BACKGROUND: The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation without fusion for treating type A3 and A4 thoracolumbar fractures. Traumatic thoracolumbar burst fracture is a common pathology without a consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) systems have been recently introduced in the treatment of spinal fractures to reduce the adverse effects associated with the conventional open approaches, such as iatrogenic muscle denervation and pain. METHODS: A prospective analysis was made to evaluate consecutive 46 patients with type A3 and A4 thoracolumbar fractures. Patients were divided into a percutaneous pedicle screw fixation group (PPSF) and an open pedicle screw fixation group (OPSF). The mean age of patients in PPSF group (12 men, 11 woman) was 49.9 years and in OPSF group (10 men, 13 women) 52.2 years. For the purpose of evaluation, the radiological assessment of the bisegmental Cobb angle, the loss of correction, the volume of blood loss, operation time, cumulative radiation time and dose were recorded and compared. RESULTS: All patients were followed up for 12 months. There were no significant differences between OPSF and PPSF in the Cobb angle preoperative and postoperative angle and the loss of bisegmental correction. In PPSF group, the mean preoperative Cobb angle was 10.9° and improved by 4.5° postoperatively, and in OPSF group the preoperative angle was 12.1° and postoperatively improved by 3.8°. Significant differences between OPSF and PPSF were found in the mean cumulative radiation time, radiation dose and operation time. PPSF group also had a significantly lower perioperative blood loss. CONCLUSIONS: Both open and percutaneous short-segment pedicle fixation were safe and effective methods to treat thoracolumbar burst fractures. Percutaneous fixation without fusion seems to be suitable for type A3 and A4 fractures.
- MeSH
- bederní obratle zranění chirurgie MeSH
- dávka záření MeSH
- délka operace MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- hrudní obratle zranění chirurgie MeSH
- kohortové studie MeSH
- krvácení při operaci MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- mladý dospělý MeSH
- pedikulární šrouby * MeSH
- prospektivní studie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- MeSH
- chirurgie operační metody MeSH
- fraktury páteře chirurgie komplikace patofyziologie terapie MeSH
- kosti a kostní tkáň patofyziologie zranění MeSH
- krční obratle patofyziologie zranění MeSH
- lidé MeSH
- ochrnutí hlasivek patofyziologie terapie MeSH
- ortopedické výkony metody MeSH
- páteř patofyziologie MeSH
- poranění krku chirurgie patofyziologie terapie MeSH
- poranění nervového systému patofyziologie terapie MeSH
- vnitřní fixace fraktury metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY In the management of dens axis fractures in patients older than 65 years of age the posterior approach is preferred due to osteoporosis and the risk of a failure of anterior osteosynthesis. The posterior approach, however, is associated with a higher incidence of complications. A combination of anterior transarticular fixation of C1/2 (ATS) with compression osteosynthesis of dens axis significantly increases the stability of osteosynthesis. MATERIAL AND METHODS In the period from 2009 to 2015 our hospital admitted 13 patients older than 65 years of age with a diagnosed type III dens axis fracture based on AO classification. 8 patients sustained a dens axis fracture combined with a stable atlas fracture. The cohort consisted of 13 women aged 67 to 90 years, with the mean age of 82.3 years. None of the female patients were affected neurologically. The dens axis fracture was treated by anterior approach. Once the screw was inserted in the dens axis, two more screws were added, the entrance points of those screws were medial and lateral to the odontoid screw and direction was divergently via C1/2 joints in order to reinforce stability. The patients were monitored at 6-week, 3-, 6- and 12-month follow-ups. Bone healing was confirmed by CT scan. RESULTS No complications were recorded during the surgery in any of the 13 patients. In one female patient the stabilization failed in the early postoperative period. A reoperation from anterior approach with the use of the same method was necessary. In eleven patients bone healing occurred after 6 to 12 months. In two patients pseudoarthrosis was formed with no clinical symptoms. No neurological deterioration or a patient s death was reported in the monitored period within 12 months after the treatment. DISCUSSION Where dens axis fractures in elderly patients are managed operatively, the posterior approach and transarticular fixation of C1/2 with sublaminar loop are preferred. This procedure is considered more reliable, owing to the fears of a failure of osteosynthesis by anterior approach. The most frequent cause of a failure is the pulling out of the screw through the anterior wall of dens axis base in patients with osteoporosis. Concurrently, the anterior approach is regarded as more considerate. The ATS fixation increases stability compared to isolated compression osteosynthesis, which makes it possible to manage the dens axis fractures by a more considerate anterior approach. CONCLUSIONS The ATS is a method that increases stability of compression osteosynthesis in managing dens axis in elderly patients. Key words: dens axis, upper cervical spine fracture, elderly, triple screw technique, anterior transarticular C1/2 stabilization.
- MeSH
- dens axis zranění MeSH
- fraktury páteře chirurgie MeSH
- hojení ran MeSH
- kostní šrouby MeSH
- krční obratle chirurgie MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury přístrojové vybavení MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. METHODS: Between 2002 and 2014, a total of 176 patients were treated by this technique. The patients received either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. RESULTS: In the anterior procedure, the average operative time was 90 min. (50 to 130 min). Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at two years follow-up. CONCLUSION: The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.
- MeSH
- bederní obratle zranění MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- fúze páteře metody MeSH
- hrudní obratle zranění MeSH
- krvácení při operaci MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- torakoskopie metody MeSH
- torakotomie metody MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Zlomeniny okcipitálního kondylu patří mezi raritní poranění. V poslední době se v souvislosti se zlepšením organizace přednemocniční péče, a zejména se zavedením diagnostických algoritmů pro vyšetřování pacientů s poraněním hlavy a krční páteře záchyt tohoto poranění zvyšuje. Mechanizmus úrazu je nejčastěji autohavárie ve vysoké rychlosti nebo pád na hlavu z výšky. Materiál a metoda: Jedná se o prospektivní studii. Od roku 2004 vyšetřujeme úrazovou krční páteř u symptomatických pacientů pomocí spirálního CT v rozsahu od C0 do T2. Každá zlomenina kondylu okciputu byla klasifikována podle Andersona a Montesana a dále podle Tuliho. U pacientů jsme sledovali věk, pohlaví, mechanizmus úrazu, typ poranění, neurologický obraz a rozsah pohybu po skončení terapie. Pacienty jsme dispenzarizovali po dobu tří měsíců. Kostní zhojení bylo konstatováno na základě CT vyšetření. Výsledky: Od roku 2004 do konce roku 2012 jsme přijali 14 pacientů s diagnózou zlomeniny kondylu okciputu. Diagnóza byla stanovena na základě CT vyšetření a multiplanárních rekonstrukcí. Do studie bylo zařazeno 12 pacientů. Průměrný věk pacientů byl 37,4 let. Třikrát byl poraněn pravý kondyl a devětkrát levý kondyl okciputu. Jedenkrát jsme zaznamenali parézu XII. hlavového nervu. Ostatní pacienti byli bez neurologické symptomatologie. U všech pacientů jsme postupovali konzervativně s dobrým výsledkem. Závěr: K zjištění zlomeniny kondylu okciputu je nutné CT vyšetření a multiplanární rekonstrukce. K terapii postačí límec Philadelphia nebo halo fixační aparát. Při zjištění kraniocervikální nestability je nutná okcipitocervikální stabilizace.
Introduction: Fractures of the occipital condyle are rare injuries. Recently, organization of pre‑hospital care improved and diagnostic algorithms for an examination of patients with an injury of the head and/or cervical spine were introduced, so the detection of this type of injury increased. The mechanism of injury is usually a high‑speed car crash or fall on the head from height. Material and method: This was a prospective study. Since 2004, we examined injured cervical spine in all symptomatic patients with spiral CT of C0 to T2. Each occipital condyle fracture was classified according to Anderson and Montesano and then also according to Tuli. We recorded patients’ age, sex, mechanism of injury, type of injury, neurological image and the range of motion after therapy. Patients were followed up for three months. Bone healing was confirmed on the basis of a CT examination. Results: From 2004 to the end of 2012, we admitted 14 patients diagnosed with occipital condyle fracture. The diagnosis was based on CT scans and multiplanar reconstructions. Twelve patients were included in the study. The mean age was 37.4 years. The right condyle was injured three times and the left condyle nine times. We diagnosed a paresis of the 12th cranial nerve once. Other patients were free of neurological symptoms. In all patients, we proceeded in a conservative way with good results. Conclusion: CT scans and multiplanar reconstruction are needed to identify a fracture of the occipital condyle. A Philadelphia collar or a halo fixation apparatus are sufficient for the therapy. When craniocervical instability is identified, occipital cervical stabilization is required. Key words: cervical spine injury – occipital condyle fractures The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Klíčová slova
- poranění krční páteře,
- MeSH
- bezvědomí MeSH
- dopravní nehody MeSH
- dospělí MeSH
- fraktury lebky diagnóza radiografie terapie MeSH
- krční obratle * radiografie zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie MeSH
- poranění páteře * diagnóza terapie MeSH
- prospektivní studie MeSH
- protetické prostředky MeSH
- týlní kost * radiografie zranění MeSH
- úrazy pádem MeSH
- uzavřené poranění hlavy diagnóza MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
1. vyd. ix, 171 s. : il., tab. ; 29 cm
Publikace přináší soudobý, komplexní pohled na diagnostiku a léčbu poranění páteře a míchy. V oboru páteřní chirurgie, kde je nedostatek doporučení založených na vědeckých důkazech, mají veliký význam doporučení založená na zkušenostech. Na stránkách této knihy jsou shrnuty dlouholeté zkušenosti jednoho z našich nejvýznamnějších spondylochirurgických pracovišť. V přehledném členění poskytuje vodítko jak pro hodnocení zobrazovacích a klinických vyšetření, tak pro klasifikační zařazení traumatu a volbu jeho ošetření. Bohatý aparát citací, provázející jednotlivé kapitoly, nabízí prakticky úplnou literární informaci k danému tématu.
- Konspekt
- Ortopedie. Chirurgie. Oftalmologie
- NLK Obory
- traumatologie
- ortopedie
- NLK Publikační typ
- kolektivní monografie
1. elektronické vydání 1 online zdroj (171 stran)
Publikace přináší soudobý, komplexní pohled na diagnostiku a léčbu poranění páteře a míchy. V oboru páteřní chirurgie, kde je nedostatek doporučení založených na vědeckých důkazech, mají veliký význam doporučení založená na zkušenostech. Na stránkách této knihy jsou shrnuty dlouholeté zkušenosti jednoho z našich nejvýznamnějších spondylochirurgických pracovišť. V přehledném členění poskytuje vodítko jak pro hodnocení zobrazovacích a klinických vyšetření, tak pro klasifikační zařazení traumatu a volbu jeho ošetření. Bohatý aparát citací, provázející jednotlivé kapitoly, nabízí prakticky úplnou literární informaci k danému tématu.
- Klíčová slova
- Chirurgie, ortopedie, traumatologie,
- MeSH
- poranění páteře diagnóza klasifikace terapie MeSH
- NLK Obory
- traumatologie
- ortopedie
We describe the case of an 80-year-old female patient who had undergone anterior C1-C2 transarticular stabilisation and was subsequently treated by the triple-screw method for failed compression osteosynthesis of a AO type III dens axis fracture. Key words: dens axis, upper cervical spine fracture, eldery, triple screw technique, anterior transarticular C1-C2 stabilisation.
Background. The aim of the experiment was to compare the mechanical properties of intact spinal segment with impaired intervertebral disc and impaired intervertebral disc fixed by TSLP (Thoracolumbar Spine Locking Plate). Methods and results. Spinal specimens were taken from domestic swine. A total of 8 test mechanical states (intact, impaired and fixed) were modeled and the mechanical properties, expressed by the value of moment of couple necessary to twist the specimen at tensile force F = 200 N and the value of moments necessary for extension straining, were determined. The study was based on in vitro biomechanical testing of the TSLP plate used to stabilize the front thoracolumbar column of spinal segments taken from a pig. The plate was used for monosegmental fixation. The disc was cut by scalpel to simulate the Type A injury to front spinal column. In each state (intact, impaired or fixed), specimens were subjected to a tension load of prescribed force and, then, twisted by a given angle. Subsequently, extension load of intact, impaired and impaired & fixed segment was measured. Statistical evaluation verified the hypothesis of the different behavior of intact, impaired and fixed specimens – both for tension & torsion load and extension load. The analyses did not indicate different mechanical behavior of intact and fixed specimens. In other words, monosegmental fixation of both impaired and intact specimens by TSLP Synthes implant will lead to similar mechanical behavior of these specimens. Further, we found that intact and fixed specimens show non-symmetric behavior at positive and negative twisting angles. This was not observed for impaired specimens. Conclusion. Several stabilization systems were developed to stabilize the front thoracolumbar spinal column. Surgery of the anterior column of injured spine should restore the correct position of the spine, ensure decompression of vertebral canal when neural structures are compressed, and stabilize the spine to allow immediate loading and mobilization of the patient. The aim of this study was to compare mechanical properties of intact spinal segment, impaired spinal segment and impaired spinal segment stabilized by TSLP Synthes implant. The problems were solved by experimental modeling using a testing machine that simulated loads for several mechanical states of the spinal segment. Favorable mechanical properties of TSLP Synthes fixator were demonstrated. The experimental results will be used for subsequent computational modeling of the spinal segment in all experimentally solved states.
PURPOSE OF THE STUDY A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. MATERIAL Between 2002 and 2006, a total of 127 patients were treated by this technique. The age of the group, including 75 men and 52 women, ranged from 18 to 75 years (average, 45.9 years). L1 and Th12 fractures were treated in 71 and 66 patients, respectively. Based on CT scans and operative findings, the fractures were assessed as type A in 81, type B in 42 and type C in four patients. The causes of injury were a fall from height in 72, a pedestrian?s fall in 29, a traffic accident in 23 and other in three patients. On admission 19 patients had a neurological deficit of varying degree: Frankel grade A, eight patients; grade B, four; grade C, five; and grade D, two patients. METHODS The patients were treated by either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. Transpedicular posterior stabilization was performed in 52 patients. All of them had an anterior procedure completed with screw-rod-screw stabilization, and the vertebral body was replaced with an allograft or an expandable titanium cage in 50 and two patients, respectively. The anterior approach alone was used in 75 patients, who received a bisegmental angle-stable implant in 43 and a monosegmental plate in 32 cases. To replace the vertebral body, allografts were used in 71 and an expandable titanium cage in four patients. RESULTS The average follow-up period was 3.9 years (range, 1 to 6 years). In the anterior procedure, the average operative time was 90 min (range, 50 to 130 min) and blood loss ranged from 200 ml to 2300 ml. A complication due to deep infection occurred in one patient and required removal of both the anterior and posterior implants. Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at 1-year follow-up. No conversion of the minimally invasive technique to a conventional approach due to visceral or vascular injury was necessary; nor was revision surgery for fluidothorax needed. No loosening of an anterior implant or cage dislocation was recorded. Hypesthesia in the operative wound area was found in four patients (3.1 %). Improvement in neurological status by at least one Frankel grade was found in 10 of the 19 affected patients. DISCUSSION The anterior approach is recommended for reconstruction of the anterior spinal column in burst fractures of the thoracolumbar junction in particular. An isolated posterior approach may result in implant failure during bony union or in the loss of correction after implant removal that can lead to the recurrence of kyphosis. Conventional thoracotomy is often associated with significant morbidity and hence there is a need for a minimally invasive approach to treat thoracolumbar junction injury. CONCLUSIONS The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.
- MeSH
- bederní obratle zranění MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- hrudní chirurgie video-asistovaná metody MeSH
- hrudní obratle chirurgie zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- ortopedické výkony metody MeSH
- senioři MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
