Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation.Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence.Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone (PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan.Results: 20 patients (age 66 ± 10 years, 65% female, BMI 28 ± 5 kg/m2) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 ± 14.5 and 7.3 ± 3.6 to 52.7 ± 9.1 and 10.5 ± 3.5 (p = 0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred.Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.
Background: The treatment of fibular hemimelia aims to achieve a functional limb nearly equal in length to the normal limb at maturity, with a plantigrade, stable and flexible foot. The aim of this work was to evaluate the functional results of reconstructive lengthening and deformity correction in fibular hemimelia using the ring external fixator. Methods: This observational study was carried out on 41 patients with fibular hemimelia. The cases either prospectively gathered (sixteen cases, 39 %) to start their management plan or retrospectively collected (twenty-five cases, 61 %) and followed up. Foot reconstruction surgery was done in 22 cases while lengthening surgery applied all cases. All patients were subjected to: history taking, clinical examination (local (lower limb), foot and knee), general examination and imaging. Results: regarding overall results, at the end of follow-up with an average period of 2 years, 4 patients had excellent results (9.76%), 21 patients (51.2%) had good results, 12 patients (29.28%) had fair results and 4 patients (9.76%) had poor result. Regarding subjective functional assessment, out of 41 patients, 20 of them (48.8%) were from 75 to 100% subjectively satisfied, 11 patients (26.8%) from 50 to 74% and 10 patients (24.4%) from 0 to 49% satisfied.
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