RESUMEN
BACKGROUND AND AIM: Posterior cervical transpedicular screw fixation has the strongest resistance to pullout forces compared with other posterior fixation systems. Here, we present a case on the use of this technique combined with a mini-laminotomy technique, which serves as a guide for accurate insertion of posterior cervical transpedicular screws. MATERIALS AND METHODS: We retrospectively analyzed data from 40 patients who underwent this procedure in our clinic between January 2014 and March 2017. RESULTS: The study population comprised 27 males (67.5%) and 13 females (32.5%) aged 15-80 years (median, 51.5 years). Surgical indications included trauma (n = 18, 45%), degenerative disease (n = 19, 47.5%), spinal infection (n = 2, 5%), and basilar invagination due to systemic rheumatoid disease (n = 1, 2.5%). In the 18 trauma patients, 14 short-segment (1-2 levels) and 4 long-segment (≥3 levels) posterior cervical instrumentation and fusion procedures were performed. The mini-laminotomy technique was used in all patients to insert, direct, and achieve exact screw fixation in the pedicles. Pedicle perforations were classified as medial or lateral and were also graded. Among the 227 cervical pedicle fixations performed, 48 were at the C3 level, 49 at C4, 60 at C5, 50 at C6, and 20 at C7. Axial computed tomography scan measurements showed that 205 of 227 (90.3%, Grade 0 and 1) screws were accurately placed, whereas 22 (9.69%, Grade 2 and 3) were misplaced. However, no additional neurological injury due to misplacement was observed. CONCLUSION: As negligible complications were observed when performed by experienced surgeons, the mini-laminotomy technique can be safely used for posterior transpedicular screw fixation in the subaxial vertebrae for single-staged fusion.
RESUMEN
OBJECTIVE: The purpose of this study was to compare pedicle screw fixation (PSF) with hybrid instrumentation (HI) in cases of adolescent idiopathic scoliosis (AIS). METHODS: Thirty-eight patients with AIS who underwent PSF (n=19) or HI (n=19) between 2001 and 2011 were retrospectively reviewed. Patients had similar age at surgery and similar number of fused vertebrae. Operative time, intraoperative blood loss, and postoperative complications were compared between the 2 groups. Spinal radiographs for apical vertebral translation, global coronal balance, major curve Cobb angle, global sagittal balance, thoracic kyphosis, and lumbar lordosis were measured in all patients preoperatively and at 2-year follow-up; the results were then compared between the 2 groups. Postoperative correction was calculated for all patients and compared between the 2 groups. RESULTS: The average time of surgery ofthe PSF group was significantly longer than that of the HI group (p<0.05). The amount of bleeding of the PSF group was significantly higher than the HI group (p<0.01). No statistically significant difference was found between the groups in respect to the development of complications (p>0.05). Both the major curve Cobb angle and the global sagittal balance showed greater improvement in the PSF group compared to the HI group (p<0.01). Postoperative correction was better in the PSF group than the HI group. CONCLUSION: The PSF system provided better improvement than the HI system in major curve Cobb angle and global sagittal balance, and postoperative correction was better in the PSF group than the HI group.
Asunto(s)
Fijadores Internos , Lordosis/diagnóstico por imagen , Tornillos Pediculares , Complicaciones Posoperatorias , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Adolescente , Pérdida de Sangre Quirúrgica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Radiografía , Estudios Retrospectivos , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Resultado del Tratamiento , Turquía , Adulto JovenRESUMEN
Background. Primary spinal dural lymphomas (PSDL) are tumors with characteristic histopathology of a lymphoma, which are completely in the spinal epidural space without any other systemic involvement. Extranodal primary lymphoma involving nervous system prefers thalamus/basal ganglia, periventricular region, cerebellum, eyes, meninges/dura, and cranial nerves or spinal cord. Rare spinal localization with acute spinal cord compression is worth attention. Case Presentation. A 48-year-old male presented with a several-month-long history of upper back pain. Lately, he had numbness and weakness at both lower extremities and was unable to walk for one week. A spinal MRI showed a thoracic lesion with cord compression at T2-T4 levels. The patient underwent surgical decompression, with his final histopathology showing diffuse large B-cell lymphoma. Systemic work-up was negative for nodal disease. Following surgery, he received radiotherapy combined with chemotherapy. He experienced a good outcome after four years. Conclusion. The upper thoracic cord is a rare location for primary spinal lesions/metastases, both of which prefer the lower thoracic and upper lumbar regions. In cases of progressive paraparesis, there should be immediate surgical intervention in the case of denovo disease, followed by combined radiotherapy and chemotherapy procedures.