PURPOSE: Extraforaminal lumbar interbody fusion as with other methods that involve the mechanism of indirect decompression, the discussion not only focuses on the benefit of minimizing the risk of thecal sac injury and postoperative scarring, but also on the risk of insufficient decompression in the affected neural structures during the reduction of the affected segment. METHODS: Eighty-two patients presenting with degenerative lumbar disease with segmental instability underwent ELIF combined with transpedicular fixation and circumferential fusion. Clinical and radiographic evaluations were performed. RESULTS: The mean ODI significantly improved from 63.4 preoperatively to 32.3 1 year postoperatively. The mean VAS back pain significantly improved from 5.95 to 2.63 postoperatively and VAS (leg pain) improved from 6.04 to 2.44. The mean CSA increased from 103 mm2 preoperatively to 169 mm2 postoperatively. The median extension ratio of CSA was 33%. Disc height, segmental disc angle, and lumbar lordosis also improved significantly. Only three (3.7%) patients were revised using direct central decompression due to neurologic deterioration. CONCLUSION: Spinal stenosis was resolved successfully by indirect decompression through extraforaminal interbody fusion via a transmuscular limited approach.

• Publikační typ
• časopisecké články MeSH

• MeSH
• nemoci nervového systému chirurgie   MeSH
• neurochirurgické výkony metody   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurochirurgie
• NLK Publikační typ
• kolektivní monografie

INTRODUCTION: Surgical treatment of high-grade developmental spondylolisthesis remains controversial with paucity of data reporting complete reduction of the deformity, especially in pediatric patients. RESEARCH QUESTION: To assess efficacy and safety of complete reduction and circumferential L5-S1 fusion in children with high-grade high-dysplastic spondylolisthesis. Emphasis was placed on fusion rates, correction of lumbosacral deformity and long-term clinical outcomes by means of patient-reported outcome measures (PROMs). MATERIAL AND METHODS: Consecutive series of 18 pediatric patients referred to surgery over an 11-years period. Several radiographic variables and PROMs were collected pre- and post-surgery with minimum follow-up of 2-years. RESULTS: The mean age of cohort was 12.9 years with a mean follow-up of 7.8 years. Postoperatively, the mean slip was reduced from 64.4±9.8% to 4.5±5.9% with no loss of correction during follow-up. PROMs significantly improved following the index procedure (p<0.0001). Lumbo-pelvic parameters improved after surgery, including SS, but not PT. Development of adjacent level spondylolisthesis was noted in eight subjects (44%), two of these patients required additional surgery. Posterolateral and anterior fusion was obtained in 100% and 78% of cases, respectively. One patient developed a transient right-sided L5 nerve paresis after surgery that gradually resolved within one year post-surgery. Preoperatively, we recorded three patients with L5 nerve root motor deficit, which resolved completely in two cases and in one patient remained unchanged. DISCUSSION AND CONCLUSION: Complete reduction can safely be accomplished without an increased risk of nerve root injury. Coupled with single-level circumferential fusion, it provides high fusion rates with satisfactory spino-pelvic alignment.

• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgie operační MeSH
• ortopedické výkony MeSH
• ortopedie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• chirurgie
• NLK Publikační typ
• kolektivní monografie

BACKGROUND: Hybrid ablation (a combination of thoracoscopic epicardial ablation and catheter ablation) has become a new technique for atrial fibrillation treatment. OBJECTIVE: The goal of this study was to evaluate the success and electrophysiological follow-up after using the COBRA Fusion device to deliver a circumferential lesion set anterior to the pulmonary veins in an attempt to isolate the posterior left atrium (box isolation). METHODS: Surgical ablation was carried out via a thoracoscopic approach using the COBRA Fusion radiofrequency catheter. An electrophysiology study was done 2-3 months later to verify box isolation (and to complete it, if needed) and to perform right-sided isthmus ablation. Fat thickness along the presumed box lesion line was measured using preprocedural computed tomography. RESULTS: Thirty patients (mean age 60.0 ± 11.6 years; 22 men; 8 with long-standing persistent AF and 22 with persistent atrial fibrillation) were enrolled. The duration of the EP study was 216.3 ± 64.2 minutes. Box isolation, based on the EP study, was complete in 12 patients (40%) and incomplete in 18 patients (60%). Successful box isolation was achieved with catheter ablation in 16 of 18 patients (89%). A total of 39 gaps in these 16 patients were identified. Typical gap locations were the anterior-superior part of the superior pulmonary veins and the roofline. Fat thickness along the roofline was substantially higher than that along the inferior line (4.58 ± 1.61 mm vs 2.37 ± 0.76 mm; P < .001). CONCLUSION: There is a relatively low rate of complete isolation using the COBRA catheter ablation system. The superior line and anterior parts of superior pulmonary veins have most conduction gaps.

• MeSH
• časové faktory MeSH
• elektrofyziologické techniky kardiologické metody   MeSH
• fibrilace síní diagnóza   patofyziologie   chirurgie   MeSH
• katetrizační ablace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• převodní systém srdeční patofyziologie   MeSH
• senioři MeSH
• torakoskopie metody   MeSH
• venae pulmonales chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY The study presents the mid-term results in patients treated with circumferential, i.e., 360-degreee, fusion of the lumbar spine carried out by posterolateral instrumented spondylodesis and anterior intersomatic fusion using a tantalum implant for replacement of an intervertebral disc. The aim of the study was to verify tantalum implant quality, to evaluate segment fusion and to assess the outcome of this method by patients? subjective findings. MATERIAL AND METHODS The prospective non-randomised study included the implantation of 47 tantalum cages in 40 patients by the technique of anterior lumbar interbody fusion (ALIF) and posterolateral spondylodesis. Only patients followed up longer than for one year were included in this evaluation. The patient group comprised 16 men and 24 women, with an average age of 47.9 years. The patients indicated for this procedure had mono- or bisegmental lumbar disc degeneration with advanced changes of articular facets. The procedure involved posterior transpedicular screw fixation with decompression, if spinal stenosis existed, and reposition of the segment, if spondylolisthesis was present, and posterior spondylodesis by the open book method. No autogenous bone grafts were used because of the risk of donor-site pain and because one of the aims of the study was to test tantalum cage properties. Subsequently, ALIF and disc replacement with a tantalum cage were carried out after cage insertion, the anterior borders of the upper and lower adjacent vertebral bodies were adjusted so that the lamellar bone should overlap the cage and thus provide continual bridging for the segment, with an emphasis being on joining the lamellae with preserving their blood supply from the respective vertebral bodies. RESULTS Implant subsidence in a rotation/flexion fashion, i.e. ventrally into the upper endplate of the distal vertebra and dorsally into the lower endplate of the proximal vertebra, was observed in two cases; subsidence in a vertical fashion, i.e., symmetrically into the lower endplate of the upper vertebra was found in one patient. Neither vertical mode of subsidence into the upper endplate of the lower vertebra only, nor rotation/extension type of subsidence was recorded. No frontal/rotational mode of subsidence was found either. No osteolytic lesion between the implant and adjacent bone was diagnosed. No migration of an implant sideways or in a ventral/dorsal direction was detected. Anterior bridging fusion was observed in 32 cages. No fusion dorsal to or lateral to the cage was seen. Evaluation of bone ingrowth into the cage was not possible due to a high X-ray contrast effect of the material. High-quality bridging posterolateral spondylodesis was diagnosed in 33 cases. Subjective evaluation by the patients was based on a visual analogue scale (VAS) and an Oswestry Disability Index (ODI) questionnaire. For the whole group, the average VAS value for back pain dropped from 58.3 points before surgery to 18.1 points at one year post-operatively; there were no differences between the genders. The VAS value for leg pain decreased from 54.1 pre-operatively to 9.4 at one year after surgery. Also, the results of ODI assessment were similar in both genders, with the average value for the whole group having decreased from 53.5 % pre-operatively to 29.0 % at one year post-operatively. DISCUSSION By using the mechanical properties of a tantalum implant, i.e., its high strength and flexibility, the structure almost identical to cancellous bone and its high stability following implantation, we avoided the necessity of harvesting autogenous bone grafts from the iliac crest. Instead, we introduced the method of bridging a stable and strong implant with lamellar bone, while preserving its blood supply from the adjacent vertebral bodies. Our results showed that this approach resulted in implant subsidence in 1.8 % of cases only. We achieved good-quality fusion by bridging the whole segment in 68 %, and diagnosed good posterolateral fusion in 71 % of the cases. All patients showed good spondylodesis, which was either anterior, posterior or bilateral. CONCLUSIONS Avery stable fixation of the lumbar spinal segment can be achieved by using posterolateral fusion and ALIF. With this approach, ALIF is augmented with a porous tantalum cage, and the use of autogenous bone grafts, derived from the adjacent anterior vertebral borders and placed before the cage, results in high-quality anterior bridging spondylodesis in a large proportion of cases. The subjective evaluation by the patients is in agreement with the stability and fusion achieved.

• MeSH
• bederní obratle chirurgie   radiografie   MeSH
• fúze páteře metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• meziobratlová ploténka chirurgie   radiografie   MeSH
• následné studie MeSH
• nemoci páteře chirurgie   MeSH
• protézy a implantáty využití   MeSH
• retrospektivní studie MeSH
• tantal terapeutické užití   MeSH
• transplantace kostí metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

The authors present a very uncommon case of unilateral lumbosacral dislocation. Twenty two similar cases have been published in the literature so far. Most of them occurred due to the flexion mechanism of injury, in our case the injury was caused by a combination of hyperextension and subsequent flexion with rotation. This rare injury can create diagnostic dilemma and in relation to complexity of soft tissue lesion we propose early circumferential instrumented fusion of lumbosacral region.

• MeSH
• bederní obratle chirurgie   zranění   MeSH
• dislokace kloubu diagnóza   chirurgie   MeSH
• dospělí MeSH
• fraktury páteře diagnóza   chirurgie   MeSH
• kloubní ligamenta chirurgie   zranění   MeSH
• křížová kost chirurgie   zranění   MeSH
• lidé MeSH
• ligamenta MeSH
• ligamentum flavum chirurgie   zranění   MeSH
• lyžování zranění   MeSH
• magnetická rezonanční tomografie MeSH
• následné studie MeSH
• počítačová rentgenová tomografie MeSH
• poranění páteře diagnóza   chirurgie   MeSH
• sportovní úrazy diagnóza   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• biologie buňky MeSH
• molekulární biologie MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Biochemie. Molekulární biologie. Biofyzika
• NLK Obory
• biologie
• cytologie, klinická cytologie