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Ikwuegbuenyi CA, Waterkeyn F, Okembo A, Bureta C, Kassim KO, Shabani HK, Zuckerman S, Härtl R. Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study. Int J Spine Surg 2024:8575. [PMID: 38499345 DOI: 10.14444/8575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality. METHODS A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO (Arbeitsgemeinschaft für Osteosynthesefragen) TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality. RESULTS The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, P < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, P = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, P < 0.001). However, this finding was lost in multivariate regression. CONCLUSIONS This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement. CLINICAL RELEVANCE Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Chibuikem A Ikwuegbuenyi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - François Waterkeyn
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Arthur Okembo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Costansia Bureta
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Kassim O Kassim
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Scott Zuckerman
- Departments of Neurological Surgery and Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
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Waterkeyn F, Ikwuegbuenyi CA, Woodfield J, Sommer F, Magogo J, Cheserem B, Schupper AJ, Shabani HK, Hussain I, Ahmad AA, Balsano M, Mangat H, Härtl R. Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa. World Neurosurg 2023; 180:e550-e559. [PMID: 37778623 DOI: 10.1016/j.wneu.2023.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. METHODS We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. RESULTS The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. CONCLUSIONS To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.
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Affiliation(s)
- François Waterkeyn
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium.
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Julie Woodfield
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Fabian Sommer
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Juma Magogo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Beverly Cheserem
- Department of Neurological Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Alexander J Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Ibrahim Hussain
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Alaaeldin Azmi Ahmad
- Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Halinder Mangat
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
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Waterkeyn F, Ikwuegbuenyi CA, Sommer F, Shayo C, Shabani HK, Härtl R. Presentation, Management, and Outcomes of Traumatic Spinal Injuries Following Coconut Tree Fall in Tanzania: A Retrospective Study of 44 Cases. World Neurosurg 2023:S1878-8750(23)00402-3. [PMID: 36966909 DOI: 10.1016/j.wneu.2023.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND In nations where tree harvesting constitutes a significant aspect of the economy, such as Tanzania, falls from trees represent a prevalent cause of traumatic injuries. This study investigates the characteristics of traumatic spinal injuries (TSIs) resulting from falls from coconut trees. (CTFs). METHODS This was a retrospective study of a prospectively maintained spine trauma database at Muhimbili Orthopedic Institute (MOI). We included patients older than 14 years, admitted for TSI secondary to CTF, and with a traumatism not more than 2 months before the admission. Our study analyzed patient data from January 2017 to December 2021. We compiled demographic and clinical information and details such as the distance from the site of trauma to the hospital, American Spinal Injury Association Impairment (ASIA) scale assessment, time to surgery, AOSpine classification, and discharge status. Descriptive analysis was done using data management software. No statistical computing was done. RESULTS We included 44 patients, all of whom were male, with a mean age of 34.3 ± 12.1 years. At admission, 47.7% of the patients had an ASIA A injury, with the lumbar spine being the most commonly fractured level at 40.9%. In contrast, only 13.6% of the cases involved the cervical spine. Most (65.9%) of the fractures were classified as type A compression fractures (AO classification). Nearly all patients admitted (95.5%) had surgical indications, but only 52.4% received surgical treatment. The overall mortality rate was 4.5%. With respect to neurologic improvement, only 11.4% experienced an improvement in their ASIA score at discharge, the majority of who were in the surgical group. CONCLUSIONS The present study demonstrates that CTFs in Tanzania constitute a substantial source of TSIs, frequently resulting in severe lumbar injuries. These findings underscore the need for the implementation of educational and preventive measures.
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Affiliation(s)
- François Waterkeyn
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Fabian Sommer
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York
| | - Consolata Shayo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York.
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Waterkeyn F, Woodfield J, Massawe SL, Mzimbiri JM, Shabhay ZA, Bureta CA, Sommer F, Mndeme H, Magawa DG, Kwelukilwa D, Ndossi MY, Kinghomella AA, Kaale AJ, Ahmed S, Mtei J, Minja F, Moses M, Medary B, Hussain I, Ikwuegbuenyi CA, Petr O, Kiloloma WO, Rutabasibwa NB, Mangat HS, Mchome LL, Härtl R, Shabani HK. The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence. Brain Spine 2023; 3:101727. [PMID: 37383451 PMCID: PMC10293233 DOI: 10.1016/j.bas.2023.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.
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Affiliation(s)
- François Waterkeyn
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Julie Woodfield
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Sylvia Leon Massawe
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Juma Magogo Mzimbiri
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Department of Neurosurgery, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Zarina Ali Shabhay
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Fabian Sommer
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Hadija Mndeme
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Dorcas Gidion Magawa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | | | - Aingaya Jackson Kaale
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Shakeel Ahmed
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - John Mtei
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Fidelis Minja
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Moses Moses
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Branden Medary
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Chibuikem Anthony Ikwuegbuenyi
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Ondra Petr
- Charles University in Prague, Prague, Czech Republic
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wanin Othman Kiloloma
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Halinder Singh Mangat
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Laurent Lemeri Mchome
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Roger Härtl
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Hamisi Kimaro Shabani
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
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Waterkeyn F, Lohkamp LN, Ikwuegbuenyi CA, Mchome LL, Rutabasibwa NB, Shabani HK, Härtl R, Petr O. Current Treatment Management of Aneurysmal Subarachnoid Hemorrhage with Prevailing Trends and Results in Tanzania: A Single-Center Experience at Muhimbili Orthopedic and Neurosurgery Institute. World Neurosurg 2023; 170:e256-e263. [PMID: 36336272 DOI: 10.1016/j.wneu.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain poorly understood, with many underdiagnosed cases. Muhimbili Orthopaedic and Neurosurgery Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim of this study is to describe the current aSAH management with regional outcomes and limitations. METHODS Patients with aSAH confirmed by computed tomography/magnetic resonance angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiologic characteristics, injury characteristics, and the modified Rankin Scale (mRS) score. RESULTS In total, 22 patients, with a female/male ratio of 1.4 and a median age of 54 years (interquartile range [IQR], 47.2-63 years) harboring 24 aneurysms were analyzed. Thirteen patients (59.1%) paid out of pocket. The median distance traveled by patients was 537 km (IQR, 34.7-635 km). The median time between admission and treatment was 12 days (IQR, 3.2-39 days). The most common symptoms were headache (n = 20; 90.9%) and high blood pressure (n = 10; 45.4%). Nine patients (40.9%) had Fisher grade 1 and 12 (54.5%) World Federation of Neurosurgical Societies grade I. The most common aneurysms were of the middle cerebral artery (7/29.2%). Fourteen patients (63.6%) underwent clipping; of those, only 4 (28.6%) were operated on within 72 hours. Mortality was 62.5% in the nonsurgical group. Among clipped patients, 78.6% showed favorable outcomes, with no mortality. Endovascular treatment is not available in Tanzania. CONCLUSIONS To our best knowledge, this is the first study highlighting aSAH management in Tanzania, with its assets and shortcomings. Our data show pertinent differences among international treatment guidelines, with the resultant outcomes, such as high preoperative mortality resulting from delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.
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Affiliation(s)
- François Waterkeyn
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Laura-Nanna Lohkamp
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chibuikem A Ikwuegbuenyi
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Lemeri L Mchome
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Nicephorus B Rutabasibwa
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Roger Härtl
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Ondra Petr
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
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Raftopoulos C, Waterkeyn F, Fomekong E, Duprez T. Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy. Adv Tech Stand Neurosurg 2012; 38:75-93. [PMID: 22592412 DOI: 10.1007/978-3-7091-0676-1_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many surgical treatments for chronic low back pain that is refractory to medical treatments focus on spine stabilization. One of the main surgical procedures consists of placing an interbody cage with bone grafts associated with pedicle screws [2, 25, 30]. This technique can be performed using different approaches: a large open posterior approach, tubular approaches (minimal open) or percutaneously (minimally invasive percutaneous or MIP) [5, 28]. One of the main difficulties is to precisely locate the screws into the pedicle avoiding especially infero-medial pedicle breaches. This difficulty is even great- er when working percutaneously. This paper focuses on percutaneously placed pedicle screws (PPS), reports the use of a robotic multi-axis 2D/3D fluoros- copy to enhance the accuracy of pedicle screw placement and reviews other strategies and results reported in the literature.
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Affiliation(s)
- C Raftopoulos
- Department of Neurosurgery and Neuroradiology, Clinique Universitaire St-Luc, Brussels, Belgium
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Waterkeyn F, Fomekong E, Duprez T, Raftopoulos C. Apport de l’imagerie intraopératoire dans les ostéosynthèses percutanées : à propos d’une série consécutive de 71 patients. Neurochirurgie 2011. [DOI: 10.1016/j.neuchi.2011.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fomekong E, Waterkeyn F, Docquier MA, Duprez T, Raftopoulos C. Résonance magnétique nucléaire intraopératoire 3.0 tesla pour l’évaluation de l’étendue de l’exérèse par voie transsphénoïdale des macroadénomes hypophysaires. Résultats préliminaires d’une série de 27 patients. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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