCID: PMC8208959 DOI: 10.22603/ssrr.2020-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Some reports revealed that hidden blood loss (HBL) during surgery for traumatic thoracolumbar fracture cannot be ignored, even when using a percutaneous approach. Using percutaneous pedicle screws (PPS) for traumatic thoracolumbar fracture, this study aimed to compare estimate blood loss (EBL), including HBL, between early and late fixation. Methods This investigation was a retrospective study. In the present study, data from 39 patients who underwent posterior spinal stabilization using PPS for single-level thoracolumbar fracture have been included. We divided the patients into an early group (group E) (n=20) in whom surgery was conducted within 3 days of fracture and a late group (group L) (n=19) in whom surgery was conducted more than 3 days after fracture. We evaluated hemoglobin (Hb) on the day of injury, and 1, 3 or 4, and 7 days after surgery, EBL, HBL, and transfusion requirement. Results Hb on day 1 (group E: 12.2±1.7 g/dL, group L: 12.3±1.6 g/dL) was significantly less than that on the injured day (group E: 14.2±1.7 g/dL, group L: 13.9±1.7 g/dL) in both groups. The values of Hb and EBL were not significantly different at any time between the two groups. HBL (group E: 487±266 mL, group L: 386±305 mL) was not significantly different between the two groups. No patients required transfusion in either group. Conclusions EBL in early fixation using PPS for traumatic thoracolumbar fracture is not significantly different compared with that in late surgery from days 1 to 7 postoperatively. Early fixation using PPS for traumatic thoracolumbar fracture does not result in negative outcomes any more than those in late surgery in terms of blood loss.
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Affiliation(s)
- Takeshi Sasagawa
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yosuke Takeuchi
- Department of Orthopedic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ikuo Aita
- Department of Orthopedic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
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Noia G, Basilico M, Vitiello R, Perna A, Leone A, Rumi N, Tamburrelli FC. Thoracic spine fracture associated with an extradural lipoma: Case report and systematic review of the literature. Orthop Rev (Pavia) 2020; 12:8684. [PMID: 32913612 PMCID: PMC7459376 DOI: 10.4081/or.2020.8684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023] Open
Abstract
Isolated extradural lipoma (IEL), not associated to spinal dysraphisms, is a rare condition. Frequently IEL was confused with much more frequent diffuse lipomatosis. The lesion can be completely asymptomatic and occasionally diagnosed with magnetic resonance (MR) imaging. This paper describes a case of a patient with an axial compression fracture of the thoracic spine associated with an extradural lipoma. We also performed a systematic review of the pertinent literature in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.
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Affiliation(s)
| | | | | | | | - Antonio Leone
- Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicolò Rumi
- Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
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Santagada DA, Perna A, Meluzio MC, Ciolli G, Proietti L, Tamburrelli FC. Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review. Orthop Rev (Pavia) 2020; 12:8685. [PMID: 32913613 PMCID: PMC7459382 DOI: 10.4081/or.2020.8685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.
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Affiliation(s)
- Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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10
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Huang Z, Hu C, Tong Y, Fan Z, Liu K, Yang B, Zhao C. Percutaneous pedicle screw fixation combined with transforaminal endoscopic spinal canal decompression for the treatment of thoracolumbar burst fracture with severe neurologic deficit: A case report. Medicine (Baltimore) 2020; 99:e20276. [PMID: 32481306 PMCID: PMC7249900 DOI: 10.1097/md.0000000000020276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES Burst fracture at L1. INTERVENTIONS The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.
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Affiliation(s)
- Zhangheng Huang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province
| | - Chuan Hu
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, Shandong Province
| | - Yuexin Tong
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province
| | - Zhiyi Fan
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province
| | - Kewen Liu
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province
| | - Binbin Yang
- Department of Oncology, Ruian People's Hospital (Third Affiliated Hospital of Wenzhou Medical University), Wenzhou, Zhejiang Province, China
| | - Chengliang Zhao
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province
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11
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Tamburrelli FC, Perna A, Proietti L, Zirio G, Santagada DA, Genitiempo M. The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up. Malays Orthop J 2019; 13:39-44. [PMID: 31890109 PMCID: PMC6915314 DOI: 10.5704/moj.1911.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-of-life, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.
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Affiliation(s)
- F C Tamburrelli
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Perna
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - L Proietti
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Zirio
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D A Santagada
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - M Genitiempo
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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12
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Donnally CJ, Madhavan K, Lugo-Pico JG, Chieng LO, Vanni S. Fish-Mouth Thoracic Fracture Fixation with Minimally Invasive Percutaneous Reduction: A Technical Note. World Neurosurg 2018; 122:106-111. [PMID: 30391618 DOI: 10.1016/j.wneu.2018.10.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Surgical stabilization of thoracic spine fractures is recommended for unstable patterns, yet much debate exists regarding the best approach for reduction. The aim of this article was to report the outcome of a novel method for stabilization of a fish-mouth thoracic spine fracture. METHODS A retrospective patient chart review was conducted. Data collected included blood loss, operative time, length of stay, perioperative complications, neurologic deficits, and secondary procedures. The patient underwent percutaneous reduction of a hyperextension injury to the thoracic spine. Sufficient reduction was achieved through a percutaneous approach, followed by sequential distraction of 1 rod with sequential locking of the contralateral rod to maintain deformity correction. Electrophysiologic monitoring was used during the procedure. RESULTS Sufficient fracture reduction was achieved and evaluated on postoperative computed tomography. Operative time was 145 minutes, and estimated blood loss was 120 mL. There were no cerebrospinal fluid leaks, iatrogenic neurologic deficits, implant failures, other systemic events or revisions during the 8-month follow-up. CONCLUSIONS This article describes the feasibility of using a novel model for reduction and stabilization of fish-mouth thoracic spine fracture with minimal soft tissue violation.
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Affiliation(s)
- Chester J Donnally
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA.
| | - Karthik Madhavan
- Department of Neurosurgery, University of Miami Hospital, Miami, Florida, USA
| | - Julian G Lugo-Pico
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - Lee Onn Chieng
- Department of Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven Vanni
- Department of Neurosurgery, University of Miami Hospital, Miami, Florida, USA
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13
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Fujino S, Miyagi M, Tajima S, Imura T, Tazawa R, Inoue G, Nakazawa T, Saito W, Shirasawa E, Minehara H, Matsuura T, Kawamura T, Uchida K, Takahira N, Takaso M. Surgical treatment for suicidal jumper's fracture (unstable sacral fracture) with thoracolumbar burst fracture: a report of three cases. Spine Surg Relat Res 2017; 1:100-106. [PMID: 31440620 PMCID: PMC6698561 DOI: 10.22603/ssrr.1.2016-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/04/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Suicidal jumper's fracture (unstable sacral fracture) is characterized not only by multiple fractures including thoracolumbar fractures, but also major chest and abdominal injuries. Early stabilization of these fractures and early ambulation are required for the treatment and management of chest and abdominal injuries. We present 3 cases of suicidal jumper's fracture with thoracolumbar burst fracture, treated with minimally invasive posterior fixation surgery, which is a combination of percutaneous pedicle screws (PPS) and the mini-open Galveston technique. Case reports Case 1. A 50-year-old woman was injured by a fall from the 5th floor of a building as the result of a suicide attempt. Computed tomography revealed an H-shaped unstable sacral fracture and thoracolumbar fractures with major chest and abdominal injuries. For early stabilization of spinopelvic instability and early ambulation, we treated the patient with PPS and the mini-open Galveston technique. Her early postoperative emergence from bedrest contributed to the improvement of her general condition. One year after surgery at the final follow-up, she was able to walk with a T-cane without any motor, bladder, or bowel dysfunction (BBD) and achieved almost complete healing of the fractures. Cases 2 and 3. A 25-year-old woman (Case 2) and a 43-year-old woman were injured in falls. They had multiple injuries including unstable sacral fractures, and thoracolumbar fractures with major chest and abdominal injuries. We treated these patients with PPS and the mini-open Galveston technique. One year after surgery, they were able to walk with a T-cane and achieved almost complete healing of thoracolumbar fractures, but delayed healing of an unstable sacral fracture in Case 2, and remaining BBD in Case 3. Conclusion PPS and the mini-open Galveston technique is a good approach to fixation because they are minimally invasive and provide moderately rigid fixation, especially in patients with multiple trauma whose general condition is poor.
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Affiliation(s)
- Shotaro Fujino
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Shuichiro Tajima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Hiroaki Minehara
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Terumasa Matsuura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Tadashi Kawamura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan.,Departments of Biomedical Engineering and Rehabilitation, Kitasato University School of Allied Health Sciences, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
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14
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Abstract
RATIONALE Lumbar burst fractures are frequent injury resulting from high-energy trauma, and the patients suffer from pain and the neurologic dysfunction. Although minimally invasive techniques have advanced rapidly, it was the first time to apply transforaminal endoscopic combined with percutaneous pedicle screw fixation to treatment of lumbar burst fractures. PATIENT CONCERNS A 33-year-old man underwent Magerl type A3.1 burst fracture at L2 and compression fractures at L3 due to falling from a height with severe lower back pain, sensory loss, and atony of the right leg. DIAGNOSES Burst fracture at L2, compression fractures at L3. INTERVENTIONS The patient was presented to 1-stage operation of percutaneous pedicle screw fixation at L1, L2, L3, and L4 instead of delayed posterior open surgery. At 1 week after injury, the 2-stage operation with a percutaneous transforaminal endoscopic was undertaken for decompression. OUTCOMES No matter the function of nerve and imaging findings, all got ideal recoveries in just 3 days after 2-stage operation. At the 3-month follow-up, there was no loss of sagittal plane alignment, and spinal cord compression was completely relieved. The patient regained near-full neurologic function postoperatively. LESSONS A minimally invasive surgery (ie, transforaminal endoscopic combined with percutaneous pedicle screw fixation) for the treatment of Magerl type A3.1 burst fracture at lumbar was feasible. In addition, the key to the recovery of neurological function is the complete and effective decompression of spinal.
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Affiliation(s)
- Yuanyi Wang
- The First Hospital of Jilin University, Jilin
| | - Cong Ning
- The First Hospital of Jilin University, Jilin
| | - Liyu Yao
- The First Hospital of Jilin University, Jilin
| | | | | | - Bin Chen
- The Hospital of Chengde Medical College, Hebei, China
| | - Nan Zhang
- The First Hospital of Jilin University, Jilin
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15
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Zou W, Xiao J, Zhang Y, Du Y, Zhou C. [Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:830-836. [PMID: 29798528 DOI: 10.7507/1002-1892.201702089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To assess the effectiveness of percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture. Methods Between May 2014 and February 2016, 43 cases of type A3 thoracolumbar burst fracture with or without nerve symptoms were treated with pedicle screw fixation and neural decompression. Of them, 21 patients underwent percutaneous pedicle screw fixation and minimally invasive decompression in the same incision (percutaneous group), and the other 22 patients underwent traditional open surgery (open group). There was no significant difference in gender, age, cause of injury, fractures level, preoperative American Spinal Injury Association (ASIA) grade, thoracolumbar injury classification and severity (TLICS) score, load-sharing classification, height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment between 2 groups ( P>0.05). The length of soft tissue dissection, operation time, intraoperative blood loss, postoperative drainage, X-ray exposure times, and incision visual analogue scale (VAS) score at 1 day after operation were recorded and compared. At last follow-up, Japanese Orthopaedic Association (JOA) score and low back pain VAS score were recorded and compared respectively. The ASIA grade recovery was evaluated; the height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment were assessed postoperatively. Results Percutaneous group was significantly better than open group in the length of soft tissue dissection, intraoperative blood loss, postoperative drainage, and incision VAS at 1 day after operation ( P<0.05), but no significant difference was found in operation time between 2 groups ( P>0.05); however, X-ray exposure times of open group were significantly better than that of percutaneous group ( P<0.01). The patients were followed up 12 to 19 months (mean, 15.1 months) in 2 groups. All patients achieved effective decompression. No complications of iatrogenic neurological injury and internal fixation failure occurred. The height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( P<0.05), but no significant difference was found between 2 groups ( P>0.05). At last follow-up, JOA score and low back pain VAS score of percutaneous group were significantly better than those of open group ( P<0.05). The neurological function under grade E was improved at least one ASIA grade in 2 groups, but no significant difference was shown between 2 groups ( Z=0.480, P=0.961). Conclusion Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture has satisfactory effectiveness. And it has the advantages of minimal trauma, quick recovery, safeness, and reliableness.
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Affiliation(s)
- Wei Zou
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002,
| | - Jie Xiao
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Yang Zhang
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Yuhui Du
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Changjun Zhou
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
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16
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Celano EC, Baum GR, Gelbard RB, Ahmad FU. Percutaneous pedicle screw fixation for an unstable thoracic spine fracture after a traumatic degloving injury. BMJ Case Rep 2015; 2015:bcr-2015-213001. [PMID: 26646146 DOI: 10.1136/bcr-2015-213001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Unstable spinal fractures require urgent surgical intervention to relieve compression of the spinal cord, correct spinal deformity, stabilise the spine and prevent further neurological injury. We report the case of a young man with a thoracic chance fracture in the setting of a devastating degloving injury, whose fracture was stabilised using minimally invasive, percutaneous pedicle screw fixation. We discuss the advantages of using a minimally invasive technique for spinal fixation and its role in the treatment of complicated, multisystem trauma patients.
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Affiliation(s)
| | - Griffin R Baum
- Department of Neurosurgery, Emory School of Medicine, Atlanta, Georgia, USA
| | - Rondi B Gelbard
- Department of Surgery, Emory School of Medicine, Atlanta, Georgia, USA
| | - Faiz U Ahmad
- Department of Neurosurgery, Emory School of Medicine, Atlanta, Georgia, USA
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17
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Beckman JM, Murray G, Bach K, Deukmedjian A, Uribe JS. Percutaneous Minimally Invasive (MIS) Guide Wire-less Self-Tapping Pedicle Screw Placement in the Thoracic and Lumbar Spine: Safety and Initial Clinical Experience: Technical Note. Oper Neurosurg (Hagerstown) 2015; 11:530-536. [PMID: 29506166 DOI: 10.1227/neu.0000000000000977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/22/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Multiple methods for minimally invasive (MIS) thoracic and lumbar pedicle screw placement exist. The guide wire is almost universally used for most insertion techniques; however, its use is not without complication and potentially prolongs surgical procedures. OBJECTIVE To evaluate the safety of percutaneous MIS guide wire-less pedicle screw placement in the thoracic and lumbar spine at a single institution over a 3-year experience. METHODS Forty-one patients who underwent posterior instrumentation with 110 transpedicular MIS thoracic and lumbar screws by a single surgeon from 2011 to 2014 were analyzed. The mean age was 63 years at the time of surgery. Etiological diagnoses were adult spinal deformity, trauma, spondylosis/spondylolisthesis, and other spinal diseases. Pedicle screws were inserted with the use of a guide wire-free technique in which anatomy-specific entry sites and fluoroscopic landmarks were used to guide the surgeon. A square, sharp-tipped pedicle screw was carefully advanced under biplanar fluoroscopic image (anteroposterior and lateral) down the pedicle into the body. No tapping or any type of electromonitoring was performed. An independent spine surgeon using medical records and thoracic/lumbar computed tomography taken during the postoperative period reviewed all patients. RESULTS The number of the screws inserted at each level was as follows: total, 110; thoracic, 30; and lumbar, 80. All screws were evaluated by computed tomography to assess screw position. Seven screws (6.3%) were inserted with moderate cortical perforation, including 3 screws (2.7%) that violated the medial wall. There were no neurological, vascular, or visceral complications with up to 3 years of follow-up. CONCLUSION The percutaneous MIS guide wire-less technique of lumbar and thoracic pedicle screw placement performed using a biplanar fluoroscopic guidance in a stepwise, consistent manner is an accurate, safe, and reproducible method of insertion to treat a variety of spinal disorders.
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18
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Kucukdurmaz F, Alijanipour P. Current Concepts in Orthopedic Management of Multiple Trauma. Open Orthop J 2015; 9:275-82. [PMID: 26312111 PMCID: PMC4541294 DOI: 10.2174/1874325001509010275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 12/13/2022] Open
Abstract
Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma.
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Affiliation(s)
- Fatih Kucukdurmaz
- Clinic of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Pouya Alijanipour
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Proietti L, Scaramuzzo L, Schirò GR, Sessa S, D'Aurizio G, Tamburrelli FC. Posterior percutaneous reduction and fixation of thoraco-lumbar burst fractures. Orthop Traumatol Surg Res 2014; 100:455-60. [PMID: 25108675 DOI: 10.1016/j.otsr.2014.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/07/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of A3 thoraco-lumbar and lumbar spinal fractures nowadays remains a controversial issue. Percutaneous techniques are becoming very popular in the last few years to reduce the approach-related morbidity associated with conventional techniques. HYPOTHESIS Purpose of the study was to analyze the clinical and radiological outcome of patients who underwent percutaneous posterior fixation without fusion for the treatment of thoraco-lumbar and lumbar A3 fractures. MATERIALS AND METHODS Sixty-three patients, having sustained a single-level thoraco-lumbar fracture, underwent short segment percutaneous instrumentation and were retrospectively analyzed. sagittal index (SI) was calculated in all patients. Clinical and functional outcome were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form General Health Status (SF-36). RESULTS Average operative blood loss was 82 mL (50-320). Mean pre-operative SI in the thoraco-lumbar segment was 13.3° decreased to 5.8° in the immediate postoperative with a mean deformity correction of 7.5. Mean pre-operative SI in the lumbar segment was 16.5° decreased to 11.3° in the immediate postoperative with a mean deformity correction of 5.2. Not statistically significant correction loss was registered at 1-year minimum follow-up. Constant clinical conditions improvement in the examined patients was observed. CONCLUSION Percutaneous pedicle screw fixation for A3 thoraco-lumbar and lumbar spinal fractures is a reliable and safe procedure. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- L Proietti
- Department of Orthopedic Science and Traumatology, Spine Surgery Division, Catholic University Rome, Largo A. Gemelli 1, 00168 Roma, Italy.
| | - L Scaramuzzo
- Spine Surgery Division 1, IRCCS Istituto Ortopedico Galeazzi Spa, via Riccardo Galeazzi, 4, 20161 Milano, Italy.
| | - G R Schirò
- Department of Orthopedic Science and Traumatology, Spine Surgery Division, Catholic University Rome, Largo A. Gemelli 1, 00168 Roma, Italy.
| | - S Sessa
- Department of Orthopedic Science and Traumatology, Spine Surgery Division, Catholic University Rome, Largo A. Gemelli 1, 00168 Roma, Italy.
| | - G D'Aurizio
- Department of Orthopedic Science and Traumatology, Spine Surgery Division, Catholic University Rome, Largo A. Gemelli 1, 00168 Roma, Italy.
| | - F C Tamburrelli
- Department of Orthopedic Science and Traumatology, Spine Surgery Division, Catholic University Rome, Largo A. Gemelli 1, 00168 Roma, Italy.
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