Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.10020.1090
Esam A. Mokbel, H. Elatrozy
Background Data: Posterior atlantoaxial fixation is indicated for C1-C2 instability or painful osteoarthritis. Different techniques were designed for atlantoaxial fixation as sublaminar wiring, transarticular screw fixation, and, recently, C1 lateral mass and C2 pedicle polyaxial screws and rod system. Purpose: To investigate the safety, advantages, and complications of posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws in C1-C2 instability. Study Design: A retrospective clinical case series. Patients and Methods: Fourteen consecutive patients, ten males and four females, with a mean age of 40.8±9.6 years were reported. All had traumatic C1-2 instability due to type II odontoid fractures and underwent posterior fixation with polyaxial C1 lateral mass and C2 pedicle screws. Nine patients suffered from motor vehicle accident (MVA) and 5 suffered from falls. All patients were neurologically intact except four patients who had neurological deficits. We used Japanese Orthopedic Association Score (JOA) for their functional evaluation. The average follow-up was 17±1.96 (range, 12–20 months). Operative time, operative blood loss, screw trajectory, screw length, and injury of neurovascular structures were reported. Fusion and construct stability were evaluated by plain radiography and/or CT. Visual Analogue Scale (VAS) of neck pain and JOA were used to evaluate the functional outcome. Results: The mean duration of surgery was 175.3±12.3 min. The mean blood loss was 553.6±106.5 ml and two patients required transfusion of one unit of blood. The mean length of C1 lateral mass and C2 pedicle screws were 30±1.6 mm and 16.4±1.8 mm, respectively. Correct screw placement and good stability were reported in all patients (100%) at the last follow-up. Mean neck pain on VAS was 2.8±0.8 and 2.3±0.5 at 6 and 12 months, respectively. The complications included moderate pain at iliac graft site for 3 months in 2 patients, pain and dysesthesia in C2 dermatome for 4 months in 3 patients, and superficial wound infection in 2 patients. Conclusion: Posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws is a safe and effective method in the treatment of traumatic atlantoaxial subluxation due to type II odontoid fractures. (2019ESJ176)
{"title":"Surgical Treatment of Traumatic Type II Odontoid Fracture Using Polyaxial C1 Lateral Mass and C2 Pedicle Screws Fixation","authors":"Esam A. Mokbel, H. Elatrozy","doi":"10.21608/ESJ.2019.10020.1090","DOIUrl":"https://doi.org/10.21608/ESJ.2019.10020.1090","url":null,"abstract":"Background Data: Posterior atlantoaxial fixation is indicated for C1-C2 instability or painful osteoarthritis. Different techniques were designed for atlantoaxial fixation as sublaminar wiring, transarticular screw fixation, and, recently, C1 lateral mass and C2 pedicle polyaxial screws and rod system. Purpose: To investigate the safety, advantages, and complications of posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws in C1-C2 instability. Study Design: A retrospective clinical case series. Patients and Methods: Fourteen consecutive patients, ten males and four females, with a mean age of 40.8±9.6 years were reported. All had traumatic C1-2 instability due to type II odontoid fractures and underwent posterior fixation with polyaxial C1 lateral mass and C2 pedicle screws. Nine patients suffered from motor vehicle accident (MVA) and 5 suffered from falls. All patients were neurologically intact except four patients who had neurological deficits. We used Japanese Orthopedic Association Score (JOA) for their functional evaluation. The average follow-up was 17±1.96 (range, 12–20 months). Operative time, operative blood loss, screw trajectory, screw length, and injury of neurovascular structures were reported. Fusion and construct stability were evaluated by plain radiography and/or CT. Visual Analogue Scale (VAS) of neck pain and JOA were used to evaluate the functional outcome. Results: The mean duration of surgery was 175.3±12.3 min. The mean blood loss was 553.6±106.5 ml and two patients required transfusion of one unit of blood. The mean length of C1 lateral mass and C2 pedicle screws were 30±1.6 mm and 16.4±1.8 mm, respectively. Correct screw placement and good stability were reported in all patients (100%) at the last follow-up. Mean neck pain on VAS was 2.8±0.8 and 2.3±0.5 at 6 and 12 months, respectively. The complications included moderate pain at iliac graft site for 3 months in 2 patients, pain and dysesthesia in C2 dermatome for 4 months in 3 patients, and superficial wound infection in 2 patients. Conclusion: Posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws is a safe and effective method in the treatment of traumatic atlantoaxial subluxation due to type II odontoid fractures. (2019ESJ176)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42620586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.10129.1092
Tarek A. Elhewala, A. Eladawy, M. Hussein
Background Data: Thoracolumbar fractures are commonly managed by posterior pedicle screw fixation. Controversy about the number of levels involved in the fixation remains as the stability of the short-segment fixation remains questionable. Recently, it has been shown that application of intermediate screw in the fractured vertebra improves the biomechanical stability of the short-segment construct. Purpose: To compare the outcome of long-segment fixation (LSF) versus short-segment fixation with intermediate screws (SSFIS) in the management of the thoracolumbar burst fractures. Study Design: A prospective, nonrandomized clinical controlled trial. Patients and Methods: Fifty patients with thoracolumbar burst fracture (T11-L2) types A3 and A4 AOSpine classification with a Thoracolumbar Injury Classification and Severity (TLICS) scale of more than 4 were treated between 2009 and 2014 with posterior pedicle screw fixation. Patients were divided into two groups according to the number of instrumented levels. Group 1 included 25 patients treated with LSF (two levels above and two levels below the fractured level) while Group 2 included 25 patients treated by SSFIS (one level above and one level below with 2 intermediate screws in the fractured level). The patients were evaluated for local kyphotic angle (LKA) correction and maintenance, anterior vertebral body height (AVH) compression, and Visual Analogue Scale (VAS) for back pain and treatment related complications. Construct failure was defined as screw pullout or instrument breakage. Results: The two groups were similar with regard to age, sex, fractured levels, fracture type, TLICS score, preoperative local kyphotic angle, and anterior vertebral body height compression. Postoperative correction of the local vertebral compression assessed with LKA and AVH significantly improved in both groups compared to the preoperative degree. There was no significant difference in the two groups in early postoperative or follow-up regarding the degree of correction and its maintenance. No construct failure or major treatment related complication was encountered in both groups with significant reduction of VAS and ODI in both groups between early postoperative and late follow-up (13.5±2 months). Conclusion: Intermediate screw applied in the fractured level in management of thoracolumbar burst fracture improves the correction and maintenance of local kyphosis in short-segment fixation like long-segment construct with saving vertebral motion levels from being fixed. More randomized controlled and multicenter studies are needed to support these findings. (2019ESJ175)
{"title":"Could Intermediate Screw in Thoracolumbar Fracture Fixation Save Motion Levels? Comparative Study between Long-Segment and Short-Segment with Intermediate Screw Fixation","authors":"Tarek A. Elhewala, A. Eladawy, M. Hussein","doi":"10.21608/ESJ.2019.10129.1092","DOIUrl":"https://doi.org/10.21608/ESJ.2019.10129.1092","url":null,"abstract":"Background Data: Thoracolumbar fractures are commonly managed by posterior pedicle screw fixation. Controversy about the number of levels involved in the fixation remains as the stability of the short-segment fixation remains questionable. Recently, it has been shown that application of intermediate screw in the fractured vertebra improves the biomechanical stability of the short-segment construct. \u0000Purpose: To compare the outcome of long-segment fixation (LSF) versus short-segment fixation with intermediate screws (SSFIS) in the management of the thoracolumbar burst fractures. \u0000Study Design: A prospective, nonrandomized clinical controlled trial. \u0000Patients and Methods: Fifty patients with thoracolumbar burst fracture (T11-L2) types A3 and A4 AOSpine classification with a Thoracolumbar Injury Classification and Severity (TLICS) scale of more than 4 were treated between 2009 and 2014 with posterior pedicle screw fixation. Patients were divided into two groups according to the number of instrumented levels. Group 1 included 25 patients treated with LSF (two levels above and two levels below the fractured level) while Group 2 included 25 patients treated by SSFIS (one level above and one level below with 2 intermediate screws in the fractured level). The patients were evaluated for local kyphotic angle (LKA) correction and maintenance, anterior vertebral body height (AVH) compression, and Visual Analogue Scale (VAS) for back pain and treatment related complications. Construct failure was defined as screw pullout or instrument breakage. \u0000Results: The two groups were similar with regard to age, sex, fractured levels, fracture type, TLICS score, preoperative local kyphotic angle, and anterior vertebral body height compression. Postoperative correction of the local vertebral compression assessed with LKA and AVH significantly improved in both groups compared to the preoperative degree. There was no significant difference in the two groups in early postoperative or follow-up regarding the degree of correction and its maintenance. No construct failure or major treatment related complication was encountered in both groups with significant reduction of VAS and ODI in both groups between early postoperative and late follow-up (13.5±2 months). \u0000Conclusion: Intermediate screw applied in the fractured level in management of thoracolumbar burst fracture improves the correction and maintenance of local kyphosis in short-segment fixation like long-segment construct with saving vertebral motion levels from being fixed. More randomized controlled and multicenter studies are needed to support these findings. (2019ESJ175)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42384744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/ESJ.2019.6326.1080
Ahmed Rizk, Andy Ottenbacher
Background Data: Cervicothoracic, high thoracic, and craniocervical instrumented anterior spinal procedures pose a considerable challenge to the surgeon, mainly because intraoperative imaging by fluoroscopy is inadequate. To a certain extent the surgeon can make use of 3D-fluoroscopy for intraoperative control of the implants. To ease this process, the surgeon can make use of the so-called cranial frame which is attached to the Mayfield clamp, in combination with navigated 3D-fluoroscopy. The use of the cranial frame for navigated anterior craniocervical approaches as in the case of transnasal procedures at the clivus and foramen magnum is quite widespread. In the literature, the use of this technique for spine approaches is limited to a few case reports. Purpose: To present the feasibility of 3D-fluoroscopy navigation in anterior cervical spine procedures with the use of cranial frame. Study Design: Retrospective clinical case cohort. Patients and Methods: We present our experience in the technique of navigation in 5 patients of anterior cervical spine procedures. Anterior instrumented fusion in the cervicothoracic spine was performed in 4 patients and in the last patient anterior C1/2 fixation was performed. We used a system composed of Arcadis Orbic 3D C-arm by Siemens Medical Solutions, Erlangen, Germany, for acquisition of 3D images and the Stealth Station system by Medtronic Inc., Louisville, USA, for navigation. We used a socalled cranial frame for navigation that is fixed to the Mayfield head holder; a preoperative 3D scan was performed in some patients. The intraoperative 3D scan was performed after removal of the retractors, and additional 3D scan was beneficial in some patients during the surgical procedure. Results: Navigation was helpful in identification of the entry points and trajectories of the screws especially in the cervicothoracic region with no need for fluoroscopy. Additional advantage of the use of this system is the possibility of performing intraoperative 3D scan after instrumentation to verify hardware placement. Conclusion: The illustrated cases demonstrate the advantages of 3D-fluoroscopy navigation with use of the cranial frame in the upper transitional zones. Disadvantages of this method are the complex intraoperative draping and logistics and the possible inaccuracy because of long distances and spinal mobility. Carbon Mayfield may facilitate positioning but is not mandatory. (2018ESJ173)
背景资料：颈胸、高胸和颅颈前路器械脊柱手术对外科医生来说是一个相当大的挑战，主要是因为术中荧光透视成像不足。在一定程度上，外科医生可以利用3D荧光透视术对植入物进行术中控制。为了简化这一过程，外科医生可以使用连接在Mayfield夹具上的所谓颅骨框架，并结合导航的3D荧光镜检查。在斜坡和大孔经鼻手术的情况下，在导航的前颅颈入路中使用颅骨支架是相当普遍的。在文献中，这种技术在脊柱入路中的应用仅限于少数病例报告。目的：探讨应用颅骨支架在颈椎前路手术中进行三维透视导航的可行性。研究设计：回顾性临床病例队列。患者和方法：我们介绍了5例颈椎前路手术患者的导航技术经验。4名患者在颈胸棘内进行了前路器械融合，最后一名患者进行了C1/2前路固定。我们使用德国埃尔兰根西门子医疗解决方案公司的Arcadis Orbic 3D C型臂系统来获取3D图像，并使用美国路易斯维尔股份有限公司的Stealth Station系统来导航。我们使用了一个所谓的颅骨支架进行导航，该支架固定在Mayfield头部支架上；对一些患者进行了术前3D扫描。术中3D扫描是在取出牵开器后进行的，在手术过程中，对一些患者进行额外的3D扫描是有益的。结果：导航有助于识别螺钉的进入点和轨迹，尤其是在不需要荧光透视的颈胸区域。使用该系统的另一个优点是可以在仪器安装后进行术中3D扫描，以验证硬件放置。结论：图示病例显示了在上过渡区使用颅骨支架进行三维透视导航的优势。这种方法的缺点是复杂的术中覆盖和后勤，以及由于长距离和脊柱活动性可能导致的不准确。Carbon Mayfield可能有助于定位，但不是强制性的。（2018ESJ173）
{"title":"Image-Guided Navigation in Anterior Cervical Spine Surgery using a Cranial Frame","authors":"Ahmed Rizk, Andy Ottenbacher","doi":"10.21608/ESJ.2019.6326.1080","DOIUrl":"https://doi.org/10.21608/ESJ.2019.6326.1080","url":null,"abstract":"Background Data: Cervicothoracic, high thoracic, and craniocervical instrumented anterior spinal procedures pose a considerable challenge to the surgeon, mainly because intraoperative imaging by fluoroscopy is inadequate. To a certain extent the surgeon can make use of 3D-fluoroscopy for intraoperative control of the implants. To ease this process, the surgeon can make use of the so-called cranial frame which is attached to the Mayfield clamp, in combination with navigated 3D-fluoroscopy. The use of the cranial frame for navigated anterior craniocervical approaches as in the case of transnasal procedures at the clivus and foramen magnum is quite widespread. In the literature, the use of this technique for spine approaches is limited to a few case reports. Purpose: To present the feasibility of 3D-fluoroscopy navigation in anterior cervical spine procedures with the use of cranial frame. Study Design: Retrospective clinical case cohort. Patients and Methods: We present our experience in the technique of navigation in 5 patients of anterior cervical spine procedures. Anterior instrumented fusion in the cervicothoracic spine was performed in 4 patients and in the last patient anterior C1/2 fixation was performed. We used a system composed of Arcadis Orbic 3D C-arm by Siemens Medical Solutions, Erlangen, Germany, for acquisition of 3D images and the Stealth Station system by Medtronic Inc., Louisville, USA, for navigation. We used a socalled cranial frame for navigation that is fixed to the Mayfield head holder; a preoperative 3D scan was performed in some patients. The intraoperative 3D scan was performed after removal of the retractors, and additional 3D scan was beneficial in some patients during the surgical procedure. Results: Navigation was helpful in identification of the entry points and trajectories of the screws especially in the cervicothoracic region with no need for fluoroscopy. Additional advantage of the use of this system is the possibility of performing intraoperative 3D scan after instrumentation to verify hardware placement. Conclusion: The illustrated cases demonstrate the advantages of 3D-fluoroscopy navigation with use of the cranial frame in the upper transitional zones. Disadvantages of this method are the complex intraoperative draping and logistics and the possible inaccuracy because of long distances and spinal mobility. Carbon Mayfield may facilitate positioning but is not mandatory. (2018ESJ173)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44024910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/ESJ.2019.4534.1053
M. Hussein, A. Eladawy, Tarek A. Elhewala
Background Data: Minimally invasive fenestration has evolved recently to become the modern standard surgical solution for degenerative lumbar spinal canal stenosis (DLCS).Purpose: To investigate the safety and the efficacy of the endoscopic fenestration for patients with monosegmental degenerative lumbar spinal canal stenosis.Study Design: Prospective clinical cohort study.Patients and Methods: Thirty-five consecutive patients with DLCS were treated with endoscopic fenestration. Patients were treated with METRx system (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), at Orthopedic Department, Zagazig University, between May 2012 and June 2015. Primary outcomes parameters included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary outcomes parameters included operative time, blood loss, preoperative and 3-month postoperative lumbar dynamic radiographs, and modified McNab criteria. Only patients who completed 36 months of follow-up were included in the final analysis of this study. Follow-up data were obtained from outpatient clinic follow-up visits by two independent physicians.Results: At the final follow-up, the improvement in claudicant leg pain and disability was statistically significant, and the endoscopic fenestration procedure did not affect the stability of the motion segment. The total success rate according to McNab criteria was 85.7% (30/35), fair 5.7% (2/35), and poor 8.6% (3/35). The mean NRS leg score significantly decreased from 7.3±1.5 preoperatively to 0.8±0.67 (P=0.001) postoperatively. The mean ODI score significantly decreased from 72.34±4.6 % preoperatively to 13.71±3.46 % postoperatively. There were no reported serious complications in any of our patients’ study.Conclusion: Endoscopic fenestration is a safe and effective technique in patients with degenerative lumbar stenosis. It allows adequate decompression of the neural elements and preserves spinal stability. (2018ESJ145)
{"title":"Endoscopic Fenestration in Management of Monosegmental Degenerative Lumbar Spinal Canal Stenosis: A Clinical Cohort Study","authors":"M. Hussein, A. Eladawy, Tarek A. Elhewala","doi":"10.21608/ESJ.2019.4534.1053","DOIUrl":"https://doi.org/10.21608/ESJ.2019.4534.1053","url":null,"abstract":"Background Data: Minimally invasive fenestration has evolved recently to become the modern standard surgical solution for degenerative lumbar spinal canal stenosis (DLCS).Purpose: To investigate the safety and the efficacy of the endoscopic fenestration for patients with monosegmental degenerative lumbar spinal canal stenosis.Study Design: Prospective clinical cohort study.Patients and Methods: Thirty-five consecutive patients with DLCS were treated with endoscopic fenestration. Patients were treated with METRx system (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), at Orthopedic Department, Zagazig University, between May 2012 and June 2015. Primary outcomes parameters included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary outcomes parameters included operative time, blood loss, preoperative and 3-month postoperative lumbar dynamic radiographs, and modified McNab criteria. Only patients who completed 36 months of follow-up were included in the final analysis of this study. Follow-up data were obtained from outpatient clinic follow-up visits by two independent physicians.Results: At the final follow-up, the improvement in claudicant leg pain and disability was statistically significant, and the endoscopic fenestration procedure did not affect the stability of the motion segment. The total success rate according to McNab criteria was 85.7% (30/35), fair 5.7% (2/35), and poor 8.6% (3/35). The mean NRS leg score significantly decreased from 7.3±1.5 preoperatively to 0.8±0.67 (P=0.001) postoperatively. The mean ODI score significantly decreased from 72.34±4.6 % preoperatively to 13.71±3.46 % postoperatively. There were no reported serious complications in any of our patients’ study.Conclusion: Endoscopic fenestration is a safe and effective technique in patients with degenerative lumbar stenosis. It allows adequate decompression of the neural elements and preserves spinal stability. (2018ESJ145)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49398398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/ESJ.2019.2705.1029
Islam Sorour, Yasser Elbanna, S. Samy
Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed.Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction.Study Design: Retrospective clinical case cohort study.Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com).Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.
{"title":"Shoulder Balance and Scoliosis: The Unresolved Issue","authors":"Islam Sorour, Yasser Elbanna, S. Samy","doi":"10.21608/ESJ.2019.2705.1029","DOIUrl":"https://doi.org/10.21608/ESJ.2019.2705.1029","url":null,"abstract":"Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed.Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction.Study Design: Retrospective clinical case cohort study.Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com).Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48251184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/ESJ.2019.7442.1088
Hesham Habba, A. Abou-Madawi, Mohmed AlQazaz, M. Moustafa
Background Data: ACDF is one of the most commonly performed operations for degenerative spinal diseases. Traditionally, graft was harvested from iliac crest which was associated with donor site morbidity. This has led to the introduction of many synthetic implants such as PEEK cages to overcome this problem.Purpose: To evaluate the patterns of spinal fusion after ACDF with PEEK cage filled with HA.Study Design: Retrospective clinical study.Patients and Methods: Twenty-five patients that underwent ACDF with PEEK cage filled HA were enrolled in this study through the period from January to December 2017. All patients were submitted to pre- and postoperative clinical and radiological follow-up. Postoperative full neurological and images evaluations were done by independent observer on outpatients at 1, 2, 3, 6, and 12 months. Postoperative neck pain was evaluated using VAS. Radiological evaluation was done using cervical X-ray and images were evaluated using software SurgimapTM.Results: The mean age of our patients was 44.4±6.57 with 9 patients being males and 16 patients females. Total numbers of levels reported were 33 in 25 patients, with 17 patients (68%) undergoing single-level ACDF and 8 patients (32%) double-level ACDF. Five patients (20%) suffered from myeloradiculopathy and twenty patients (80%) had radiculopathy. The mean follow-up was 11.04±1.2. The mean preoperative neck pain VAS was 7.8±1.9, while postoperative VAS was 2.9±1.8. Continuous bridging bony trabeculae were reported in 29 levels (87.9 %) (N=21), while they were absent in 4 levels (12.1%) (N=4). Cage migration was reported in two patients (6%) and both showed >2 mm mobility in dynamic cervical X-ray indicating instability and nonunion.Conclusion: ACDF with PEEK cage filled with HA is a safe and effective method to achieve interbody fusion in patients with cervical disc disease. Although fusion occurred within usual time, remodeling took longer time than that previously reported with iliac graft (2018ESJ171).
{"title":"Patterns of Spinal Fusion after Anterior Cervical Discectomy and Fusion with Polyether Ether Ketone Cage Filled Hydroxyapatite","authors":"Hesham Habba, A. Abou-Madawi, Mohmed AlQazaz, M. Moustafa","doi":"10.21608/ESJ.2019.7442.1088","DOIUrl":"https://doi.org/10.21608/ESJ.2019.7442.1088","url":null,"abstract":"Background Data: ACDF is one of the most commonly performed operations for degenerative spinal diseases. Traditionally, graft was harvested from iliac crest which was associated with donor site morbidity. This has led to the introduction of many synthetic implants such as PEEK cages to overcome this problem.Purpose: To evaluate the patterns of spinal fusion after ACDF with PEEK cage filled with HA.Study Design: Retrospective clinical study.Patients and Methods: Twenty-five patients that underwent ACDF with PEEK cage filled HA were enrolled in this study through the period from January to December 2017. All patients were submitted to pre- and postoperative clinical and radiological follow-up. Postoperative full neurological and images evaluations were done by independent observer on outpatients at 1, 2, 3, 6, and 12 months. Postoperative neck pain was evaluated using VAS. Radiological evaluation was done using cervical X-ray and images were evaluated using software SurgimapTM.Results: The mean age of our patients was 44.4±6.57 with 9 patients being males and 16 patients females. Total numbers of levels reported were 33 in 25 patients, with 17 patients (68%) undergoing single-level ACDF and 8 patients (32%) double-level ACDF. Five patients (20%) suffered from myeloradiculopathy and twenty patients (80%) had radiculopathy. The mean follow-up was 11.04±1.2. The mean preoperative neck pain VAS was 7.8±1.9, while postoperative VAS was 2.9±1.8. Continuous bridging bony trabeculae were reported in 29 levels (87.9 %) (N=21), while they were absent in 4 levels (12.1%) (N=4). Cage migration was reported in two patients (6%) and both showed >2 mm mobility in dynamic cervical X-ray indicating instability and nonunion.Conclusion: ACDF with PEEK cage filled with HA is a safe and effective method to achieve interbody fusion in patients with cervical disc disease. Although fusion occurred within usual time, remodeling took longer time than that previously reported with iliac graft (2018ESJ171).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68511443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/esj.2019.6468.1083
M. Abdellatif
Background Data: Neurofibromatosis type 1 (NF-1) patients with dystrophic changes of the spine develop severe spinal deformity and/or instability and always need early surgical treatment. Combined anterior-posterior fusion was the treatment of choice of such curves because of the risk of progression and pseudoarthrosis even in the presence of solid posterior fusion mass. Recent 3rd-generation posterior stabilization systems using pedicle screw fixation allow better 3-column purchase and 3D control and correction of deformity and stable posterior fixation of the spine preventing progression of the curves. Posterior-only surgery has been recently used in dystrophic NF-1 scoliosis due to use of pedicle screws fixation and development of different types of posterior release/osteotomies which lead to successful and sustained correction of these curves. Study Design: A retrospective clinical cohort study. Purpose
{"title":"Evaluation of Efficacy and Safety of All Pedicle Screw Posterior-Only Surgery in Patients with Dystrophic Neurofibromatosis Scoliosis","authors":"M. Abdellatif","doi":"10.21608/esj.2019.6468.1083","DOIUrl":"https://doi.org/10.21608/esj.2019.6468.1083","url":null,"abstract":"Background Data: Neurofibromatosis type 1 (NF-1) patients with dystrophic changes of the spine develop severe spinal deformity and/or instability and always need early surgical treatment. Combined anterior-posterior fusion was the treatment of choice of such curves because of the risk of progression and pseudoarthrosis even in the presence of solid posterior fusion mass. Recent 3rd-generation posterior stabilization systems using pedicle screw fixation allow better 3-column purchase and 3D control and correction of deformity and stable posterior fixation of the spine preventing progression of the curves. Posterior-only surgery has been recently used in dystrophic NF-1 scoliosis due to use of pedicle screws fixation and development of different types of posterior release/osteotomies which lead to successful and sustained correction of these curves. Study Design: A retrospective clinical cohort study. Purpose","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48944808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21608/ESJ.2019.6463.1084
Mohamed bdEllatif
Background Data: Lumber spine mobility is very important clinically and functionally especially in younger patients. Fusion in Scheuermann kyphosis is a long fusion surgery that usually extends into the lumber spine leaving less mobile segments. Debate has focused on the selection of the LIV. Some recommend fusing into the SSV to decrease the incidence of DJK while others use the FLV which is just caudal to the first lordotic disc as the LIV to save more motion segments. Few studies recommend fusion into the vertebra just cephalic to the first lordotic disc (FLV-1).Study Design: A prospective clinical case study.Purpose: To evaluate the outcomes of fusing into the FLV-1 in surgical treatment of SK and whether it is associated with increased incidence of distal junctional failure and DJK or not.Patients and Methods: The study included 25 patients with SK treated by posterior-only surgery using all pedicular screw instrumentation with or without posterior release/Ponte osteotomies using the FLV-1 as the LIV. The study was done in the period between February 2011 and February 2015. Patients were evaluated radiologically by full length standing biplanar X-rays and hyperextension flexibility X-ray. Parameters assessed included KA, TK, LL, and SVA for assessments of sagittal balance together with three pelvic parameters including the PI, PT, and SS angles. Clinical outcome was measured by the ODI and SRS-30 scores. Any complication encountered was documented, especially DJK, PJK, or implant failure.Results: Mean follow-up period of the patients was 40±14.88 months. The average KA improved from 82.2±9.2◦ preoperatively to 38.2±5.47◦ yielding 53.54% correction rate with minimal change at final follow-up of 39.9±5.47◦ and 2% loss of correction. SVA improved from 6.35 mm (range, 60–40) to 12.25 mm (range, 25–10) at final follow-up. The difference between the FLV and FLV-1 was 1 segment whereas the difference between the SSV and FLV-1 was 1.7±0.47 segments (range, 1-2) and the difference between the SSV and the FLV was 0.7±0.47 segments (range, 0-1). PJK occurred in 2 patients without symptoms and another 2 patients suffered mild radiological DJK and all required no treatment. Only one patient had screw pull-out and required revision. Final SRS-30 score was 125.4±15.71 (range, 95–140) and the average ODI was 7.3±2.56 (range, 4–12) without any disability.
{"title":"Selection of the Distal Fusion Level in Posterior-Only Surgery of Scheuermann Kyphosis: The Concept of the FLV-1","authors":"Mohamed bdEllatif","doi":"10.21608/ESJ.2019.6463.1084","DOIUrl":"https://doi.org/10.21608/ESJ.2019.6463.1084","url":null,"abstract":"Background Data: Lumber spine mobility is very important clinically and functionally especially in younger patients. Fusion in Scheuermann kyphosis is a long fusion surgery that usually extends into the lumber spine leaving less mobile segments. Debate has focused on the selection of the LIV. Some recommend fusing into the SSV to decrease the incidence of DJK while others use the FLV which is just caudal to the first lordotic disc as the LIV to save more motion segments. Few studies recommend fusion into the vertebra just cephalic to the first lordotic disc (FLV-1).Study Design: A prospective clinical case study.Purpose: To evaluate the outcomes of fusing into the FLV-1 in surgical treatment of SK and whether it is associated with increased incidence of distal junctional failure and DJK or not.Patients and Methods: The study included 25 patients with SK treated by posterior-only surgery using all pedicular screw instrumentation with or without posterior release/Ponte osteotomies using the FLV-1 as the LIV. The study was done in the period between February 2011 and February 2015. Patients were evaluated radiologically by full length standing biplanar X-rays and hyperextension flexibility X-ray. Parameters assessed included KA, TK, LL, and SVA for assessments of sagittal balance together with three pelvic parameters including the PI, PT, and SS angles. Clinical outcome was measured by the ODI and SRS-30 scores. Any complication encountered was documented, especially DJK, PJK, or implant failure.Results: Mean follow-up period of the patients was 40±14.88 months. The average KA improved from 82.2±9.2◦ preoperatively to 38.2±5.47◦ yielding 53.54% correction rate with minimal change at final follow-up of 39.9±5.47◦ and 2% loss of correction. SVA improved from 6.35 mm (range, 60–40) to 12.25 mm (range, 25–10) at final follow-up. The difference between the FLV and FLV-1 was 1 segment whereas the difference between the SSV and FLV-1 was 1.7±0.47 segments (range, 1-2) and the difference between the SSV and the FLV was 0.7±0.47 segments (range, 0-1). PJK occurred in 2 patients without symptoms and another 2 patients suffered mild radiological DJK and all required no treatment. Only one patient had screw pull-out and required revision. Final SRS-30 score was 125.4±15.71 (range, 95–140) and the average ODI was 7.3±2.56 (range, 4–12) without any disability.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47162758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.21608/ESJ.2019.5180.1066
M. Saleh, Mohamed Abdelrazek, S. Elgawhary
Background Data: Lumbar degenerative disorders may result in low back pain, leg pain and limitation of walking distance that can disturb the patients’ life. Several surgical procedures have been used to treat spinal canal stenosis ranging from minimal invasive to extensive decompression and fusion. However, recurrence of symptoms or instability may occur postoperatively. Purpose: To evaluate efficacy and safety of sublaminar decompression and fusion in the management of lumbar degenerative disorders. Study Design: Prospective clinical case study. Patients and Methods: Twenty patients including; 7 central canal stenosis, 5 degenerative disc disease, 4 foraminal and central stenosis, and 4 central stenosis and spondylolisthesis patients were enrolled in this study. All were treated with sublaminar decompression and fusion. Preand post-operative clinical evaluation included Visual Analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI). Preand post-operative measurement of anteroposterior thecal diameter, thecal cross-sectional area, right and left foraminal height were obtained using MRI and CT-scan. The mean follow up duration was 13.85±8.30 (Range, 8-33) months. Results: VAS of leg pain improved from 7.3±1.4 to 2.4±0.9, VAS of the back pain improved from 7.4±0.9 to 2.3±0.5. ODI improved from 76±7.5 to 29.5±8.3. Anteroposterior thecal diameter changed from 10.4±1.4 mm to 14.1±1.1mm. Thecal sac cross sectional area improved from 134.2±19.6 mm to 184±20.4 mm. Right foraminal height changed from 4.4±0.5 mm to 5.4±0.5 mm and left foraminal height changed from 4.2±0.5 mm to 5.2±0.5 mm. The mean time to achieve bone fusion in our series was 8.1 months and the fusion rate was 95%. Conclusion: Sublaminar decompression and fusion is safe and effective procedure in treatment of stenotic degenerative spinal disorders. It achieves high fusion rate without serious complications. (2018ESJ166)
{"title":"Sublaminar Decompression and Fusion in the Management of Stenotic Lumbar Degenerative Disorders","authors":"M. Saleh, Mohamed Abdelrazek, S. Elgawhary","doi":"10.21608/ESJ.2019.5180.1066","DOIUrl":"https://doi.org/10.21608/ESJ.2019.5180.1066","url":null,"abstract":"Background Data: Lumbar degenerative disorders may result in low back pain, leg pain and limitation of walking distance that can disturb the patients’ life. Several surgical procedures have been used to treat spinal canal stenosis ranging from minimal invasive to extensive decompression and fusion. However, recurrence of symptoms or instability may occur postoperatively. Purpose: To evaluate efficacy and safety of sublaminar decompression and fusion in the management of lumbar degenerative disorders. Study Design: Prospective clinical case study. Patients and Methods: Twenty patients including; 7 central canal stenosis, 5 degenerative disc disease, 4 foraminal and central stenosis, and 4 central stenosis and spondylolisthesis patients were enrolled in this study. All were treated with sublaminar decompression and fusion. Preand post-operative clinical evaluation included Visual Analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI). Preand post-operative measurement of anteroposterior thecal diameter, thecal cross-sectional area, right and left foraminal height were obtained using MRI and CT-scan. The mean follow up duration was 13.85±8.30 (Range, 8-33) months. Results: VAS of leg pain improved from 7.3±1.4 to 2.4±0.9, VAS of the back pain improved from 7.4±0.9 to 2.3±0.5. ODI improved from 76±7.5 to 29.5±8.3. Anteroposterior thecal diameter changed from 10.4±1.4 mm to 14.1±1.1mm. Thecal sac cross sectional area improved from 134.2±19.6 mm to 184±20.4 mm. Right foraminal height changed from 4.4±0.5 mm to 5.4±0.5 mm and left foraminal height changed from 4.2±0.5 mm to 5.2±0.5 mm. The mean time to achieve bone fusion in our series was 8.1 months and the fusion rate was 95%. Conclusion: Sublaminar decompression and fusion is safe and effective procedure in treatment of stenotic degenerative spinal disorders. It achieves high fusion rate without serious complications. (2018ESJ166)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42142516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.21608/ESJ.2018.4651.1054
M. Hassanein
Background Data: Burst fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and instrumentation failure due to inadequate support of the anterior column. Purpose: To evaluate the efficacy of pedicle screw instrumentation combined with transpedicular titanium mesh cage augmentation for treatment of burst fractures. Study Design: Prospective descriptive cohort clinical case study. Patients and Methods: Fourteen neurologically intact patients with acute incomplete thoracolumbar burst fracture (AO type A 3.1), and operated upon through period from January 2016 to June 2017 were included. Patients were treated using a three vertebrae pedicle screw fixation construct combined with bilateral transpedicular titanium mesh cage augmentation of the fracture. Patients were followed for at least one year. Data about pain (VAS), function (ODI) and vertebral body deformity (Beck index and local kyphotic angle) were recorded prospectively. Results: Patients were operated within 5 days after trauma. The mean VAS score improved after surgeryfrom 8.2±1.3 to 3.7±1.1 postoperatively and to 1.8±0.7 at final follow up (P<0.05). The mean ODI score improved from 69.4±5.2 preoperatively to 17.2±2.4 at final follow up. The mean Beck index improved from 0.63 preoperatively to 0.81 postoperatively and to 0.79 at final follow up. The mean local kyphotic angle improved from 20.4 preoperatively to 11.5 postoperatively and declined to 13.7 at final visit. No patient had neurological deterioration or hardware failure during the follow up.The mean follow up was 13.4±1.8 months. Conclusion: Posterior stabilization using pedicle screw fixation in combination with titanium mesh cage augmentation can maintain vertebral restoration, prevent hardware failure and lead to better clinical outcome. (2018ESJ162)
背景资料:爆裂性骨折通常是由破坏前柱的轴向压迫引起的。在这种情况下，单独使用椎弓根螺钉进行后路稳定可能会由于前柱支撑不足而导致延迟性后凸和内固定失败。目的:评价经椎弓根螺钉内固定联合经椎弓根钛网笼增强术治疗爆裂性骨折的疗效。研究设计:前瞻性描述性队列临床病例研究。患者与方法:选取2016年1月至2017年6月手术治疗的急性不完全性胸腰椎爆裂性骨折(AO A 3.1型)患者14例，患者神经功能完整。患者采用三椎弓根螺钉固定结构结合双侧经椎弓根钛网笼增强骨折治疗。患者被随访了至少一年。前瞻性记录疼痛(VAS)、功能(ODI)和椎体畸形(Beck指数和局部后凸角)数据。结果:患者均在创伤后5天内完成手术。术后VAS评分由8.2±1.3分提高至3.7±1.1分，末次随访时VAS评分为1.8±0.7分(P<0.05)。平均ODI评分由术前的69.4±5.2分改善至最终随访时的17.2±2.4分。平均贝克指数从术前的0.63提高到术后的0.81，最后随访时提高到0.79。平均局部后凸角从术前的20.4角改善到术后的11.5角，最后一次就诊时下降到13.7角。随访期间无患者出现神经功能恶化或硬件故障。平均随访13.4±1.8个月。结论:经椎弓根螺钉固定联合钛网笼增强后路稳定可维持椎体复位，防止硬件失效，临床效果较好。(2018 esj162)
{"title":"Evaluation of Posterior Stabilization Reinforced with Intravertebral Titanium Mesh Cages in Treating Acute Thoracolumbar Burst Fractures","authors":"M. Hassanein","doi":"10.21608/ESJ.2018.4651.1054","DOIUrl":"https://doi.org/10.21608/ESJ.2018.4651.1054","url":null,"abstract":"Background Data: Burst fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and instrumentation failure due to inadequate support of the anterior column. Purpose: To evaluate the efficacy of pedicle screw instrumentation combined with transpedicular titanium mesh cage augmentation for treatment of burst fractures. Study Design: Prospective descriptive cohort clinical case study. Patients and Methods: Fourteen neurologically intact patients with acute incomplete thoracolumbar burst fracture (AO type A 3.1), and operated upon through period from January 2016 to June 2017 were included. Patients were treated using a three vertebrae pedicle screw fixation construct combined with bilateral transpedicular titanium mesh cage augmentation of the fracture. Patients were followed for at least one year. Data about pain (VAS), function (ODI) and vertebral body deformity (Beck index and local kyphotic angle) were recorded prospectively. Results: Patients were operated within 5 days after trauma. The mean VAS score improved after surgeryfrom 8.2±1.3 to 3.7±1.1 postoperatively and to 1.8±0.7 at final follow up (P<0.05). The mean ODI score improved from 69.4±5.2 preoperatively to 17.2±2.4 at final follow up. The mean Beck index improved from 0.63 preoperatively to 0.81 postoperatively and to 0.79 at final follow up. The mean local kyphotic angle improved from 20.4 preoperatively to 11.5 postoperatively and declined to 13.7 at final visit. No patient had neurological deterioration or hardware failure during the follow up.The mean follow up was 13.4±1.8 months. Conclusion: Posterior stabilization using pedicle screw fixation in combination with titanium mesh cage augmentation can maintain vertebral restoration, prevent hardware failure and lead to better clinical outcome. (2018ESJ162)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47945211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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