This is a retrospective study on a series of 70 patients with thoracolumbar fractures (TL), surgically treated by the in situ bending technique (ISB). Its purpose is to show the performances and limits of the ISB technique for the early correction of post-traumatic spine deformities as well as to estimate the overall outcome in this series and to discuss the indications for anterior grafting. Although the management of limbs fractures is a cleared issue today, spine fractures management is still a matter of debate. Surgical treatment progresses fast, while indications, the fixation techniques, fracture reduction options, and associated grafting are still blurry. Seventy patients with TL fractures, mean age 40.3 years (20-80) were treated by posterior fusion with a standard construct and deformity reduction by means of the ISB technique. Mean follow-up was 30.7 months (12-78). Pre- and post-operative deformity was evaluated and the relative deformity as defined by Farcy's sagittal index (SIF) was analyzed. Thirty-eight patients underwent anterior interbody grafting. The pre-operative SIF decreased from 16.98 to 1.62 degrees (15.36 degrees decrease). Eighty percent of patients were normo- or hyper-corrected. The loss of correction during the follow-up occurred within the disc (SIF: -2.24 degrees , vertebral kyphosis 0.94 degrees , p<0.001), and was lower in patients who underwent secondary anterior grafting (-5.21 degrees vs.-1.18 degrees , p=0.002). Clinical outcome is good (Oswestry=29.75) and seems to be better in cases of double approach (20.71 vs. 37.,4, p=0.001). Sepsis occurred in ten cases, and two patients experienced construct dismounting. One patient had a retroperitoneal hematoma that required embolization. Seventy-one percent of operated patients went back to their previous work after surgery. Spine fractures deserve an efficient treatment. The ISB technique improves post traumatic kyphosis. This results is maintained at long term if the posterior fusion is associated with anterior grafting in cases where the correction within the disc exceeds 50% of the total correction.
Burst fractures typically occur at T12 or L1 and create a sagittal deformity by a compression mechanism. This posttraumatic kyphosis is evaluated preoperatively by measuring the sagittal index of Farcy. Posterior instrumentation using in situ contouring is based on a bilateral insertion of rods which take the shape of the spine first. The rods are placed in a perpendicular position to monoaxial pedicular screws and then bent in situ, which makes the spine follow the movements of the rods. This principle makes it possible to correct the posttraumatic kyphosis at the level of the fractured vertebra and the overlying disk, which will open progressively using a ligamentotaxis mechanism. An additional anterior approach is indicated if the sagittal correction through the disk represents less than 50% compared to the total correction (in other words, if the correction of the traumatic deformity is obtained more in the disk than in the bone (>50%), an additional anterior approach is performed: more through the disk than the vertebral body (>50%)). This reliable technique meets the requirements of sagittal posttraumatic kyphosis correction, and provides a solid construct which avoids bracing.
Purpose: Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats. Methods: 36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content). Results: Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points ( P < 0.05). DD progressed over time in the Punct and Punct+OVX groups ( P < 0.05). The changes were more severe in the Punct+OVX group compared to the Punct group and the OVX group. Conclusion: The combination of puncture and ovariectomy induced rapid and progressive DD in the lumbar discs of rats without spontaneous recovery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.