Posterior plate or rod and screw fixation is a good method of treatment for cervicothoracic instability in spine tumors. Facet screw fixation in the cervical spine with Roy-Camille drilling technique and transpedicular screw fixation in the thoracic spine provides an efficacious means by which to stabilize the cervicothoracic junction. This stabilization technique was effective even in cases of high postoperative instability, such as with partial or total vertebrectomy. This screw-type stabilization is clinically effective and well documented. The evolution through 3 different systems reflects our attempts to improve accuracy in light of variable facet and pedicle interspaces. Importantly, posterior instrumentation will not interfere with subsequent laminectomy or more extreme surgical procedures.
The morbidity of degenerative lumbar spine surgery in patients 80 years of age or older was high. Blood loss, operative time, instrumentation, previous surgery and dural tears increased significantly the morbidity. This surgery must be decided very carefully and requires to inform the patient and his family of the high rate of complications.
Arthrodesis for elderly patients will undoubtedly increase in the coming years. The conditions for this surgery are different than those for younger patients and it is desirable to try to provide reliable surgical techniques and solutions regarding options for instrumentation and overall perioperative care for these fragile patients. Dedicated instrumentation for osteoporotic bone seems to allow good clinical outcomes.
This study compares the osteogenic effects of nacre and autogenous bone grafts in a rabbit model of lumbar spine transverse process arthrodesis. A total of 15 rabbits were processed for arthrodesis between the fifth and sixth lumbar vertebrae using nacre powder mixed with autologous blood or autogenous iliac crest bone. Control rabbits were sham operated. Sample vertebrae were removed from the nacre-implanted rabbits at 2, 5, and 11 weeks postsurgery. The autogenous bone graft and sham-operated groups were processed for histological study 11 weeks postsurgery. The results for the three groups were compared at 11 weeks. The nacre-implanted samples taken at 2 weeks showed that the nacre was well tolerated by the host tissue. Endochondral bone formation was seen in the region of the dissolving nacre particles by 5 weeks. The newly formed bone formed a solid fusion between the transverse processes in one-third of the rabbits. There was still new bone formation at 11 weeks at the nacre implant site. Two-thirds of the rabbits had formed a solid fusion. Light microscopy also showed new bone formation 11 weeks after the autologous bone graft.
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