Even the largest patients had some pedicles that could not accommodate the smallest standard pedicle screw, and more than one half of the pedicles average patients were too small. Transpedicular screw placement is not safe in these patients. Proper placement must avoid penetration of the medial pedicle wall.
For decades spinal surgeons have attempted to design simple, single stage anterior internal ®xation systems for the thoracic and lumbar spine. Early devices presented both biomechanical and technical problems. The AO Anterior Thoracolumbar Locking Plate (ATLP) was designed to solve some of the problems encountered with early anterior instrumentation. The ATLP system is constructed in Commercially Pure titanium. It is a low pro®le device indicated for use for unstable burst fractures in the anterior column; metastatic tumor management; and degenerative diseases of the thoracolumbar spine between levels T10 and L5. Implantation of the device involves direct anterior decompression with sagittal reduction and corpectomy. This is followed by grafting reconstruction, and plate ®xation. This device has been implanted in 25 patients with an average follow-up of 38 months. There were ®ve (5) broken screws in three (3) patients, and no broken plates. Implant related postoperative complications included two misplaced screws. Preliminary results indicate that the ATLP system seems to be a safe, low pro®le, MRI/CT compatible device that provides de®nitive single stage ®xation of the anterior spinal column.
A modified transthoracic approach to the thoracic vertebral column is described. In this method, the parietal pleura is detached from the chest wall and refracted with the visceral pleura and its contents. A direct approach to the vertebral bodies is thus achieved without fransgression of the intrapleuralspace. The technique can be extended to include exposure of the thoracolumbar spinal column, utilising a thoracoabdominal approach with extrapleural and extraperitoneal dissection. Management of the costophrenic detachment is thus simplified. This approach has significant advantages for orthopaedic, vascular and neurosurgical procedures.
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