OBJECT: The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. METHODS: Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1-A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. RESULTS: The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). CONCLUSIONS: This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.
- MeSH
- bederní obratle zranění radiografie chirurgie MeSH
- dospělí MeSH
- fraktury páteře radiografie chirurgie MeSH
- hrudní obratle zranění radiografie chirurgie MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- vnitřní fixace fraktury přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Endothelin-1 (ET-1) is a neuroactive protein produced in most brain cell types and participates in regulation of cerebral blood flow and blood pressure. In addition to its vascular effects, ET-1 affects synaptic and nonsynaptic neuronal and glial functions. Direct application of ET-1 to the hippocampus of immature rats results in cerebral ischemia, acute seizures, and epileptogenesis. Here, we investigated whether ET-1 itself modifies the excitability of hippocampal and cortical circuitry and whether acute seizures observed in vivo are due to nonvascular actions of ET-1. We used acute hippocampal and cortical slices that were preincubated with ET-1 (20 μM) for electrophysiological recordings. None of the slices preincubated with ET-1 exhibited spontaneous epileptic activity. The slope of the stimulus intensity-evoked response (input-output) curve and shape of the evoked response did not differ between ET-1-pretreated and control groups, suggesting no changes in excitability after ET-1 treatment. The threshold for eliciting an evoked response was not significantly increased in either hippocampal or cortical regions when pretreated with ET-1. Our data suggest that acute seizures after intrahippocampal application of ET-1 in rats are likely caused by ischemia rather than by a direct action of ET-1 on brain tissue.
- MeSH
- endotelin-1 farmakologie MeSH
- excitační postsynaptické potenciály fyziologie účinky léků MeSH
- hipokampus fyziologie účinky léků MeSH
- krysa rodu rattus MeSH
- nervový přenos fyziologie účinky léků MeSH
- potkani Wistar MeSH
- záchvaty chemicky indukované metabolismus MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- financování organizované MeSH
- Publikační typ
- abstrakty MeSH
