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Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series
Gabriel C Tender, Larry E Miller, Jon E Block
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-454
Abstract: Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50)-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA) was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL). Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up.Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis.Patients with intractable low back pain or radiculopathy (or both) resulting from lumbar or lumbosacral spondylolisthesis benefit from surgical intervention [1,2]. Standard surgical protocols use a midline incision, posterior decompressive laminectomy, and posterolateral or interbody fusion (or both) [1]. Minimally invasive spinal surgery techniques have recently allowed the surgeon to obtain comparable clinical and radiographic results with less iatrogenic soft tissue injury and minimal blood loss. These techniques use a tubular ret
A Universal Pedicle Screw and V-Rod System for Lumbar Isthmic Spondylolysis: A Retrospective Analysis of 21 Cases  [PDF]
Xiong-sheng Chen, Sheng-yuan Zhou, Lian-shun Jia, Xiao-min Gu, Lei Fang, Wei Zhu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0063713
Abstract: Objective To investigate the surgical outcome of a universal pedicle screw-V rod system and isthmic bone grafting for isthmic spondylolysis. Methods Twenty-four patients with isthmic spondylolysis at L5 and grade 0–I spondylolisthesis (Meyerding classification) received isthmic bone graft and stabilization using the universal pedicle screw-V rod system. Back pain was evaluated using the visual analog scale (VAS) and time to bone healing, improvement in spondylolisthesis and intervertebral space height at L5/S1 and L4/L5 were assessed. Results Twenty-one patients were followed up for 24 months and included in the analysis. Back pain was markedly improved at 3 months postoperatively with a statistical difference in VAS scores compared with preoperative VAS scores (P<0.001). The VAS scores were 0 to 3 at 6 months postoperatively in all patients and no back pain was reported in all patients except 2 patients who complained of back pain after prolonged sitting. X-ray examination showed a bone graft healing time of 3 to 12 months. Grade I spondylolisthesis improved to grade 0 in 4 patients and no noticeable change was observed in the remaining 17 cases. The intervertebral space height at L5/S1 was statistically increased (P<0.05) while no statistically significant change was seen at L4/L5. There was no statistically significant difference in the ROM of the intervertebral disks of L5/S1 and L4/5 before and after surgery. Conclusions The universal pedicle screw-V rod system and isthmic bone grafting directly repairs isthmic spondylolysis and reduces back pain, prevents anterior displacement of the diseased segment and maintains intervertebral space height, thus offering a promising alternative to current approaches for isthmic spondylolysis.
Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series  [cached]
Mohi Eldin Mohamed
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-396
Abstract: Introduction Symptomatic spondylolysis is always challenging to treat because the pars defect causing the instability needs to be stabilized while segmental fusion needs to be avoided. Direct repair of the pars defect is ideal in cases of spondylolysis in which posterior decompression is not necessary. We report clinical results using segmental pedicle-screw-rod fixation with bone grafting in patients with symptomatic spondylolysis, a modification of a technique first reported by Tokuhashi and Matsuzaki in 1996. We also describe the surgical technique, assess the fusion and analyze the outcomes of patients. Case presentation At Cairo University Hospital, eight out of twelve Egyptian patients’ acute pars fractures healed after conservative management. Of those, two young male patients underwent an operative procedure for chronic low back pain secondary to pars defect. Case one was a 25-year-old Egyptian man who presented with a one-year history of axial low back pain, not radiating to the lower limbs, after falling from height. Case two was a 29-year-old Egyptian man who presented with a one-year history of axial low back pain and a one-year history of mild claudication and infrequent radiation to the leg, never below the knee. Utilizing a standardized mini-access fluoroscopically-guided surgical protocol, fixation was established with two titanium pedicle screws place into both pedicles, at the same level as the pars defect, without violating the facet joint. The cleaned pars defect was grafted; a curved titanium rod was then passed under the base of the spinous process of the affected vertebra, bridging the loose fragment, and attached to the pedicle screw heads, to uplift the spinal process, followed by compression of the defect. The patients were discharged three days after the procedure, with successful fusion at one-year follow-up. No rod breakage or implant-related complications were reported. Conclusions Where there is no evidence of frank spondylolisthesis or displacement and pain does not radiate below the knee, we recommend direct repair of the pars interarticularis fracture, especially in young active adults. We describe a modified form of the Buck screw procedure with a minimally invasive, image-guided method of pars interarticularis fixation. The use of image guidance simplifies the otherwise difficult visualization required for pars interarticularis screw placement and allows minimal skin and muscle dissection, which may translate into a more rapid postoperative recovery.
Rod and Screw Fixation for Cranio-Cervical Instability  [PDF]
Hedaya Hendam, Ahmed Taha, Mohamed Youssef
Open Journal of Modern Neurosurgery (OJMN) , 2020, DOI: 10.4236/ojmn.2020.101003
Abstract: Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.
Percutaneous Pedicle Screw and Rod Insertion for the Treatment of Thoracic and Lumbar Spine Fracture  [PDF]
Pashupati Chaudhary,Navin Kumar Karn,Bikram Prasad Shrestha,Guru Prasad Khanal,Raju Rijal
Nepal Orthopaedic Association Journal , 2013, DOI: 10.3126/noaj.v3i1.9322
Abstract: Introduction: Standard techniques for lumbar pedicle screw and rod fixation involve open exposure and extensive muscle dissection. Percutaneous pedicle screw system minimises the morbidity associated with traditional open approaches without compromising the quality of spinal fixation. A preliminary experience with this device has been encouraging. The purpose of this study was to demonstrate operative techniques and experiences with percutaneous lumbar pedicle screw and rod insertion for internal fixation of the lumbar spine without use of Zig. Methods: It was hospital based retrospective interventional study done at the department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal over a period of 2 and half years. The study enrolled 30 patients aged 18-55 years who had presented with traumatic fracture of thoracic and lumbar spine. All thirty patients underwent percutaneous pedicle screw and rod fixation and successful percutaneous single/two level fusions. The follow up period ranged from 6 to 24 months. Results: The study comprised of 25 males and 5 females. Average patient’s age was 36.5 years (range 18-55 years). The common mode of injury was fall from height, road traffic accident, physical assault followed by sports related injury. All patients were having unstable spine fracture without neurological deficit. Operation time, loss of blood, post operative pain was less in percutaneous method. Post operative rehabilitation was easier. Spinal fusion was achieved in all patients in 6 months to 1 year time. There was no post-operative neurological deficit, infection, implant failure. Conclusion: Our early experience suggests that Minimally invasive approaches for performing lumbar fusion, is able to achieve the same clinical results as conventional open procedures. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9322 ? Nepal Orthopedic Association Journal 2013 Vol.3(1): 23-27
A COMPARISON OF PULLOUT STRENGTH OF PEDICULAR SCREWS BETWEEN DIFFERENT METHODS OF SCREW INSERTION IN POSTERIOR FIXATION OF THORACIC SPINE
P Habib-Allah -Zadeh,B Mirzashahi,M M Sadat,B Siavashi
Acta Medica Iranica , 2008,
Abstract: "nPedicle screws provide rigid fixation for instabilities in the lumbar and lumbosacral spine. Anatomical consideration and potential risk of neurologic complications are the reasons to hesitate using pedicle screws in the thoracic spine. Twenty moulages similar to human vertebrae were instrumented with Cotrel-Dubousset (CD) system pedicle screw by intratransverse process, extrapedicular and intrapedicular methods and pullout strength was measured. There was statistically significant difference between three techniques. By increasing the length of screw in any method, pullout strength increased. Average pullout strength in extrapedicular technique was less than two other techniques in dynamic state. The strongest technique for screw placement was intratransverse process technique. It seems that intratransverse process technique is safe for posterior fixation of spine.
Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction
Ziad M Audat, Fayeq T Darwish, Moh'd M Al Barbarawi, Moatasem M Obaidat, Walid H Haddad, Khaldoon M Bashaireh, Ihsan A Al-Aboosy
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-14
Abstract: A randomized and double blinded study consisted of 41 patients aged 36-69 years (18 females and 28 males) treated for symptomatic spondylolisthesis between December,2006 and December, 2009. All patients were randomly distributed into two groups I and II. Twenty patients were in Group I; they underwent reduction of the slipped vertebrae by using Reduction-Screw Technique and posterior lumbar interbody fixation (PLIF). Group II consisted of twenty one patients who underwent only surgical fixation (PLIF) without reduction. All patients in this study had same pre and post operative management.only one case had broken rod in group I that required revision. Superficial wound infection was experienced in two patients and one patient, from group II, developed wound hematoma. The outcome in both groups was variable on the short term but was almost the same on the long term follow up.surgical management of symptomatic low grade spondylolisthesis should include neural decompression and surgical fixation. Reduction of slipped vertebral bodies is unnecessary as the ultimate outcome will be likely similar.Lumbar isthmic spondylolisthesis in adults is a frequent pathology that is encountered by spinal surgeon. It affects 5% of populations in the USA [1]. Clinical presentation is usually variable and ranging from mild to severe symptoms and disability which are related to the neural compression. The symptoms are typically related to the biomechanical spinal instability which leads to disc degeneration and lumber canal stenosis that ends with encroachment of nerve roots and thecal sac at the slide level [2-7].Medical treatment is usually the first line on management. Surgical approaches are preserved to cases with failure of conservative treatment or those with overt neurological deficits. However, Various surgical techniques have been advocated to deal with symptomatic isthmic spondylolisthesis; the main perception of these surgical techniques focused on spinal fixation and neural
Functionality Evaluation of a Novel Smart Expandable Pedicle Screw to Mitigate Osteoporosis Effect in Bone Fixation: Modeling and Experimentation  [PDF]
Ahmadreza Eshghinejad,Mohammad Elahinia,Vijay K. Goel
Smart Materials Research , 2013, DOI: 10.1155/2013/840413
Abstract: This paper proposes a novel expandable-retractable pedicle screw and analyzes its functionality. A specially designed pedicle screw is described which has the ability to expand and retract using nitinol elements. The screw is designed to expand in body temperature and retract by cooling the screw. This expansion-retraction function is verified in an experiment designed in larger scale using a nitinol antagonistic assembly. The results of this experiment are compared to the results of a finite element model developed in Abaqus in combination with a user material subroutine (UMAT). This code has been developed to analyze the nonlinear thermomechanical behavior of shape memory alloy materials. The functionality of the proposed screw is evaluated with simulation and experimentation in a pullout test as well. The pullout force of a normal screw inserted in a normal bone was simulated, and the result is compared with the results of the expandable screw in osteoporotic bone. Lastly, strength of the designed pedicle screw in a foam block is also verified with experiment. The reported finite element simulations and experiments are the proof for the concept of nitinol expandable-retractable elements on a pedicle screw which validate the functionality in a pullout test. 1. Introduction Bone screws for various spinal treatments and fixations have been used for about 70 years [1]. Pedicle screws are used as bone anchoring elements to firmly grip the bone to facilitate attachment to the spinal implants. Using the pedicle screws’ connection rod, surgeons can fixate the spinal segments together for spinal fusion. The pedicular fixation system (which consists of a minimum of four pedicle screws and the rod) can resist high loads and stabilize a fractured spine. Medical applications of pedicle screws show that tolerating the applied forces is possible for pedicle screws inside a healthy bone. When the bone is not healthy, poor screw purchase becomes the main concern [2]. Osteoporosis is a common bone disease in which the bone mineral density (BMD) reduces. Osteoporosis decreases the bone strength which causes an increased risk of fracture in the bony structures of the patients. This disease is very common in elderly people and steeply increases with age. The main concern of surgeons performing the pedicle screw fixation surgery on patients suffering from osteoporosis is the probability of loosening or pullout failure of the screw during or after surgery [3]. To overcome the drawbacks of osteoporosis in pedicle screw fixations, several methods have been used. Increasing
Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome
Moh'd M Al Barbarawi, Ziad A Audat, Moutasem M Obeidat, Tareq M Qudsieh, Waleed F Dabbas, Mouness H Obaidat, Anas A Malkawi
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-10
Abstract: A retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males). All cases were performed with a polyaxial screw-rod construct and screws were placed by using Anderson-Sekhon trajectory. Most patients had 12-14-mm length and 3.5 mm diameter screws placed for subaxial and 28-30 for C1 lateral mass. Screw location was assessed by post operative plain x-ray and computed tomography can (CT), besides that; the facet joint, nerve root foramen and foramen transversarium violation were also appraised.No patients experienced neural or vascular injury as a result of screw position. Only one patient needed screw repositioning. Six patients experienced superficial wound infection. Fifteen patients had pain around the shoulder of C5 distribution that subsided over the time. No patients developed screw pullouts or symptomatic adjacent segment disease within the period of follow up.decompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency.Posterior cervical fixation with lateral mass screws was first introduced by Roy-Camille in 1979; it has been increasingly used since that time to treat a wide range of cervical spine disorders [1]. posterior cervical fixation was frequently involved in form of wire and bone construct fixation. With a proven long-term effectiveness, and requires no special skills or x-ray guidance [2-4]. posterior cervical wire fixation may not be efficient in osteoporotic patient, as this technique can compromise the posterior cervical elements and may result in aggravating the primary pathology and worsen up the neurological status that requires full fixation by using the lateral mass fixation technique [5-7]. Furthermore, Stainless-steel wire can interfere with postoperative magnetic resonance (MR) imaging results, in contrast to the MRI compatible titanium screw/rod constructs. La
Increased rod stiffness improves the degree of deformity correction by segmental pedicle screw fixation in adolescent idiopathic scoliosis
Kasim Abul-Kasim, Magnus K Karlsson, Acke Ohlin
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-13
Abstract: The aims of this study were to evaluate the 3-dimentional deformity correction achieved by segmental pedicle screw fixation in patients with adolescent idiopathic scoliosis, and to find out if learning or the change to stiffer rods had any positive impact on deformity correction.Retrospective study.Plain radiographs and low-dose spine CTs of 116 consecutive patients (aged 15.9 ± 2.8 years) operated during the period 2005-2009 (group 1: patients operated autumn 2005-2006; group 2: 2007; group 3: 2008; group 4: 2009) were retrospectively evaluated.There was no statistically significant difference between the correction of the Cobb angle (P = 0.425) or lower end vertebra tilt (P = 0.298) in patients operated during the first versus the remaining periods of the study. No restoration of the sagittal kyphosis was reported in the first period compared with 5.9° in the last study period (P < 0.001). The correction of vertebral rotation was also improved from 4.2° to 7.8° (P < 0.001) for the same periods. For the whole study population, there was statistically significant correlation between the order of the operation (patient number) and the restoration of sagittal kyphosis (r = -0.344, P = 0.001), and the correction of vertebral rotation (r = 0.370, P < 0.001), but not for the Cobb angle or LEVT. However, there was no significant difference in restoration of sagittal kyphosis and the vertebral rotation in the first 17 patients compared with the last 17 patients operated with rods of 5.5 mm diameter (P = 0.621, and 0.941, respectively), indicating that rod stiffness had more impact on the deformity correction than did learning.This study showed that rod stiffness had more impact on the deformity correction than did learning.The method of using segmental pedicle screw fixation in scoliosis surgery was presented by Suk in 1994 [1]. Recently a quantitative study showed that rod derotation and direct vertebral derotation can significantly improve the 3-dimensional correction of
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