Introduction With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine.
Materials and methodsWe considered all prospective in vivo clinical studies in the English literature that assessed the results of different pedicle screw placement techniques (free-hand technique, fluoroscopy guided, computed tomography (CT)-based navigation, fluoro-based navigation). MEDLINE, OVID, and Springer databases were used for the literature search covering the period from January 1950 until May 2010. Results 26 prospective clinical studies were eventually included in the analysis. These studies included in total 1,105 patients in which 6,617 screws were inserted. In the studies using free-hand technique, the percentage of the screws fully contained in the pedicle ranged from 69 to 94%, with the aid of fluoroscopy from 28 to 85%, using CT navigation from 89 to 100% and using fluoroscopy-based navigation from 81 to 92%. The screws positioned with free-hand technique tended to perforate the cortex medially, whereas the screws placed with CT navigation guidance seemed to perforate more often laterally.
ConclusionsIn conclusion, navigation does indeed exhibit higher accuracy and increased safety in pedicle screw placement than free-hand technique and use of fluoroscopy.
Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Low grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma with a high metastasizing potential and sometimes long interval between tumour presentation and metastasis. We present the case of a 50-year-old male who developed a large mass in the posterior aspect of his lower left thigh. The tumor was excised with preservation of the neurovascular structures surrounded by the mass. The tumour measured 11 × 10 × 9 cm and on pathology evaluation was diagnosed as LGFMS. Due to the relative rarity of LGFMS, there is no dedicated protocol regarding follow-up recommendations. In order to early diagnose possible metastasis it is important to inform the patients about the longstanding metastatic potential of the disease.
Most patients with degenerative lumbar spinal stenosis benefit from decompressive surgery. Patients with long-standing preoperative symptoms and concomitant diseases often have poor results and are less satisfied with the postoperative outcome.
The purpose of this study was to assess the maximum rapid intraoperative elongation of the rat sciatic nerve with the use of tissue expander, and its possible functional recovery. One hundred and eight rats were divided into five groups, and their right sciatic nerves were expanded with a 10-cc, 12-cc, 14-cc, 16-cc, and 18-cc expander, respectively, for 1 h. The functional recovery of the nerve was assessed at intervals up to 3 months, using the sciatic function index (SFI), neurophysiological indices, and histology. The maximum intraoperative elongation was observed in group IV (16-cc volume of tissue expander), at about 23.83%. SFI decreased between the first and seventh postoperative days, but gradually recovered, reaching preoperative values in all groups according to the formulas of De Medinaceli et al. (Exp. Neurol. 77:634-643, 1982) and Bain et al. (Plast. Reconstr. Surg. 83:129-136, 1989). Latency and motor conduction velocity demonstrated deterioration after expansion, which peaked after surgery. Recovery was gradually completed by the end of the experiment. The histological findings indicated minor aberrations immediately after expansion and maximal demyelination with axonal disruption on day 15. The reparative process started by day 30 and continued until day 90, when almost no histological changes were observed. In conclusion, intraoperative nerve expansion successfully elongates the rat sciatic nerve up to 23.83%. But it causes functional and morphological abnormalities, which are of moderate to severe degree, are of short duration, and are reversible. Intraoperative nerve expansion might be a valuable solution in the treatment of short nerve gaps, but its clinical application still needs to be evaluated.
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