Biomechanical comparison of anterior lumbar screw-plate fixation versus posterior lumbar pedicle screw fixation

Treatment of Single-Level Thoracic Tuberculosis by Percutaneous Endoscopic Débridement and Allograft via the Transforaminal Approach Combined with Percutaneous Pedicle Screw Fixation: A Multicenter Study with a Median Follow-Up of 36 Months

OBJECTIVE

To examine effects of percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation as treatment for single-level thoracic tuberculosis.

METHODS

This multicenter retrospective analysis included 75 patients with single-level thoracic tuberculosis who underwent percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation and were followed for >36 months between January 2012 and December 2014.

RESULTS

Follow-up was 36-48 months (average 41.1 ± 2.2 months). Intraoperative blood loss was low (average 30.5 ± 7.9 mL), and bed rest time was short (average 1.5 ± 0.3 days). No recurrence was observed in all 75 patients. Except for 3 patients, almost all patients (96%) achieved grade I or II fusion in interbody bone grafting. Segmental Cobb angle was 13.5° ± 4.1° before surgery, 10.5° ± 3.7° immediately after surgery, and 11.7° ± 3.9° at 36 months of follow-up. All patients achieved complete recovery of neurologic function (American Spinal Injury Association grade E), including 15 patients with spinal cord injury (American Spinal Injury Association grade D) before surgery. The visual analog scale and 36-Item Short-Form Health Survey scores significantly improved at 1, 3, 12, and 36 months of follow-up. No complications related to internal fixation occurred within the follow-up period; complication rate was 9.0%.

CONCLUSIONS

Median follow-up clinical experience with percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation indicates that the technique is safe, effective, feasible, and minimally invasive.

Imaging Anatomical Research on the Operative Windows of Oblique Lumbar Interbody Fusion

To provide applied anatomical evidence of the preoperative assessment of oblique lumbar interbody fusion (OLIF), the anatomical parameters of the OLIF operative window were observed through computed tomography angiography (CTA). We selected imaging data from 60 adults (30 males, 30 females) who underwent abdominal CTA and T12-S1 vertebral computed tomography (CT) with three-dimensional reconstruction. The OLIF operative windows at the L1-2, L2-3, L3-4, L4-5 and L5-S1 levels were as follows: the vascular window, bare window, psoas major window, ideal operative window, and actual operative window. Each level's actual operative window was statistically analyzed based on an actual operative window of <1 cm and ≥1 cm. The vascular window was largest at L4-5 (1.72 ± 0.58 cm). The bare window was largest at L5-S1 (1.59 ± 0.93 cm) and smallest at L3-4 (1.37 ± 0.51 cm). The psoas major window was largest at L3-4 (1.14 ± 0.35 cm) and smallest at L1-2 (0.41 ± 0.34 cm). The ideal operative window was largest at L4-5 (3.74 ± 0.36 cm) and smallest at L1-2 (3.23 ± 0.30 cm). The actual operative window was largest at L3-4, followed by L2-3, L4-5, L1-2, and L5-S1, which were 2.51 ± 0.56 cm, 2.28 ± 0.54 cm, 2.01 ± 0.74 cm, 1.80 ± 0.45 cm and 1.59 ± 0.93 cm, respectively (P = 0.000), and the percentages of the actual surgical window were 69%, 66%, 53%, 56% and 43%, respectively. The actual surgical window was <1 cm in 2 cases at L1-2 (3.3%), 4 cases at L4-5 (6.7%), and 17 cases at L5-S1 (28.3%) (11 males and 6 females). The regional anatomy of each level related to OLIF has its own peculiarities, and not all levels are suitable for OLIF. Before OLIF surgery, surgeons should analyze the imaging anatomy and select the appropriate surgical procedures.

Treatment of Severely Displaced Radial Neck Fractures in Children With Percutaneous K-wire Leverage and Closed Intramedullary Pinning

To evaluate the efficacy and safety of percutaneous K-wire leverage (PKWL) reduction and closed intramedullary pinning (CIMP) for the treatment of pediatric radial neck fractures. From June 2010 to December 2013, a total of 50 children with Judet III and IV radial neck fractures were treated at our hospital. Manual closed reduction was first attempted to reduce the radial neck fractures. Upon successful closed reduction or the radial neck-shaft angle was reduced to <45°, radial intramedullary pinning or CIMP was performed for fixation. Unsuccessful manual reduction was corrected using percutaneous K-wire leverage and CIMP. The injured arm was fixed at the functional position using plaster for 4 to 6 weeks. Sixteen patients were treated with manual closed reduction and CIMP (group A). Percutaneous K-wire leverage and CIMP were performed for 30 patients (group B). Another 4 patients were treated with open reduction and CIMP (group C). Groups B and C showed no significant difference in the radial neck-shaft angle, fracture displacement, and angle/displace ratio (P > 0.05), but were significantly larger than group A in the radial neck-shaft angle and fracture displacement (P < 0.05). Group A and B had significantly shorter operation time than group C (58.4 ± 14.5 minutes, 55.2 ± 11.2 minutes, versus 81.4 ± 7.5 minutes, P < 0.05). Forty-five patients were followed up for a mean of 2 years. Bone union was achieved in all patients within a mean time of 4.1 months. The patients treated with manual reduction or percutaneous leverage reduction showed excellent results. Three patients, however, treated with open reduction showed 10 to 20° limitation in range of motion of the elbow. No other complications were seen. Percutaneous K-wire leverage and CIMP are safe and effective for the treatment of pediatric Judet III and IV radial neck fractures.

Improved Monosegment Pedicle Instrumentation for Treatment of Thoracolumbar Incomplete Burst Fractures

Aim. Comparing the clinical results of improved monosegment pedicle instrumentation (iMSPI) and short-segment pedicle instrumentation (SSPI) retrospectively. Method. 63 patients with thoracolumbar incomplete burst fracture were managed with iMSPI or SSPI. 30 patients were managed with iMSPI and fusion. 33 patients were managed with SSPI and fusion. Operative time, blood loss, postoperative drainage, and complications were recorded. Percentage of anterior body height compression (ABHC%) and sagittal index (SI) were obtained preoperatively, one week postoperatively, and at the last followup. Results. The blood loss and postoperative drainage were significantly less in the iMSPI group than in SSPI group (P < 0.05). The follow-up duration of the two groups was not significantly different (P > 0.05). At 12 months postoperatively posterolateral fusion was obtained satisfactorily. Neither preoperative ABHC% and SI nor postoperative SI were significantly different (P > 0.05), but there was a significant difference in postoperative ABHC% (P = 0.000). The ABHC% and SI were not significantly different between the two groups at the last followup (P > 0.05). There were no fixation failures or other complications. Summary. IMSPI yielded satisfactory results similar to those of SSPI in patients with type A3.1/3.2 thoracolumbar fractures. IMSPI is recommended for minor trauma, reducing one-segment fusion, and maximization of the remaining motor function.