Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the range of motion of the atlantoaxial joint after odontoid fracture healing is complete. Purpose: To assess the clinical and radiological outcome of the posterior C1-C2 temporary fixation technique in the treatment of a new odontoid fracture. Study Design: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. Patients and Methods: Twelve consecutive patients, suffering from type-II odontoid fracture, were retrospectively recruited for this study. The age ranged between 15 and 43 years with a mean age being 24±11.6 years. Eight patients were males and four were females. All cases suffered from acute posttraumatic type-II dens fracture. Eight patients suffered from reducible subluxation and four cases were in place. Only two patients were suffering from partial neurologic deficit preoperatively (grade 4). All patients were submitted to Harms' atlantoaxial fixation procedure. Surgical removal of the implants was done after a mean of 15.5 (range, 12-20 weeks) weeks from the first surgery. All patients had MSCT scan to assess healing and then dynamic MSCT scan after removal to assess C1-C2 ROM. Results: All of our twelve patients completed the two procedures without significant events. Two patients with preoperative neurological illness had improved gradually with physiotherapy. All patients had complete healing of their factures. Postoperative dynamic CT scan showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°. Significantly better functional outcomes were observed after the temporary fixation removal using Visual Analog Scale (VAS) score for neck pain (P=0.0033), neck stiffness, and the patient satisfaction. Conclusion: Posterior atlantoaxial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved. (2019ESJ187)
Introduction Congenital scoliosis isa progressive three-dimensional deformity caused by congenital anomalies of vertebrae that result in an imbalance of the longitudinal growth of the spine. Failure of the vertebral formation if complete will produce hemivertebra with unilateral pedicle Material and Methods The study included 30 patients with thoracic (16)and lumbar (14) hemivertebra. Posterior only hemivertebra resection with correction by short segment fixation was done for all cases. Intr-operative monitoring was used in (11) cases. Results Full correction was achieved in all cases. Temporary neurological deficit occurred in only two cases. Conclusion Because of the development in anesthesia and post-operative care, today posterior hemivertebra resection has become the standard treatment method for the single hemivertebra of the thoracolumbar and lumbar region.
Introduction With progress continuing in the development of anterior lumbar constructs, the need for complete anterior access to the lumbar spine continues to increase. Material and Methods The study included 18 patients with various types of degenerative lumbar spine diseases as degenerative disc lesions with or without hernias (15), degenerative spondylolisthesis (2) and degenerative stenosis (one case). The follow up period was 6 months. Results Back and leg pain have been markedly improved and assessed by ODI. Conclusion With various techniques evolving over the years, the mini-open retroperitoneal approach is becoming the standard, with decreased complication rate, better cosmesis and less abdominal wall disruption to provide exposure to the lumbar spine.
Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed. Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction. Study Design: Retrospective clinical case cohort study. Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com). Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.
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